Oral cancer detection by dentists is significantly on the rise

After examining data gathered over an 11-year period in a first-of-its-kind provincial study, University of Toronto clinician-scientist Marco Magalhaes has one vital message: dentists in Ontario are detecting more cases of oral cancer and pre-cancer than ever before -- and it's saving lives.
Magalhaes, lead author of the study that appears in the Journal of the American Dental Association, is an assistant professor at the University of Toronto's Faculty of Dentistry, and one of the oral pathologists at the Toronto Oral Pathology Service (TOPS). Operated by the Faculty of Dentistry, TOPS is one of the largest oral pathology services in Canada, which provides comprehensive evaluation of biopsy specimens -- the overwhelming majority of which are submitted by dentists.
For the study, Magalhaes looked at 63,483 biopsies submitted to the service between 2005 and 2015. "We wanted to look at the scope of oral biopsies performed by dentists, what they're seeing in practice," says Magalhaes of the study's design. The biopsy data from TOPS were then compared to numbers collected by the Ontario Cancer registry, Cancer Care Ontario, which tracks all reported cancers in the province.
Surprisingly, the data showed a steep rise in the overall numbers of carcinomas (oral cancers) and dysplasia (pre-cancerous lesions) detected by dentists.
Overall, 828 cases of oral cancer were diagnosed by the U of T oral pathology service between 2005 to 2015, along with 2,679 premalignant lesions. But over time, the percentage of oral cancer detection by oral health professionals rose significantly. In 2005, only 56 cases of oral cancer and 99 cases of oral epithelial dysplasia were detected through biopsy.
By 2015, though, the number of cancers detected through the biopsy service had nearly doubled, rising to 103 cases of oral cancer. Dysplasia cases more than tripled from 2005, rising to 374 cases.
"These numbers are important, because the number of diagnosed cases outpaced both the rise in population in Ontario and the increased number of dentists licensed in Ontario," says Magalhaes.
In fact, the number of cases detected at TOPS was significantly higher than the overall increase of oral cancers recorded in the province over that same period -- just 30 per cent -- compared to the 180 per cent rise at TOPS. Cancer Care Ontario identified a total of 9,045 cases of oral cancer between 2005 and 2015.
So what does it all mean? For one, argues Magalhaes, dentists in Ontario are playing an important role in detecting the deadly disease.
And more comprehensive training and continuing education programs for oral health professionals may be behind the dramatic rise in detection rates. While advanced oral cancers are fairly easy to detect, says Magalhaes, premalignant lesions and early cancer can be easy to miss without specialized training. Early detection of oral cancers, meanwhile, is "critical" to survival rates, he explains.
Calling the Toronto Oral Pathology service "extraordinary," Michael Glogauer, acting chief dentist at the Princess Margaret Cancer Centre and professor at the University of Toronto's Faculty of Dentistry, agrees that strong training is likely playing a role in the higher detection rates.
"The focus on oral cancer education thought the universities and continuing education in the area of cancer has led to the increased surveillance by dentists, and validates the focus that the dentists in this province are placing on this important health initiative," says Glogauer.
Tracking precancerous links
An added dimension of the data collected in this study is that researchers may learn to pinpoint which -- and how many -- precancerous lesions will, over time, turn cancerous. While the data of the study provide evidence that TOPS was involved in the diagnosis of approximately 10 per cent of all oral cancers in the province, it also demonstrates a dramatic increase in the number of precancerous lesions identified by these health care providers.
Importantly, the provincial cancer agency does not keep statistical data on precancerous lesions, making the TOPS biopsy data especially relevant in the hunt to discover which premalignant lesions will become cancers.
"This is the first time that we have assessed dysplasia detected by dentists over such a long period of time," says Magalhaes.
Early detection is key
Oral cancer survival rates have remained steady over the past several decades. What that means, says Magalhaes, is that "advancements in treatment have minimally improved survival rates." Yet, treated in its early stages, patients with oral cancer have the highest survival rates: around 80 per cent over five years. That statistic drops to approximately 30 per cent over five years when the cancer is detected at an advanced stage.
"This supports the fact that early detection really is the most important step here," Magalhaes adds. And, as the study suggests, regular check-ups at the dentist's office may be our best line of defense.

Dentists can be the first line of defense against domestic violence

The University of Arizona College of Medicine - Phoenix and Midwestern University have published an article to bring to light the important role dentists can play in identifying domestic violence victims.
Published April 11 in the Journal of Aggression, Maltreatment and Trauma, the article reports that as much as 75 percent of head and neck trauma associated with domestic violence occurs with oral injury. Researchers concluded that dentists are in the unique position to be the first line of defense in identifying evidence of assault, and then reporting potential cases of domestic violence.
"The overall purpose of the paper is to bring dentistry and its subspecialties into the conversation about traumatic brain injury (TBI), specifically in cases of domestic violence," said Midwestern University dental student Timothy Ellis, lead author of the study.
"In our society, and others around the world, domestic violence is more common than many would suspect. Survivors recount 'too many times to remember' that they were abused and blacked out or were struck in the head. Thus, oral and facial trauma may be treated or identified by dentists and dental sub-specialists, opening another avenue for patients to gain access to proper care or needed assistance."
Ellis and Jonathan Lifshitz, PhD, director of the Translational Neurotrauma Research Program at the UA College of Medicine - Phoenix, reported an estimated 41.5 million individuals who will experience some type of domestic violence during their lifetime, and 20.75 million will sustain a TBI. Of the victims that sustain a TBI, 8.3 million will live with some form of long-term physiological or psychological consequences of the injury, they said.
"This is a societal need and we have to call on all health care providers and mandatory reporters to join the fight," Dr. Lifshitz said. "This paper is creating additional touchpoints between victims and the health-care delivery system. It is an opportunity for dentists to be early detectors who can refer those individuals for follow-up care."
The oral biomarkers that could help dentists potentially identify domestic violence victims include tears, fractures, breaks and chips in the teeth and mouth that would be inconsistent with personal history and, therefore, raise the index of suspicion. Obvious signs of violence that may indicate brain injury include jaw or tooth fractures, trauma to nerves in the mouth and jaw, as well as damage to the nasal bone. Tooth discoloration, blunted roots and pulpal necrosis, which is the death of cells and tissues in the center of a tooth, also may be signs of a previous dental trauma warranting further investigation.
According to the publication, dentists receive little to no education about identifying and discussing domestic violence with potential victims, yet they may be the first and only health professional to evaluate a domestic violence victim.
"I have spoken with several dentists regarding the topic," Ellis said. "Many find it interesting, however, they have little experience. The most common answer I receive is that they had just never thought about it or believed that such a case would be more likely to present in a medical facility and thus, it does not cross their mind when interacting with patients on a daily basis. That said, many dentists are intrigued by the topic and the response has been positive. It is interesting that very stringent protocols exist in pediatric dentistry, but a large gap exists when dealing with teens, young adults and adults in general."
Sheri Brownstein, DMD, director of preclinical faculty at the Midwestern University College of Dental Medicine - Arizona and a co-author of the study, said that as a dentist, she always is sensitive to head and neck injuries and behaviors and how these may be a sign of domestic violence, but never thought of the oral biomarkers as they relate to traumatic brain injury and domestic violence.
"All dentists should be educated on the identification of potential injuries sustained as a result of domestic violence," she said. "As health-care providers, we are already obligated to report suspected abuse. I do not feel that this will add an undue burden to dentists."

Ellis said next steps may include collecting data from dentists to document oral biomarkers of injury. He continues these queries with the objective to help at least one patient and their situation.

Common oral infections in childhood may increase the risk of atherosclerosis in adulthood

The association between childhood oral infections and adulthood carotid atherosclerosis was observed in The Cardiovascular Risk in Young Finns Study, an ongoing prospective cohort.
"The observation is novel, since there are no earlier follow-up studies on childhood oral infections and the risk of cardiovascular diseases," says docent Pirkko Pussinen from the University of Helsinki.
More progressed oral infections and inflammations - endodontic lesions and periodontitis - are known to be associated with several cardiovascular risk factors and disease risk in adults. In adults periodontitis in particular has been studied extensively, and currently it is considered an independent risk factor for atherosclerotic vascular diseases. The treatment of periodontitis is also known to decrease cardiovascular risk factors.
The association between childhood oral infections and atherosclerosis was found in a study conducted at the University of Helsinki, Department of Oral and Maxillofacial Diseases, in collaboration with the national Cardiovascular Risk in Young Finns Study research group. The study was published in JAMA Network Open.
The study was initiated in 1980, when clinical oral examinations were conducted for 755 children aged 6, 9, and 12 years. The follow-up ended in 2007, when the carotid artery intima-media thickness was measured in an ultrasound examination of participants, who were then 33, 36, and 39 years old.
The follow-up was 27 years, and cardiovascular risk factors were measured at several time points. A cumulative exposure to the risk factor was calculated in both childhood and adulthood. The signs of oral infections and inflammation collected in the study included caries, fillings, bleeding on probing, and probing pocket depth.
THE MORE SIGNS OF ORAL INFECTIONS, THE HIGHER RISK FOR ATHEROSCLEROSIS From all children, 68%, 87%, and 82% had bleeding, caries, and fillings, respectively. There were no differences between the boys and the girls. Slight periodontal pocketing was observed in 54% of the children, and it was more frequent in the boys than in the girls. Only 5% of the examined mouths were totally healthy, whereas 61% and 34% of the children had one to three signs and four signs of oral infections, respectively.
"The number of signs associated significantly with the cumulative exposure to the cardiovascular risk factors in adulthood, but especially in childhood," says professor Markus Juonala from the University of Turku.
Both caries and periodontal diseases in childhood were significantly associated with carotid artery intima-media thickness in adulthood. Thickening of the carotid artery wall indicates the progression of atherosclerosis and an increased risk for myocardial or cerebral infarction.
The researchers emphasise, in conclusion: "Oral infections were an independent risk factor for subclinical atherosclerosis; and their association with cardiovascular risk factors persevered through the entire follow-up. Prevention and treatment of oral infections is important already in childhood."

Nursing, dental, and medical students train together to improve kids' oral health \

Team-based clinical experiences help health professionals develops skills for working together

New York University

Nursing, medical, and dental students can work as a team to improve their knowledge of pediatric oral health--and how to work with their fellow health professionals, finds new research led by NYU Rory Meyers College of Nursing. The study appears in the Journal of Dental Education.
Cavities are the most common chronic childhood disease. Over the past two decades, reports and policies have called for pediatric primary care providers to incorporate oral health into their well visits, including screening and referring children to dentists. Despite these efforts, many primary care providers are not integrating oral health into patient visits, and some report feeling unprepared or uncomfortable in this role.
To improve interprofessional skills and collaboration between primary care and dental providers, NYU Meyers' Oral Health Nursing Education and Practice (OHNEP) program-which works to help nurses and other health professionals incorporate oral health into patient care--developed an innovative pediatric oral health clinical experience.
In the interprofessional experience, family nurse practitioner, medical, and dental students work as a team to assess patients. Together they review a patient's chart, take a patient's medical and dental history, perform an oral assessment, apply fluoride varnish, and educate children and parents. Students also learn to identify the connection between oral health and overall health--for instance, how certain diseases or medications can affect oral health. The goal is to increase the oral health knowledge and skills of non-dental primary care providers while boosting dental students' knowledge about the link between oral and systemic health.
"Collaborative, workplace-ready students are valuable assets to any clinical team. Our goal is for team-based, whole person care to become the norm for promoting children's oral health and preventing cavities," said Erin Hartnett, DNP, PPCNP-BC, CPNP, director of OHNEP at NYU Meyers and the study's lead author.
Over three semesters, a total of 162 family nurse practitioner, dental, and medical students participated in this interprofessional experience at a New York City hospital. Students completed surveys before and after their participation to evaluate whether their interprofessional competencies changed.
The researchers found that all students had significantly improved interprofessional competency scores after the team-based experience. This includes improvements in important factors for working with other professionals, such as communication, collaboration, conflict management, team functioning, and using a patient-centered approach.
"Our findings suggest that a team-based, clinical approach can be an effective strategy to help health professional students develop interprofessional competencies," said Judith Haber, PhD, APRN-BC, FAAN, the Ursula Springer Leadership Professor in Nursing at NYU Meyers, executive director of OHNEP, and the study's coauthor.
In addition to Hartnett and Haber, study authors include Peter Catapano of Bellevue Hospital Center, NYU School of Medicine, and NYU College of Dentistry; Nancy Dougherty, Amr Moursi, and Courtney Chinn of NYU College of Dentistry; Ramin Kashani of NYU College of Dentistry and Bellevue; Cindy Osman of NYU School of Medicine and Bellevue; and Abigail Bella of NYU Meyers.

Research shows remedy for painful jaw disease

A new treatment method could help cancer patients and others by eliminating an agonizing side effect called osteonecrosis of the jaw

University of Southern California

researchers and collaborators report a breakthrough to prevent damage to the jaw, a side effect suffered by some people undergoing treatment for cancer or osteoporosis.
The newly published research is an important step toward a cure for osteonecrosis of the jaw, which is a rare side effect caused by drugs commonly used to combat bone loss. It causes severe and persistent inflammation leading to loss of bone from the jaw and has no effective prevention or cure. The risk, though small, deters people from taking drugs needed to fight bone cancer or prevent fractures due to loss of bone density.
USC scientist Charles McKenna said the successful animal experiment, conducted by researchers at USC and UCLA, raises hope that physicians could adapt the new method to treat the condition in people.
"This is a condition that has been excruciatingly painful and difficult to treat for more than a decade," said McKenna, a professor of chemistry in the USC Dornsife College of Letters, Arts and Sciences and adjunct professor of pharmacology and pharmaceutical sciences in the USC School of Pharmacy. "We think our new approach may provide hope for the future", he said.
The new published findings appear in Bone. The authors are affiliated with the USC Center for Drug Discovery and Development at the Michelson Center for Convergent Bioscience, the UCLA School of Dentistry and a Pasadena-based startup biotech company, BioVinc LLC.
For years, physicians have prescribed a class of drugs called bisphosphonates (BPs) for metastatic bone cancer patients and to maintain bone density in osteoporosis patients. BPs include a range of compounds that share a remarkable ability to stick to bone like Velcro.
But when used in high doses in the cancer clinic, BP drugs sometimes have a terrible side effect causing necrosis in the jaw. The problem often occurs after a tooth is removed, the gap doesn't heal and the jaw begins to deteriorate.
Although the condition is very rare at the lower BP doses used to combat osteoporosis, many patients are avoiding the drugs altogether for fear of the side effects. The risk is low as the National Osteoporosis Foundation estimates incidence of osteonecrosis of the jaw due to BP used to treat osteoporosis to be between 1 in 10,000 and 1 in 100,000 people annually. Risk has been estimated to be much higher, about 3 percent of patients, at the BP dose used to treat cancer, McKennna said.
Nonetheless, more and more osteoporosis patients are willing to take their chances with the disease rather than risk the side effects. Surveys have shown the recent trend in reduced hip fractures among post-menopausal women may be reversing due to BP drug aversion.
"The fear factor of this condition has led to severe underuse of bisphosphonates for osteoporosis so much so that we're seeing a rise in hip fractures in elderly people, aversion to bisphosphonates in oncology clinics and liability concerns in the dental office," McKenna said.
To solve the problem, McKennna devised an elegant solution. The research team used a different BP compound, an inactive compound that could be used locally in the mouth to push the BP drug from the jawbone while leaving undisturbed the useful drug in the rest of the skeleton.
Said McKenna: "Think of it as a way to fight fire with fire."
The scientists involved in the study used mice to test different BPs attached to fluorescent dyes. One color label coded the BP zoledronate, which is administered systemically to treat osteoporosis and cancer, while a different color labeled "rescue BP" coded a BP compound with similar bone affinity, but no biological activity. The researchers discovered that rescue BP injected into the jaw removed most of the BP drug causing the jaw bone tissue damage, clearing the way for the animal's natural healing process to repair the extraction site.
The new technique isn't ready for clinical use in humans yet. McKenna said BioVinc, which provided funding for the study via a National Institutes of Health small business research grant, will be responsible for advancing the treatment to commercial clinical use. Several of the authors of the study disclose a financial interest in BioVinc, a company specializing in "bone targeted therapeutics and diagnostics." McKenna is the company's academic founder

Teeth whitening products can harm protein-rich tooth layer

Americans spend more than a billion dollars on teeth whitening products each year. Although these products can make smiles brighter, new research shows that they might also be causing tooth damage.
In three new studies, researchers found that hydrogen peroxide, the active ingredient in over-the-counter whitening strips, can damage the protein-rich dentin tissue found beneath the tooth's protective enamel.
Undergraduates working in the laboratory of Kelly Keenan, PhD, associate professor of chemistry at Stockton University in New Jersey, will present this research at the American Society for Biochemistry and Molecular Biology annual meeting during the 2019 Experimental Biology meeting to be held April 6-9 in Orlando, Fla.
The tooth is made of three layers: the outer tooth enamel, an underlying dentin layer and connective tissue that binds the roots to the gum. Most studies of whitening strips have focused on tooth enamel, which contains very little protein. Kennan's research team focuses on dentin, which makes up most of the tooth and has high levels of protein, most of which is collagen.
It is well established that hydrogen peroxide can penetrate the enamel and dentin. Previous work by the researchers showed that collagen in the dentin layer decreased when teeth were treated with whitening strips.
"We sought to further characterize what the hydrogen peroxide was doing to collagen," said Keenan. "We used entire teeth for the studies and focused on the impact hydrogen peroxide has on the proteins."
In the new work, the researchers demonstrated that the major protein in the dentin is converted to smaller fragments when treated with hydrogen peroxide. In additional experiments, they treated pure collagen with hydrogen peroxide and then analyzed the protein using a gel electrophoresis laboratory technique that allows the protein to be visualized.
"Our results showed that treatment with hydrogen peroxide concentrations similar to those found in whitening strips is enough to make the original collagen protein disappear, which is presumably due to the formation of many smaller fragments," said Keenan.
The researchers point out that their experiments did not address whether collagen and other proteins in the teeth can be regenerated, so it is unknown if the tooth damage is permanent. Next, they plan to further characterize the protein fragments released when collagen is treated with hydrogen peroxide and determine if hydrogen peroxide has the same impact on other proteins in the teeth.

Gum bacteria implicated in Alzheimer's and other diseases S

IMAGE: The mouth of a person with severe gum disease. Bacteria involved in periodontitis have been linked with Alzheimer's disease, aspiration pneumonia, rheumatoid arthritis and other common disorders. view more 

Credit: Image courtesy of Jan Potempa, University of Louisville.

Orlando, Fla. (April 7, 2019) - Researchers are reporting new findings on how bacteria involved in gum disease can travel throughout the body, exuding toxins connected with Alzheimer's disease, rheumatoid arthritis and aspiration pneumonia. They detected evidence of the bacteria in brain samples from people with Alzheimer's and used mice to show that the bacterium can find its way from the mouth to the brain.
The bacterium, Porphyromonas gingivalis, is the bad actor involved in periodontitis, the most serious form of gum disease. These new findings underscore the importance of good dental hygiene as scientists seek ways to better control this common bacterial infection.
"Oral hygiene is very important throughout our life, not only for having a beautiful smile but also to decrease the risk of many serious diseases," said Jan Potempa, PhD, DSc, a professor at the University of Louisville School of Dentistry and head of the department of microbiology at Jagiellonian University in Krakow, Poland. "People with genetic risk factors that make them susceptible to rheumatoid arthritis or Alzheimer's disease should be extremely concerned with preventing gum disease."
While previous researchers have noted the presence of P. gingivalis in brain samples from Alzheimer's patients, Potempa's team, in collaboration with Cortexyme, Inc., offers the strongest evidence to date that the bacterium may actually contribute to the development of Alzheimer's disease. Potempa will present the research at the American Association of Anatomists annual meeting during the 2019 Experimental Biology meeting, held April 6-9 in Orlando, Fla.
The researchers compared brain samples from deceased people with and without Alzheimer's disease who were roughly the same age when they died. They found P. gingivalis was more common in samples from Alzheimer's patients, evidenced by the bacterium's DNA fingerprint and the presence of its key toxins, known as gingipains.
In studies using mice, they showed P. gingivalis can move from the mouth to the brain and that this migration can be blocked by chemicals that interact with gingipains. An experimental drug that blocks gingipains, known as COR388, is currently in phase 1 clinical trials for Alzheimer's disease. Cortexyme, Inc. and Potempa's team are working on other compounds that block enzymes important to P. gingivalis and other gum bacteria in hopes of interrupting their role in advancing Alzheimer's and other diseases.
The researchers also report evidence on the bacterium's role in the autoimmune disease rheumatoid arthritis, as well as aspiration pneumonia, a lung infection caused by inhaling food or saliva.
"P. gingivalis's main toxins, the enzymes the bacterium need to exert its devilish tasks, are good targets for potential new medical interventions to counteract a variety of diseases," said Potempa. "The beauty of such approaches in comparison to antibiotics is that such interventions are aimed only at key pathogens, leaving alone good, commensal bacteria, which we need."
P. gingivalis commonly begins to infiltrate the gums during the teenage years. About one in five people under age 30 have low levels of the bacterium in their gums. While it is not harmful in most people, if it grows to large numbers the bacteria provoke the body's immune system to create inflammation, leading to redness, swelling, bleeding and the erosion of gum tissue.
Making matters worse, P. gingivalis even causes benign bacteria in the mouth to change their activities and further increase the immune response. Bacteria can travel from the mouth into the bloodstream through the simple act of chewing or brushing teeth.
The best way to prevent P. gingivalis from growing out of control is by brushing and flossing regularly and visiting a dental hygienist at least once a year, Potempa said. Smokers and older people are at increased risk for infection. Genetic factors are also thought to play a role, but they are not well understood.

Dentists underdiagnose when faced with time pressure

Dentists can miss important details on x-rays when put under time pressure, according to new research led by the University of Plymouth.
The study, published in the Journal of Dentistry, showed that primary care dentists missed 67% of bone loss and 40% of tooth decay on a sample of dental x-rays, when given limited time to assess them. However, the 40 study participants diagnosed correctly, on average, all the pathologies related to bone loss and tooth decay correctly, when not faced with time pressure.
Dental x-rays are taken routinely by dentists to detect dental decay and loss of bone support around teeth (which is a sign of severe gum disease).
The study participants, all from dental practices in and around the south west of England, rated their stress levels as much higher in the time pressured situation than in without time pressure.
The research was led by Anastasios Plessas, Academic Clinical Fellow in Peninsula Dental School, in collaboration with the School of Psychology at the University of Plymouth.
He said: "I conducted this research as there are no other studies out there evaluating the performance of dentists under time pressure, and it's a really important issue.
"This work showed a significant deterioration of dentists' diagnostic performance when examining x-rays under time pressure. Diagnostic errors may put patient safety at risk. Underdiagnosis may lead patients to be needing more complex treatment in the future or even extraction of teeth unnecessarily. This study shows that we shouldn't be cutting appointment times in order to fit more people in, but looking at other ways to meet the patient needs."
The full study is entitled Impact of time pressure on dentists' diagnostic performance and is now available to view in the Journal of Dentistry (doi: 10.1016/j.jdent.2019.01.011).

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Media Contact
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More on this News Release

Dentists underdiagnose when faced with time pressure, research shows

University of Plymouth

Journal

Journal of Dentistry

Keywords

• DENTISTRY/PERIODONTAL DISEASE
• DIAGNOSTICS
• HEALTH CARE
• MEDICINE/HEALTH

Related Journal Article

http://dx.doi.org/10.1016/j.jdent.2019.01.011

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Anti-inflammatory plant-based diet helps reduce gingivitis

A plant-based whole food diet reduced gingivitis in a recent randomized trial published in the Journal of Clinical Periodontology.

For the trial, 30 patients with gingivitis were randomized to an experimental and a control group. The experimental group changed to a diet low in processed carbohydrates and animal proteins, and rich in omega-3 fatty acids, vitamin C, vitamin D, antioxidants, plant nitrates, and fibers for four weeks. The control group did not change their diet. All participants suspended the use of dental floss and other tools to clean between their teeth.

Although there were no differences regarding plaque values, the experimental group experienced a significant reduction in gingival bleeding. They also showed an increase in vitamin D values and weight loss.

"Study results clearly demonstrate the possibility to naturally reduce gingivitis by an optimized diet that also promotes general health. According to this, dental teams should address dietary habits and give adequate recommendations in the treatment of gingivitis, since it might be a side effect of a pro-inflammatory western diet," said lead author Dr. Johan Woelber, of the University of Freiburg, in Germany.

 

FDA proposes updated standards for fluoride added to bottled water to maximize health benefits while avoiding excess exposure

The U.S. Food and Drug Administration today released a proposed rule, “Proposed Rule to Revise the Allowable Level of Fluoride in Bottled Water to which Fluoride Has Been Added,” to lower the allowable level of fluoride in bottled water to which fluoride is added by the manufacturer to 0.7 mg/L to be consistent with the 2015 recommendation by the U.S. Public Health Service (PHS) for community water systems that add fluoride for the prevention of dental caries. This action ensures that consumers receive its dental benefits while avoiding unintentional excess exposure. If finalized, this rule will revise the current allowable levels of fluoride in domestically packaged and imported bottled water to which fluoride is added by the manufacturer. It will not affect the allowable levels for fluoride in bottled water to which fluoride is not added by the manufacturer (such as bottled water that may contain fluoride from its source water).

The FDA is issuing this proposed rule as part of a formal process to revise the standards for bottled water with added fluoride. If adopted, this rule will align with the recommended level of 0.7 mg/L set forth by PHS for municipal, community water in 2015. At that time, the FDA also advised the bottled water industry that the PHS’ recommendations should be considered for their products as well. That’s why many manufacturers of bottled water with added fluoride have already taken steps to reduce fluoride levels

“Fluoride provides an important public health benefit by helping to reduce cavities and tooth decay. But too much fluoride over a long time when teeth are forming under the gums can cause changes in the appearance of tooth enamel, called dental fluorosis. Striking the right balance is especially important for children under the age of 8 as their permanent teeth are still forming. It’s the FDA’s responsibility to ensure that if fluoride is added to bottled water, it is added at appropriate levels so that consumers receive its important health benefit while also being protected from potential adverse effects. That’s why today we are taking this step to lower the amount of fluoride in bottled water if added by manufacturers. This proposed rule would align the limits for fluoride with the updated recommendation by the U.S. Public Health Service for community water systems that add fluoride, a recommendation that provides an optimal balance between the prevention of dental caries and the risk of dental fluorosis,” said Susan Mayne, Ph.D., director of FDA’s Center for Food Safety and Applied Nutrition. “Most fluoride added to bottled water is already at or below the limit being proposed. Today’s action, if finalized, is a step toward helping to ensure that bottled water strikes the right fluoride balance by setting out requirements that manufacturers who add fluoride to bottled water must adhere to. By lowering the allowable level of fluoride in bottled water following its addition by the manufacturer, we can help ensure that consumers enjoy the important health benefits of fluoride while preventing overexposure.”

Dental Sealants for Caries Prevention

Complete report

Dental sealants applied in childhood can help prevent caries, but knowledge of the availability of sealants and their function is not widespread. We assessed knowledge of dental sealants among US adults and adult parents of children younger than 18 and the differences in knowledge among demographic and socioeconomic groups.
Methods
We used data on 3,550 respondents to the 2015 FallStyles B survey of noninstitutionalized US adults aged 18 or older. Authors constructed estimates by using weights provided to reflect the distribution of the US population. Knowledge of dental sealants was assessed by sex, age, race/ethnicity, education, household income, and parental status. Multivariate analysis was conducted by using a main effects logistic regression model.
Results
Overall, 46.3% of adults and 55.1% of parents of children younger than 18 had knowledge of dental sealants. Sealant knowledge was highest among parents, women, respondents aged 45 to 59, and respondents with incomes greater than 200% of the federal poverty level and more than a high school education. Non-Hispanic blacks had less than half the odds of non-Hispanic whites of having knowledge of sealants (adjusted odds ratio [OR] = 0.4), and nonparents had half the odds as parents (OR = 0.5) of knowing. The strongest predictors of parental sealant knowledge were race/ethnicity, sex, and income.
Conclusion
Disparities in sealant knowledge correspond to disparities in sealant prevalence. Increasing knowledge among low-income and racial/ethnic minority parents could reduce disparities in sealant prevalence and untreated caries.

Although largely preventable, dental caries is one of the most common chronic diseases among children and adolescents (1). National data from 2011 through 2014 show that approximately 18% of children aged 6 to 11 and 58% of children aged 12 to 19 in the United States had treated or untreated caries in their permanent teeth (2). Disparities in caries prevalence exist across races and ethnicities and family income levels, and prevalence is highest among minority and socio-economically disadvantaged populations (2). If left untreated, dental caries can cause pain, speech problems, and missed time from school (1).
About 90% of caries in permanent teeth occur in the posterior teeth (3). Dental sealants are widely recommended by professional health organizations (4,5) because they prevent about 90% of posterior caries one year after placement and about 50% 5 years after placement (6). Prevalence of sealant use in children aged 6 to 11 rose 12.4 percentage points from 1999–2004 to 2011–2014, from 31.1% to 43.6% (7). Children from low-income households (<185 20="" a="" about="" are="" children="" federal="" from="" higher="" households="" however="" income="" less="" level="" likely="" of="" p="" poverty="" receive="" sealant="" than="" the="" to=""> Recent attention to health literacy highlights the complex relationship between knowledge and actions that support health (8). A recent analysis of sealant prevalence in children found that among high income parents (≥100% of the federal poverty level), sealant prevalence increased with parental education (a proxy for health literacy) (9). Because oral health literacy is required to make informed health decisions and can affect receipt of services, determining public knowledge of the purpose of sealants is important. No national data characterize knowledge of sealants among all US adults and among parents of children younger than 18. We assessed knowledge of the purpose of sealants and the differences in knowledge among demographic and socioeconomic groups. Information from our study provides a baseline for future studies of sealant knowledge and can be used to identify need for promoting oral health education and increasing oral health literacy.