Impact of SARS-CoV-2 on the sustainability of dental practice: National-Dental-PBRN

 Jeffrey L Fellows, Kaiser Permanente Center for Health Research, Portland, OR, presented the “Impact of SARS-CoV-2 on the Sustainability of Dental Practice: National-Dental-PBRN” at the hybrid 51st Annual Meeting & Exhibition of the AADOCR, held in conjunction with the 46th Annual Meeting of the Canadian Association for Dental Research (CADR), online and onsite in Atlanta, GA, on March 24, 2022.

The SARS-CoV-2 pandemic adversely impacted US dental practitioners’ patient volumes, revenues, and practice expenses associated with efforts to reduce virus transmission at dental facilities. As part of the National Dental Practice-Based Research Network (Network) COVID-19 Research (CORE) Registry study, Fellows evaluated dental practitioner’s confidence that their practice could maintain current patient volume, revenues, and expenditures on SARS-CoV-2 risk mitigation over the 24 months. The protocol and study materials were approved by Central and Regional Node National Dental Practice-Based Research Network IRBs.

Between January and February 2021 the researchers invited 5,484 eligible US dentists, dental hygienists, and therapists enrolled in the Network to complete a 195-item web-based survey via weekly emails and personal outreach.

The results of the study demonstrated that network practitioners overall were somewhat to moderately confident about the sustainability of their practice over the next 24 months. Private practice general dentists and academic/hospital-based specialists had the lowest confidence levels.

This research was presented as an in-person Interactive Talk on March 24, 2022 at 8 a.m. EDT, view the abstract on the 2022 Annual Meeting Hybrid Platform.

 

About AADOCR

The American Association for Dental, Oral, and Craniofacial Research (AADOCR) is a nonprofit organization with over 3,000 members in the United States with a mission to drive dental, oral, and craniofacial research to advance health and well-being. AADOCR is the largest division of the International Association for Dental Research which has over 10,000 members. Learn more at www.aadocr.org.

Machine learning presentations examine dental caries predication and diagnosis

 Various aspects of machine earning were explored at the hybrid 51stAnnual Meeting & Exhibition of the AADOCR, held in conjunction with the 46th Annual Meeting of the Canadian Association for Dental Research (CADR), online and onsite in Atlanta, GA, on March 23-26, 2022.

Presentations included “Prediction of Caries in Young Adults Using Machine Learning Approach,” presented as an in-person Interactive Talk on March 26, 2022 at 11 a.m. EDT by Chukwuebuka Elozona Ogwo, Temple University, Philadelphia, PA. This study was the first to apply machine learning techniques in the prediction of caries risk and identification of the most important predictors for caries in young adults with high accuracy and precision. The research concluded that more studies are needed using additional clinical variables and data from a more diverse population to improve the quality and generalizability of caries prediction in young adults.

Two presenters from The University of Texas Health Science Center at Houston shared their machine learning research. “Using A Deep Learning Model to Improve Dental Caries Diagnosis” was presented by Maryam Baldawi as an in-person Interactive Talk on March 26, 2022 at 8 a.m. EDT. The study aimed to compare the examiners’ performance of caries lesion detection on the intraoral radiographic images to the performance of the deep learning Convolutional Neural Network (CNN) model. The study concluded that the deep learning model can help clinicians diagnose caries with more accuracy and reliability and ultimately improve patient care.  “Developing a Deep Learning Model to Diagnose Dental Caries” was presented by Sonamben Patel as a virtual Interactive Talk on March 24, 2022 at 8 a.m. EDT. The objective of this study was to develop a deep Convolutional Neural Network (CNN) for the diagnosis of dental caries lesions using intraoral radiographic images. The results suggest that CNN network can improve the accuracy of caries detection based on intraoral radiographic images.

Registered attendees can view these presentation in the 2022 Annual Meeting Hybrid Platform.

Periodontitis and erectile dysfunction linked to serious cardiovascular events

 

IMAGE: THE UGR RESEARCHERS WHO CONDUCTED THIS STUDY. FROM LEFT TO RIGHT: MIGUEL ÁNGEL ARRABAL, MIGUEL ARRABAL, FRANCISCO MESA, ANTONIO MAGÁN, AND ALEJANDRO RODRÍGUEZ view more 

CREDIT: UNIVERSITY OF GRANADA

A team of researchers led by the University of Granada (UGR) has shown in a prospective study that men with periodontitis who are also diagnosed with erectile dysfunction are almost four times more likely to suffer a major adverse cardiovascular event (MACE).

These pathologies refer specifically to cerebral infarction, non-fatal myocardial infarction, cardiovascular death, heart failure, acute coronary syndrome (stable and unstable angina), coronary artery bypass grafting, or percutaneous coronary intervention. They were found to occur, on average, four years after the sexual dysfunction was diagnosed.

This study, published in the prestigious Journal of Periodontology (the official publication of the American Academy of Periodontology), was conducted by the ‘CTS 583’ research group, led by the UGR’s Francisco Mesa (from the Department of Stomatology), in collaboration with the Urology Service of the ‘Clínico San Cecilio’ Teaching Hospital in Granada. The Director of the Service is Miguel Arrabal of the Department of Surgery and Surgical Specialties at the UGR.

Epidemiological study

These results are of particular importance, given that MACEs are life-threatening in middle-aged men. Thanks to its longitudinal design, this epidemiological association-study provides the greatest volume of scientific evidence among studies of its kind, to date.

Although it was not the aim of the research to identify the cause of this link, the authors attribute it to an accelerated atherosclerotic process triggered by periodontitis—first, in the small vessels of the corpus cavernosum of the penis, and, later, in the rest of the arterioles of other vital organs. Therefore, in the case of men with periodontitis, the onset of erectile dysfunction could be a warning sign of potentially much more serious (cardiovascular) conditions and events in the near future. This line of research was initiated by the authors in 2017 in a case–control (observational) study, in which they demonstrated that men with periodontitis were 2.17 times more likely to suffer from erectile dysfunction.

---

JOURNAL

Journal of Periodontology

DOI

10.1002/JPER.21-0477 

New dental tool prototype can spot the acidic conditions that lead to cavities

You and your dentist have a lot of tools and techniques for stopping cavities, but detecting the specific chemical conditions that can lead to cavities and then preventing them from ever getting started is much harder. Now, in a new study, University of Washington researchers have shown that a dental tool they created can measure the acidity built up by the bacteria in plaque that leads to cavities.

The O-pH system is a prototype optical device that emits an LED light and measures the reactions of that light, the fluorescence, with an FDA-approved chemical dye applied to teeth. The O-pH then produces a numerical reading of the pH, or acidity, of the plaque covering those teeth. Knowing how acidic the plaque is can tell dentists and patients what area of a tooth is most at risk of developing a cavity.

"Plaque has a lot of bacteria that produce acid when they interact with the sugar in our food," said Manuja Sharma, lead author and a doctoral student in the UW Department of Electrical and Computer Engineering. "This acid is what causes the corrosion of the tooth surface and eventually cavities. So, if we can capture information about the acidic activity, we can get an idea of how bacteria are growing in the dental biofilm, or plaque."

Sharma explained that not all bacteria in that biofilm are bad or will lead to cavities, so measuring the acidity of the environment can tell a dentist what they need to know about the threat of developing problems. That can limit the need to test for specific harmful bacteria, of which there can be a multitude.

To test their device, the researchers recruited 30 patients between the ages of 10 and 18, with a median age of 15, in the UW School of Dentistry's Center for Pediatric Dentistry. The researchers chose kids for their study in large part because the enamel on kids' teeth is much thinner than that of adults, so getting early warning of acid erosion is even more important. To perform the measurements with the O-pH device, the researchers also recruited second- and third-year students in the dentistry school, who were supervised by a faculty member.

The test is non-invasive. While the dye is applied to the teeth, at the end of a length of cord is the probe that transmits and collects light while hovering over the surface of a tooth (see photos). The collected light travels back to a central box that provides a pH reading. The conditions on the patients' teeth were read several times before and after sugar rinses and other condition changes, such as pre- and post-professional dental cleaning.

Eric Seibel, senior author and research professor of mechanical engineering in the UW College of Engineering, said the idea for adding the acidity test as a new clinical procedure came from envisioning that when a patient first sits in the dental chair, before their teeth get cleaned, "a dentist would rinse them with the tasteless fluorescent dye solution and then get their teeth optically scanned to look for high acid production areas where the enamel is getting demineralized."

The study was published in February in IEEE Transactions on Biomedical Engineering. The research team reported that one limitation to their study was being unable to consistently measure the same location on each tooth during each phase of testing. To address this limitation, in particular, the researchers are evolving their device to a version that produces images for dentists that instantly show the exact location of high acidity, where the next cavity may occur.

"We do need more results to show how effective it is for diagnosis, but it can definitely help us understand some of your oral health quantitatively," said Sharma. "It can also help educate patients about the effects of sugar on the chemistry of plaque. We can show them, live, what happens, and that is an experience they'll remember and say, OK, fine, I need to cut down on sugar!"

Co-authors include Lauren Lee, UW Department of Microbiology; Matthew Carson, UW Human Photonics Laboratory; David Park, Se An, Micah Bovenkamp, Jess Cayetano, Ian Berude, Zheng Xu, Alireza Sadr, UW School of Dentistry; and Shwetak Patel, UW Electrical and Computer Engineering, Paul. G. Allen School of Computer Science. This research was funded by the National Science Foundation, Oral Health Monitor, Institute of Translational Health Sciences; and the National Center for Advancing Translational Sciences of the National Institutes of Health.

Some oral bacteria linked with hypertension in older women

Some oral bacteria were associated with the development of hypertension, also known as high blood pressure, in postmenopausal women, according to new research published today in the Journal of the American Heart Association, an open access, peer-reviewed journal of the American Heart Association.

High blood pressure is typically defined by two measurements: systolic blood pressure (the upper number measuring pressure when the heart beats) of 130 mm Hg or higher, and diastolic blood pressure (the lower number indicating pressure between heart beats) of 80 mm Hg or higher.

While previous research has indicated that blood pressure tends to be higher in people with existing periodontal disease compared to those without it, researchers believe that this study is the first to prospectively examine the association between oral bacteria and developing hypertension.

“Since periodontal disease and hypertension are especially prevalent in older adults, if a relationship between the oral bacteria and hypertension risk could be established, there may be an opportunity to enhance hypertension prevention through increased, targeted oral care,” said Michael J. LaMonte, Ph.D., M.P.H., one of the study’s senior authors, a research professor in epidemiology at the University at Buffalo - State University of New York and a co-investigator in the Women’s Health Initiative clinical center in the University’s epidemiology and environmental health department.

Researchers evaluated data for 1,215 postmenopausal women (average age of 63 years old at study enrollment, between 1997 and 2001) in the Buffalo Osteoporosis and Periodontal Disease Study in Buffalo, New York. At study enrollment, researchers recorded blood pressure and collected oral plaque from below the gum line, “which is where some bacteria keep the gum and tooth structures healthy, and others cause gum and periodontal disease,” LaMonte said. They also noted medication use and medical and lifestyle histories to assess if there is a link between oral bacteria and hypertension in older women.

At study enrollment, about 35% (429) of the study participants had normal blood pressure: readings below 120/80 mm Hg, with no use of blood pressure medication. Nearly 24% (306) of participants had elevated blood pressure: readings above 120/80 mm Hg with no medication use. About 40% (480) of participants were categorized as having prevalent treated hypertension: diagnosed and treated for hypertension with medication.

Researchers identified 245 unique strains of bacteria in the plaque samples. Nearly one-third of the women who did not have hypertension or were not being treated for hypertension at the beginning of the study were diagnosed with high blood pressure during the follow-up period, which was an average of 10 years.

The analysis found:

• 10 bacteria were associated with a 10% to 16% higher risk of developing high blood pressure; and
• five other kinds of bacteria were associated with a 9% to 18% lower hypertension risk.

These results were consistent even after considering demographic, clinical and lifestyle factors (such as older age, treatment for high cholesterol, dietary intake and smoking) that also influence the development of high blood pressure.

The potential associations for the same 15 bacteria with hypertension risk among subgroups was analyzed, comparing women younger than age 65 to those older than 65; smokers versus nonsmokers; those with normal versus elevated blood pressure at the start of the study, and other comparisons. Results remained consistent among the groups compared.

The findings are particularly relevant for postmenopausal women, since the prevalence of high blood pressure is higher among older women than older men, according to LaMonte.

More than 70% of American adults ages 65 and older have high blood pressure. That age category, the fastest growing in the U.S., is projected to reach 95 million by 2060, with women outnumbering men 2 to 1, according to a 2020 U.S. Census report. The 2020 U.S. Surgeon General’s Call to Action to Control Hypertension underscores the serious public health issue imposed by hypertension in adults, especially those in later life. Identifying new approaches to prevent this disease is, thus, paramount in an aging society.

According to the American Heart Association, nearly half of U.S. adults have high blood pressure, and many don’t know they have it. High blood pressure is a major risk factor for cardiovascular disease and stroke.

“We have come to better appreciate that health is influenced by more than just the traditional risk factors we know to be so important. This paper is a provocative reminder of the need to expand our understanding of additional health factors that may even be influenced by our environments and potentially impact our biology at the endothelial level,” said Willie Lawrence, M.D., chair of the American Heart Association’s National Hypertension Control Initiative’s (NHCI) Oversight Committee. ”Inclusive research on hypertension must continue to be a priority to better understand and address the condition.”

Due to the study’s observational approach, cause and effect cannot be inferred, limiting the researchers’ ability to identify with certainty that only some bacteria are related to lower risk of hypertension while others are related to higher risk. A randomized trial would provide the evidence necessary to confirm which bacteria were causal agents in developing – or not developing – hypertension over time, according to LaMonte.