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"Mass Spectrometric Analyses of Peptides and Proteins in Human Gingival Crevicular Fluid"
A little-known fluid produced in tiny amounts in the gums, those tough pink tissues that hold the teeth in place, has become a hot topic for scientists trying to develop an early, non-invasive test for gum disease, the No. 1 cause of tooth loss in adults. It's not saliva, a quart of which people produce each day, but gingival crevicular fluid (GCF), produced at the rate of millionths of a quart per tooth. The study, the most comprehensive analysis of GCF to date, appears in ACS' monthly Journal of Proteome Research.
Eric Reynolds and colleagues note that GCF accumulates at sites of inflammation in the crevice between teeth and gums. Since dental workers can easily collect the fluid from patients, GCF has become a prime candidate for a simple inexpensive test to distinguish mild gum disease from the serious form that leads to tooth loss. But researchers have little information about the chemical composition of GCF.
The scientists collected GCF samples from 12 patients with a history of gum disease. Using high-tech instruments, they identified 66 proteins, 43 of which they found in the fluid for the first time. The fluid contained proteins from several sources, including bacteria and the breakdown products of gum tissue and bone, they note. They also identified antibacterial substances involved in fighting infection. The findings advance efforts to develop an early test for gum disease, they suggest.
Thursday, May 27, 2010
Wednesday, May 26, 2010
Bisphosphonates Possible Side Effects on Oral Health
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People undergoing bisphosphonate therapy to prevent or treat osteoporosis (a thinning of the bones) may be unfamiliar with the drug and possible adverse side effects on oral health, according to a study in the May issue of The Journal of the American Dental Association (JADA).
Use of bisphosphonates has been associated with a small risk of developing bisphosphonate-associated osteonecrosis of the jaw (BON) that occurs spontaneously or after the patient has undergone dental surgery. BON is a rare but serious condition that can cause severe damage to the jaw bone. The prevalence of BON is between three and 12 percent for patients who receive bisphosphonates intravenously for cancer therapy and less than one percent for patients who receive bisphosphonates orally for osteoporosis or osteopenia.
In the study, the authors sought to determine whether patients taking bisphosphonates had knowledge about the medical indication for the therapy and how long the treatment would last. They also wanted to know whether participants’ physicians told them about possible adverse reactions.
The researchers interviewed 73 participants (71 women, two men) seeking routine care in a dental clinic. These participants, with an average age of 66 years that ranged from 44 to 88 years, also were undergoing bisphosphonate treatment. Eighty-four percent of the participants stated they knew why they were receiving bisphosphonate therapy. However, 80 percent said they were unsure about the duration of the therapy and 82 percent could not recall receiving information about the risk of experiencing adverse reactions, including oral osteonecrosis, by their physicians.
“The results of our small study show that patients who take bisphosphonates may not be aware that BON can develop after they undergo invasive dental care,” the authors wrote. “We believe that a more effective communication process between prescribing physicians, dentists and patients using bisphosphonates is needed.”
The American Dental Association Advisory Committee on Medication-induced Osteonecrosis of the Jaw recommends that dental patients on bisphosphonate therapy advise their dentist. The Committee believes that it is always appropriate for physicians to encourage patients to visit the dentist regularly for professional cleanings and oral exams, as recommended by their dentist. This is especially important for patients whose oral health is put at risk from medications or medical problems.
People undergoing bisphosphonate therapy to prevent or treat osteoporosis (a thinning of the bones) may be unfamiliar with the drug and possible adverse side effects on oral health, according to a study in the May issue of The Journal of the American Dental Association (JADA).
Use of bisphosphonates has been associated with a small risk of developing bisphosphonate-associated osteonecrosis of the jaw (BON) that occurs spontaneously or after the patient has undergone dental surgery. BON is a rare but serious condition that can cause severe damage to the jaw bone. The prevalence of BON is between three and 12 percent for patients who receive bisphosphonates intravenously for cancer therapy and less than one percent for patients who receive bisphosphonates orally for osteoporosis or osteopenia.
In the study, the authors sought to determine whether patients taking bisphosphonates had knowledge about the medical indication for the therapy and how long the treatment would last. They also wanted to know whether participants’ physicians told them about possible adverse reactions.
The researchers interviewed 73 participants (71 women, two men) seeking routine care in a dental clinic. These participants, with an average age of 66 years that ranged from 44 to 88 years, also were undergoing bisphosphonate treatment. Eighty-four percent of the participants stated they knew why they were receiving bisphosphonate therapy. However, 80 percent said they were unsure about the duration of the therapy and 82 percent could not recall receiving information about the risk of experiencing adverse reactions, including oral osteonecrosis, by their physicians.
“The results of our small study show that patients who take bisphosphonates may not be aware that BON can develop after they undergo invasive dental care,” the authors wrote. “We believe that a more effective communication process between prescribing physicians, dentists and patients using bisphosphonates is needed.”
The American Dental Association Advisory Committee on Medication-induced Osteonecrosis of the Jaw recommends that dental patients on bisphosphonate therapy advise their dentist. The Committee believes that it is always appropriate for physicians to encourage patients to visit the dentist regularly for professional cleanings and oral exams, as recommended by their dentist. This is especially important for patients whose oral health is put at risk from medications or medical problems.
Tuesday, May 25, 2010
Mutant gum disease bacteria provide clue to treatment for Alzheimer's
A defective, mutant strain of the bacterium that causes gum disease could provide a clue to potential treatments for Alzheimer's, Parkinson's and a number of other diseases. Researchers from the University of Florida College of Dentistry report their findings today at the 110th General Meeting of the American Society for Microbiology in San Diego.
Autophagy, or "self-eating," is an essential component of cellular survival and defense against invading organisms. It is how the cell degrades and recycles material into amino acids that can be reused. Several neurological disorders, including Parkinson's and Alzheimer's disease, are associated with the build up of polypeptides within neurons. Current evidence suggests that if the affected cells could break down these plaque build-ups it would greatly increase the chances of recovery. The ability to activate autophagy within these cells could prove invaluable in the treatment of neurodegenerative disorders.
"Although we do not yet completelt understand how these diseases develop, we do know that the proteins clump together and form a plaque buildup in affected patients' neurons. If we can direct the cell's own ability to break down waste products against the plaques, we could keep them from forming and potentially intercept the development of these and other diseases," says Ann Progulske-Fox, a researcher on the study.
In previous studies Progulske-Fox and her colleagues demonstrated that the bacterium Porphyromonas gingivalis had the ability to activate autophagy when exposed to a human cell line, suggesting the bacterium secreted some unknown substance that initiated the process.
In the current study, they report on a mutant strain of P. gingivalis (PG0717) that does not induce autophagy.
"Understanding how P. gingivalis turns on autophagy in host cells could lead to novel therapeutics for the treatment of neurodegenerative disorders as well as advancements in the general understanding of the autophagic pathway. Study of the mutant will facilitate this understanding and the development of new potential strategies for the treatment of multiple diseases," says Progulske-Fox.
Autophagy, or "self-eating," is an essential component of cellular survival and defense against invading organisms. It is how the cell degrades and recycles material into amino acids that can be reused. Several neurological disorders, including Parkinson's and Alzheimer's disease, are associated with the build up of polypeptides within neurons. Current evidence suggests that if the affected cells could break down these plaque build-ups it would greatly increase the chances of recovery. The ability to activate autophagy within these cells could prove invaluable in the treatment of neurodegenerative disorders.
"Although we do not yet completelt understand how these diseases develop, we do know that the proteins clump together and form a plaque buildup in affected patients' neurons. If we can direct the cell's own ability to break down waste products against the plaques, we could keep them from forming and potentially intercept the development of these and other diseases," says Ann Progulske-Fox, a researcher on the study.
In previous studies Progulske-Fox and her colleagues demonstrated that the bacterium Porphyromonas gingivalis had the ability to activate autophagy when exposed to a human cell line, suggesting the bacterium secreted some unknown substance that initiated the process.
In the current study, they report on a mutant strain of P. gingivalis (PG0717) that does not induce autophagy.
"Understanding how P. gingivalis turns on autophagy in host cells could lead to novel therapeutics for the treatment of neurodegenerative disorders as well as advancements in the general understanding of the autophagic pathway. Study of the mutant will facilitate this understanding and the development of new potential strategies for the treatment of multiple diseases," says Progulske-Fox.
Monday, May 24, 2010
Body’s Own Stem Cells Can Lead to Tooth Regeneration
Work at Columbia University College of Dental Medicine Holds Promise for a Biological Substitute for Dental Implants, According to Latest Journal of Dental Research
A technique pioneered in the Tissue Engineering and Regenerative Medicine Laboratory of Dr. Jeremy Mao, the Edward V. Zegarelli Professor of Dental Medicine at Columbia University Medical Center, can orchestrate stem cells to migrate to a three-dimensional scaffold infused with growth factor, holding the translational potential to yield an anatomically correct tooth in as soon as nine weeks once implanted.
People who have lost some or all of their adult teeth typically look to dentures, or, more recently, dental implants to improve a toothless appearance that can have a host of unsettling psycho-social ramifications. Despite being the preferred (but generally painful and potentially protracted) treatment for missing teeth nowadays, dental implants can fail and are unable to “remodel” with surrounding jaw bone that undergoes necessary changes throughout a person’s life.
An animal-model study has shown that by homing stem cells to a scaffold made of natural materials and integrated in surrounding tissue, there is no need to use harvested stem cell lines, or create an environment outside of the body (e.g., a Petri dish) where the tooth is grown and then implanted once it has matured. The tooth instead can be grown “orthotopically,” or in the socket where the tooth will integrate with surrounding tissue in ways that are impossible with hard metals or other materials.
"These findings represent the first report of regeneration of anatomically shaped tooth-like structures in vivo, and by cell homing without cell delivery,” Dr. Mao and his colleagues say in the paper. "The potency of cell homing is substantiated not only by cell recruitment into scaffold microchannels, but also by the regeneration of periodontal ligaments and newly formed alveolar bone."
This study is published in the most recent Journal of Dental Research, the top-rated, peer-reviewed scientific journal dedicated to the dissemination of new knowledge and information on all sciences relevant to dentistry, the oral cavity and associated structures in health and disease.
Dental implants usually consist of a cone-shaped titanium screw with a roughened or smooth surface and are placed in the jaw bone. While implant surgery may be performed as an outpatient procedure, healing times vary widely and successful implantation is a result of multiple visits to different clinicians, including general dentists, oral surgeons, prosthodontists and periodontists. Implant patients must allow two to six months for healing and if the implant is installed too soon, it is possible that the implant may fail. The subsequent time to heal, graft and eventually put into place a new implant may take up to 18 months.
The work of Dr. Mao and his laboratory, however, holds manifold promise: a more natural process, faster recovery times and a harnessing of the body’s own potential to re-grow tissue that will not give out and could ultimately last the patient’s lifetime.
“A key consideration in tooth regeneration is finding a cost-effective approach that can translate into therapies for patients who cannot afford or who aren’t good candidates for dental implants,” Dr. Mao says. “Cell-homing-based tooth regeneration may provide a tangible pathway toward clinical translation.”
Dr. Ira B. Lamster, dean of the College of Dental Medicine, stated: “This research provides an example of what is achievable when today’s biology is applied to common clinical problems. Dr. Mao’s research is a look into the future of dental medicine.”
This research was supported by NIH ARRA Funding via 5RC2 DE020767 from the National Institute of Dental and Craniofacial Research. Columbia has filed patent applications relating to the engineered tooth and, through its technology transfer office, Columbia Technology Ventures, is actively seeking partners to help commercialize the technology.
A technique pioneered in the Tissue Engineering and Regenerative Medicine Laboratory of Dr. Jeremy Mao, the Edward V. Zegarelli Professor of Dental Medicine at Columbia University Medical Center, can orchestrate stem cells to migrate to a three-dimensional scaffold infused with growth factor, holding the translational potential to yield an anatomically correct tooth in as soon as nine weeks once implanted.
People who have lost some or all of their adult teeth typically look to dentures, or, more recently, dental implants to improve a toothless appearance that can have a host of unsettling psycho-social ramifications. Despite being the preferred (but generally painful and potentially protracted) treatment for missing teeth nowadays, dental implants can fail and are unable to “remodel” with surrounding jaw bone that undergoes necessary changes throughout a person’s life.
An animal-model study has shown that by homing stem cells to a scaffold made of natural materials and integrated in surrounding tissue, there is no need to use harvested stem cell lines, or create an environment outside of the body (e.g., a Petri dish) where the tooth is grown and then implanted once it has matured. The tooth instead can be grown “orthotopically,” or in the socket where the tooth will integrate with surrounding tissue in ways that are impossible with hard metals or other materials.
"These findings represent the first report of regeneration of anatomically shaped tooth-like structures in vivo, and by cell homing without cell delivery,” Dr. Mao and his colleagues say in the paper. "The potency of cell homing is substantiated not only by cell recruitment into scaffold microchannels, but also by the regeneration of periodontal ligaments and newly formed alveolar bone."
This study is published in the most recent Journal of Dental Research, the top-rated, peer-reviewed scientific journal dedicated to the dissemination of new knowledge and information on all sciences relevant to dentistry, the oral cavity and associated structures in health and disease.
Dental implants usually consist of a cone-shaped titanium screw with a roughened or smooth surface and are placed in the jaw bone. While implant surgery may be performed as an outpatient procedure, healing times vary widely and successful implantation is a result of multiple visits to different clinicians, including general dentists, oral surgeons, prosthodontists and periodontists. Implant patients must allow two to six months for healing and if the implant is installed too soon, it is possible that the implant may fail. The subsequent time to heal, graft and eventually put into place a new implant may take up to 18 months.
The work of Dr. Mao and his laboratory, however, holds manifold promise: a more natural process, faster recovery times and a harnessing of the body’s own potential to re-grow tissue that will not give out and could ultimately last the patient’s lifetime.
“A key consideration in tooth regeneration is finding a cost-effective approach that can translate into therapies for patients who cannot afford or who aren’t good candidates for dental implants,” Dr. Mao says. “Cell-homing-based tooth regeneration may provide a tangible pathway toward clinical translation.”
Dr. Ira B. Lamster, dean of the College of Dental Medicine, stated: “This research provides an example of what is achievable when today’s biology is applied to common clinical problems. Dr. Mao’s research is a look into the future of dental medicine.”
This research was supported by NIH ARRA Funding via 5RC2 DE020767 from the National Institute of Dental and Craniofacial Research. Columbia has filed patent applications relating to the engineered tooth and, through its technology transfer office, Columbia Technology Ventures, is actively seeking partners to help commercialize the technology.
Rice University students' portable suction device
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Rice University bioengineering students really get their teeth into their senior design projects. This year, one team got everybody else's teeth into it, too.
Five Rice seniors have created a portable dental suction device, an inexpensive, battery-powered version of the vacuum system commonly used in dentists' offices to remove blood and saliva from a patient's mouth.
IMAGE: The members of Team Pearly Whites show their dental vacuum device. From left, Tiffany Kim, Carmen Perez, Jaime Wirth and Jessica Ma. Brian Benjamin is missing from the photo.
It's no surprise that big systems cost a lot, more than dental practitioners in developing countries can afford or even use because of limited access to electricity. For clinicians who travel from village to village to treat patients, gauze usually serves the purpose of soaking up fluids.
What is surprising is that many dentists in this country find themselves in the same situation.
Faculty at the University of Texas Dental Branch-Houston (UTDB-H) have long been aware of the need for a portable dental suction device and turned to Rice students to see how they could help.
Team Pearly Whites has come through with flying colors. Bioengineering majors Brian Benjamin, Jaime Wirth, Carmen Perez and Tiffany Kim and biochemistry and cell biology major Jessica Ma assembled a foot-operated portable system that will go on the road with UTDB-H faculty this summer for testing by rural Texas dentists. They hope the device will eventually become a standard part of Rice's dental Lab-in-a-Backpack developed by Beyond Traditional Borders to fulfill needs in developing countries around the world.
"I can't adequately describe how motivated and enthusiastic the students were this year," said Dan Bentley, an assistant professor of restorative dentistry at UTDB-H and one of the team's advisers. "It was amazing. I think their independent effort and willing attitude have produced exactly the desired outcome for the project."
"The students evaluated the need described by their mentors at the dental branch and created a viable solution that is ready to field test," said co-adviser Maria Oden, professor in the practice of engineering education and director of Rice's Oshman Engineering Design Kitchen, where the device was designed. "The system can run without direct electrical service and should protect patients from swallowing debris during procedures, save dentists time as they perform these procedures and greatly reduce the amount of waste the team needs to dispose of -- all at low cost."
Knowing the work would have immediate impact motivated the team, which took the project on at the request of UTDB-H faculty who took Rice's dental backpack to Nicaragua last summer. "They realized that during procedures, the clinicians were using gauze to soak up saline and the blood, and they would end up with huge amounts of hazardous waste," Wirth said.
The goal was clear: The unit had to be portable, low-cost and run on alternative energy sources where AC power was limited or unavailable. It also had to handle multiple patients on one charge, use various tip sizes and prevent fluids from flowing back into the patient's mouth.
The team evaluated a number of portable vacuums and finally settled on an 18-volt DeWalt wet/dry unit. They split the battery from the main unit and put a foot switch between the two so dentists could turn it on and off as needed without disrupting their work. All the materials for the device cost less than $200.
Extensive testing proved the vacuum would hold up over five hours of heavy-duty use. "We would turn it on, suction 500 milliliters of water, turn it off and leave it for three minutes – and then do it again," Wirth said. "With intermittent use, we really don't see power as a problem at all."
The students built in several ways to control backflow, adding a hand-operated valve at the tip, building in L-shaped joints at the top and bottom of the hose and using tubing that won't kink. And, Ma said, "If you leave the vacuum running for a couple of seconds before you turn it off, that will clear all the liquid out of the applicator tip."
Future refinements, to be made by the senior team that takes over next year, will include streamlining the vacuum and adding the ability to charge the battery with solar or mechanical power.
Bentley certainly likes what he's seen so far. "These young bioengineers worked together, modifying and listening to our input to complete a real working prototype we can easily use," he said.
Rice University bioengineering students really get their teeth into their senior design projects. This year, one team got everybody else's teeth into it, too.
Five Rice seniors have created a portable dental suction device, an inexpensive, battery-powered version of the vacuum system commonly used in dentists' offices to remove blood and saliva from a patient's mouth.
IMAGE: The members of Team Pearly Whites show their dental vacuum device. From left, Tiffany Kim, Carmen Perez, Jaime Wirth and Jessica Ma. Brian Benjamin is missing from the photo.
It's no surprise that big systems cost a lot, more than dental practitioners in developing countries can afford or even use because of limited access to electricity. For clinicians who travel from village to village to treat patients, gauze usually serves the purpose of soaking up fluids.
What is surprising is that many dentists in this country find themselves in the same situation.
Faculty at the University of Texas Dental Branch-Houston (UTDB-H) have long been aware of the need for a portable dental suction device and turned to Rice students to see how they could help.
Team Pearly Whites has come through with flying colors. Bioengineering majors Brian Benjamin, Jaime Wirth, Carmen Perez and Tiffany Kim and biochemistry and cell biology major Jessica Ma assembled a foot-operated portable system that will go on the road with UTDB-H faculty this summer for testing by rural Texas dentists. They hope the device will eventually become a standard part of Rice's dental Lab-in-a-Backpack developed by Beyond Traditional Borders to fulfill needs in developing countries around the world.
"I can't adequately describe how motivated and enthusiastic the students were this year," said Dan Bentley, an assistant professor of restorative dentistry at UTDB-H and one of the team's advisers. "It was amazing. I think their independent effort and willing attitude have produced exactly the desired outcome for the project."
"The students evaluated the need described by their mentors at the dental branch and created a viable solution that is ready to field test," said co-adviser Maria Oden, professor in the practice of engineering education and director of Rice's Oshman Engineering Design Kitchen, where the device was designed. "The system can run without direct electrical service and should protect patients from swallowing debris during procedures, save dentists time as they perform these procedures and greatly reduce the amount of waste the team needs to dispose of -- all at low cost."
Knowing the work would have immediate impact motivated the team, which took the project on at the request of UTDB-H faculty who took Rice's dental backpack to Nicaragua last summer. "They realized that during procedures, the clinicians were using gauze to soak up saline and the blood, and they would end up with huge amounts of hazardous waste," Wirth said.
The goal was clear: The unit had to be portable, low-cost and run on alternative energy sources where AC power was limited or unavailable. It also had to handle multiple patients on one charge, use various tip sizes and prevent fluids from flowing back into the patient's mouth.
The team evaluated a number of portable vacuums and finally settled on an 18-volt DeWalt wet/dry unit. They split the battery from the main unit and put a foot switch between the two so dentists could turn it on and off as needed without disrupting their work. All the materials for the device cost less than $200.
Extensive testing proved the vacuum would hold up over five hours of heavy-duty use. "We would turn it on, suction 500 milliliters of water, turn it off and leave it for three minutes – and then do it again," Wirth said. "With intermittent use, we really don't see power as a problem at all."
The students built in several ways to control backflow, adding a hand-operated valve at the tip, building in L-shaped joints at the top and bottom of the hose and using tubing that won't kink. And, Ma said, "If you leave the vacuum running for a couple of seconds before you turn it off, that will clear all the liquid out of the applicator tip."
Future refinements, to be made by the senior team that takes over next year, will include streamlining the vacuum and adding the ability to charge the battery with solar or mechanical power.
Bentley certainly likes what he's seen so far. "These young bioengineers worked together, modifying and listening to our input to complete a real working prototype we can easily use," he said.
Tuesday, May 18, 2010
Good Oral Health Is Essential During Pregnancy
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It’s no secret that pregnancy is an important time in a woman’s life. While women often hear about how pregnancy causes physical changes that affect their hormone or appetite levels, these changes can have a great effect on their oral health as well. Despite the fact that good oral health is essential for the overall health of both mother and child, only 22 to 34 percent of women in the United States visit a dentist during pregnancy. In fact, dental care during pregnancy is not only safe and effective, it’s essential for combating the adverse effects of oral disease, according to an article published in the May/June 2010 issue of General Dentistry, the peer-reviewed clinical journal of the Academy of General Dentistry (AGD). Dentists have the ability to maintain the oral health of expectant mothers by treating the dental findings that are common during pregnancy.
“Hormonal changes during pregnancy can result in several changes in the mouth,” says Homa Amini, DDS, co-author of the article. “Reports show that the most common oral disease is gingivitis, which has been reported in 30 to 100 percent of pregnancies.”
Gingivitis, a buildup of plaque that causes inflammation of the gums, should be treated with a professional cleaning and proper toothbrushing and flossing. If left untreated, gingivitis can lead to periodontitis, a more serious form of gum disease. “Patients tend to delay the treatment of oral disease due to concerns for fetal safety; however, routine dental treatment can be performed safely at any time during pregnancy,” says Dr. Amini. What’s more, untreated dental disease can lead to pain, infections and unnecessary exposure to medications, any of which could harm the developing fetus. Poor oral health also can affect the nutritional intake of expectant mothers, which is essential for fetal growth and survival.
The hormonal fluctuations that result from pregnancy can produce benign pregnancy tumors in the mouth. These tumors usually appear after the first trimester and typically go away after delivery; however, surgical removal may be required when these tumors bleed, interfere with eating or do not resolve after delivery.
In addition to examining for oral disease, dentists may notice dental erosion—the chemical or mechanochemical destruction of tooth material—in pregnant women, due to increased acid in the mouth following morning sickness.
“To neutralize acid after vomiting, pregnant women should rinse the mouth with a mixture of a teaspoon of baking soda dissolved in a cup of water,” says Patricia Meredith, DDS, FAGD, spokesperson for the AGD. “The teeth should be brushed only after the mouth has been rinsed and the acid has been neutralized to prevent further damage to the enamel.”
Oral health assessment and treatment should be an essential part of prenatal care, as these steps allow the patient to receive ongoing advice concerning proper oral hygiene and infant oral health care.
It’s no secret that pregnancy is an important time in a woman’s life. While women often hear about how pregnancy causes physical changes that affect their hormone or appetite levels, these changes can have a great effect on their oral health as well. Despite the fact that good oral health is essential for the overall health of both mother and child, only 22 to 34 percent of women in the United States visit a dentist during pregnancy. In fact, dental care during pregnancy is not only safe and effective, it’s essential for combating the adverse effects of oral disease, according to an article published in the May/June 2010 issue of General Dentistry, the peer-reviewed clinical journal of the Academy of General Dentistry (AGD). Dentists have the ability to maintain the oral health of expectant mothers by treating the dental findings that are common during pregnancy.
“Hormonal changes during pregnancy can result in several changes in the mouth,” says Homa Amini, DDS, co-author of the article. “Reports show that the most common oral disease is gingivitis, which has been reported in 30 to 100 percent of pregnancies.”
Gingivitis, a buildup of plaque that causes inflammation of the gums, should be treated with a professional cleaning and proper toothbrushing and flossing. If left untreated, gingivitis can lead to periodontitis, a more serious form of gum disease. “Patients tend to delay the treatment of oral disease due to concerns for fetal safety; however, routine dental treatment can be performed safely at any time during pregnancy,” says Dr. Amini. What’s more, untreated dental disease can lead to pain, infections and unnecessary exposure to medications, any of which could harm the developing fetus. Poor oral health also can affect the nutritional intake of expectant mothers, which is essential for fetal growth and survival.
The hormonal fluctuations that result from pregnancy can produce benign pregnancy tumors in the mouth. These tumors usually appear after the first trimester and typically go away after delivery; however, surgical removal may be required when these tumors bleed, interfere with eating or do not resolve after delivery.
In addition to examining for oral disease, dentists may notice dental erosion—the chemical or mechanochemical destruction of tooth material—in pregnant women, due to increased acid in the mouth following morning sickness.
“To neutralize acid after vomiting, pregnant women should rinse the mouth with a mixture of a teaspoon of baking soda dissolved in a cup of water,” says Patricia Meredith, DDS, FAGD, spokesperson for the AGD. “The teeth should be brushed only after the mouth has been rinsed and the acid has been neutralized to prevent further damage to the enamel.”
Oral health assessment and treatment should be an essential part of prenatal care, as these steps allow the patient to receive ongoing advice concerning proper oral hygiene and infant oral health care.
Learning good oral health habits
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Parents are a child’s first teacher in life and play a significant role in maintaining his or her overall health. Providing oral health education to mothers and families is essential to teaching children healthy habits and preventing early childhood tooth decay, according to an article published in the May/June 2010 issue of General Dentistry, the peer-reviewed clinical journal of the Academy of General Dentistry (AGD).
With all of the challenges that new parents face, they may not think much about the link between their child’s oral health and overall health. In fact, an understanding of oral hygiene can help parents to prevent tooth decay—the single most common chronic childhood disease in America—and to create a lifetime of healthy habits for their child.
“Ideally, the oral health education for any family will begin with prenatal education and the establishment of a dental home by the time the child is 12 to 18 months of age,” says Tegwyn Brickhouse, DDS, author of the study. “Many people don’t realize that the oral health of the mother affects both the infant’s future oral health and the child’s overall health. In fact, some studies show that periodontal disease has been linked to preterm labor. That’s why pregnant women should be evaluated for cavities, poor oral hygiene, gingivitis, loose teeth and diet.”
After the child is born, families should become familiar with their child’s dental and oral health milestones, which will be determined by discussion with the family dentist or a pediatric dentist. Children should have their first dental visit at age 1 or within six months of the eruption of their first tooth. A dentist will be able to discuss when parents can expect to see a child’s first tooth and the best technique for brushing his or her new teeth.
Diet is another factor that affects a child’s oral health. Frequent and long-term exposure to liquids that contain sugars commonly results in tooth decay. In addition to eliminating sugary drinks altogether from a child’s diet, parents can adopt other habits to prevent tooth decay due to beverage consumption.
“Parents should avoid giving their children milk, formula, juice or soda at naptime or nighttime,” says Bruce DeGinder, DDS, MAGD, spokesperson for the AGD. “The sugars will linger on their teeth and gums for a prolonged period of time, promoting decay.”
Parents are responsible for their child’s oral hygiene practices and are advised to meet with a general dentist to determine the best way to establish and maintain their child’s oral health. A general dentist also can provide families with oral health literature that is designed to educate both the parent and child. This education has multiple benefits; as Dr. Brickhouse notes, “Healthy teeth in early childhood can provide a positive self-image and improve the child’s quality of life.”
Parents are a child’s first teacher in life and play a significant role in maintaining his or her overall health. Providing oral health education to mothers and families is essential to teaching children healthy habits and preventing early childhood tooth decay, according to an article published in the May/June 2010 issue of General Dentistry, the peer-reviewed clinical journal of the Academy of General Dentistry (AGD).
With all of the challenges that new parents face, they may not think much about the link between their child’s oral health and overall health. In fact, an understanding of oral hygiene can help parents to prevent tooth decay—the single most common chronic childhood disease in America—and to create a lifetime of healthy habits for their child.
“Ideally, the oral health education for any family will begin with prenatal education and the establishment of a dental home by the time the child is 12 to 18 months of age,” says Tegwyn Brickhouse, DDS, author of the study. “Many people don’t realize that the oral health of the mother affects both the infant’s future oral health and the child’s overall health. In fact, some studies show that periodontal disease has been linked to preterm labor. That’s why pregnant women should be evaluated for cavities, poor oral hygiene, gingivitis, loose teeth and diet.”
After the child is born, families should become familiar with their child’s dental and oral health milestones, which will be determined by discussion with the family dentist or a pediatric dentist. Children should have their first dental visit at age 1 or within six months of the eruption of their first tooth. A dentist will be able to discuss when parents can expect to see a child’s first tooth and the best technique for brushing his or her new teeth.
Diet is another factor that affects a child’s oral health. Frequent and long-term exposure to liquids that contain sugars commonly results in tooth decay. In addition to eliminating sugary drinks altogether from a child’s diet, parents can adopt other habits to prevent tooth decay due to beverage consumption.
“Parents should avoid giving their children milk, formula, juice or soda at naptime or nighttime,” says Bruce DeGinder, DDS, MAGD, spokesperson for the AGD. “The sugars will linger on their teeth and gums for a prolonged period of time, promoting decay.”
Parents are responsible for their child’s oral hygiene practices and are advised to meet with a general dentist to determine the best way to establish and maintain their child’s oral health. A general dentist also can provide families with oral health literature that is designed to educate both the parent and child. This education has multiple benefits; as Dr. Brickhouse notes, “Healthy teeth in early childhood can provide a positive self-image and improve the child’s quality of life.”
Thursday, May 13, 2010
Sniff of local anesthetic in the dentist's chair could replace the needle
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Modern dentistry has eliminated much of the "ouch!" from getting a shot of local anesthetic. Now a new discovery may replace the needle used to give local anesthetic in the dentist's chair for many procedures. Scientists are reporting evidence that a common local anesthetic, when administered to the nose as nose drops or a nasal spray, travels through the main nerve in the face and collects in high concentrations in the teeth, jaw, and structures of the mouth.
The discovery could lead to a new generation of intranasal drugs for noninvasive treatment for dental pain, migraine, and other conditions, the scientists suggest in American Chemical Society's bi-monthly journal Molecular Pharmaceutics. The article is scheduled for the journal's May-June issue.
William H. Frey II, Ph.D., and colleagues note that drugs administered to the nose travel along nerves and go directly to the brain. One of those nerves is the trigeminal nerve, which brings feelings to the face, nose and mouth. Until now, however, scientists never checked to see whether intranasal drugs passing along that nerve might reach the teeth, gums and other areas of the face and mouth to reduce pain sensations in the face and mouth.
Neil Johnson, working in the labs of Frey and Leah R. Hanson, Ph.D., at Regions Hospital in St. Paul, Minn., found that lidocaine or Xylocaine, sprayed into the noses of laboratory rats, quickly traveled down the trigeminal nerve and collected in their teeth, jaws, and mouths at levels 20 times higher than in the blood or brain. The approach could provide a more effective and targeted method for treating dental pain/anxiety, trigeminal neuralgia (severe facial pain), migraine, and other conditions, the scientists say.
Furthermore, these scientists discovered an improved future location to administer anesthetic, the maxillary sinus. The maxillary sinus is a golfball-sized space located underneath each cheek where drug can be sprayed. Delivery into this confined space may be the next generation approach beyond a nasal spray in providing a more rapid and focused delivery of anesthetic.
Modern dentistry has eliminated much of the "ouch!" from getting a shot of local anesthetic. Now a new discovery may replace the needle used to give local anesthetic in the dentist's chair for many procedures. Scientists are reporting evidence that a common local anesthetic, when administered to the nose as nose drops or a nasal spray, travels through the main nerve in the face and collects in high concentrations in the teeth, jaw, and structures of the mouth.
The discovery could lead to a new generation of intranasal drugs for noninvasive treatment for dental pain, migraine, and other conditions, the scientists suggest in American Chemical Society's bi-monthly journal Molecular Pharmaceutics. The article is scheduled for the journal's May-June issue.
William H. Frey II, Ph.D., and colleagues note that drugs administered to the nose travel along nerves and go directly to the brain. One of those nerves is the trigeminal nerve, which brings feelings to the face, nose and mouth. Until now, however, scientists never checked to see whether intranasal drugs passing along that nerve might reach the teeth, gums and other areas of the face and mouth to reduce pain sensations in the face and mouth.
Neil Johnson, working in the labs of Frey and Leah R. Hanson, Ph.D., at Regions Hospital in St. Paul, Minn., found that lidocaine or Xylocaine, sprayed into the noses of laboratory rats, quickly traveled down the trigeminal nerve and collected in their teeth, jaws, and mouths at levels 20 times higher than in the blood or brain. The approach could provide a more effective and targeted method for treating dental pain/anxiety, trigeminal neuralgia (severe facial pain), migraine, and other conditions, the scientists say.
Furthermore, these scientists discovered an improved future location to administer anesthetic, the maxillary sinus. The maxillary sinus is a golfball-sized space located underneath each cheek where drug can be sprayed. Delivery into this confined space may be the next generation approach beyond a nasal spray in providing a more rapid and focused delivery of anesthetic.
Wednesday, May 12, 2010
Better dental care may help people with diabetes, study finds
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Treating serious gum disease in diabetics can help to lower their blood sugar levels, a study has shown.
Researchers have found that reducing inflammation of the gums in people with diabetes can help lower the risk of serious complications associated with the condition, such as eye problems and heart disease.
The study – led by the University of Edinburgh– analysed the findings of previous research into the link between diabetes and serious gum disease – known as periodontal disease.
The findings are published as part of the international Cochrane Collaboration.
The team analysed the results of three of the included studies to show that there is a small but significant benefit to treating periodontal disease in people with diabetes. They say there is a need for further research to fully understand the link between the conditions.
It is thought that when bacteria infect the mouth and cause inflammation, the resulting chemical changes reduce the effectiveness of insulin and raise the levels of blood sugar.
Dental treatment to reduce this inflammation may therefore help to reduce blood sugar levels.
The team – including researchers from UCL Eastman Dental Institute, Peninsula Dental School and the University of Ottawa – say their findings highlight the need for doctors and dentists to work together in the treatment of people with diabetes.
Dr Terry Simpson, Honorary Research Fellow at the University of Edinburgh's Dental Institute, who led the study, said: "This research confirms that there may be a link between serious gum disease and diabetes. It highlights the role dentists can play in managing the condition, given that gum disease is very treatable.
"By far the most important aspect of diabetes management is the use of insulin, drugs and diet to control blood sugar levels – but maintaining good dental health is something patients and healthcare professionals should also recognise. Although the benefit in terms of insulin management is small, anything we can do to promote the wellbeing of people with diabetes should be welcomed."
Treating serious gum disease in diabetics can help to lower their blood sugar levels, a study has shown.
Researchers have found that reducing inflammation of the gums in people with diabetes can help lower the risk of serious complications associated with the condition, such as eye problems and heart disease.
The study – led by the University of Edinburgh– analysed the findings of previous research into the link between diabetes and serious gum disease – known as periodontal disease.
The findings are published as part of the international Cochrane Collaboration.
The team analysed the results of three of the included studies to show that there is a small but significant benefit to treating periodontal disease in people with diabetes. They say there is a need for further research to fully understand the link between the conditions.
It is thought that when bacteria infect the mouth and cause inflammation, the resulting chemical changes reduce the effectiveness of insulin and raise the levels of blood sugar.
Dental treatment to reduce this inflammation may therefore help to reduce blood sugar levels.
The team – including researchers from UCL Eastman Dental Institute, Peninsula Dental School and the University of Ottawa – say their findings highlight the need for doctors and dentists to work together in the treatment of people with diabetes.
Dr Terry Simpson, Honorary Research Fellow at the University of Edinburgh's Dental Institute, who led the study, said: "This research confirms that there may be a link between serious gum disease and diabetes. It highlights the role dentists can play in managing the condition, given that gum disease is very treatable.
"By far the most important aspect of diabetes management is the use of insulin, drugs and diet to control blood sugar levels – but maintaining good dental health is something patients and healthcare professionals should also recognise. Although the benefit in terms of insulin management is small, anything we can do to promote the wellbeing of people with diabetes should be welcomed."
Tuesday, May 11, 2010
Even Healthy Pregnant Women Need to Worry About Oral Bacteria
Healthy pregnant women can be at risk for pregnancy problems caused by oral bacteria. Researchers from Case Western Reserve University have begun to understand how and which bacteria from the 700 species living in the mouth are responsible for the increasing numbers of preterm and stillbirths.
Yiping Han, from the department of periodontics in the School of Dental Medicine, led the study that found several new bacteria originating in the mouth travel through the blood to cause an inflammatory reaction in the placenta and eventually cause a range of health issues from miscarriages to stillbirths.
The findings were featured in the spotlight section in a recent Infection and Immunity. The study was also reported on the home page of the American Society for Microbiology.
Researchers have been baffled why oral bacteria have shown up in the placenta or amniotic fluid of pregnant women.
The researchers found that after injecting the blood in the tails of pregnant mice with saliva from healthy people and dental plaque from those with periodontal disease, oral bacteria continued to grow in the placentas after it had left the mice blood 24 hours later.
Prior to Han’s work in connecting oral bacteria to the problems in pregnancy, it was thought that infections were transmitted through the vaginal tract.
Information from Han’s previous studies over the past decade shows that oral bacteria can be transported through the blood when there is a cut in the mouth’s lining or an oral health problem such as gingivitis or periodontitis which breaks down the defenses in the mouth’s lining that block or prevent bacteria from entering the bloodstream.
According to Han, this suggests that even healthy pregnant women should be concerned bacteria that normally lives in the mouth can enter the blood stream and make their way into the placenta’s immune-free environment to ignite an inflammatory reaction that can lead to premature or stillbirths.
“We found many bacteria did locate to the placenta, but they were not the most famous periodontal pathogens,” said Han. “In fact, many of the bacteria were the kind that are found in healthy people’s mouths.” These include Streptococcus, Leptotricia, Fusobacterium nucleautm, Veillenella, among others.
The researchers are finding that many of the bacteria found in the placentas cannot be grown in the lab, which has been the traditional way to identify the strains. They are identified through DNA cloning techniques that match the bacteria in the placenta with the bacteria found in the mouth. This DNA fingerprinting allows researchers to trace the origin of the bacteria.
Han notes that as long as these bacteria stay in the mouth, they cause very little problems. However in the uterus, they stimulate the inflammatory response that leads to cervical and membrane weaknesses and ruptures and uterine contractions. In several case studies, Han said the mothers did not have a pronounced periodontal disease or periodontitis. The mothers did have a form a pregnancy-associated gingivitis, which results from changes in the hormones and disappears after the birth of the baby.
“The normal healthy woman is under risk,” Han said. “People should be concerned about it. This is what the experiment is showing.”
She added, “We need to know which bacteria colonize in the placenta and design therapies for better treatments.”
These are the kinds of bacteria that are with us all our lives and only cause disease when the opportunity arises, Han said.
She added, “What is happening with the oral bacteria colonizing in the placenta happens with other diseases that trigger an inflammatory response.”
During CWRU Research ShowCASE 2010, Yann Fardini, one of the paper’s researchers, received honors for his presentation on the research.
Other authors on the paper, “Transmission of Diverse Oral Bacteria to Murine Placenta: Evidence for the Oral Microbiome as a Potential Source of Intrauterine Infection”, were: Peter Chung and Nishiant Joshi from the dental school. Also contributing to the research was Rochelle Dumm, a student from Hathaway Brown School in Shaker Heights.
Yiping Han, from the department of periodontics in the School of Dental Medicine, led the study that found several new bacteria originating in the mouth travel through the blood to cause an inflammatory reaction in the placenta and eventually cause a range of health issues from miscarriages to stillbirths.
The findings were featured in the spotlight section in a recent Infection and Immunity. The study was also reported on the home page of the American Society for Microbiology.
Researchers have been baffled why oral bacteria have shown up in the placenta or amniotic fluid of pregnant women.
The researchers found that after injecting the blood in the tails of pregnant mice with saliva from healthy people and dental plaque from those with periodontal disease, oral bacteria continued to grow in the placentas after it had left the mice blood 24 hours later.
Prior to Han’s work in connecting oral bacteria to the problems in pregnancy, it was thought that infections were transmitted through the vaginal tract.
Information from Han’s previous studies over the past decade shows that oral bacteria can be transported through the blood when there is a cut in the mouth’s lining or an oral health problem such as gingivitis or periodontitis which breaks down the defenses in the mouth’s lining that block or prevent bacteria from entering the bloodstream.
According to Han, this suggests that even healthy pregnant women should be concerned bacteria that normally lives in the mouth can enter the blood stream and make their way into the placenta’s immune-free environment to ignite an inflammatory reaction that can lead to premature or stillbirths.
“We found many bacteria did locate to the placenta, but they were not the most famous periodontal pathogens,” said Han. “In fact, many of the bacteria were the kind that are found in healthy people’s mouths.” These include Streptococcus, Leptotricia, Fusobacterium nucleautm, Veillenella, among others.
The researchers are finding that many of the bacteria found in the placentas cannot be grown in the lab, which has been the traditional way to identify the strains. They are identified through DNA cloning techniques that match the bacteria in the placenta with the bacteria found in the mouth. This DNA fingerprinting allows researchers to trace the origin of the bacteria.
Han notes that as long as these bacteria stay in the mouth, they cause very little problems. However in the uterus, they stimulate the inflammatory response that leads to cervical and membrane weaknesses and ruptures and uterine contractions. In several case studies, Han said the mothers did not have a pronounced periodontal disease or periodontitis. The mothers did have a form a pregnancy-associated gingivitis, which results from changes in the hormones and disappears after the birth of the baby.
“The normal healthy woman is under risk,” Han said. “People should be concerned about it. This is what the experiment is showing.”
She added, “We need to know which bacteria colonize in the placenta and design therapies for better treatments.”
These are the kinds of bacteria that are with us all our lives and only cause disease when the opportunity arises, Han said.
She added, “What is happening with the oral bacteria colonizing in the placenta happens with other diseases that trigger an inflammatory response.”
During CWRU Research ShowCASE 2010, Yann Fardini, one of the paper’s researchers, received honors for his presentation on the research.
Other authors on the paper, “Transmission of Diverse Oral Bacteria to Murine Placenta: Evidence for the Oral Microbiome as a Potential Source of Intrauterine Infection”, were: Peter Chung and Nishiant Joshi from the dental school. Also contributing to the research was Rochelle Dumm, a student from Hathaway Brown School in Shaker Heights.
Susceptibility for Caries, Gum Disease Found in Genes
Certain genetic variations may be linked to higher rates of tooth decay and aggressive periodontitis, according to two recently published papers by researchers at the University of Pittsburgh School of Dental Medicine and their collaborators.
Alexandre R. Vieira, D.D. S., Ph.D., senior author of both papers and an assistant professor of oral biology, and his colleagues at the School of Dental Medicine found that the rate of dental caries was influenced by individual variations, or polymorphisms, in a gene called beta defensin 1(DEFB1), which plays a key role in the first-line immune response against invading germs. The findings are available online in the Journal of Dental Research.
"We were able to use data gathered from our Dental Registry and DNA Repository, the only one of its kind in the world, to see if certain polymorphisms were associated with the development of caries," Dr. Vieira said. "This could help us find new ways to treat people who are particularly susceptible to tooth decay, a problem that afflicts millions of Americans."
For the study, the researchers analyzed nearly 300 anonymous dental records and accompanying saliva samples from the registry, assigning each case a DMFT score based on the presence of decayed teeth, missing teeth due to caries, and tooth fillings, as well as a DMFS score, based on decayed teeth, missing teeth, and filled surface of a tooth. In general, individuals with fewer caries have lower DMFT and DMFS scores.
Saliva samples contained one of three variants, dubbed G-20A, G-52A and C-44G, of the DEFB1 gene. Individuals who carried a G-20A copy had DMFT and DMFS scores that were five-times higher than for people who had other variants. The G-52A polymorphism was associated with lower DMFT scores.
"It's possible that these variations lead to differences in beta defensin's ability to inhibit bacterial colonization," Dr. Vieira said. "In the future, we might be able to test for these polymorphisms as clinical markers for caries risk."
In a second paper, published in PLoS ONE, Dr. Vieira, colleagues at Pitt and collaborators in Brazil studied saliva samples of 389 people in 55 families to look for genetic links to aggressive periodontitis, which is rapid and severe destruction of the gums and bone that starts at a young age and is thought to be more common in Africans and those of African descent. Brazil's population is composed primarily of Caucasians of Portuguese ancestry, Africans and native Indians.
They found hints of an association between the disease and the FAM5C gene. While further testing did not find any mutations or polymorphisms that bore out a relationship, other experiments showed elevated levels of FAM5C expression, or activation, in areas of diseased periodontal tissue compared to healthy tissue.
"The FAM5C gene recently was implicated in cardiovascular disease, in which inflammation plays a role, just as in periodontitis," Dr. Vieira said. "More research is needed to see if variation in the gene is associated with different activity profiles."
Ayla Ozturk, D.D.S., Ph.D., and Pouran Famili, D.D.S., Ph.D., Pitt School of Dental Medicine, co-authored the Journal of Dental Research paper, which was funded by the School of Dental Medicine.
Co-authors of the PLoS ONE paper included researchers at Pitt, the Federal University of Rio de Janeiro, Rio de Janeiro State University, Sao Paulo University and other universities in Brazil. The study was funded by the Pitt School of Dental Medicine and Brazilian funding agencies.
Alexandre R. Vieira, D.D. S., Ph.D., senior author of both papers and an assistant professor of oral biology, and his colleagues at the School of Dental Medicine found that the rate of dental caries was influenced by individual variations, or polymorphisms, in a gene called beta defensin 1(DEFB1), which plays a key role in the first-line immune response against invading germs. The findings are available online in the Journal of Dental Research.
"We were able to use data gathered from our Dental Registry and DNA Repository, the only one of its kind in the world, to see if certain polymorphisms were associated with the development of caries," Dr. Vieira said. "This could help us find new ways to treat people who are particularly susceptible to tooth decay, a problem that afflicts millions of Americans."
For the study, the researchers analyzed nearly 300 anonymous dental records and accompanying saliva samples from the registry, assigning each case a DMFT score based on the presence of decayed teeth, missing teeth due to caries, and tooth fillings, as well as a DMFS score, based on decayed teeth, missing teeth, and filled surface of a tooth. In general, individuals with fewer caries have lower DMFT and DMFS scores.
Saliva samples contained one of three variants, dubbed G-20A, G-52A and C-44G, of the DEFB1 gene. Individuals who carried a G-20A copy had DMFT and DMFS scores that were five-times higher than for people who had other variants. The G-52A polymorphism was associated with lower DMFT scores.
"It's possible that these variations lead to differences in beta defensin's ability to inhibit bacterial colonization," Dr. Vieira said. "In the future, we might be able to test for these polymorphisms as clinical markers for caries risk."
In a second paper, published in PLoS ONE, Dr. Vieira, colleagues at Pitt and collaborators in Brazil studied saliva samples of 389 people in 55 families to look for genetic links to aggressive periodontitis, which is rapid and severe destruction of the gums and bone that starts at a young age and is thought to be more common in Africans and those of African descent. Brazil's population is composed primarily of Caucasians of Portuguese ancestry, Africans and native Indians.
They found hints of an association between the disease and the FAM5C gene. While further testing did not find any mutations or polymorphisms that bore out a relationship, other experiments showed elevated levels of FAM5C expression, or activation, in areas of diseased periodontal tissue compared to healthy tissue.
"The FAM5C gene recently was implicated in cardiovascular disease, in which inflammation plays a role, just as in periodontitis," Dr. Vieira said. "More research is needed to see if variation in the gene is associated with different activity profiles."
Ayla Ozturk, D.D.S., Ph.D., and Pouran Famili, D.D.S., Ph.D., Pitt School of Dental Medicine, co-authored the Journal of Dental Research paper, which was funded by the School of Dental Medicine.
Co-authors of the PLoS ONE paper included researchers at Pitt, the Federal University of Rio de Janeiro, Rio de Janeiro State University, Sao Paulo University and other universities in Brazil. The study was funded by the Pitt School of Dental Medicine and Brazilian funding agencies.
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