Treating gum disease linked to lower medical costs for patients with diabetes
A new report suggests that treating gum disease in patients who have diabetes with procedures such as cleanings and periodontal scaling is linked to 10 to 12 percent lower medical costs per month.
The findings are encouraging but the study was not designed to firmly establish cause and effect, said George Taylor, University of Michigan associate professor of dentistry, who also has an appointment in epidemiology in the U-M School of Public Health. Taylor led the research project to investigate whether routine, non-surgical treatment for gum disease is linked to lower medical care costs for people with diabetes.
In periodontal disease, the body reacts to the bacteria causing the gum infection by producing proteins or chemicals called inflammatory mediators. Ulcers and open sores in the gums become passageways for these proteins and for the bacteria themselves to enter the body's blood circulation. These inflammatory mediators, as well as some parts of the bacteria, prevent the body from effectively removing glucose, or sugar, from the blood.
The higher level of blood sugar is known as poor diabetes control. Poor diabetes control leads to serious diabetes complications such as vision disorders, cardiovascular and kidney disease and amputations, among others.
"Cleanings and other non-surgical periodontal treatment remove the harmful bacteria," Taylor said. "We believe this helps prevent the body from producing those harmful chemicals that can enter the systemic circulation and contribute to poorer diabetes control."
Blue Care Network provided U-M researchers data from 2,674 patients aged 18-64 who were enrolled in BCN between 2001 and 2005 and had at least 12 consecutive months of medical, dental, and pharmaceutical coverage.
"We found insured adults with diabetes in Michigan who received routine periodontal treatment, such as dental cleanings and scaling, have significantly lower medical care costs than those who do not," Taylor said. "These results could be meaningful to individuals, employers, health care providers and insurers."
The study showed that medical care costs decreased by an average of 11 percent per month for patients who received one or two periodontal treatment procedures annually compared to those who received none. For patients receiving three or four annual treatments, costs decreased nearly 12 percent.
The study also showed that combined medical and pharmaceutical monthly costs were 10 percent lower for patients who received one or two periodontal procedures annually.
"The results of our analyses provide additional evidence supporting a beneficial role for periodontal treatment in improving overall health for people with diabetes," Taylor said. The findings could fuel changes in policies and practices for diabetes patients and their insurers.
Friday, December 26, 2008
Monday, December 22, 2008
New Tooth Cavity Protection Discovered
Clarkson University Center for Advanced Materials Processing Professor Igor Sokolov and graduate student Ravi M. Gaikwad have discovered a new method of protecting teeth from cavities by ultrafine polishing with silica nanoparticles.
The researchers adopted polishing technology used in the semiconductor industry (chemical mechanical planarization) to polish the surface of human teeth down to nanoscale roughness. Roughness left on the tooth after the polishing is just a few nanometers, which is one-billionth of a meter or about 100,000 times smaller than a grain of sand.
Sokolov and Gaikwad showed that teeth polished in this way become too “slippery” for the "bad" bacteria that is responsible for the destruction of dental enamel. As a result the bacteria can be removed fairly easily before they cause damage to the enamel.
Although silica particles have been used before for tooth polishing, polishing with nanosized particles has not been reported. The researchers hypothesized that such polishing may protect tooth surfaces against the damage caused by cariogenic bacteria, because the bacteria can be removed easily from such polished surfaces.
The Clarkson researchers' findings were published in the October issue of the Journal of Dental Research, the dentistry journal with the top worldwide scientific impact index.
Sokolov is a professor of physics, professor of chemical and biomolecular science, and director of Clarkson's Nanoengineering and Biotechnology Laboratories Center (NABLAB). This is one of the first research projects performed in the recently established NABLAB.
Gaikwad is a graduate student in physics.
Read more at http://jdr.iadrjournals.org/cgi/content/short/87/10/980.
The researchers adopted polishing technology used in the semiconductor industry (chemical mechanical planarization) to polish the surface of human teeth down to nanoscale roughness. Roughness left on the tooth after the polishing is just a few nanometers, which is one-billionth of a meter or about 100,000 times smaller than a grain of sand.
Sokolov and Gaikwad showed that teeth polished in this way become too “slippery” for the "bad" bacteria that is responsible for the destruction of dental enamel. As a result the bacteria can be removed fairly easily before they cause damage to the enamel.
Although silica particles have been used before for tooth polishing, polishing with nanosized particles has not been reported. The researchers hypothesized that such polishing may protect tooth surfaces against the damage caused by cariogenic bacteria, because the bacteria can be removed easily from such polished surfaces.
The Clarkson researchers' findings were published in the October issue of the Journal of Dental Research, the dentistry journal with the top worldwide scientific impact index.
Sokolov is a professor of physics, professor of chemical and biomolecular science, and director of Clarkson's Nanoengineering and Biotechnology Laboratories Center (NABLAB). This is one of the first research projects performed in the recently established NABLAB.
Gaikwad is a graduate student in physics.
Read more at http://jdr.iadrjournals.org/cgi/content/short/87/10/980.
Wednesday, December 17, 2008
Dieting May Cut Risk for Gum Disease
For men, especially older men, dieting may help reduce the risk of gum disease more than for women, according to a new study by researchers at the University of Maryland, Baltimore and other institutions.
The study, published in the journal Nutrition, also provides the latest clue to a powerful link between chronic inflammation and poor health, according to Mark Reynolds, DDS, PhD, associate professor at the Dental School, part of UMB.
“Chronic inflammation appears to be an important factor underlying aging and many age-related disorders, and dietary restriction has been shown to reduce the risk for chronic disease and promote longevity in multiple animal models,” says Reynolds, who is chair of the Department of periodontics at the School.
The study, of 81 rhesus monkeys at the National Institutes of Health, showed that males fed a diet of 30 percent fewer calories for 13 to 17 years had significantly lower levels of a gum-damaging condition known as periodontal pocketing, less immune response to invading bacteria, and higher inflammatory molecules than males fed a normal diet. Periodontal inflammation and disease start from bacteria.
Also, for the monkeys not fed the reduced-calorie diet, males showed “significantly greater periodontal breakdown” than females. Consistent with previous studies of humans, the monkeys in the study showed an increasing degree of gum problems as they aged.
Aging and obesity are associated with increased biological signs of overall inflammation and periodontal disease in humans, says Reynolds. Although about one-third of adults aged 30 to 90 have periodontitis, attempts to study humans directly have been hampered by the environmental complexities of oral diseases and factors such as smoking.
Non-human primates, such as rhesus monkeys, are an important model for studying inflammatory gum disease and oral infections in humans, says Reynolds.
Reynolds studies the role of inflammation in periodontal disease, including modifiable risk factors such as nutrition. Periodontal disease is one of the few inflammatory conditions that can be readily seen and studied in humans and other animals.
Reynolds was at the National Institute on Aging (NIA) before joining the faculty at the Dental School in 1999. Continuing research verified that the monkeys develop visible gum disease, and the NIA awarded John Novak, BDS, LDS, RCS, MS, at the University of Kentucky; Reynolds; and others a five-year grant for their study.
Men develop higher rates of periodontal and coronary heart disease than do women on the whole, says Reynolds. A major question has been: how much do modifiable risk factors, such as smoking, physical inactivity, and obesity, contribute to the male-female gap? Or, is this difference in risk a natural occurrence between males and females? The monkey study seems to point to a genetic basis for the difference in risk, he says, reflecting underlying differences in how males and females respond to injury and inflammation.
He adds, “An understanding of such sex differences will become increasingly more important in the selection of treatments as we move toward personalized medicine based on individual genetic profiles.”
The study appears in the Oct. 15 online issue of Nutrition, and will appear in the January hard copy. Along with Novak and Reynolds, the study team included other researchers from the Maryland Dental School and the University of Kentucky, as well as researchers at the Virginia Commonwealth University, the National Institute of Aging, and Louisiana State University.
The study, published in the journal Nutrition, also provides the latest clue to a powerful link between chronic inflammation and poor health, according to Mark Reynolds, DDS, PhD, associate professor at the Dental School, part of UMB.
“Chronic inflammation appears to be an important factor underlying aging and many age-related disorders, and dietary restriction has been shown to reduce the risk for chronic disease and promote longevity in multiple animal models,” says Reynolds, who is chair of the Department of periodontics at the School.
The study, of 81 rhesus monkeys at the National Institutes of Health, showed that males fed a diet of 30 percent fewer calories for 13 to 17 years had significantly lower levels of a gum-damaging condition known as periodontal pocketing, less immune response to invading bacteria, and higher inflammatory molecules than males fed a normal diet. Periodontal inflammation and disease start from bacteria.
Also, for the monkeys not fed the reduced-calorie diet, males showed “significantly greater periodontal breakdown” than females. Consistent with previous studies of humans, the monkeys in the study showed an increasing degree of gum problems as they aged.
Aging and obesity are associated with increased biological signs of overall inflammation and periodontal disease in humans, says Reynolds. Although about one-third of adults aged 30 to 90 have periodontitis, attempts to study humans directly have been hampered by the environmental complexities of oral diseases and factors such as smoking.
Non-human primates, such as rhesus monkeys, are an important model for studying inflammatory gum disease and oral infections in humans, says Reynolds.
Reynolds studies the role of inflammation in periodontal disease, including modifiable risk factors such as nutrition. Periodontal disease is one of the few inflammatory conditions that can be readily seen and studied in humans and other animals.
Reynolds was at the National Institute on Aging (NIA) before joining the faculty at the Dental School in 1999. Continuing research verified that the monkeys develop visible gum disease, and the NIA awarded John Novak, BDS, LDS, RCS, MS, at the University of Kentucky; Reynolds; and others a five-year grant for their study.
Men develop higher rates of periodontal and coronary heart disease than do women on the whole, says Reynolds. A major question has been: how much do modifiable risk factors, such as smoking, physical inactivity, and obesity, contribute to the male-female gap? Or, is this difference in risk a natural occurrence between males and females? The monkey study seems to point to a genetic basis for the difference in risk, he says, reflecting underlying differences in how males and females respond to injury and inflammation.
He adds, “An understanding of such sex differences will become increasingly more important in the selection of treatments as we move toward personalized medicine based on individual genetic profiles.”
The study appears in the Oct. 15 online issue of Nutrition, and will appear in the January hard copy. Along with Novak and Reynolds, the study team included other researchers from the Maryland Dental School and the University of Kentucky, as well as researchers at the Virginia Commonwealth University, the National Institute of Aging, and Louisiana State University.
Tuesday, December 16, 2008
Link between inflamed gums and heart disease
Scientists find link between inflamed gums and heart disease
New article in the FASEB Journal shows that proper dental care can reduce the risk of atherosclerosis, a leading cause of heart disease
The next person who reminds you to floss might be your cardiologist instead of your dentist. Scientists have known for some time that a protein associated with inflammation (called CRP) is elevated in people who are at risk for heart disease. But where's the inflammation coming from? A new research study by Italian and U.K. scientists published online in The FASEB Journal shows that infected gums may be one place. Indeed, proper dental hygiene should reduce the risk of atherosclerosis, stroke and heart disease independently of other measures, such as managing cholesterol.
"It has been long suspected that atherosclerosis is an inflammatory process, and that periodontal disease plays a role in atherosclerosis," said Mario Clerici, M.D., a senior researcher on the study. "Our study suggests that this is the case, and indicates that something as simple as taking good care of your teeth and gums can greatly reduce your risk of developing serious diseases."
To reach this conclusion, the scientists examined the carotid arteries of 35 otherwise healthy people (median age 46) with mild to moderate periodontal disease before and after having their periodontal disease treated. One year after treatment, the scientists observed a reduction in oral bacteria, immune inflammation and the thickening of the blood vessels associated with atherosclerosis.
"Because many Americans have some form of gum disease, this research can't be brushed aside," said Gerald Weissmann, M.D., Editor-in-Chief of The FASEB Journal. "As it turns out, the health of our blood vessels could be hanging by the proverbial thread: dental floss."
New article in the FASEB Journal shows that proper dental care can reduce the risk of atherosclerosis, a leading cause of heart disease
The next person who reminds you to floss might be your cardiologist instead of your dentist. Scientists have known for some time that a protein associated with inflammation (called CRP) is elevated in people who are at risk for heart disease. But where's the inflammation coming from? A new research study by Italian and U.K. scientists published online in The FASEB Journal shows that infected gums may be one place. Indeed, proper dental hygiene should reduce the risk of atherosclerosis, stroke and heart disease independently of other measures, such as managing cholesterol.
"It has been long suspected that atherosclerosis is an inflammatory process, and that periodontal disease plays a role in atherosclerosis," said Mario Clerici, M.D., a senior researcher on the study. "Our study suggests that this is the case, and indicates that something as simple as taking good care of your teeth and gums can greatly reduce your risk of developing serious diseases."
To reach this conclusion, the scientists examined the carotid arteries of 35 otherwise healthy people (median age 46) with mild to moderate periodontal disease before and after having their periodontal disease treated. One year after treatment, the scientists observed a reduction in oral bacteria, immune inflammation and the thickening of the blood vessels associated with atherosclerosis.
"Because many Americans have some form of gum disease, this research can't be brushed aside," said Gerald Weissmann, M.D., Editor-in-Chief of The FASEB Journal. "As it turns out, the health of our blood vessels could be hanging by the proverbial thread: dental floss."
Thursday, December 11, 2008
Toothbrushing prevents hospital-borne pneumonia
Hospital-borne infections are a serious risk of a long-term hospital stay, and ventilator-associated pneumonia (VAP), a lung infection that develops in about 15% of all people who are ventilated, is among the most dangerous. With weakened immune systems and a higher resistance to antibiotics, patients who rely on a mechanical ventilator can easily develop serious infections — as 26,000 Americans do every year.
Thanks to a proven new clinical approach developed by Tel Aviv University nurses, though, there is a new tool for stopping the onset of VAP in hospitals.
This new high-tech tool? An ordinary toothbrush.
Three Times a Day Keeps Pneumonia Away
“Pneumonia is a big problem in hospitals everywhere, even in the developed world,” says Nurse Ofra Raanan, the chief researcher in the new study and a lecturer at Tel Aviv University’s Department of Nursing. “Patients who are intubated can be contaminated with pneumonia only 2 or 3 days after the tube is put in place. But pneumonia can be effectively prevented if the right measures are taken.”
Raanan, who works at the Sheba Academic School of Nursing at The Chaim Sheba Medical Center, collaborated with a team of nurses at major medical centers around Israel. The nurses found that if patients — even unconscious ones — have their teeth brushed three times a day, the onset of pneumonia can be reduced by as much as 50%.
A Pioneering Study with Measurable Effects
It’s difficult to quantify the effects precisely, the researchers say. “While the research shows a definite improvement in reducing the incidence of hospital-borne pneumonia, it’s hard to say by exactly how much toothbrushing prevents VAP,” says Raanan, but the published evidence shows a direct correlation for intubated patients.
“Sometimes, however, doctors and nurses do everything right and the patient still gets pneumonia. But this approach will certainly improve the odds for survival.”
Normally, the teeth and oral cavity in a healthy mouth maintain a colony of otherwise harmless bacteria. Infection takes root when a breathing tube allows free passage of the “good” bacteria into the lower parts of the lung. The bacteria travel in small water droplets through the tube and colonize the lung. Once there, the bacteria take advantage of a patient’s weakened immune system and multiply. A regular toothbrushing kills the growth and subsequent spread of the bacterium that leads to VAP.
Augmenting the Preventative Routine
There are additional steps for preventing the onset of VAP. Today, nurses typically use a mechanical suction device to remove secretions from the mouth and throat. They also put patients in a seated position and change the position every few hours. Toothbrushing, say Tel Aviv University nurses, should be added to the routine.
Although nurses in some American hospitals already practice toothbrushing on ventilated patients, these new results may convince medical centers around the world to invest more resources in this routine practice, thereby saving lives.
The research and recommendations are scheduled for publication in a leading nursing journal.
Thanks to a proven new clinical approach developed by Tel Aviv University nurses, though, there is a new tool for stopping the onset of VAP in hospitals.
This new high-tech tool? An ordinary toothbrush.
Three Times a Day Keeps Pneumonia Away
“Pneumonia is a big problem in hospitals everywhere, even in the developed world,” says Nurse Ofra Raanan, the chief researcher in the new study and a lecturer at Tel Aviv University’s Department of Nursing. “Patients who are intubated can be contaminated with pneumonia only 2 or 3 days after the tube is put in place. But pneumonia can be effectively prevented if the right measures are taken.”
Raanan, who works at the Sheba Academic School of Nursing at The Chaim Sheba Medical Center, collaborated with a team of nurses at major medical centers around Israel. The nurses found that if patients — even unconscious ones — have their teeth brushed three times a day, the onset of pneumonia can be reduced by as much as 50%.
A Pioneering Study with Measurable Effects
It’s difficult to quantify the effects precisely, the researchers say. “While the research shows a definite improvement in reducing the incidence of hospital-borne pneumonia, it’s hard to say by exactly how much toothbrushing prevents VAP,” says Raanan, but the published evidence shows a direct correlation for intubated patients.
“Sometimes, however, doctors and nurses do everything right and the patient still gets pneumonia. But this approach will certainly improve the odds for survival.”
Normally, the teeth and oral cavity in a healthy mouth maintain a colony of otherwise harmless bacteria. Infection takes root when a breathing tube allows free passage of the “good” bacteria into the lower parts of the lung. The bacteria travel in small water droplets through the tube and colonize the lung. Once there, the bacteria take advantage of a patient’s weakened immune system and multiply. A regular toothbrushing kills the growth and subsequent spread of the bacterium that leads to VAP.
Augmenting the Preventative Routine
There are additional steps for preventing the onset of VAP. Today, nurses typically use a mechanical suction device to remove secretions from the mouth and throat. They also put patients in a seated position and change the position every few hours. Toothbrushing, say Tel Aviv University nurses, should be added to the routine.
Although nurses in some American hospitals already practice toothbrushing on ventilated patients, these new results may convince medical centers around the world to invest more resources in this routine practice, thereby saving lives.
The research and recommendations are scheduled for publication in a leading nursing journal.
Thursday, December 4, 2008
Philadelphia dentist and motivational speaker
A little down in the mouth? Dr. Joe Capista knows where you are coming from... but won't let you stay there. That's because Dr. Capista, a dentist by training, is emerging as the most in-demand motivational speaker and author to come out of Philadelphia since fellow healthcare-professional-turn-personal-motivator Pat Croce hit the scene.
Dr. Capista is using his unlikely rise to fame as a way for others to transform their lives, achieve balance, and succeed in their personal and professional lives. His book, What Can a Dentist Teach You About Business, Life and Success?, reached top-selling status on Amazon.com this year. He has parlayed that success into a series of national speaking engagements and media appearances.
In the beginning of his career, Dr Capista worked endless hours, in cramped offices trying to make a career in general dentistry. The work was good, but it limited his worldview and sapped his energy. For the next 25 years of his life, Dr. Capista practiced general dentistry and learned to apply certain techniques through the use of consultants and mentors on how to grow a successful business.
In the year 2002 at age 52, Dr. Capista decided to expand in his profession to help advance his practice to the next level. He spent $300,000 and three years learning cosmetic dentistry and improving the systems he uses for everything-from how he meets, greets, and treats his patients, to the way he markets his practice. The process allowed him to grow his dental practice in Broomall, Pa., into one of the most successful, systemized small businesses in the country.
But, it's not dentists that he wants to talk to. Rather, Dr. Capista's message is broader and for everyone. In fact, he uses his background as a dentist to convince audiences that if he can do it, anyone can.
"Think about it. There's not another business in the world where your customer hates the experience and pays for it," says Dr. Capista in his trademark rapid-fire style. "I started at a disadvantage, and had to learn how to understand and read people, and gain their trust and confidence in order to help them with their treatments."
It's just that type of insight Dr. Capista imparts to audiences as diverse as sales people, corporate executives, religious groups, college students, and of course, the interested dentist, who might want to emulate Dr. Capista's success.
It's a message with teeth. "My book and talks have really struck home with anyone who wants to achieve more in life, but doesn't know how. That was my early experience, and it took me a lifetime to figure out how to systemize my life so that I could replicate success, and give myself more balance both personally and professionally."
For more information about Dr. Joe Capista or to interview/book Dr. Joe Capista, contact Jackie Zima at 610-228-2138, 215-534-2973 (cell), or write to Jackie@GregoryFCA.com.
ABOUT DR. JOE CAPISTA
Dr. Joe Capista, founder and president of Williamsburg Dental, a 5-Star dental practice located in Broomall, Pennsylvania. Williamsburg Dental is recognized as one of the most successful dental practices in the entire United States. For the fifth year running, Dr. Capista has been named The Cosmetic Dentist of the Philadelphia Sixers Dancers and just recently recognized as the 2008 Small Business Person of the Year. For over three decades, Dr. Capista has dedicated himself to the study of the power and impact of the mind and spirit in creating success both personally and professionally. Dr. Capista's success philosophy is simple; combine your deepest passion, develop solid business principles while striving for balance in all areas of your life.
Dr. Capista is using his unlikely rise to fame as a way for others to transform their lives, achieve balance, and succeed in their personal and professional lives. His book, What Can a Dentist Teach You About Business, Life and Success?, reached top-selling status on Amazon.com this year. He has parlayed that success into a series of national speaking engagements and media appearances.
In the beginning of his career, Dr Capista worked endless hours, in cramped offices trying to make a career in general dentistry. The work was good, but it limited his worldview and sapped his energy. For the next 25 years of his life, Dr. Capista practiced general dentistry and learned to apply certain techniques through the use of consultants and mentors on how to grow a successful business.
In the year 2002 at age 52, Dr. Capista decided to expand in his profession to help advance his practice to the next level. He spent $300,000 and three years learning cosmetic dentistry and improving the systems he uses for everything-from how he meets, greets, and treats his patients, to the way he markets his practice. The process allowed him to grow his dental practice in Broomall, Pa., into one of the most successful, systemized small businesses in the country.
But, it's not dentists that he wants to talk to. Rather, Dr. Capista's message is broader and for everyone. In fact, he uses his background as a dentist to convince audiences that if he can do it, anyone can.
"Think about it. There's not another business in the world where your customer hates the experience and pays for it," says Dr. Capista in his trademark rapid-fire style. "I started at a disadvantage, and had to learn how to understand and read people, and gain their trust and confidence in order to help them with their treatments."
It's just that type of insight Dr. Capista imparts to audiences as diverse as sales people, corporate executives, religious groups, college students, and of course, the interested dentist, who might want to emulate Dr. Capista's success.
It's a message with teeth. "My book and talks have really struck home with anyone who wants to achieve more in life, but doesn't know how. That was my early experience, and it took me a lifetime to figure out how to systemize my life so that I could replicate success, and give myself more balance both personally and professionally."
For more information about Dr. Joe Capista or to interview/book Dr. Joe Capista, contact Jackie Zima at 610-228-2138, 215-534-2973 (cell), or write to Jackie@GregoryFCA.com.
ABOUT DR. JOE CAPISTA
Dr. Joe Capista, founder and president of Williamsburg Dental, a 5-Star dental practice located in Broomall, Pennsylvania. Williamsburg Dental is recognized as one of the most successful dental practices in the entire United States. For the fifth year running, Dr. Capista has been named The Cosmetic Dentist of the Philadelphia Sixers Dancers and just recently recognized as the 2008 Small Business Person of the Year. For over three decades, Dr. Capista has dedicated himself to the study of the power and impact of the mind and spirit in creating success both personally and professionally. Dr. Capista's success philosophy is simple; combine your deepest passion, develop solid business principles while striving for balance in all areas of your life.
Tuesday, November 25, 2008
Gum disease = risk for cardiovascular disease
Presence of gum disease may help dentists and physicians identify risk for cardiovascular disease
NEW YORK (Nov. 25, 2008) -- Individuals reporting a history of periodontal disease were more likely to have increased levels of inflammation, a risk factor for heart disease, compared to those who reported no history of periodontal disease, according to an American Journal of Cardiology report available online today. Led by investigators from Columbia University Medical Center and NewYork-Presbyterian Hospital, the findings suggest persons with increased levels of inflammatory markers associated with a higher risk of cardiovascular disease might be identified by asking about oral health history. This group might not be detected by traditional cardiovascular risk screening.
Inflammation has been associated with cardiovascular disease and has been suggested to be a potential link between periodontal disease and cardiovascular disease. To examine whether oral health history and inflammatory markers associated with cardiovascular disease were linked, the investigators followed participants in the National Heart, Lung and Blood Institute (NHLBI) Family Intervention Trial for Heart Health (F.I.T. Heart), an ongoing national trial led by principal investigator Lori Mosca, M.D., M.P.H., Ph.D., professor of medicine at Columbia University College of Physicians and Surgeons and director of preventive cardiology at NewYork-Presbyterian Hospital/Columbia University Medical Center.
The NHLBI Family Intervention Trial for Heart Health aims to study family members of patients hospitalized with heart disease because they may be at increased risk themselves due to shared genetic and/or lifestyle factors. Dr. Mosca and her research team recruited family members or co-habitants of patients hospitalized for such cardiac events as a heart attack or narrowed arteries that required bypass surgery or an angioplasty procedure. Previous research has shown that family members of cardiovascular disease patients may be at increased risk for the disease due to the genes and lifestyle habits they share.
In this study, 421 individuals who were blood related to and/or living with a person recently hospitalized due to cardiovascular disease were screened for traditional cardiovascular risk factors (such as elevated blood pressure and abnormal cholesterol levels), inflammatory markers associated with disease risk (high-sensitivity c-reactive protein (hsCRP) and lipoprotein-associated phospholipase A2 (Lp-PLA2)). They were also asked standardized questions about their oral health status, including whether they had ever been diagnosed with periodontal (gum) disease, whether they had ever been treated for periodontal disease, whether they used partial or complete removable dentures, and the date of their last teeth cleaning. The oral health history was then correlated with standard markers of inflammation.
Results found that among participants who did not have traditional cardiovascular disease risk factors (such as high blood pressure, high cholesterol, and overweight/obese status), almost one in four were found to have a personal history of periodontal disease and higher levels of Lp-PLA2, an inflammatory marker which has been found present in inflamed rupture prone plaque in heart arteries/valves.
It is important to note that it is not possible to determine from this study that poor oral health causes cardiovascular disease risk or that any therapy based on oral health status would be effective in preventing cardiovascular disease. However, Dr. Mosca says, "Our finding is novel because it suggests the dentist and oral health exam may be the latest weapon in identifying persons at risk of cardiovascular disease, our nation's number one killer."
"Many people don't realize how oral health is often a predictor of one's overall health," says co-author John T. Grbic, DMD, MS, MMSc, professor of clinical dental medicine at the Columbia University College of Dental Medicine. "Symptoms for many life-threatening illnesses, such as diabetes and heart disease, first appear in the mouth. For this reason, it's vitally important for people to have routine dental check-ups and have an ongoing dialogue with their dentist about their oral health. Patients may also benefit from seeing dentists affiliated with an academic medical center, where they are tapped into deep referral networks to appropriate clinicians."
NEW YORK (Nov. 25, 2008) -- Individuals reporting a history of periodontal disease were more likely to have increased levels of inflammation, a risk factor for heart disease, compared to those who reported no history of periodontal disease, according to an American Journal of Cardiology report available online today. Led by investigators from Columbia University Medical Center and NewYork-Presbyterian Hospital, the findings suggest persons with increased levels of inflammatory markers associated with a higher risk of cardiovascular disease might be identified by asking about oral health history. This group might not be detected by traditional cardiovascular risk screening.
Inflammation has been associated with cardiovascular disease and has been suggested to be a potential link between periodontal disease and cardiovascular disease. To examine whether oral health history and inflammatory markers associated with cardiovascular disease were linked, the investigators followed participants in the National Heart, Lung and Blood Institute (NHLBI) Family Intervention Trial for Heart Health (F.I.T. Heart), an ongoing national trial led by principal investigator Lori Mosca, M.D., M.P.H., Ph.D., professor of medicine at Columbia University College of Physicians and Surgeons and director of preventive cardiology at NewYork-Presbyterian Hospital/Columbia University Medical Center.
The NHLBI Family Intervention Trial for Heart Health aims to study family members of patients hospitalized with heart disease because they may be at increased risk themselves due to shared genetic and/or lifestyle factors. Dr. Mosca and her research team recruited family members or co-habitants of patients hospitalized for such cardiac events as a heart attack or narrowed arteries that required bypass surgery or an angioplasty procedure. Previous research has shown that family members of cardiovascular disease patients may be at increased risk for the disease due to the genes and lifestyle habits they share.
In this study, 421 individuals who were blood related to and/or living with a person recently hospitalized due to cardiovascular disease were screened for traditional cardiovascular risk factors (such as elevated blood pressure and abnormal cholesterol levels), inflammatory markers associated with disease risk (high-sensitivity c-reactive protein (hsCRP) and lipoprotein-associated phospholipase A2 (Lp-PLA2)). They were also asked standardized questions about their oral health status, including whether they had ever been diagnosed with periodontal (gum) disease, whether they had ever been treated for periodontal disease, whether they used partial or complete removable dentures, and the date of their last teeth cleaning. The oral health history was then correlated with standard markers of inflammation.
Results found that among participants who did not have traditional cardiovascular disease risk factors (such as high blood pressure, high cholesterol, and overweight/obese status), almost one in four were found to have a personal history of periodontal disease and higher levels of Lp-PLA2, an inflammatory marker which has been found present in inflamed rupture prone plaque in heart arteries/valves.
It is important to note that it is not possible to determine from this study that poor oral health causes cardiovascular disease risk or that any therapy based on oral health status would be effective in preventing cardiovascular disease. However, Dr. Mosca says, "Our finding is novel because it suggests the dentist and oral health exam may be the latest weapon in identifying persons at risk of cardiovascular disease, our nation's number one killer."
"Many people don't realize how oral health is often a predictor of one's overall health," says co-author John T. Grbic, DMD, MS, MMSc, professor of clinical dental medicine at the Columbia University College of Dental Medicine. "Symptoms for many life-threatening illnesses, such as diabetes and heart disease, first appear in the mouth. For this reason, it's vitally important for people to have routine dental check-ups and have an ongoing dialogue with their dentist about their oral health. Patients may also benefit from seeing dentists affiliated with an academic medical center, where they are tapped into deep referral networks to appropriate clinicians."
Drink brewed tea to avoid tooth erosion
Low erosive effect on teeth and antioxidants provide health benefits
Today, the average size soft drink is 20 ounces and contains 17 teaspoons of sugar. More startling is that some citric acids found in fruit drinks are more erosive than hydrochloric or sulfuric acid—which is also known as battery acid. These refined sugars and acids found in soda and citrus juice promote tooth erosion, which wears away the hard part of the teeth, or the enamel. Once tooth enamel is lost, it's gone forever. There is a beverage that does not produce such irreversible results. When deciding between the many options available, the best thing to drink is brewed tea, according to a study in the July/August issue of General Dentistry, the clinical, peer-reviewed journal of the Academy of General Dentistry (AGD).
Apart from tasting good, brewed tea has many health benefits. Tea is loaded with natural antioxidants, which are thought to decrease incidence of cancer, cardiovascular disease, and diabetes.
Mohamed A. Bassiouny, DMD, BDS, MSc, PhD, the lead author of the study, compared green and black tea to soda and orange juice in terms of their short- and long-term erosive effect on human teeth. The study found that the erosive effect of tea was similar to that of water, which has no erosive effect. And, when comparing green versus black, he discovered that there is a better option among those as well.
Dr. Bassiouny says that "when we look at tea and read about the benefits, it's amazing—not because green tea is 'the in thing'—but because there are advantages." He adds that much research done overseas, in countries such as Japan and Europe, found that green tea was identified to being superior over black due to its natural flavonoids (plant nutrients) and antioxidants.
But, if you do drink tea, experts suggest avoiding additives such as milk, lemon, or sugar because they combine with tea's natural flavonoids and decrease the benefits. In addition, stay away from prepackaged iced teas because they contain citric acid and high amounts of sugars. It does not matter whether the tea is warm or cold—as long as it is home brewed without additives.
Kenton Ross, DMD, FAGD, AGD spokesperson, sees patients' erosion problems on a daily basis in his practice. "Severe cases of erosion occur monthly and are frequently associated with high rates of soft drink consumption," he says. "This study clearly shows that brewed teas resulted in dramatically less enamel loss than soft drinks and acidic juices," says Dr. Ross. "I would highly recommend patients choose tea as an alternative to more erosive drinks like soda and fruit juice."
Today, the average size soft drink is 20 ounces and contains 17 teaspoons of sugar. More startling is that some citric acids found in fruit drinks are more erosive than hydrochloric or sulfuric acid—which is also known as battery acid. These refined sugars and acids found in soda and citrus juice promote tooth erosion, which wears away the hard part of the teeth, or the enamel. Once tooth enamel is lost, it's gone forever. There is a beverage that does not produce such irreversible results. When deciding between the many options available, the best thing to drink is brewed tea, according to a study in the July/August issue of General Dentistry, the clinical, peer-reviewed journal of the Academy of General Dentistry (AGD).
Apart from tasting good, brewed tea has many health benefits. Tea is loaded with natural antioxidants, which are thought to decrease incidence of cancer, cardiovascular disease, and diabetes.
Mohamed A. Bassiouny, DMD, BDS, MSc, PhD, the lead author of the study, compared green and black tea to soda and orange juice in terms of their short- and long-term erosive effect on human teeth. The study found that the erosive effect of tea was similar to that of water, which has no erosive effect. And, when comparing green versus black, he discovered that there is a better option among those as well.
Dr. Bassiouny says that "when we look at tea and read about the benefits, it's amazing—not because green tea is 'the in thing'—but because there are advantages." He adds that much research done overseas, in countries such as Japan and Europe, found that green tea was identified to being superior over black due to its natural flavonoids (plant nutrients) and antioxidants.
But, if you do drink tea, experts suggest avoiding additives such as milk, lemon, or sugar because they combine with tea's natural flavonoids and decrease the benefits. In addition, stay away from prepackaged iced teas because they contain citric acid and high amounts of sugars. It does not matter whether the tea is warm or cold—as long as it is home brewed without additives.
Kenton Ross, DMD, FAGD, AGD spokesperson, sees patients' erosion problems on a daily basis in his practice. "Severe cases of erosion occur monthly and are frequently associated with high rates of soft drink consumption," he says. "This study clearly shows that brewed teas resulted in dramatically less enamel loss than soft drinks and acidic juices," says Dr. Ross. "I would highly recommend patients choose tea as an alternative to more erosive drinks like soda and fruit juice."
Lightheadedness at the dentist could prove serious
Vasovagal syncope affects patients of all ages
You see it in movies or while viewing your favorite sitcom; a scene at the doctor's office where the character inevitably gets a little woozy which leads to a fainting spell. It may seem funny when watching it all unfold on television, but according to a study in the May/June 2008 issue of General Dentistry, the Academy of General Dentistry's (AGD) clinical, peer-reviewed journal, this type of reaction, in real life settings, these breath-holding scenarios are the most common emergency situation in the dental office.
This condition is known as vasovagal syncope and lead author of the study, Rubia Kapusta, DDS, MS, explains that both dentists and patients should be aware of the signs and be prepared in case it occurs. Vasovagal syncope is characterized by a loss of consciousness and muscle tone, which typically are preceded by non-specific symptoms that last anywhere from a few seconds to a minute. These symptoms result from alterations in the nervous system that can include dizziness, lightheadedness, paleness, palpitations, nausea, sweating, hyperventilation and changes in vision.
According to Dr. Kapusta, "Any patient who experiences a syncope reaction may have an underlying cause that can predispose him or her to a life-threatening situation."
It is considered the most common clinical problem that occurs among patients of all ages, affecting 3.5 percent of the general population. Emotional stress, anxiety, pain, fatigue and being in a hot and crowded environment can lead to vasovagal syncope.
"It is not uncommon for patients to experience some anxiety when visiting their general dentist," says AGD spokesperson, Melvin Pierson, DDS. "Yet, there are ways to lessen the possibility of an anxiety-related incident." Dr. Pierson encourages patients to discuss with their general dentist any fears they may have, and when seeing a dentist for the first time, schedule a preliminary visit.
"Asking questions and requesting informational materials can help you get a better understanding of your dental service or treatment," says Dr. Pierson. "General dentists are trained to answer questions and tell you what to expect to help you feel comfortable."
If the signs and symptoms of vasovagal syncope do occur, the dental procedure will be immediately stopped and treatment provided as soon as possible.
You see it in movies or while viewing your favorite sitcom; a scene at the doctor's office where the character inevitably gets a little woozy which leads to a fainting spell. It may seem funny when watching it all unfold on television, but according to a study in the May/June 2008 issue of General Dentistry, the Academy of General Dentistry's (AGD) clinical, peer-reviewed journal, this type of reaction, in real life settings, these breath-holding scenarios are the most common emergency situation in the dental office.
This condition is known as vasovagal syncope and lead author of the study, Rubia Kapusta, DDS, MS, explains that both dentists and patients should be aware of the signs and be prepared in case it occurs. Vasovagal syncope is characterized by a loss of consciousness and muscle tone, which typically are preceded by non-specific symptoms that last anywhere from a few seconds to a minute. These symptoms result from alterations in the nervous system that can include dizziness, lightheadedness, paleness, palpitations, nausea, sweating, hyperventilation and changes in vision.
According to Dr. Kapusta, "Any patient who experiences a syncope reaction may have an underlying cause that can predispose him or her to a life-threatening situation."
It is considered the most common clinical problem that occurs among patients of all ages, affecting 3.5 percent of the general population. Emotional stress, anxiety, pain, fatigue and being in a hot and crowded environment can lead to vasovagal syncope.
"It is not uncommon for patients to experience some anxiety when visiting their general dentist," says AGD spokesperson, Melvin Pierson, DDS. "Yet, there are ways to lessen the possibility of an anxiety-related incident." Dr. Pierson encourages patients to discuss with their general dentist any fears they may have, and when seeing a dentist for the first time, schedule a preliminary visit.
"Asking questions and requesting informational materials can help you get a better understanding of your dental service or treatment," says Dr. Pierson. "General dentists are trained to answer questions and tell you what to expect to help you feel comfortable."
If the signs and symptoms of vasovagal syncope do occur, the dental procedure will be immediately stopped and treatment provided as soon as possible.
Wednesday, November 12, 2008
1/4 of children have had no dental care in a year+
A University of South Carolina study of children’s dental health has found that nearly one-fourth of the nation’s children have had no dental care in at least a year.
Conducted by researchers at the S.C. Rural Health Research Center at the Arnold School of Public Health, the study found that nearly 32 percent of Hispanic children in rural areas had no dental care in the past year. Twenty-six percent of rural black children had no dental care, followed by 23 percent of “other” children and 22 percent of white children.
“Our nation has a group of children suffering dental disease severe enough to constitute a public health problem,” said Dr. Amy Brock Martin, the lead author of “Dental Health and Access to Care among Rural Children: A National and State Report.”
Data for the report came from the 2003 National Survey of Children’s Health, which used parents’ reports to measure the health and well-being of children from birth to age 17. The survey asked parents in urban and rural areas about the condition of their children’s teeth, utilization of dental care and dental insurance coverage.
The University of South Carolina report looks at dental health from a national perspective and also provides state and regional analyses.
More than 47 percent of all children 5 and younger had not seen a dentist in the previous year. Among rural children, the percentage was more than 48 percent. More than 33 percent of rural children had no dental insurance.
“Dental care is critical for children, even preschoolers,” she said. “A thorough dental exam not only helps children have healthy teeth, but also can detect nutritional deficiencies, injuries and some diseases and infections.
“This report gives us a better understanding of children’s oral health and the challenges faced by healthcare providers. It also gives us information specific to rural children, particularly rural minority children.”
Among the report’s other findings:
* Hispanic children in rural and urban areas are the least likely to receive preventive dental care. Vermont led the nation in the percentage of its children receiving preventive dental care (84 percent); Florida, with nearly 61 percent, had the lowest.
* Hispanic children in rural and urban areas were the least likely to have dental insurance. Hawaii, with nearly 89 percent of children having dental insurance, was No. 1. Montana had the lowest number (nearly 61 percent) of children with dental insurance.
* Rural counties throughout the nation are likely to have Dental Health Professional Shortage Areas (HPSA), a federal designation. Of all rural counties, nearly 60 percent had a dental HPSA designation between 2000 and 2004. The areas with the greatest shortages are in Northwest and Southwest states, followed by those in the Midwest and Southeast.
* More than 68 percent of parents in the United States consider their children’s teeth to be in very good or excellent condition. Urban white, black and Hispanic parents were more likely to describe their children’s teeth as “excellent” than those in rural areas. Among states with a large number of rural people responding to the study, New Hampshire, with nearly 54 percent, had the highest proportion of children with excellent teeth.
Brock Martin said the study provides a foundation for future studies on children’s dental health and provides data for policymakers and healthcare providers who make decisions on children’s health needs.
“This report provides state-by-state information on children living in urban and rural areas,” she said. “Dental care has been designated as the most prevalent unmet health need in U.S. children, and this report underscores that the problem is particularly acute among rural children.”
Visit http://rhr.sph.sc.edu/index.php for more information on the report.
Conducted by researchers at the S.C. Rural Health Research Center at the Arnold School of Public Health, the study found that nearly 32 percent of Hispanic children in rural areas had no dental care in the past year. Twenty-six percent of rural black children had no dental care, followed by 23 percent of “other” children and 22 percent of white children.
“Our nation has a group of children suffering dental disease severe enough to constitute a public health problem,” said Dr. Amy Brock Martin, the lead author of “Dental Health and Access to Care among Rural Children: A National and State Report.”
Data for the report came from the 2003 National Survey of Children’s Health, which used parents’ reports to measure the health and well-being of children from birth to age 17. The survey asked parents in urban and rural areas about the condition of their children’s teeth, utilization of dental care and dental insurance coverage.
The University of South Carolina report looks at dental health from a national perspective and also provides state and regional analyses.
More than 47 percent of all children 5 and younger had not seen a dentist in the previous year. Among rural children, the percentage was more than 48 percent. More than 33 percent of rural children had no dental insurance.
“Dental care is critical for children, even preschoolers,” she said. “A thorough dental exam not only helps children have healthy teeth, but also can detect nutritional deficiencies, injuries and some diseases and infections.
“This report gives us a better understanding of children’s oral health and the challenges faced by healthcare providers. It also gives us information specific to rural children, particularly rural minority children.”
Among the report’s other findings:
* Hispanic children in rural and urban areas are the least likely to receive preventive dental care. Vermont led the nation in the percentage of its children receiving preventive dental care (84 percent); Florida, with nearly 61 percent, had the lowest.
* Hispanic children in rural and urban areas were the least likely to have dental insurance. Hawaii, with nearly 89 percent of children having dental insurance, was No. 1. Montana had the lowest number (nearly 61 percent) of children with dental insurance.
* Rural counties throughout the nation are likely to have Dental Health Professional Shortage Areas (HPSA), a federal designation. Of all rural counties, nearly 60 percent had a dental HPSA designation between 2000 and 2004. The areas with the greatest shortages are in Northwest and Southwest states, followed by those in the Midwest and Southeast.
* More than 68 percent of parents in the United States consider their children’s teeth to be in very good or excellent condition. Urban white, black and Hispanic parents were more likely to describe their children’s teeth as “excellent” than those in rural areas. Among states with a large number of rural people responding to the study, New Hampshire, with nearly 54 percent, had the highest proportion of children with excellent teeth.
Brock Martin said the study provides a foundation for future studies on children’s dental health and provides data for policymakers and healthcare providers who make decisions on children’s health needs.
“This report provides state-by-state information on children living in urban and rural areas,” she said. “Dental care has been designated as the most prevalent unmet health need in U.S. children, and this report underscores that the problem is particularly acute among rural children.”
Visit http://rhr.sph.sc.edu/index.php for more information on the report.
Tuesday, October 14, 2008
Why do women get more cavities than men?
Reproduction pressures and rising fertility explain why women suffered a more rapid decline in dental health than did men as humans transitioned from hunter-and-gatherers to farmers and more sedentary pursuits, says a University of Oregon anthropologist.
The conclusion follows a comprehensive review of records of the frequencies of dental cavities in both prehistoric and living human populations from research done around the world. A driving factor was dramatic changes in female-specific hormones, reports John R. Lukacs, a professor of anthropology who specializes in dental, skeletal and nutritional issues.
His conclusions are outlined in the October issue of Current Anthropology. The study examined the frequency of dental caries (cavities) by sex to show that women typically experience poorer dental health than men. Among research reviewed were studies previously done by Lukacs. Two clinical dental studies published this year (one done in the Philippines, the other in Guatemala) and cited in the paper, Lukacs said, point to the same conclusions and "may provide the mechanism through which the biological differences are mediated."
A change in food production by agrarian societies has been associated with an increase in cavities. Anthropologists have attributed men-women differences to behavioral factors, including a sexual division of labor and dietary preferences. However, Lukacs said, clinical and epidemiological literature from varied ecological and cultural settings reveals a clear picture of the impacts on women's oral health.
"The role of female-specific factors has been denied by anthropologists, yet they attain considerable importance in the model proposed here, because the adoption of agriculture is associated with increased sedentism and fertility," Lukacs said. "I argue that the rise of agriculture increased demands on women's reproductive systems, contributing to an increase in fertility that intensified the negative impact of dietary change on women's oral health. The combined impacts of increased fertility, dietary changes and division of labor during the move into agricultural societies contributed to the widespread gender differential observed in dental caries rates today."
Lukacs' meta-analysis looked at both prehistoric anthropological and modern health records. He repeatedly found that increases in cavities go in favor of women in adulthood. Lukacs' review found that women's higher rates of cavities are influenced by three main changes:
Female sex hormones. Citing his own research published in 2006, he notes that these hormones and associated physiological factors can significantly impact cavity formation. A study on animals published in 1954 found that female estrogens, but not male androgens, were correlated to cavity rates. He argues for a cumulative effect of estrogens, including fluctuations at puberty and high levels during pregnancy that both promote cavities and dietary changes.
The biochemical composition and flow rate of saliva. Women produce less saliva than do men, reducing the removal of food residue from the teeth, and that during pregnancies the chemical composition changes, reducing saliva's antimicrobial capacity.
Food cravings, immune response and aversions during pregnancy. Lukacs points to findings that women crave high-energy, sweet foods during the third trimester, as well as an aversion to meat in first trimesters.
How the factors combine to contribute to higher risk of cavities in women as they age is not fully documented or understood, he wrote. "However, if hormonal and physiological factors work in an independent or additive manner, their impact on women's oral health could be significant. The fact that women's caries experience increases with age at a greater rate than men's in diverse ethnic groups from different ecological and cultural settings supports this interpretation."
The conclusion follows a comprehensive review of records of the frequencies of dental cavities in both prehistoric and living human populations from research done around the world. A driving factor was dramatic changes in female-specific hormones, reports John R. Lukacs, a professor of anthropology who specializes in dental, skeletal and nutritional issues.
His conclusions are outlined in the October issue of Current Anthropology. The study examined the frequency of dental caries (cavities) by sex to show that women typically experience poorer dental health than men. Among research reviewed were studies previously done by Lukacs. Two clinical dental studies published this year (one done in the Philippines, the other in Guatemala) and cited in the paper, Lukacs said, point to the same conclusions and "may provide the mechanism through which the biological differences are mediated."
A change in food production by agrarian societies has been associated with an increase in cavities. Anthropologists have attributed men-women differences to behavioral factors, including a sexual division of labor and dietary preferences. However, Lukacs said, clinical and epidemiological literature from varied ecological and cultural settings reveals a clear picture of the impacts on women's oral health.
"The role of female-specific factors has been denied by anthropologists, yet they attain considerable importance in the model proposed here, because the adoption of agriculture is associated with increased sedentism and fertility," Lukacs said. "I argue that the rise of agriculture increased demands on women's reproductive systems, contributing to an increase in fertility that intensified the negative impact of dietary change on women's oral health. The combined impacts of increased fertility, dietary changes and division of labor during the move into agricultural societies contributed to the widespread gender differential observed in dental caries rates today."
Lukacs' meta-analysis looked at both prehistoric anthropological and modern health records. He repeatedly found that increases in cavities go in favor of women in adulthood. Lukacs' review found that women's higher rates of cavities are influenced by three main changes:
Female sex hormones. Citing his own research published in 2006, he notes that these hormones and associated physiological factors can significantly impact cavity formation. A study on animals published in 1954 found that female estrogens, but not male androgens, were correlated to cavity rates. He argues for a cumulative effect of estrogens, including fluctuations at puberty and high levels during pregnancy that both promote cavities and dietary changes.
The biochemical composition and flow rate of saliva. Women produce less saliva than do men, reducing the removal of food residue from the teeth, and that during pregnancies the chemical composition changes, reducing saliva's antimicrobial capacity.
Food cravings, immune response and aversions during pregnancy. Lukacs points to findings that women crave high-energy, sweet foods during the third trimester, as well as an aversion to meat in first trimesters.
How the factors combine to contribute to higher risk of cavities in women as they age is not fully documented or understood, he wrote. "However, if hormonal and physiological factors work in an independent or additive manner, their impact on women's oral health could be significant. The fact that women's caries experience increases with age at a greater rate than men's in diverse ethnic groups from different ecological and cultural settings supports this interpretation."
Wednesday, October 1, 2008
Saliva proteins could help detection of oral cancer
Clinicians could detect oral squamous cell carcinoma, a form of oral cancer, using a simple test that detects proteins in saliva, according to a report in the October 1, 2008, issue of Clinical Cancer Research, a journal of the American Association for Cancer Research. This work was led by David T. Wong, D.M.D., D.M.Sc., professor and associate dean for research, at the University of California, Los Angeles School of Dentistry.
Previous studies have shown that saliva can be a useful diagnostic tool, but this is the first study to globally evaluate saliva protein levels from oral cancer patients. Since it is very simple to collect and process saliva fluids, the discovery of these biomarkers may lead to a useful clinical tool for noninvasive diagnosis of oral cancer in the future.
"This test is currently not available, but we are developing point-of-care microfluidic devices to detect these markers that we can use in clinical trials," said Shen Hu, Ph.D., assistant professor of Oral Biology and Proteomics at the University of California, Los Angeles School of Dentistry.
Wong, Hu and colleagues have been working as part of the National Institute of Dental and Craniofacial Research (NIDCR)'s Human Saliva Proteome Project, which focuses on identifying and cataloguing the proteomic components of saliva in healthy subjects. This work, also supported by NIDCR, demonstrates the first translational utility of the salivary proteome for oral cancer detection.
Researchers collected saliva samples from 64 patients with oral squamous cell carcinoma and 64 healthy patients.
Five candidate biomarkers were successfully validated using immunoassays: M2BP, MRP14, CD59, profilin and catalase.
The presence of these biomarkers confirmed the presence of oral cancer 93 percent of the time.
"I believe a test measuring these biomarkers will come to a point of regular use in the future," Hu said. "We have demonstrated a new approach for cancer biomarker discovery using saliva proteomics."
Previous studies have shown that saliva can be a useful diagnostic tool, but this is the first study to globally evaluate saliva protein levels from oral cancer patients. Since it is very simple to collect and process saliva fluids, the discovery of these biomarkers may lead to a useful clinical tool for noninvasive diagnosis of oral cancer in the future.
"This test is currently not available, but we are developing point-of-care microfluidic devices to detect these markers that we can use in clinical trials," said Shen Hu, Ph.D., assistant professor of Oral Biology and Proteomics at the University of California, Los Angeles School of Dentistry.
Wong, Hu and colleagues have been working as part of the National Institute of Dental and Craniofacial Research (NIDCR)'s Human Saliva Proteome Project, which focuses on identifying and cataloguing the proteomic components of saliva in healthy subjects. This work, also supported by NIDCR, demonstrates the first translational utility of the salivary proteome for oral cancer detection.
Researchers collected saliva samples from 64 patients with oral squamous cell carcinoma and 64 healthy patients.
Five candidate biomarkers were successfully validated using immunoassays: M2BP, MRP14, CD59, profilin and catalase.
The presence of these biomarkers confirmed the presence of oral cancer 93 percent of the time.
"I believe a test measuring these biomarkers will come to a point of regular use in the future," Hu said. "We have demonstrated a new approach for cancer biomarker discovery using saliva proteomics."
Saturday, September 27, 2008
More U.S. Kids Getting Government Dental Insurance
About 30 percent of U.S. children and adolescents were covered by government-sponsored dental insurance in 2006, a significant increase from the 18 percent covered in 1996, according to the latest News and Numbers from the Agency for Healthcare Research and Quality. Private dental insurance enrollment remained relatively unchanged during the period.
Much of the increase resulted from the State Children's Health Insurance Program, which began in 1997, and extensions of Medicaid coverage for dental services.
AHRQ's analysis also found that between 1996 and 2006:
• Enrollment in government dental insurance rose sharply among Hispanic and black adolescents and children, 48 percent and 35 percent, respectively
• White children and adolescents were less likely than blacks and Hispanics to have public dental insurance, but their enrollment doubled, climbing from 10 percent to 20 percent.
• Largely due to expanded government coverage, only 19 percent of U.S. children had no dental insurance in 2006 compared with 29 percent in 1996.
AHRQ, which is part of the U.S. Department of Health and Human Services, works to enhance the quality, safety, efficiency, and effectiveness of health care in the United States. The data in this AHRQ News and Numbers summary are taken from the Medical Expenditure Panel Survey, a detailed source of information on the health services used by Americans, the frequency with which they are used, the cost of those services, and how they are paid. For more information, go to Dental Coverage of Children and Young Adults under Age 21, United States, 1996 and 2006 (http://www.meps.ahrq.gov/mepsweb/data_files/publications/st221/stat221.pdf).
Much of the increase resulted from the State Children's Health Insurance Program, which began in 1997, and extensions of Medicaid coverage for dental services.
AHRQ's analysis also found that between 1996 and 2006:
• Enrollment in government dental insurance rose sharply among Hispanic and black adolescents and children, 48 percent and 35 percent, respectively
• White children and adolescents were less likely than blacks and Hispanics to have public dental insurance, but their enrollment doubled, climbing from 10 percent to 20 percent.
• Largely due to expanded government coverage, only 19 percent of U.S. children had no dental insurance in 2006 compared with 29 percent in 1996.
AHRQ, which is part of the U.S. Department of Health and Human Services, works to enhance the quality, safety, efficiency, and effectiveness of health care in the United States. The data in this AHRQ News and Numbers summary are taken from the Medical Expenditure Panel Survey, a detailed source of information on the health services used by Americans, the frequency with which they are used, the cost of those services, and how they are paid. For more information, go to Dental Coverage of Children and Young Adults under Age 21, United States, 1996 and 2006 (http://www.meps.ahrq.gov/mepsweb/data_files/publications/st221/stat221.pdf).
Friday, September 12, 2008
Does Treating Periodontitis Help Control Diabetes?
Researchers at Stony Brook University’s (SBU) School of Dental Medicine and School of Medicine received a $12.5 million five-year grant from the National Institute of Dental and Craniofacial Research (NIDCR), an arm of the National Institutes of Health, to conduct a multi-center clinical trial to evaluate whether treatment of chronic periodontitis may help to improve diabetes control. The study will be the largest clinical trial of diabetes and periodontitis to date and may lead to potential improvements in diabetes patient care. This collaborative effort, led by the SBU team, includes researchers from the University of Alabama, University of Minnesota, and the University of Texas.
The 2000 Surgeon General’s Report on Oral Health identified the relationship between improvement in periodontal health and glycemic control as an area in need of further investigation. Thus, SBU researchers were prompted to design a large scale clinical trial to meet this research need and to address the important public health goal of improving the standard of care for patients with diabetes. They will test whether non-surgical periodontal therapy helps to improve glycemic control in patients with Type 2 diabetes.
According to the American Diabetes Association, Type 2 diabetes is the fifth leading cause of death in the U.S. and affects an estimated 23.6 million Americans (7.8% of the population). The American Academy of Periodontology estimates that chronic periodontitis affects about half of Americans over the age of 55 but is 2 to 4 times more likely to occur among people with diabetes.
“Research clearly shows an association between chronic periodontitis and Type 2 diabetes, and there is early evidence that treating periodontal infection and inflammation can improve glycemic control,” says Steven Engebretson, D.M.D., M.S., M.S., Principal Investigator for the study and Assistant Professor of Peridontics and Implantology at the Stony Brook University School of Dental Medicine. “Previous studies in this area have been encouraging but are too small to be conclusive. This will be the first large multi-center study to determine whether periodontal treatment can improve glycemic control.”
Dr. Engebretson says that scientifically the exact connection between periodontitis and diabetes or blood sugar control has not been fully defined. He adds that researchers suspect the association is related to inflammatory molecules caused by the periodontal infection that reach the circulation and disrupt the insulin pathway.
“Inflammation anywhere in the body can lead to glucose management problems, and keeping glucose levels as close to normal as possible is the key to managing diabetes,” says Dr. Ralph DeFronzo, Deputy Director of the Texas Diabetes Institute and Co-Investigator of the study. “If treating chronic periodontitis can help reduce blood glucose, the implications could be very significant to patient care.”
“Our study will address limitations of prior studies and will follow the highest standards for clinical trial design and conduct,” says Leslie Hyman, Ph.D., Director of the Coordinating Center for the study, and Professor, SBU Department of Preventive Medicine. “The multi-disciplinary study team includes leading researchers from the fields of periodontics, diabetology, clinical trials, and biostatistics who will provide their different expertise to ensure that the study can provide a clear answer to this important question.”
Drs. Engebretson and Hyman’s colleagues from SBU include Elinor Schoenfeld, Ph.D., and Li Ming Dong, Ph.D. The Clinical Centers are led by Dr. Michael Reddy and Dr. Beth Lewis of the University of Alabama, Dr. Bryan Michalowicz, Dr. Michael Tsai, and Dr. Betsy Seaquist of the University of Minnesota, and Dr. Thomas Oates and Dr. Ralph DeFronzo of the University of Texas. Dr. Mohammed Saad and Dr. Kevin A. Peterson are consultants for the study.
Participant enrollment in the trial is slated to begin during spring/summer 2009.
The 2000 Surgeon General’s Report on Oral Health identified the relationship between improvement in periodontal health and glycemic control as an area in need of further investigation. Thus, SBU researchers were prompted to design a large scale clinical trial to meet this research need and to address the important public health goal of improving the standard of care for patients with diabetes. They will test whether non-surgical periodontal therapy helps to improve glycemic control in patients with Type 2 diabetes.
According to the American Diabetes Association, Type 2 diabetes is the fifth leading cause of death in the U.S. and affects an estimated 23.6 million Americans (7.8% of the population). The American Academy of Periodontology estimates that chronic periodontitis affects about half of Americans over the age of 55 but is 2 to 4 times more likely to occur among people with diabetes.
“Research clearly shows an association between chronic periodontitis and Type 2 diabetes, and there is early evidence that treating periodontal infection and inflammation can improve glycemic control,” says Steven Engebretson, D.M.D., M.S., M.S., Principal Investigator for the study and Assistant Professor of Peridontics and Implantology at the Stony Brook University School of Dental Medicine. “Previous studies in this area have been encouraging but are too small to be conclusive. This will be the first large multi-center study to determine whether periodontal treatment can improve glycemic control.”
Dr. Engebretson says that scientifically the exact connection between periodontitis and diabetes or blood sugar control has not been fully defined. He adds that researchers suspect the association is related to inflammatory molecules caused by the periodontal infection that reach the circulation and disrupt the insulin pathway.
“Inflammation anywhere in the body can lead to glucose management problems, and keeping glucose levels as close to normal as possible is the key to managing diabetes,” says Dr. Ralph DeFronzo, Deputy Director of the Texas Diabetes Institute and Co-Investigator of the study. “If treating chronic periodontitis can help reduce blood glucose, the implications could be very significant to patient care.”
“Our study will address limitations of prior studies and will follow the highest standards for clinical trial design and conduct,” says Leslie Hyman, Ph.D., Director of the Coordinating Center for the study, and Professor, SBU Department of Preventive Medicine. “The multi-disciplinary study team includes leading researchers from the fields of periodontics, diabetology, clinical trials, and biostatistics who will provide their different expertise to ensure that the study can provide a clear answer to this important question.”
Drs. Engebretson and Hyman’s colleagues from SBU include Elinor Schoenfeld, Ph.D., and Li Ming Dong, Ph.D. The Clinical Centers are led by Dr. Michael Reddy and Dr. Beth Lewis of the University of Alabama, Dr. Bryan Michalowicz, Dr. Michael Tsai, and Dr. Betsy Seaquist of the University of Minnesota, and Dr. Thomas Oates and Dr. Ralph DeFronzo of the University of Texas. Dr. Mohammed Saad and Dr. Kevin A. Peterson are consultants for the study.
Participant enrollment in the trial is slated to begin during spring/summer 2009.
Dentist Says OK To Eat Lots Of Haloween Candy
Halloween can present a very scary time of year for any parent concerned about their child’s oral health. Megan Chiplock says that when her daughters go trick or treating, they come back with a pretty big haul – but she lets them enjoy as much as they want.
“We let them go at it, gorge themselves, and maybe for a few days after if they want a piece here and there,” she says. “But they really get their fill on Halloween night, and [then] it’s sort of out of their system.”
Temple University pediatric dentist Mark Helpin says that might not be such a bad idea.
“The frequency of eating candy, and other refined carbohydrates, and their stickiness, are big factors in creating the risk of caries (cavities),” he said.
Eating carbohydrates can change the pH balance of the mouth, making it more acidic, which can increase the risk of cavities. Each time candy is eaten, the acid environment in the mouth can take up to an hour to dissipate.
“So, if I eat a piece of candy now, the pH in my mouth will become acidic, and it will take 30-60 minutes for it to become normal,” said Helpin. “If I keep eating candy throughout the day, there is acid in my mouth for a much longer period of time. The longer teeth are in an acid environment, the greater the risk they will become decayed.”
Helpin, the acting chair of Pediatric Dentistry at Temple’s Maurice H. Kornberg School of Dentistry, says that there are a number of ways parents can minimize this risk while still letting their children enjoy the holiday.
“Parents can let kids eat a bunch [of candy] now and a bunch later. But don’t let them have one piece now, then an hour later let them have another piece,” he said, adding that candy can also be dispensed as a dessert or snack.
Meals are a good time at which to have treats as dessert because the production of saliva increases, which helps to wash away acidity in the mouth. Helpin also recommends that parents have their children brush their teeth after eating candy, or if that's not possible, tell their children to rinse their mouth with water 3 or 4 times after eating, which will help reduce acidity in the mouth.
Helpin warns that substituting small bags of chips or pretzels for candy doesn't solve the cavity problem, either.
“Chips and pretzels are also carbohydrates and they also will create an acid environment that can create cavities,” he says. “These treats and snacks get stuck on your teeth, and that’s the stickiness factor,” he said.
When trick-or-treaters come to his door, Helpin likes to give out sugar-free candies, and avoids the sticky, gummy candies. Megan says her kids don’t really go for those sticky treats either.
“My three-year-old doesn’t enjoy the chewy candies,” she said. “She’s tried them but they just get stuck in her teeth.”
Ultimately, “it's not realistic to think you can tell your child you can't have candy, cookies, cakes, or other treats,” says Helpin. “Those are the things most people enjoy—and we want our kids to enjoy life.”
“We let them go at it, gorge themselves, and maybe for a few days after if they want a piece here and there,” she says. “But they really get their fill on Halloween night, and [then] it’s sort of out of their system.”
Temple University pediatric dentist Mark Helpin says that might not be such a bad idea.
“The frequency of eating candy, and other refined carbohydrates, and their stickiness, are big factors in creating the risk of caries (cavities),” he said.
Eating carbohydrates can change the pH balance of the mouth, making it more acidic, which can increase the risk of cavities. Each time candy is eaten, the acid environment in the mouth can take up to an hour to dissipate.
“So, if I eat a piece of candy now, the pH in my mouth will become acidic, and it will take 30-60 minutes for it to become normal,” said Helpin. “If I keep eating candy throughout the day, there is acid in my mouth for a much longer period of time. The longer teeth are in an acid environment, the greater the risk they will become decayed.”
Helpin, the acting chair of Pediatric Dentistry at Temple’s Maurice H. Kornberg School of Dentistry, says that there are a number of ways parents can minimize this risk while still letting their children enjoy the holiday.
“Parents can let kids eat a bunch [of candy] now and a bunch later. But don’t let them have one piece now, then an hour later let them have another piece,” he said, adding that candy can also be dispensed as a dessert or snack.
Meals are a good time at which to have treats as dessert because the production of saliva increases, which helps to wash away acidity in the mouth. Helpin also recommends that parents have their children brush their teeth after eating candy, or if that's not possible, tell their children to rinse their mouth with water 3 or 4 times after eating, which will help reduce acidity in the mouth.
Helpin warns that substituting small bags of chips or pretzels for candy doesn't solve the cavity problem, either.
“Chips and pretzels are also carbohydrates and they also will create an acid environment that can create cavities,” he says. “These treats and snacks get stuck on your teeth, and that’s the stickiness factor,” he said.
When trick-or-treaters come to his door, Helpin likes to give out sugar-free candies, and avoids the sticky, gummy candies. Megan says her kids don’t really go for those sticky treats either.
“My three-year-old doesn’t enjoy the chewy candies,” she said. “She’s tried them but they just get stuck in her teeth.”
Ultimately, “it's not realistic to think you can tell your child you can't have candy, cookies, cakes, or other treats,” says Helpin. “Those are the things most people enjoy—and we want our kids to enjoy life.”
Thursday, September 11, 2008
Bleeding gums linked to heart disease
Bad teeth, bleeding gums and poor dental hygiene can end up causing heart disease, scientists heard today (Thursday 11 September 2008) at the Society for General Microbiology's Autumn meeting being held this week at Trinity College, Dublin.
People with poor dental hygiene and those who don't brush their teeth regularly end up with bleeding gums, which provide an entry to the bloodstream for up to 700 different types of bacteria found in our mouths. This increases the risk of having a heart attack, according to microbiologists from the University of Bristol and the Royal College of Surgeons in Ireland.
"The mouth is probably the dirtiest place in the human body," said Dr Steve Kerrigan from the Royal College of Surgeons in Dublin, Ireland. "If you have an open blood vessel from bleeding gums, bacteria will gain entry to your bloodstream. When bacteria get into the bloodstream they encounter tiny fragments called platelets that clot blood when you get a cut. By sticking to the platelets bacteria cause them to clot inside the blood vessel, partially blocking it. This prevents the blood flow back to the heart and we run the risk of suffering a heart attack."
The only treatment for this type of disease is aggressive antibiotic therapy, but with the increasing problem of multiple drug resistant bacteria, this option is becoming short lived.
"Cardiovascular disease is currently the biggest killer in the western world. Oral bacteria such as Streptococcus gordonii and Streptococcus sanguinis are common infecting agents, and we now recognise that bacterial infections are an independent risk factor for heart diseases," said Professor Howard Jenkinson from the University of Bristol. "In other words it doesn't matter how fit, slim or healthy you are, you're adding to your chances of getting heart disease by having bad teeth."
Researchers at Bristol have been investigating the ways in which the bacteria interact with platelets in order to develop new and improved therapies.
"Most of the studies that have looked at how bacteria interact with platelets were carried out under conditions that do not resemble those in the human circulatory system. We mimicked the pressure inside the blood vessels and in the heart", said Professor Jenkinson. "Using this technique we demonstrated that bacteria use different mechanisms to cause platelets to clump together, allowing them to completely encase the bacteria. This shields the bacteria from the cells of our immune systems, which would normally kill bacteria, and most importantly also protects them from antibiotics."
These findings suggest why antibiotics do not always work in the treatment of infectious heart disease and also highlight the need to develop new drugs to treat this disease. "We are currently in the process of identifying the exact site at which the bacteria stick to the platelets," said Professor Jenkinson. "Once this is identified we will design a new drug to prevent this interaction."
"We also identified several proteins on the bacteria that lead to platelet clumping," said Dr Kerrigan. "Genetic deletion of these proteins from the bacteria prevented the platelets from clumping which shows that these proteins play an essential role and may be candidate proteins for new drug development or producing vaccines."
People with poor dental hygiene and those who don't brush their teeth regularly end up with bleeding gums, which provide an entry to the bloodstream for up to 700 different types of bacteria found in our mouths. This increases the risk of having a heart attack, according to microbiologists from the University of Bristol and the Royal College of Surgeons in Ireland.
"The mouth is probably the dirtiest place in the human body," said Dr Steve Kerrigan from the Royal College of Surgeons in Dublin, Ireland. "If you have an open blood vessel from bleeding gums, bacteria will gain entry to your bloodstream. When bacteria get into the bloodstream they encounter tiny fragments called platelets that clot blood when you get a cut. By sticking to the platelets bacteria cause them to clot inside the blood vessel, partially blocking it. This prevents the blood flow back to the heart and we run the risk of suffering a heart attack."
The only treatment for this type of disease is aggressive antibiotic therapy, but with the increasing problem of multiple drug resistant bacteria, this option is becoming short lived.
"Cardiovascular disease is currently the biggest killer in the western world. Oral bacteria such as Streptococcus gordonii and Streptococcus sanguinis are common infecting agents, and we now recognise that bacterial infections are an independent risk factor for heart diseases," said Professor Howard Jenkinson from the University of Bristol. "In other words it doesn't matter how fit, slim or healthy you are, you're adding to your chances of getting heart disease by having bad teeth."
Researchers at Bristol have been investigating the ways in which the bacteria interact with platelets in order to develop new and improved therapies.
"Most of the studies that have looked at how bacteria interact with platelets were carried out under conditions that do not resemble those in the human circulatory system. We mimicked the pressure inside the blood vessels and in the heart", said Professor Jenkinson. "Using this technique we demonstrated that bacteria use different mechanisms to cause platelets to clump together, allowing them to completely encase the bacteria. This shields the bacteria from the cells of our immune systems, which would normally kill bacteria, and most importantly also protects them from antibiotics."
These findings suggest why antibiotics do not always work in the treatment of infectious heart disease and also highlight the need to develop new drugs to treat this disease. "We are currently in the process of identifying the exact site at which the bacteria stick to the platelets," said Professor Jenkinson. "Once this is identified we will design a new drug to prevent this interaction."
"We also identified several proteins on the bacteria that lead to platelet clumping," said Dr Kerrigan. "Genetic deletion of these proteins from the bacteria prevented the platelets from clumping which shows that these proteins play an essential role and may be candidate proteins for new drug development or producing vaccines."
Tuesday, September 9, 2008
Study Shows High Gum Disease Rates
Research on 445 families centered in two Pennsylvania towns and two West Virginia counties shows that 80 percent of adults suffer from more severe forms of periodontal disease, according to Richard Crout, D.M.D., Ph.D., an expert on gum disease and associate dean for research in the West Virginia University School of Dentistry.
“Leaving periodontal disease untreated is a major public health problem,” Crout says. “Not only do we see cases where the inflammatory process has eaten down around the bone, ultimately causing tooth loss in many patients, but also more important the inflammation likely has traveled throughout the body. A person with periodontitis may be twice as likely to have a heart attack and almost three times more likely to have a stroke.”
He added, “If a woman is pregnant, she is four to seven times more likely to have a preterm, low birth-weight baby compared to someone who does not have gum disease.”
Unlike gingivitis, an inflammation of the gums that is reversible, periodontitis can create infections below the gum line leading to bone destruction and tooth loss if not treated. Bleeding of the gums can signal gingivitis. But in periodontitis, no pain or symptoms may accompany the infection spreading into the bone.
Eighty-five percent of adults in the study showed signs of bone loss.
The study focusing on rural areas of Appalachia is a WVU-University of Pittsburgh collaboration, yielding a gold mine of dental data. Crout, who is directing the West Virginia portion of the collaboration, is sharing some of the more significant findings at the 94th Annual Meeting of the American Academy of Periodontology in Seattle Sept. 8. (The academy’s annual meeting runs Sept. 6 through 9.)
“This is the largest oral health study ever done in Appalachia,” Crout says.
In addition to dramatic rates of periodontal disease, discovery of high bacterial counts and the virulence of the disease-causing organisms in the mouth surprised the researchers, Crout says.
“These findings are significant in a state that leads the nation in all those who have lost all their teeth over the age of 65,” Crout says. “The national average is 20 percent, but in West Virginia, it’s 43 percent.”
The West Virginia families in the study live in Webster and Nicholas Counties. The Pennsylvania families are from the towns of Burgettstown and Bradford.
WVU’s portion of the National Institutes of Health grant is approximately $3.12 million. WVU researchers have followed the West Virginia families since 2002, studying genetic as well as environmental factors including attitudes, behaviors and beliefs. They are also examining microbial samples.
The study is part of COHRA – the Center for Oral Health Research in Appalachia. Originally involving only WVU and the University of Pittsburgh, the study has expanded to include the University of Michigan and the University of Iowa.
The researchers say parents and grandparents who have already lost their teeth are likely to transmit attitudes to the next generation. “Too often the attitude is, ‘Don’t worry, you’re going to lose them anyway,’ ” Crout says.
When Crout travels throughout West Virginia giving presentations to students on the importance of oral health, he sometimes meets schoolchildren who come up after the talk and say, “Hey, Mister, what’s this bump?” The child will crook a finger inside his cheek to offer a look, and Crout will observe a large, untreated abscess of the tooth.
A large abscess sometimes means the mouth can’t be numbed. So the child’s first visit to the dentist may end up being painful. Fear of pain may lead to a lifelong reluctance to visit the dentist.
“We have found that dental fear is highest in the very young. It may be one of the reasons that, by the age of 8, one-third of children have untreated dental decay in West Virginia,” Crout says. “One-third of West Virginians under age 35 have lost at least six permanent teeth. Our research has found that more than 25 percent of people would rather have a tooth out than have treatment done that might preserve the tooth. Fear was one of the main factors.”
Crout would like the study to lead to interventions such as introducing children to the dentist and the dentist’s chair at age 1 or when the first tooth comes in.
“It’s likely that at this age, treatment will be more preventive and provide a more positive first dental visit experience. This would go a long way in reducing fear and be very helpful in getting larger numbers of people to go to the dentist,” Crout says.
“It is also critically important to get the word out to our people in the state of the importance of oral health. Not only will it keep their teeth, but it will also be very important for good systemic health. Brushing, flossing and routine dental visits have never been more important,” Crout says.
“Leaving periodontal disease untreated is a major public health problem,” Crout says. “Not only do we see cases where the inflammatory process has eaten down around the bone, ultimately causing tooth loss in many patients, but also more important the inflammation likely has traveled throughout the body. A person with periodontitis may be twice as likely to have a heart attack and almost three times more likely to have a stroke.”
He added, “If a woman is pregnant, she is four to seven times more likely to have a preterm, low birth-weight baby compared to someone who does not have gum disease.”
Unlike gingivitis, an inflammation of the gums that is reversible, periodontitis can create infections below the gum line leading to bone destruction and tooth loss if not treated. Bleeding of the gums can signal gingivitis. But in periodontitis, no pain or symptoms may accompany the infection spreading into the bone.
Eighty-five percent of adults in the study showed signs of bone loss.
The study focusing on rural areas of Appalachia is a WVU-University of Pittsburgh collaboration, yielding a gold mine of dental data. Crout, who is directing the West Virginia portion of the collaboration, is sharing some of the more significant findings at the 94th Annual Meeting of the American Academy of Periodontology in Seattle Sept. 8. (The academy’s annual meeting runs Sept. 6 through 9.)
“This is the largest oral health study ever done in Appalachia,” Crout says.
In addition to dramatic rates of periodontal disease, discovery of high bacterial counts and the virulence of the disease-causing organisms in the mouth surprised the researchers, Crout says.
“These findings are significant in a state that leads the nation in all those who have lost all their teeth over the age of 65,” Crout says. “The national average is 20 percent, but in West Virginia, it’s 43 percent.”
The West Virginia families in the study live in Webster and Nicholas Counties. The Pennsylvania families are from the towns of Burgettstown and Bradford.
WVU’s portion of the National Institutes of Health grant is approximately $3.12 million. WVU researchers have followed the West Virginia families since 2002, studying genetic as well as environmental factors including attitudes, behaviors and beliefs. They are also examining microbial samples.
The study is part of COHRA – the Center for Oral Health Research in Appalachia. Originally involving only WVU and the University of Pittsburgh, the study has expanded to include the University of Michigan and the University of Iowa.
The researchers say parents and grandparents who have already lost their teeth are likely to transmit attitudes to the next generation. “Too often the attitude is, ‘Don’t worry, you’re going to lose them anyway,’ ” Crout says.
When Crout travels throughout West Virginia giving presentations to students on the importance of oral health, he sometimes meets schoolchildren who come up after the talk and say, “Hey, Mister, what’s this bump?” The child will crook a finger inside his cheek to offer a look, and Crout will observe a large, untreated abscess of the tooth.
A large abscess sometimes means the mouth can’t be numbed. So the child’s first visit to the dentist may end up being painful. Fear of pain may lead to a lifelong reluctance to visit the dentist.
“We have found that dental fear is highest in the very young. It may be one of the reasons that, by the age of 8, one-third of children have untreated dental decay in West Virginia,” Crout says. “One-third of West Virginians under age 35 have lost at least six permanent teeth. Our research has found that more than 25 percent of people would rather have a tooth out than have treatment done that might preserve the tooth. Fear was one of the main factors.”
Crout would like the study to lead to interventions such as introducing children to the dentist and the dentist’s chair at age 1 or when the first tooth comes in.
“It’s likely that at this age, treatment will be more preventive and provide a more positive first dental visit experience. This would go a long way in reducing fear and be very helpful in getting larger numbers of people to go to the dentist,” Crout says.
“It is also critically important to get the word out to our people in the state of the importance of oral health. Not only will it keep their teeth, but it will also be very important for good systemic health. Brushing, flossing and routine dental visits have never been more important,” Crout says.
Friday, September 5, 2008
Dental fillings without gaps
Tooth cavities are usually closed with plastic fillings. However, the initially soft plastic shrinks as it hardens. The tension can cause gaps to appear between the tooth and the filling, encouraging more caries to form. For the first time, researchers have simulated this process.
The patient’s hands are clasped firmly around the armrests as the dentist drills away the caries-stricken sections of the tooth. Once the drilling is over, most toothache sufferers can begin to relax. All the doctor now has to do is to slightly etch the cavity, apply an adhesive film, and fill it with a special type of plastic. The plastic is soft at first, so that the doctor can easily press it into the cavity. It only solidifies afterwards under the light of a small lamp. However, the material tends to shrink slightly as it hardens, occasionally producing tension that can cause tiny gaps to form between the plastic filling and the tooth. Bits of food can get caught in these gaps and lead to more caries. Manufacturers of filling materials therefore offer a variety of plastics to choose from. But which filling is best suited to which shape of cavity? This is where dentists have to draw on their experience. “Until now, it has not been possible to establish a theoretical model of the hardening process. The tension occurring in the material always depends on the shape of the cavity, and can vary widely by a factor of up to ten, particularly at the edges,” says Dr.-Ing. Christof Koplin, research assistant at the Fraunhofer Institute for Mechanics of Materials IWM in Freiburg. Measurements do not help either, as tension can only be measured selectively. Its precise course of development has never yet been observed.
A new method of simulation now enables tension in dental fillings to be accurately predicted, helping doctors to choose the least tension-prone plastic for each shape of cavity. Dentists can now draw on the results of the IWM to select the best material, and manufacturers can use the simulations to optimize their products. “We theoretically subdivide the dental filling into thousands of small parcels and calculate how each element affects its neighbor. Experimental parameters are incorporated in the individual elements. We started our laboratory tests by using a standard geometry to find out how each material reacts to the stresses that occur when the volume shrinks, and how the flow capability of the material changes as it hardens,” explains Koplin. The IWM researchers have now successfully simulated the development of tension in dental fillings for various cavity shapes and materials, and more will follow.
The patient’s hands are clasped firmly around the armrests as the dentist drills away the caries-stricken sections of the tooth. Once the drilling is over, most toothache sufferers can begin to relax. All the doctor now has to do is to slightly etch the cavity, apply an adhesive film, and fill it with a special type of plastic. The plastic is soft at first, so that the doctor can easily press it into the cavity. It only solidifies afterwards under the light of a small lamp. However, the material tends to shrink slightly as it hardens, occasionally producing tension that can cause tiny gaps to form between the plastic filling and the tooth. Bits of food can get caught in these gaps and lead to more caries. Manufacturers of filling materials therefore offer a variety of plastics to choose from. But which filling is best suited to which shape of cavity? This is where dentists have to draw on their experience. “Until now, it has not been possible to establish a theoretical model of the hardening process. The tension occurring in the material always depends on the shape of the cavity, and can vary widely by a factor of up to ten, particularly at the edges,” says Dr.-Ing. Christof Koplin, research assistant at the Fraunhofer Institute for Mechanics of Materials IWM in Freiburg. Measurements do not help either, as tension can only be measured selectively. Its precise course of development has never yet been observed.
A new method of simulation now enables tension in dental fillings to be accurately predicted, helping doctors to choose the least tension-prone plastic for each shape of cavity. Dentists can now draw on the results of the IWM to select the best material, and manufacturers can use the simulations to optimize their products. “We theoretically subdivide the dental filling into thousands of small parcels and calculate how each element affects its neighbor. Experimental parameters are incorporated in the individual elements. We started our laboratory tests by using a standard geometry to find out how each material reacts to the stresses that occur when the volume shrinks, and how the flow capability of the material changes as it hardens,” explains Koplin. The IWM researchers have now successfully simulated the development of tension in dental fillings for various cavity shapes and materials, and more will follow.
Tuesday, September 2, 2008
Diabetes and Obesity Linked to Periodontitis?
The University of Illinois at Chicago has received a two-year federal grant to continue a study on how periodontitis, an inflammatory disease of the tissues surrounding teeth, is linked to type 2 diabetes and obesity.
Dr. Keiko Watanabe of the UIC College of Dentistry has found that periodontitis accelerates the onset of insulin resistance in rats fed a high-fat diet. Her new research will determine how periodontitis affects diabetic complications in the retina, aorta and pancreas.
"The prevalence of type 2 diabetes has risen dramatically as the result of an increase in obesity caused by a high-fat diet, junk food and a sedentary lifestyle," said Watanabe, associate professor of periodontics. Although the association between obesity, type 2 diabetes and periodontitis is recognized, she said, the underlying causes remain poorly understood.
Watanabe said the goal of the new study is to identify the causes by which periodontitis influences insulin resistance, type 2 diabetes and organ damage, so clinicians will be able to screen prediabetic individuals at risk of developing the disease. A plan to treat periodontal inflammation will also be developed so that insulin resistance will not accelerate to diabetes.
A key challenge is to determine whether the relationship between diabetes, obesity and periodontitis is causal, Watanabe said. Most of the data linking the conditions are based on epidemiologic or cross-sectional studies, she said.
Watanabe uses female diabetic fatty rats in her research, a model that closely resembles humans who consume a high-fat diet and subsequently develop insulin resistance and type 2 diabetes. Human subjects, she said, cannot be used to study the direct effect of periodontitis because it is not ethical to induce the disease.
"Several prospective studies using human subjects demonstrated that the treatment of periodontitis led to improvement of glycemic control in subjects with type 2 diabetes," she said. "However, confounding factors, such as medications used to treat type 2 diabetes, body mass index, the stage and duration of diabetes, and the onset and severity of periodontitis are difficult to assess or are broadly controlled in such studies.
"Thus, the causal nature between periodontitis, diabetes and obesity remains unclear."
Diabetes is a disease in which the body fails to produce -- or responds poorly to -- insulin, a hormone needed to control the level of blood sugar. It is estimated that 300 million people worldwide will suffer from type 2 diabetes by the year 2025, nearly double the number of people affected in the year 2000. Most Americans diagnosed with diabetes have type 2, according to the American Diabetes Association.
Watanabe's initial study was published in the July issue of the Journal of Periodontology. The study was funded by a UIC College of Dentistry Research Seed Grant.
The new study, totaling $432,000, is being funded by the National Institute of Dental and Craniofacial Research, one of the National Institutes of Health. Dr. Terry Unterman, professor of medicine, physiology and biophysics, and Haohua Qian, associate professor of ophthalmology, will collaborate on the project.
Dr. Keiko Watanabe of the UIC College of Dentistry has found that periodontitis accelerates the onset of insulin resistance in rats fed a high-fat diet. Her new research will determine how periodontitis affects diabetic complications in the retina, aorta and pancreas.
"The prevalence of type 2 diabetes has risen dramatically as the result of an increase in obesity caused by a high-fat diet, junk food and a sedentary lifestyle," said Watanabe, associate professor of periodontics. Although the association between obesity, type 2 diabetes and periodontitis is recognized, she said, the underlying causes remain poorly understood.
Watanabe said the goal of the new study is to identify the causes by which periodontitis influences insulin resistance, type 2 diabetes and organ damage, so clinicians will be able to screen prediabetic individuals at risk of developing the disease. A plan to treat periodontal inflammation will also be developed so that insulin resistance will not accelerate to diabetes.
A key challenge is to determine whether the relationship between diabetes, obesity and periodontitis is causal, Watanabe said. Most of the data linking the conditions are based on epidemiologic or cross-sectional studies, she said.
Watanabe uses female diabetic fatty rats in her research, a model that closely resembles humans who consume a high-fat diet and subsequently develop insulin resistance and type 2 diabetes. Human subjects, she said, cannot be used to study the direct effect of periodontitis because it is not ethical to induce the disease.
"Several prospective studies using human subjects demonstrated that the treatment of periodontitis led to improvement of glycemic control in subjects with type 2 diabetes," she said. "However, confounding factors, such as medications used to treat type 2 diabetes, body mass index, the stage and duration of diabetes, and the onset and severity of periodontitis are difficult to assess or are broadly controlled in such studies.
"Thus, the causal nature between periodontitis, diabetes and obesity remains unclear."
Diabetes is a disease in which the body fails to produce -- or responds poorly to -- insulin, a hormone needed to control the level of blood sugar. It is estimated that 300 million people worldwide will suffer from type 2 diabetes by the year 2025, nearly double the number of people affected in the year 2000. Most Americans diagnosed with diabetes have type 2, according to the American Diabetes Association.
Watanabe's initial study was published in the July issue of the Journal of Periodontology. The study was funded by a UIC College of Dentistry Research Seed Grant.
The new study, totaling $432,000, is being funded by the National Institute of Dental and Craniofacial Research, one of the National Institutes of Health. Dr. Terry Unterman, professor of medicine, physiology and biophysics, and Haohua Qian, associate professor of ophthalmology, will collaborate on the project.
Monday, August 25, 2008
Immigrants respond best to oral hygiene campaign
Tapping into the desire to have an attractive smile is the best motivator for improving oral hygiene, and new immigrants are the most receptive to oral health messages, according to a new study in the Journal of Consumer Research.
Authors Shuili Du (Simmons College), Sankar Sen (City University of New York), and C.B. Bhattacharya (Boston University) evaluated the effectiveness of an oral health outreach program in disadvantaged communities. They found that focusing on the social benefits of having a beautiful smile was the most effective strategy for improving dental hygiene habits among participants.
"Our findings suggest that, among children from less acculturated families, participation in this oral health program leads to not only more favorable beliefs about the health-related (preventing cavities and gum diseases) and psychosocial (beautiful smile and self-confidence) benefits of oral care behavior, but also an increase in oral care behavior such as brushing, flossing and dental checkups," write the authors.
The research found that families that had been in the United States longer were less responsive to the program's messages than new immigrants.
According to the U.S. Department of Health and Human Services (2002), there is a "silent epidemic" of dental and oral diseases in disadvantaged communities, particularly among children of minority racial and ethnic groups. The researchers conducted focus groups of participants in urban areas with large Hispanic populations. Those participants were parents of children in the national oral health outreach program that was launched in 2000, with the involvement of a corporate sponsor, the Boys and Girls Club of America, the American Dental Association, and dental schools.
And here's good news for the corporate sponsor: the parents who participated in the program said they intended to reciprocate by purchasing the sponsor's products. "Their intention to reciprocate toward the company is proportionate to their perceptions of how much the program has helped their children and family," the researchers conclude.
Authors Shuili Du (Simmons College), Sankar Sen (City University of New York), and C.B. Bhattacharya (Boston University) evaluated the effectiveness of an oral health outreach program in disadvantaged communities. They found that focusing on the social benefits of having a beautiful smile was the most effective strategy for improving dental hygiene habits among participants.
"Our findings suggest that, among children from less acculturated families, participation in this oral health program leads to not only more favorable beliefs about the health-related (preventing cavities and gum diseases) and psychosocial (beautiful smile and self-confidence) benefits of oral care behavior, but also an increase in oral care behavior such as brushing, flossing and dental checkups," write the authors.
The research found that families that had been in the United States longer were less responsive to the program's messages than new immigrants.
According to the U.S. Department of Health and Human Services (2002), there is a "silent epidemic" of dental and oral diseases in disadvantaged communities, particularly among children of minority racial and ethnic groups. The researchers conducted focus groups of participants in urban areas with large Hispanic populations. Those participants were parents of children in the national oral health outreach program that was launched in 2000, with the involvement of a corporate sponsor, the Boys and Girls Club of America, the American Dental Association, and dental schools.
And here's good news for the corporate sponsor: the parents who participated in the program said they intended to reciprocate by purchasing the sponsor's products. "Their intention to reciprocate toward the company is proportionate to their perceptions of how much the program has helped their children and family," the researchers conclude.
Seeing through tooth decay
X-ray spectral analysis reveals early-stage dental caries
Dental caries afflict at least 90% of the world's population at some time in their lives. Detecting the first signs of this disease, which can be lethal in extreme cases, just got easier thanks to work by researchers in India discussed in the latest issue of the International Journal of Biomedical Engineering and Technology.
R. Siva Kumar of the Department of Electronics and Communication Engineering, at RMK Engineering College, in Tamil Nadu, explains that dental caries, known colloquially as tooth decay or dental cavities, is an infectious disease which damages the structures of teeth. The disease causes toothache, tooth loss, infection of the jawbone and beyond, and in severe cases, death.
Caries are caused by acid-producing bacteria that feed on fermentable carbohydrates including sucrose, fruit sugars, and glucose. The higher level of acidity in the mouth due to this bacterial activity effectively dissolves the mineral content of the tooth. In the USA, dental caries is the most common chronic childhood disease, being at least five times more common than asthma. It is the primary cause of tooth loss in children, while between a third and two thirds of people over 50 years experience caries too.
There are two types of dental caries, those that form on the smooth surfaces of the teeth and those in the pits and fissures. The latter are difficult to detect visually or manually with a dental explorer. Detecting caries in the early stages of development is important for saving affected teeth and avoiding the possibility of tooth loss and invasive surgery at later stages. Siva Kumar suggests that X-rays of a patient's teeth analyzed by specialist software could help.
The researchers at RMK engineering college have now developed an X-ray image analysis technique that reveals the pixel intensities at different X-ray wavelengths, much like the histogram analysis of images by a high-specification digital camera. Siva Kumar explains that the software reveals that the X-ray histogram and spectrum are very different depending on whether the teeth X-rayed are normal or exhibiting the early stages of decay. The researchers found that in the X-ray histogram the pixel intensities are concentrated in different ranges depending on degree of decay.
The technique could be very useful for dental clinicians, the researchers explain, and could be extended using neural networks to automatically identify the different stages of dental caries.
Dental caries afflict at least 90% of the world's population at some time in their lives. Detecting the first signs of this disease, which can be lethal in extreme cases, just got easier thanks to work by researchers in India discussed in the latest issue of the International Journal of Biomedical Engineering and Technology.
R. Siva Kumar of the Department of Electronics and Communication Engineering, at RMK Engineering College, in Tamil Nadu, explains that dental caries, known colloquially as tooth decay or dental cavities, is an infectious disease which damages the structures of teeth. The disease causes toothache, tooth loss, infection of the jawbone and beyond, and in severe cases, death.
Caries are caused by acid-producing bacteria that feed on fermentable carbohydrates including sucrose, fruit sugars, and glucose. The higher level of acidity in the mouth due to this bacterial activity effectively dissolves the mineral content of the tooth. In the USA, dental caries is the most common chronic childhood disease, being at least five times more common than asthma. It is the primary cause of tooth loss in children, while between a third and two thirds of people over 50 years experience caries too.
There are two types of dental caries, those that form on the smooth surfaces of the teeth and those in the pits and fissures. The latter are difficult to detect visually or manually with a dental explorer. Detecting caries in the early stages of development is important for saving affected teeth and avoiding the possibility of tooth loss and invasive surgery at later stages. Siva Kumar suggests that X-rays of a patient's teeth analyzed by specialist software could help.
The researchers at RMK engineering college have now developed an X-ray image analysis technique that reveals the pixel intensities at different X-ray wavelengths, much like the histogram analysis of images by a high-specification digital camera. Siva Kumar explains that the software reveals that the X-ray histogram and spectrum are very different depending on whether the teeth X-rayed are normal or exhibiting the early stages of decay. The researchers found that in the X-ray histogram the pixel intensities are concentrated in different ranges depending on degree of decay.
The technique could be very useful for dental clinicians, the researchers explain, and could be extended using neural networks to automatically identify the different stages of dental caries.
Friday, August 8, 2008
Periodontal disease predicts new onset diabetes
Periodontal disease may be an independent predictor of incident Type 2 diabetes, according to a study by researchers at Columbia University Mailman School of Public Health. While diabetes has long been believed to be a risk factor for periodontal infections, this is the first study exploring whether the reverse might also be true, that is, if periodontal infections can contribute to the development of diabetes. The full study findings are published in the July 2008 issue of Diabetes Care.
The Mailman School of Public Health researchers studied over 9,000 participants without diabetes from a nationally representative sample of the U.S. population, 817 of whom went on to develop diabetes. They then compared the risk of developing diabetes over the next 20 years between people with varying degrees of periodontal disease and found that individuals with elevated levels of periodontal disease were nearly twice as likely to become diabetic in that 20 year timeframe. These findings remained after extensive multivariable adjustment for potential confounders including, but not limited to, age, smoking, obesity, hypertension, and dietary patterns.
"These data add a new twist to the association and suggest that periodontal disease may be there before diabetes," said Ryan T. Demmer, PhD, MPH, associate research scientist in the Department of Epidemiology at the Mailman School of Public Health and lead author. "We found that over two decades of follow-up, individuals who had periodontal disease were more likely to develop Type 2 diabetes later in life when compared to individuals without periodontal disease."
Also of interest, the researchers found that those study participants who had lost all of their teeth were at intermediate risk for incident diabetes. "This could be suggestive that the people who lost all of their teeth had a history of infection at some point, but subsequently lost their teeth and removed the source of infection," noted Dr. Demmer. "This is particularly interesting as it supports previous research originating from The Oral Infections and Vascular Disease Epidemiology Study (INVEST) which has shown that individuals lacking teeth are at intermediate risk for cardiovascular disease" said Moïse Desvarieux, MD, PhD, director of INVEST, associate professor and Inserm Chair of Excellence in the Department of Epidemiology at the Mailman School and senior author of the paper.
The contributory role of periodontal disease in the development of Type 2 diabetes is potentially of public health importance because of the prevalence of treatable periodontal diseases in the population and the pervasiveness of diabetes-associated morbidity and mortality. However, observes Dr. Demmer, more studies are needed both to determine whether gum disease directly contributes to type 2 diabetes and, from there, that treating the dental problem can prevent diabetes. In addition to Dr. Desvarieux, David R. Jacobs Jr., PhD, professor in the Department of Epidemiology and Community Health at the University of Minnesota, also contributed to the research.
The Mailman School of Public Health researchers studied over 9,000 participants without diabetes from a nationally representative sample of the U.S. population, 817 of whom went on to develop diabetes. They then compared the risk of developing diabetes over the next 20 years between people with varying degrees of periodontal disease and found that individuals with elevated levels of periodontal disease were nearly twice as likely to become diabetic in that 20 year timeframe. These findings remained after extensive multivariable adjustment for potential confounders including, but not limited to, age, smoking, obesity, hypertension, and dietary patterns.
"These data add a new twist to the association and suggest that periodontal disease may be there before diabetes," said Ryan T. Demmer, PhD, MPH, associate research scientist in the Department of Epidemiology at the Mailman School of Public Health and lead author. "We found that over two decades of follow-up, individuals who had periodontal disease were more likely to develop Type 2 diabetes later in life when compared to individuals without periodontal disease."
Also of interest, the researchers found that those study participants who had lost all of their teeth were at intermediate risk for incident diabetes. "This could be suggestive that the people who lost all of their teeth had a history of infection at some point, but subsequently lost their teeth and removed the source of infection," noted Dr. Demmer. "This is particularly interesting as it supports previous research originating from The Oral Infections and Vascular Disease Epidemiology Study (INVEST) which has shown that individuals lacking teeth are at intermediate risk for cardiovascular disease" said Moïse Desvarieux, MD, PhD, director of INVEST, associate professor and Inserm Chair of Excellence in the Department of Epidemiology at the Mailman School and senior author of the paper.
The contributory role of periodontal disease in the development of Type 2 diabetes is potentially of public health importance because of the prevalence of treatable periodontal diseases in the population and the pervasiveness of diabetes-associated morbidity and mortality. However, observes Dr. Demmer, more studies are needed both to determine whether gum disease directly contributes to type 2 diabetes and, from there, that treating the dental problem can prevent diabetes. In addition to Dr. Desvarieux, David R. Jacobs Jr., PhD, professor in the Department of Epidemiology and Community Health at the University of Minnesota, also contributed to the research.
Monday, July 21, 2008
A virtual toothache helps student dentists
Masha is a dental patient. Her oral health problems continue to change as she meets new Case Western Reserve University student dentists in Second Life's virtual dental office.
The middle-aged avatar is an integral part of a new research project of the Case Western Reserve University School of Dental Medicine and the College of Arts and Sciences department of communication sciences to teach and give students practice time to communicate with mock patients.
Not only do findings from the study have potential to revolutionize dental education but also to change the way national testing is done for patient-side communication skills.
Kristin Z. Victoroff from the dental medicine's department of community dentistry will direct the three-year Innovative Dental Assessment Research and Development (IDEA) Grant project from the American Dental Association's Joint Commission on National Dental Examinations. She will develop patient communication scenarios for simulated education and test their effectiveness in preclinical training for students.
"More dental schools are experimenting with simulation as a way to teach," said Victoroff. She is joined in the research project by Roma Jasinevicius and Catherine Demko from the dental school faculty in testing and implementing simulations in dental education at the university.
Since 2001, the Case Western Reserve dental school has been on the forefront in using simulations in teaching the physical dexterity skills by using a technology called DentSim (http://www.denx.com/). DentSim is a simulated and computerized training system that uses a simulated dental patient. The school's use of the technology in dental education was spearheaded by Jasinevicius.
From that technology, the attention turned to developing what Victoroff's describes simulated experiences for the "softer" skills of dental medicine—communicating with patients.
Victoroff enlisted virtual reality experts and Art and Sciences' communication disorder scientists Stacy Williams, who directs the Virtual Immersion Center for Simulation Research (VICSR), and Kyra Rothenberg, director of the health communications minor.
They will take three approaches to simulated communications training—live actors, the immersion theater where students interact with a virtual patient in a 180-degree surround theater and with avatars, like Masha, in Second Life.
Of the three simulation methods, Victoroff is interested in using the immersion theater and Second Life. She noted that paper-based, live actors and real patients present limitations from ethical issues to logistical challenges. Meanwhile, the interactive theater and Second Life have capabilities to assess competencies in a convenient, standardized and cost-effective situation.
According to Victoroff, if successful, the virtual scenarios in an immersion theater setting or the online Second Life community might provide a potentially better way of assessing a student's abilities to communicate with patients than the current multiple-choice questions on the national examinations required for practicing professionally.
During spring semester, 70 students in the third-year dental class participated in a pilot study to develop their communication skills with live actors and virtual patients during communication skills training at the Mt. Sinai Skills and Simulation Center at the Veterans Administration Hospital.
The research project focuses on developing scenarios that aid and test students in taking patient histories, providing oral health education like tobacco cessation counseling for smokers, explaining procedures, talking about healthcare options and obtaining informed consent, and working through situations that present ethical dilemmas. These are among the competencies outlined by the American Dental Education Association.
Along with communication sciences students, the use of the virtual reality theater by dental students will advance the researchers understanding in how this technology can be applied to teaching and assessing students in different disciplines. The dental students will use a portable 50-inch LCD panel instead of the larger fixed 180-degree theater. In real time, the students interact and communicate with Masha.
"Ideally it is not that we are out to prove that virtual worlds or the VICSR system is better than standard instruction, but that they are of equal value," said Williams, adding that students should be able to walk away learning the same types of knowledge they can learn from working with live patients.
Students are very accepting of the VICR environment and put a lot of reflection in their voices when they are talking to the animated characters, said Williams.
Rothenberg will piece together students' motivations and perceptions when using this technology for their education.
According to Rothenberg who works in health communications, VICSR is already showing positive results from communication science students and patients using the virtual theater for their education and speech therapy.
"Virtual patients have much to offer in training healthcare providers, and it is equally important to explore how interactive virtual reality technology can enhance assessment of competency," said Victoroff.
The middle-aged avatar is an integral part of a new research project of the Case Western Reserve University School of Dental Medicine and the College of Arts and Sciences department of communication sciences to teach and give students practice time to communicate with mock patients.
Not only do findings from the study have potential to revolutionize dental education but also to change the way national testing is done for patient-side communication skills.
Kristin Z. Victoroff from the dental medicine's department of community dentistry will direct the three-year Innovative Dental Assessment Research and Development (IDEA) Grant project from the American Dental Association's Joint Commission on National Dental Examinations. She will develop patient communication scenarios for simulated education and test their effectiveness in preclinical training for students.
"More dental schools are experimenting with simulation as a way to teach," said Victoroff. She is joined in the research project by Roma Jasinevicius and Catherine Demko from the dental school faculty in testing and implementing simulations in dental education at the university.
Since 2001, the Case Western Reserve dental school has been on the forefront in using simulations in teaching the physical dexterity skills by using a technology called DentSim (http://www.denx.com/). DentSim is a simulated and computerized training system that uses a simulated dental patient. The school's use of the technology in dental education was spearheaded by Jasinevicius.
From that technology, the attention turned to developing what Victoroff's describes simulated experiences for the "softer" skills of dental medicine—communicating with patients.
Victoroff enlisted virtual reality experts and Art and Sciences' communication disorder scientists Stacy Williams, who directs the Virtual Immersion Center for Simulation Research (VICSR), and Kyra Rothenberg, director of the health communications minor.
They will take three approaches to simulated communications training—live actors, the immersion theater where students interact with a virtual patient in a 180-degree surround theater and with avatars, like Masha, in Second Life.
Of the three simulation methods, Victoroff is interested in using the immersion theater and Second Life. She noted that paper-based, live actors and real patients present limitations from ethical issues to logistical challenges. Meanwhile, the interactive theater and Second Life have capabilities to assess competencies in a convenient, standardized and cost-effective situation.
According to Victoroff, if successful, the virtual scenarios in an immersion theater setting or the online Second Life community might provide a potentially better way of assessing a student's abilities to communicate with patients than the current multiple-choice questions on the national examinations required for practicing professionally.
During spring semester, 70 students in the third-year dental class participated in a pilot study to develop their communication skills with live actors and virtual patients during communication skills training at the Mt. Sinai Skills and Simulation Center at the Veterans Administration Hospital.
The research project focuses on developing scenarios that aid and test students in taking patient histories, providing oral health education like tobacco cessation counseling for smokers, explaining procedures, talking about healthcare options and obtaining informed consent, and working through situations that present ethical dilemmas. These are among the competencies outlined by the American Dental Education Association.
Along with communication sciences students, the use of the virtual reality theater by dental students will advance the researchers understanding in how this technology can be applied to teaching and assessing students in different disciplines. The dental students will use a portable 50-inch LCD panel instead of the larger fixed 180-degree theater. In real time, the students interact and communicate with Masha.
"Ideally it is not that we are out to prove that virtual worlds or the VICSR system is better than standard instruction, but that they are of equal value," said Williams, adding that students should be able to walk away learning the same types of knowledge they can learn from working with live patients.
Students are very accepting of the VICR environment and put a lot of reflection in their voices when they are talking to the animated characters, said Williams.
Rothenberg will piece together students' motivations and perceptions when using this technology for their education.
According to Rothenberg who works in health communications, VICSR is already showing positive results from communication science students and patients using the virtual theater for their education and speech therapy.
"Virtual patients have much to offer in training healthcare providers, and it is equally important to explore how interactive virtual reality technology can enhance assessment of competency," said Victoroff.
Tuesday, July 15, 2008
New, Improved 'OralLongevity' Web Site;
American Dental Association Launches New, Improved 'OralLongevity' Web Site; Refreshed Site Features New Content, Updated Design for Older Adult's Oral Health Care
The OralLongevity(tm) section of the American Dental Association (ADA) web site has received a "face-lift."
Retaining its domain at http://www.orallongevity.ada.org , the refreshed site features an updated design, enhanced navigation and new content for the initiative that helps increase awareness about the importance of older Americans maintaining good oral health for a lifetime.
To create a user-friendly online experience and a more effective mechanism for distributing oral health messages to key audiences, the site is arranged in three distinct sections:
- OralLongevity landing page with an overview of the program objectives and information tools
- Resources for dental professionals to raise awareness of the special oral needs of an aging population
- Resources for consumers to empower seniors to take control of their oral health
For easy navigation, a link to the OralLongevity brochure and DVD appears on each page, along with anchor tags that jump directly into a specific topic within the section.
In addition, the web site offers presentation materials to assist dentists in educating other health professionals, older adult patients and caregivers about the importance of oral health. These online resources can be used in the dental office or in the community. New and expanded materials that may be downloaded and duplicated directly from the web site include:
- Commonly asked questions and answers for patients
- Program outlines for presenting the DVD to health professionals, patients or caregivers
- Post-test for consumers
- Sample press release to publicize your OralLongevity outreach activity
- Clinical articles from JADA and other dental publications
In the Consumer Resources section, visitors will find tips for taking care of their teeth, pointers on making the most of visiting the dentist, and a discussion of the connection between oral health and overall health. A reference list of articles on various oral health topics is provided for those seeking more in-depth information. A link to "Find an ADA Member Dentist" also can be found here.
About OralLongevity(tm)
OralLongevity(tm) is a cooperative initiative between the American Dental Association (ADA), the ADA Foundation (ADAF) and GlaxoSmithKline Consumer Healthcare (GSKCH). The OralLongevity initiative was designed to support dental professionals in enhancing and preserving the oral health of older Americans
About the American Dental Association
The not-for-profit ADA is the nation's largest dental association, representing more than 156,000 dentist members. The premier source of oral health information, the ADA has advocated for the public's health and promoted the art and science of dentistry since 1859. The ADA's state-of-the-art research facilities develop and test dental products and materials that have advanced the practice of dentistry and made the patient experience more positive. The ADA Seal of Acceptance long has been a valuable and respected guide to consumer dental care products. JADA, a monthly journal, is the ADA's flagship publication and the best-read scientific journal in dentistry. For more information about the ADA, visit the Association's Web site at http://www.ada.org .
The OralLongevity(tm) section of the American Dental Association (ADA) web site has received a "face-lift."
Retaining its domain at http://www.orallongevity.ada.org , the refreshed site features an updated design, enhanced navigation and new content for the initiative that helps increase awareness about the importance of older Americans maintaining good oral health for a lifetime.
To create a user-friendly online experience and a more effective mechanism for distributing oral health messages to key audiences, the site is arranged in three distinct sections:
- OralLongevity landing page with an overview of the program objectives and information tools
- Resources for dental professionals to raise awareness of the special oral needs of an aging population
- Resources for consumers to empower seniors to take control of their oral health
For easy navigation, a link to the OralLongevity brochure and DVD appears on each page, along with anchor tags that jump directly into a specific topic within the section.
In addition, the web site offers presentation materials to assist dentists in educating other health professionals, older adult patients and caregivers about the importance of oral health. These online resources can be used in the dental office or in the community. New and expanded materials that may be downloaded and duplicated directly from the web site include:
- Commonly asked questions and answers for patients
- Program outlines for presenting the DVD to health professionals, patients or caregivers
- Post-test for consumers
- Sample press release to publicize your OralLongevity outreach activity
- Clinical articles from JADA and other dental publications
In the Consumer Resources section, visitors will find tips for taking care of their teeth, pointers on making the most of visiting the dentist, and a discussion of the connection between oral health and overall health. A reference list of articles on various oral health topics is provided for those seeking more in-depth information. A link to "Find an ADA Member Dentist" also can be found here.
About OralLongevity(tm)
OralLongevity(tm) is a cooperative initiative between the American Dental Association (ADA), the ADA Foundation (ADAF) and GlaxoSmithKline Consumer Healthcare (GSKCH). The OralLongevity initiative was designed to support dental professionals in enhancing and preserving the oral health of older Americans
About the American Dental Association
The not-for-profit ADA is the nation's largest dental association, representing more than 156,000 dentist members. The premier source of oral health information, the ADA has advocated for the public's health and promoted the art and science of dentistry since 1859. The ADA's state-of-the-art research facilities develop and test dental products and materials that have advanced the practice of dentistry and made the patient experience more positive. The ADA Seal of Acceptance long has been a valuable and respected guide to consumer dental care products. JADA, a monthly journal, is the ADA's flagship publication and the best-read scientific journal in dentistry. For more information about the ADA, visit the Association's Web site at http://www.ada.org .
Thursday, July 10, 2008
Oral Health Care Model in Rural Alaska Villages
Evaluation to Measure Effectiveness of Oral Health Care Model in Rural Alaska Native Villages; Communities Involved in Project Experience Nation's Highest Rate of Oral Health Disease
A model oral health program serving isolated Alaska Native communities is being evaluated for effectiveness with a goal of improving the quality of services to children and families vulnerable to some of the highest levels of measured oral health disease in the country.
Supported through a partnership of four foundations, the comprehensive evaluation will be conducted by RTI International of Research Triangle Park, North Carolina - a nonprofit research institute that provides research and technical services to governments and businesses worldwide. The two-year study offers an opportunity to determine the quality of service provided by the Alaska Native Tribal Health Consortium's Dental Health Aide Therapist Program.
"If the evaluation proves the viability of the dental health aide therapist model, the program has the potential to have the same impact on rural Alaska as the tuberculosis eradication program did in the 1940s and 1950s," said Jerry Drake, executive director of the Bethel Community Services Foundation, located in Bethel, Alaska.
Research will be guided by a National Advisory Committee and an Alaska Tribal Advisory Coordinating Committee - with members ranging from professional dentists to Alaska Native community members. The aim is to fully examine the program and its effectiveness, while assuring that cultural aspects of evaluation are done with respect, and within tribal tradition and custom.
Funding for the evaluation is being provided by the W.K. Kellogg Foundation of Battle Creek, Michigan, in partnership with the Rasmuson Foundation of Anchorage, Alaska; the Bethel Community Services Foundation Inc. of Bethel, Alaska; and the M.J. Murdock Charitable Trust of Vancouver, Washington.
"Through this research, we hope to establish a long-term process for continuous quality improvement to ensure that the best possible dental care is provided to Alaska Native patients in the state's more remote communities," said Al Yee, a Kellogg Foundation program director.
There are more than 200 Native villages in Alaska, many located in extremely remote sections of the state. Transportation is difficult and expensive, and health care services are often sparse and inconsistent. Most Alaska villages receive the services of a dentist for a week a year and often only the most urgent cases are seen.
According to the 1999 Indian Health Service Survey, the Alaska Native population has a high rate of oral disease. For example, children 2 to 5 years of age have almost five times the amount of tooth decay as do children of similar ages elsewhere in the United States. Children ages 6 to 14 have 4.5 times the amount of tooth decay and adult periodontal disease is 2.5 times higher than in the general population.
"Contributing to these unacceptable oral health statistics is the inability to recruit and retain an adequate dental health workforce in this isolated part of the country," said Yee.
"The Kellogg Foundation has a special interest in helping vulnerable children and their families succeed," said Sterling Speirn, the Kellogg Foundation's president and chief executive officer. "That's our primary organizational mission, so it's natural we would be interested in supporting programs such as this."
"Rasmuson Foundation has been unwavering in its support of improving oral health care access and outcomes in rural Alaska villages," said Diane Kaplan, Rasmuson Foundation president. "We are delighted that our partnership can have such far reaching benefits for Alaska."
Scott Wetterhall of RTI International, project director for the evaluation, said that the researchers will evaluate the implementation of the Dental Health Aide Therapist Program in communities where they work to assess its integrity to the overall program model, and identify barriers and facilitators for longer-term success.
"Among other things, we will look at patient access to care and the level of patient satisfaction from using dental therapists," Wetterhall said. "We'll also look at the quality of diagnosis and treatment, the development of community-based prevention programs and the general practice procedures used by the therapists."
In addition, he said, evaluators will examine the costs and explore the cost-effectiveness of the dental therapist program in Alaska. "Our overall approach to this evaluation will be participatory, transparent and thorough," Wetterhall said.
A final report of the results from this evaluation will be available in 2010.
About the Dental Health Aide Therapist Workforce Model
The Kellogg Foundation funds the Dental Health Aide Therapist training program through the Alaska Native Tribal Health Consortium, which is partnering with the University of Washington. Support is provided through a $2.7 million grant to the Alaska Native Tribal Health Consortium, along with additional funding of more than $1 million from the partner foundations.
The program trains mid-level oral health providers who live and work in the rural communities to provide prevention services, perform fillings, extractions and other limited dental services for children. It is based on a model program that was begun in New Zealand during the 1920s. The Alaska Native Tribal Health Consortium is currently working with the University of Washington to train approximately 24 dental health aid therapists from Alaska during a four-year period. Once trained, these therapists will work under the supervision of dentists who oversee the services in villages throughout the state.
"This model has succeeded in more than 40 countries," said Yee, "and holds great promise for improving dental access to underserved communities in Alaska."
Partners for the Evaluation
Bethel Community Services Foundation Inc. of Bethel, Alaska, is dedicated to the development, growth, continuance and enhancement of community based programs and services. In partnership with other communal institutions, foundations, restricted and unrestricted philanthropic donors, it seeks to support effective community growth and development. The Foundation was created in 1992 to manage the assets of, and contribute financial support for, the program of services offered through Bethel Community Services (BCS). BCS was founded in 1969 and introduced many human service programs to the Bethel community and the region. Visit http://bcsfoundation.org/ .
The M. J. Murdock Charitable Trust seeks to enrich the quality of life in the Pacific Northwest by providing grants and enrichment programs to non-profit organizations that seek to strengthen the region's educational, spiritual, and cultural base in creative and sustainable ways. Since its establishment on June 30, 1975, the Trust has focused most of its grantmaking efforts in the five states of the Pacific Northwest: Alaska, Idaho, Montana, Oregon, and Washington. A historical emphasis in grantmaking has been in higher education, scientific research and development, human social services, health care, and the arts. Visit http://www.murdock-trust.org .
The Rasmuson Foundation of Anchorage, Alaska, is a private foundation that works as a catalyst to promote a better life for Alaskans. Since its founding and first grant of $125 in 1955, the Rasmuson Foundation has supported Alaskan non-profit organizations in the pursuit of their goals, with particular emphasis on organizations that demonstrate strong leadership, clarity of purpose, and cautious use of resources. The vision and values established by Elmer Rasmuson continue to guide the Foundation today. The Foundation awards approximately $20 million annually to help improve the quality of life in Alaska. Visit http://www.rasmuson.org .
Established in 1930, the W.K. Kellogg Foundation of Battle Creek, Michigan, supports children, families and communities as they strengthen and create conditions that propel vulnerable children to achieve success as individuals and as contributors to the larger community and society. Grants are concentrated in the United States, Latin America and the Caribbean, and the southern African countries of Botswana, Lesotho, Malawi, Mozambique, South Africa, Swaziland and Zimbabwe. Visit http://www.wkkf.org .
RTI International is one of the world's leading research institutes, dedicated to improving the human condition by turning knowledge into practice. A staff of more than 2,600 provides research and technical services to governments and businesses worldwide in the areas of health and pharmaceuticals, education and training, surveys and statistics, advanced technology, international development, economic and social policy, energy, and the environment. RTI also employs about 1,200 term employees who support projects in more than 40 countries. Visit http://www.rti.org .
The Alaska Native Tribal Health Consortium is a non-profit health organization owned and managed by Alaska Native tribal governments and their regional health organizations. The Consortium was created in 1997 to provide statewide Native health services. To achieve its goals, ANTHC works closely with tribes, Native health organizations, the state of Alaska, and municipalities. Visit http://www.anthc.org .
A model oral health program serving isolated Alaska Native communities is being evaluated for effectiveness with a goal of improving the quality of services to children and families vulnerable to some of the highest levels of measured oral health disease in the country.
Supported through a partnership of four foundations, the comprehensive evaluation will be conducted by RTI International of Research Triangle Park, North Carolina - a nonprofit research institute that provides research and technical services to governments and businesses worldwide. The two-year study offers an opportunity to determine the quality of service provided by the Alaska Native Tribal Health Consortium's Dental Health Aide Therapist Program.
"If the evaluation proves the viability of the dental health aide therapist model, the program has the potential to have the same impact on rural Alaska as the tuberculosis eradication program did in the 1940s and 1950s," said Jerry Drake, executive director of the Bethel Community Services Foundation, located in Bethel, Alaska.
Research will be guided by a National Advisory Committee and an Alaska Tribal Advisory Coordinating Committee - with members ranging from professional dentists to Alaska Native community members. The aim is to fully examine the program and its effectiveness, while assuring that cultural aspects of evaluation are done with respect, and within tribal tradition and custom.
Funding for the evaluation is being provided by the W.K. Kellogg Foundation of Battle Creek, Michigan, in partnership with the Rasmuson Foundation of Anchorage, Alaska; the Bethel Community Services Foundation Inc. of Bethel, Alaska; and the M.J. Murdock Charitable Trust of Vancouver, Washington.
"Through this research, we hope to establish a long-term process for continuous quality improvement to ensure that the best possible dental care is provided to Alaska Native patients in the state's more remote communities," said Al Yee, a Kellogg Foundation program director.
There are more than 200 Native villages in Alaska, many located in extremely remote sections of the state. Transportation is difficult and expensive, and health care services are often sparse and inconsistent. Most Alaska villages receive the services of a dentist for a week a year and often only the most urgent cases are seen.
According to the 1999 Indian Health Service Survey, the Alaska Native population has a high rate of oral disease. For example, children 2 to 5 years of age have almost five times the amount of tooth decay as do children of similar ages elsewhere in the United States. Children ages 6 to 14 have 4.5 times the amount of tooth decay and adult periodontal disease is 2.5 times higher than in the general population.
"Contributing to these unacceptable oral health statistics is the inability to recruit and retain an adequate dental health workforce in this isolated part of the country," said Yee.
"The Kellogg Foundation has a special interest in helping vulnerable children and their families succeed," said Sterling Speirn, the Kellogg Foundation's president and chief executive officer. "That's our primary organizational mission, so it's natural we would be interested in supporting programs such as this."
"Rasmuson Foundation has been unwavering in its support of improving oral health care access and outcomes in rural Alaska villages," said Diane Kaplan, Rasmuson Foundation president. "We are delighted that our partnership can have such far reaching benefits for Alaska."
Scott Wetterhall of RTI International, project director for the evaluation, said that the researchers will evaluate the implementation of the Dental Health Aide Therapist Program in communities where they work to assess its integrity to the overall program model, and identify barriers and facilitators for longer-term success.
"Among other things, we will look at patient access to care and the level of patient satisfaction from using dental therapists," Wetterhall said. "We'll also look at the quality of diagnosis and treatment, the development of community-based prevention programs and the general practice procedures used by the therapists."
In addition, he said, evaluators will examine the costs and explore the cost-effectiveness of the dental therapist program in Alaska. "Our overall approach to this evaluation will be participatory, transparent and thorough," Wetterhall said.
A final report of the results from this evaluation will be available in 2010.
About the Dental Health Aide Therapist Workforce Model
The Kellogg Foundation funds the Dental Health Aide Therapist training program through the Alaska Native Tribal Health Consortium, which is partnering with the University of Washington. Support is provided through a $2.7 million grant to the Alaska Native Tribal Health Consortium, along with additional funding of more than $1 million from the partner foundations.
The program trains mid-level oral health providers who live and work in the rural communities to provide prevention services, perform fillings, extractions and other limited dental services for children. It is based on a model program that was begun in New Zealand during the 1920s. The Alaska Native Tribal Health Consortium is currently working with the University of Washington to train approximately 24 dental health aid therapists from Alaska during a four-year period. Once trained, these therapists will work under the supervision of dentists who oversee the services in villages throughout the state.
"This model has succeeded in more than 40 countries," said Yee, "and holds great promise for improving dental access to underserved communities in Alaska."
Partners for the Evaluation
Bethel Community Services Foundation Inc. of Bethel, Alaska, is dedicated to the development, growth, continuance and enhancement of community based programs and services. In partnership with other communal institutions, foundations, restricted and unrestricted philanthropic donors, it seeks to support effective community growth and development. The Foundation was created in 1992 to manage the assets of, and contribute financial support for, the program of services offered through Bethel Community Services (BCS). BCS was founded in 1969 and introduced many human service programs to the Bethel community and the region. Visit http://bcsfoundation.org/ .
The M. J. Murdock Charitable Trust seeks to enrich the quality of life in the Pacific Northwest by providing grants and enrichment programs to non-profit organizations that seek to strengthen the region's educational, spiritual, and cultural base in creative and sustainable ways. Since its establishment on June 30, 1975, the Trust has focused most of its grantmaking efforts in the five states of the Pacific Northwest: Alaska, Idaho, Montana, Oregon, and Washington. A historical emphasis in grantmaking has been in higher education, scientific research and development, human social services, health care, and the arts. Visit http://www.murdock-trust.org .
The Rasmuson Foundation of Anchorage, Alaska, is a private foundation that works as a catalyst to promote a better life for Alaskans. Since its founding and first grant of $125 in 1955, the Rasmuson Foundation has supported Alaskan non-profit organizations in the pursuit of their goals, with particular emphasis on organizations that demonstrate strong leadership, clarity of purpose, and cautious use of resources. The vision and values established by Elmer Rasmuson continue to guide the Foundation today. The Foundation awards approximately $20 million annually to help improve the quality of life in Alaska. Visit http://www.rasmuson.org .
Established in 1930, the W.K. Kellogg Foundation of Battle Creek, Michigan, supports children, families and communities as they strengthen and create conditions that propel vulnerable children to achieve success as individuals and as contributors to the larger community and society. Grants are concentrated in the United States, Latin America and the Caribbean, and the southern African countries of Botswana, Lesotho, Malawi, Mozambique, South Africa, Swaziland and Zimbabwe. Visit http://www.wkkf.org .
RTI International is one of the world's leading research institutes, dedicated to improving the human condition by turning knowledge into practice. A staff of more than 2,600 provides research and technical services to governments and businesses worldwide in the areas of health and pharmaceuticals, education and training, surveys and statistics, advanced technology, international development, economic and social policy, energy, and the environment. RTI also employs about 1,200 term employees who support projects in more than 40 countries. Visit http://www.rti.org .
The Alaska Native Tribal Health Consortium is a non-profit health organization owned and managed by Alaska Native tribal governments and their regional health organizations. The Consortium was created in 1997 to provide statewide Native health services. To achieve its goals, ANTHC works closely with tribes, Native health organizations, the state of Alaska, and municipalities. Visit http://www.anthc.org .
Wednesday, July 9, 2008
BEST DENTAL BRACES ARE LEAST ATTRACTIVE
When it comes to the attractiveness of orthodontic braces, less metal is better, according to a recent survey.
The study of the public’s attitude about the attractiveness of various styles of braces indicates that the types of dental appliances with no visible metal were considered the most attractive. Braces that combine clear ceramic brackets with thin metal or clear wires were a less desirable option, and braces with metal brackets and metal wires were rated as the least aesthetic combination.
“The paradox is that the more aesthetic these dental appliances are, the more difficult they are to manage for the orthodontist,” said senior study author Henry Fields, professor and division chair of orthodontics at Ohio State University. “But those are what people like the most.”
The survey did not ask respondents about the attractiveness of decorative and colorful elastic modules that attach the wires to the braces, which have become popular among some teen-agers in the past few years.
The study findings were published in a recent issue of the American Journal of Orthodontics and Dentofacial Orthopedics.
Fields and colleagues questioned 200 adults using a computer-based survey that presented standardized images of teeth with a variety of orthodontic appliances. The images did not show the patients’ faces, so the attractiveness of the person wearing the appliances was not a factor.
Respondents were asked to rate the appliances using a range from “extremely unattractive” to “extremely attractive” on a scale of 1 to 100.
The responses fell into three clear categories, Fields said. The stainless steel appliances were considered the least attractive, with average ratings hovering between about 25 and 40 on the 100-point scale. Ceramic appliances, which are often clear or tooth-colored and less visible than metal, received average ratings of between about 55 and 70 on the scale. Ceramic brackets with clear or white wires were considered more attractive than ceramic brackets with metal wires. Clear tooth trays and teeth with no visible appliances ranked as the most attractive, with the average of most scores exceeding 90. Appliances called lingual braces are invisible because they are applied behind the teeth, creating the appearance of appliance-free teeth.
The researchers collected demographic information on the adult respondents, but any differences in demographic influences were insignificant in the overall analysis.
“The general trends of appliance attractiveness are universal,” Fields said. “The stainless steel that we like to use, which is the most durable and efficient, is often ranked the lowest in attractiveness. These braces don’t wear out and you can get total control with them.
“The most aesthetic ones, the trays, have limitations on the types of movements you can make and forces you can deliver, and the efficiency. And the ceramics sometimes have breakage problems, and they tend to just be a little bit more delicate.”
Standard braces consist of metal or ceramic brackets that are cemented to each tooth. A metal wire is laced through each bracket to exert force on the teeth to correct their placement. Braces are used to tip teeth in one direction or another, to rotate one or several teeth, or to shift the location of a tooth forward, backward, sideways, up or down in the mouth. Each kind of correction requires specific manipulation of the wires in the brackets, and some require specially shaped wires to perform the task. Fields said the ideal is to move teeth about 1 millimeter, a little less than the thickness of a dime, every four weeks.
The clear tray appliances reposition multiple teeth in tiny increments of about a quarter of a millimeter every two weeks, he said. Patients receive an assortment of trays that they change every two weeks. They wear the trays all day and night, removing them to eat and brush their teeth.
Adults make up about one in four patients being fitted with braces, Fields said. And adults may be more concerned about aesthetics of braces than are adolescents, who, if they require braces, typically get them between the ages of 10 and 13.
Fields said some kids tend to go a different route, thinking of their braces as accessories that should be enhanced rather than hidden.
“Some of the kids are going for braces made in the shape of a star, or have colors put on the ties that hold the wires to their brackets,” he said. “Some people are decorating their braces.”
He and colleagues are also exploring attitudes about how much patients are willing to pay for more expensive dental appliances. The more aesthetically pleasing options often are more costly, as well. The group’s data suggest that adults are willing to pay several hundred dollars extra for more attractive appliances for themselves or their children.
The study of the public’s attitude about the attractiveness of various styles of braces indicates that the types of dental appliances with no visible metal were considered the most attractive. Braces that combine clear ceramic brackets with thin metal or clear wires were a less desirable option, and braces with metal brackets and metal wires were rated as the least aesthetic combination.
“The paradox is that the more aesthetic these dental appliances are, the more difficult they are to manage for the orthodontist,” said senior study author Henry Fields, professor and division chair of orthodontics at Ohio State University. “But those are what people like the most.”
The survey did not ask respondents about the attractiveness of decorative and colorful elastic modules that attach the wires to the braces, which have become popular among some teen-agers in the past few years.
The study findings were published in a recent issue of the American Journal of Orthodontics and Dentofacial Orthopedics.
Fields and colleagues questioned 200 adults using a computer-based survey that presented standardized images of teeth with a variety of orthodontic appliances. The images did not show the patients’ faces, so the attractiveness of the person wearing the appliances was not a factor.
Respondents were asked to rate the appliances using a range from “extremely unattractive” to “extremely attractive” on a scale of 1 to 100.
The responses fell into three clear categories, Fields said. The stainless steel appliances were considered the least attractive, with average ratings hovering between about 25 and 40 on the 100-point scale. Ceramic appliances, which are often clear or tooth-colored and less visible than metal, received average ratings of between about 55 and 70 on the scale. Ceramic brackets with clear or white wires were considered more attractive than ceramic brackets with metal wires. Clear tooth trays and teeth with no visible appliances ranked as the most attractive, with the average of most scores exceeding 90. Appliances called lingual braces are invisible because they are applied behind the teeth, creating the appearance of appliance-free teeth.
The researchers collected demographic information on the adult respondents, but any differences in demographic influences were insignificant in the overall analysis.
“The general trends of appliance attractiveness are universal,” Fields said. “The stainless steel that we like to use, which is the most durable and efficient, is often ranked the lowest in attractiveness. These braces don’t wear out and you can get total control with them.
“The most aesthetic ones, the trays, have limitations on the types of movements you can make and forces you can deliver, and the efficiency. And the ceramics sometimes have breakage problems, and they tend to just be a little bit more delicate.”
Standard braces consist of metal or ceramic brackets that are cemented to each tooth. A metal wire is laced through each bracket to exert force on the teeth to correct their placement. Braces are used to tip teeth in one direction or another, to rotate one or several teeth, or to shift the location of a tooth forward, backward, sideways, up or down in the mouth. Each kind of correction requires specific manipulation of the wires in the brackets, and some require specially shaped wires to perform the task. Fields said the ideal is to move teeth about 1 millimeter, a little less than the thickness of a dime, every four weeks.
The clear tray appliances reposition multiple teeth in tiny increments of about a quarter of a millimeter every two weeks, he said. Patients receive an assortment of trays that they change every two weeks. They wear the trays all day and night, removing them to eat and brush their teeth.
Adults make up about one in four patients being fitted with braces, Fields said. And adults may be more concerned about aesthetics of braces than are adolescents, who, if they require braces, typically get them between the ages of 10 and 13.
Fields said some kids tend to go a different route, thinking of their braces as accessories that should be enhanced rather than hidden.
“Some of the kids are going for braces made in the shape of a star, or have colors put on the ties that hold the wires to their brackets,” he said. “Some people are decorating their braces.”
He and colleagues are also exploring attitudes about how much patients are willing to pay for more expensive dental appliances. The more aesthetically pleasing options often are more costly, as well. The group’s data suggest that adults are willing to pay several hundred dollars extra for more attractive appliances for themselves or their children.
Monday, July 7, 2008
Mother's vitamin D status = baby's dental health
Low maternal vitamin D levels during pregnancy may affect primary tooth calcification, leading to enamel defects, which are a risk factor for early-childhood tooth decay. Today, during the 86th General Session of the International Association for Dental Research, investigators from the University of Manitoba (Winnipeg and Victoria) present the results of a study they conducted to determine the vitamin D status of pregnant women, the incidence of enamel defects and early-childhood tooth decay among their infants, and the relationship with pre-natal vitamin D levels.
Two hundred six pregnant women in their second trimester participated in the study. Only 21 women (10.5%) were found to have adequate vitamin D levels. Vitamin D concentrations were related to the frequency of milk consumption and pre-natal vitamin use. The investigators examined 135 infants (55.6% male) at 16.1 ± 7.4 months of age, and found that 21.6% of them had enamel defects, while 33.6% had early-childhood tooth decay. Mothers of children with enamel defects had lower, but not significantly different, mean vitamin D concentrations during pregnancy than those of children without defects.
However, mothers of children with early-childhood tooth decay had significantly lower vitamin D levels than those whose children were cavity-free. Infants with enamel defects were significantly more likely to have early-childhood tooth decay.
This is the first study to show that maternal vitamin D levels may have an influence on primary teeth and the development of early-childhood tooth decay.
Two hundred six pregnant women in their second trimester participated in the study. Only 21 women (10.5%) were found to have adequate vitamin D levels. Vitamin D concentrations were related to the frequency of milk consumption and pre-natal vitamin use. The investigators examined 135 infants (55.6% male) at 16.1 ± 7.4 months of age, and found that 21.6% of them had enamel defects, while 33.6% had early-childhood tooth decay. Mothers of children with enamel defects had lower, but not significantly different, mean vitamin D concentrations during pregnancy than those of children without defects.
However, mothers of children with early-childhood tooth decay had significantly lower vitamin D levels than those whose children were cavity-free. Infants with enamel defects were significantly more likely to have early-childhood tooth decay.
This is the first study to show that maternal vitamin D levels may have an influence on primary teeth and the development of early-childhood tooth decay.
Dental referrals by primary care physicians
How effective are dental referrals by primary care physicians?
Young children from low-income families experience high levels of tooth decay and face many barriers to getting dental treatment and preventive services. Because these children usually visit their pediatrician or other primary care provider far more frequently than a dentist, the primary care medical setting is gaining popularity as a place to provide preventive dental services. Currently, physicians in more than 400 pediatric primary care offices in North Carolina (NC) have been trained to screen for tooth decay, so that referrals for those in need can be made to dentists. This effort is part of a preventive dental program known as "Into the Mouths of Babes" (IMB).
In a study undertaken by investigators at the University of North Carolina at Chapel Hill and Duke University, researchers examined factors that lead to dental referrals by physicians and whether these referrals result in dental office visits for children who received IMB services. The study used information from Medicaid reimbursement claims for IMB services provided during 2001 and 2002 and patient records completed by physicians for 24,403 children. The patient records provide information on the child's tooth decay experience, results of a dental risk assessment, and whether the child was referred to a dentist.
The investigators report their results today during the 86th General Session of the International Association for Dental Research. Of the 24,403 children in the study, about 5% had tooth decay, 2.8% were referred to a dentist, and 3.5% made a dental visit before 42 months of age. Among children with tooth decay, 32% were referred, and a higher percentage of children with a referral visited a dentist (35.6%) than those not referred (12.0%). Several factors were associated with whether a child received a referral to a dentist besides the presence of any decayed teeth, including increasing age of child, the availability of a general dentist in the county where the child received IMB services, and whether the child was seen in a practice located in a rural area.
In a second analysis, child tooth decay, a referral, increasing age of child, availability of a general dentist in the county, and having a dental visit prior to the first IMB visit were related to shorter time intervals between the referral and a dental visit.
The authors concluded that referrals by physicians increased access to dentists for children with tooth decay, but use of dentist services for those needing care remained low.
Young children from low-income families experience high levels of tooth decay and face many barriers to getting dental treatment and preventive services. Because these children usually visit their pediatrician or other primary care provider far more frequently than a dentist, the primary care medical setting is gaining popularity as a place to provide preventive dental services. Currently, physicians in more than 400 pediatric primary care offices in North Carolina (NC) have been trained to screen for tooth decay, so that referrals for those in need can be made to dentists. This effort is part of a preventive dental program known as "Into the Mouths of Babes" (IMB).
In a study undertaken by investigators at the University of North Carolina at Chapel Hill and Duke University, researchers examined factors that lead to dental referrals by physicians and whether these referrals result in dental office visits for children who received IMB services. The study used information from Medicaid reimbursement claims for IMB services provided during 2001 and 2002 and patient records completed by physicians for 24,403 children. The patient records provide information on the child's tooth decay experience, results of a dental risk assessment, and whether the child was referred to a dentist.
The investigators report their results today during the 86th General Session of the International Association for Dental Research. Of the 24,403 children in the study, about 5% had tooth decay, 2.8% were referred to a dentist, and 3.5% made a dental visit before 42 months of age. Among children with tooth decay, 32% were referred, and a higher percentage of children with a referral visited a dentist (35.6%) than those not referred (12.0%). Several factors were associated with whether a child received a referral to a dentist besides the presence of any decayed teeth, including increasing age of child, the availability of a general dentist in the county where the child received IMB services, and whether the child was seen in a practice located in a rural area.
In a second analysis, child tooth decay, a referral, increasing age of child, availability of a general dentist in the county, and having a dental visit prior to the first IMB visit were related to shorter time intervals between the referral and a dental visit.
The authors concluded that referrals by physicians increased access to dentists for children with tooth decay, but use of dentist services for those needing care remained low.
Novel hydrogel systems for dentin regeneration
Dental caries, or tooth decay, continues to be the most prevalent infectious disease in the world, presenting significant public health challenges and socio-economic consequences. It leads to the loss of the hard tissues of the tooth, followed by inflammation and necrosis of the subjacent dental pulp. In the U.S. alone, over 20 million dental restorations are placed each year, with failure rates of up to 60%. Hence, there exists a critical need for better biologic therapeutics to restore the damaged dentin-pulp complex to its original form and function. However, progress in this area has been slow compared with that in other fields of regenerative medicine.
Tissue-engineering strategies directed at mimicking the natural extracellular matrix have utilized synthetic and non-synthetic scaffolds to direct cell differentiation and matrix mineralization (in the case of bone). The most promising among the new generation of delivery systems are synthetic peptide hydrogels, which provide a nanostructured matrix highly similar to natural matrix. Short peptides can be designed to self-assemble into nanofibers, form macroscopic gels, and entrap living cells. With single amino acids as building blocks, the resulting materials are non-toxic, non-inflammatory, and biodegradable. The modular concept allows for high control over the system and, at the same time, makes it extremely versatile.
Speaking today during the 86th General Session of the International Association for Dental Research, a team of investigators from Baylor College of Dentistry (Dallas), the University of Regensburg (Germany), and Rice University (Houston) presents its preliminary data describing the results of studies on hydrogels made of peptide amphiphiles, where a short peptide sequence is attached to a fatty acid, which provides the driving force for self-assembly. However, they recently applied a different design concept, where the self-assembly of peptide chains is achieved without attaching a hydrophobic tail. Based on their design, the chains can include bioactive peptide sequences for cell adhesion, binding of growth factors, or other biological molecules with therapeutic potential. Hence, multidomain peptide hydrogels represent a novel and highly versatile material offering a higher degree of control over nanofiber architecture and better chemical functionality.
The overarching goal of this research is to utilize these multidomain peptides as a biomimetic scaffold, along with dental stem cell therapy, to provide a natural 3D environment that can control and direct the differentiation and function of dental stem cells for the targeted regeneration of the dentin-pulp complex.
This work is highly translational and innovative, since it capitalizes on a new and previously untested material with novel properties for the regeneration of the dentin-pulp complex. Importantly, the results will provide the foundation for developing multidomain peptide scaffolds as novel therapeutics for the regeneration of the dentin-pulp complex.
Tissue-engineering strategies directed at mimicking the natural extracellular matrix have utilized synthetic and non-synthetic scaffolds to direct cell differentiation and matrix mineralization (in the case of bone). The most promising among the new generation of delivery systems are synthetic peptide hydrogels, which provide a nanostructured matrix highly similar to natural matrix. Short peptides can be designed to self-assemble into nanofibers, form macroscopic gels, and entrap living cells. With single amino acids as building blocks, the resulting materials are non-toxic, non-inflammatory, and biodegradable. The modular concept allows for high control over the system and, at the same time, makes it extremely versatile.
Speaking today during the 86th General Session of the International Association for Dental Research, a team of investigators from Baylor College of Dentistry (Dallas), the University of Regensburg (Germany), and Rice University (Houston) presents its preliminary data describing the results of studies on hydrogels made of peptide amphiphiles, where a short peptide sequence is attached to a fatty acid, which provides the driving force for self-assembly. However, they recently applied a different design concept, where the self-assembly of peptide chains is achieved without attaching a hydrophobic tail. Based on their design, the chains can include bioactive peptide sequences for cell adhesion, binding of growth factors, or other biological molecules with therapeutic potential. Hence, multidomain peptide hydrogels represent a novel and highly versatile material offering a higher degree of control over nanofiber architecture and better chemical functionality.
The overarching goal of this research is to utilize these multidomain peptides as a biomimetic scaffold, along with dental stem cell therapy, to provide a natural 3D environment that can control and direct the differentiation and function of dental stem cells for the targeted regeneration of the dentin-pulp complex.
This work is highly translational and innovative, since it capitalizes on a new and previously untested material with novel properties for the regeneration of the dentin-pulp complex. Importantly, the results will provide the foundation for developing multidomain peptide scaffolds as novel therapeutics for the regeneration of the dentin-pulp complex.
Topical oral syrup prevents early childhood caries
Dental researchers at the University of Washington have reported a significant reduction of tooth decay in toddlers who were treated with the topical syrup xylitol, a naturally occurring non-cavity-causing sweetener. Their results were presented today during the 86th General Session of the International Association for Dental Research.
In a recent clinical trial in the Republic of the Marshall Islands, children 6 to 15 months old were given oral doses of xylitol in fruit-flavored syrup daily to determine whether the substance can prevent early-childhood tooth decay, or "caries".
Researchers reported that nearly 76% of the children in the group who received xylitol were free of tooth decay by the end of the study, compared with 48% of the children in the group that did not receive the substance.
The Marshall Islands in the Pacific were chosen for the study because it is an area where childhood tooth decay is a serious public health problem. The average child entering Head Start at age 5 has 6.8 cavities—two to three times the rate in a typical mainland community. Researchers came from the Northwest/Alaska Center to Reduce Oral Health Disparities and the Department of Dental Public Health Sciences at the University of Washington, Seattle.
Xylitol can be administered in the form of chewing gum, lozenges, or syrup. The U.S. Food and Drug Administration has approved xylitol's use in food since 1963 and classifies the substance as safe.
According to researchers, at the end of the trial nearly 76% of the children in the study group were caries-free, compared with 48% in a comparable group that did not receive treatment.
Xylitol is a five-carbon sugar alcohol that is used as a sugar substitute.
In a recent clinical trial in the Republic of the Marshall Islands, children 6 to 15 months old were given oral doses of xylitol in fruit-flavored syrup daily to determine whether the substance can prevent early-childhood tooth decay, or "caries".
Researchers reported that nearly 76% of the children in the group who received xylitol were free of tooth decay by the end of the study, compared with 48% of the children in the group that did not receive the substance.
The Marshall Islands in the Pacific were chosen for the study because it is an area where childhood tooth decay is a serious public health problem. The average child entering Head Start at age 5 has 6.8 cavities—two to three times the rate in a typical mainland community. Researchers came from the Northwest/Alaska Center to Reduce Oral Health Disparities and the Department of Dental Public Health Sciences at the University of Washington, Seattle.
Xylitol can be administered in the form of chewing gum, lozenges, or syrup. The U.S. Food and Drug Administration has approved xylitol's use in food since 1963 and classifies the substance as safe.
According to researchers, at the end of the trial nearly 76% of the children in the study group were caries-free, compared with 48% in a comparable group that did not receive treatment.
Xylitol is a five-carbon sugar alcohol that is used as a sugar substitute.
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