New study supports the effectiveness of the ForsythKids school-based dental program for reducing untreated tooth decay

 

FORSYTH INSTITUTE

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IMAGE: TOOTH DECAY IS THE MOST COMMON CHRONIC EARLY CHILDHOOD DISEASE IN THE UNITED STATES. MORE THAN HALF OF CHILDREN AGED 6-8 YEARS OLD HAVE HAD A CAVITY, AND KIDS FROM... view more 

CREDIT: FORSYTH INSTITUTE

In a longitudinal study published earlier this month in the Journal of the American Dental Association, researchers analyzed untreated decay in a cohort of nearly 7,000 children enrolled in the ForsythKids preventive dentistry program. Over the course of six years, the percentage of children with untreated cavities in the program decreased from 39 to 19 percent, suggesting that school-based prevention programs are effective in combating childhood dental disease.

Tooth decay is the most common chronic early childhood disease in the United States. More than half of children aged 6-8 years old have had a cavity, and kids from low-income families are twice as likely to suffer from untreated tooth decay as their higher-income peers.

To address this critical unmet need, the ForsythKids mobile dental program has provided preventive oral health care to children and teens at schools, community centers, and other sites across Massachusetts since 2003.

Researchers from the Forsyth Institute analyzed data from students at 33 public elementary schools in Massachusetts, all of which are classified as Title I, with high numbers of children from low-income families. The ForsythKids dental team provided comprehensive preventative oral health care twice per year, which includes dental examinations, dental cleanings, sealants, fluoride varnish, toothbrushes, toothpaste, oral hygiene instruction, and referrals to community dentists as needed. ForsythKids provides care at no cost to the patients or participating sites.

School-based dental treatment helps families overcome common barriers to accessing care, says Dr. Helen Nguyen, the Public Health Dentist for the ForsythKids program.

"Parents are often working a day job, a night job, another job in between," Dr. Nguyen says. "If they take time off work to bring their child to the dentist, they could lose money or lose their job."

Many parents are also under the impression that a dental visit is cost-prohibitive, or that their child would need to miss a full day of school to visit a dental office, Dr. Nguyen says, even though many of the schools are within a few blocks of a community health center that offers pediatric dental care.

With schools temporarily closed due to the COVID-19 pandemic, the ForsythKids program has been unable to see most of the children in over a year. Dr. Nguyen worries this has exacerbated the problem of untreated dental decay.

"For about half of these kids, we're their only source of preventive dental care. This could mean that no one has an eye on their dental needs." Dr. Nguyen says. "We know these communities need us."

People with severe gum disease may be twice as likely to have increased blood pressure

 

Hypertension journal report

AMERICAN HEART ASSOCIATION

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DALLAS, March 29, 2021 -- Adults with periodontitis, a severe gum infection, may be significantly more likely to have higher blood pressure compared to individuals who had healthy gums, according to new research published today in Hypertension, an American Heart Association journal.

Previous studies have found an association between hypertension and periodontitis, however, research confirming the details of this association is scarce. Periodontitis is an infection of the gum tissues that hold teeth in place that can lead to progressive inflammation, bone or tooth loss. Prevention and treatment of periodontitis is cost effective and can lead to reduction of systemic markers of inflammation as well as improvement in function of the endothelium (thin membrane lining the inside of the heart and blood vessels).

"Patients with gum disease often present with elevated blood pressure, especially when there is active gingival inflammation, or bleeding of the gums," said lead study author Eva Muñoz Aguilera, D.D.S., M.Clin.Dent., senior researcher at UCL Eastman Dental Institute in London, United Kingdom. "Elevated blood pressure is usually asymptomatic, and many individuals may be unaware that they are at increased risk of cardiovascular complications. We aimed to investigate the association between severe periodontitis and high blood pressure in healthy adults without a confirmed diagnosis of hypertension."

The study included 250 adults with generalized, severe periodontitis (?50% of teeth measured with gum infection) and a control group of 250 adults who did not have severe gum disease, all of whom were otherwise healthy and had no other chronic health conditions. The median age of the participants was 35 years, and 52.6% were female. The research was completed in collaboration with the department of dentistry at the Universitat Internacional de Catalunya in Barcelona, Spain.

All participants underwent comprehensive periodontal examinations including detailed measures of gum disease severity, such as full-mouth dental plaque, bleeding of the gums and the depth of the infected gum pockets. Blood pressure assessments were measured three times for each participant to ensure accuracy. Fasting blood samples were also collected and analyzed for high levels of white blood cells and high sensitivity C-reactive protein (hsCRP), as both are markers of increased inflammation in the body. Additional information analyzed as confounders included family history of cardiovascular disease, age, body mass index, gender, ethnicity, smoking and physical activity levels.

The researchers found that a diagnosis of gum disease was associated with higher odds of hypertension, independent of common cardiovascular risk factors. Individuals with gum disease were twice as likely to have high systolic blood pressure values ?140 mm Hg, compared to people with healthy gums (14% and 7%, respectively). Researchers also found:

• The presence of active gum inflammation (identified by bleeding gums) was associated with higher systolic blood pressure.
• Participants with periodontitis exhibited increased glucose, LDL ("bad" cholesterol), hsCRP and white blood cell levels, and lower HDL ("good" cholesterol) levels compared to those in the control group.
• Nearly 50% of participants with gum disease and 42% of the control group had blood pressure values for a diagnosis of hypertension, defined as ?130/80 mmHg.

"This evidence indicates that periodontal bacteria cause damage to the gums and also triggers inflammatory responses that can impact the development of systemic diseases including hypertension," said corresponding author Francesco D'Aiuto, D.M.D., M.Clin.Dent., Ph.D., professor of periodontology and head of the periodontology unit at the UCL Eastman Dental Institute. "This would mean that the link between gum disease and elevated blood pressure occurs well before a patient develops high blood pressure. Our study also confirms that a worryingly high number of individuals are unaware of a possible diagnosis of hypertension."

D'Aiuto added, "Integration of hypertension screening by dental professionals with referrals to primary care professionals and periodontal disease screening by medical professionals with referrals to periodontists could improve detection and treatment of both conditions to improve oral health and reduce the burden of hypertension and its complications. Oral health strategies such as brushing teeth twice daily are proven to be very effective in managing and preventing the most common oral conditions, and our study's results indicate they can also be a powerful and affordable tool to help prevent hypertension."

This study did not account for other factors that may also impact blood pressure, such as abdominal obesity, salt intake, use of anti-inflammatory medications, hormone treatments or stress, or any other oral health conditions.

Researchers discover why cold induces tooth pain and hypersensitivity -- and how to stop it

Odontoblasts, the cells that form a tooth's dentin, have a newly discovered function: Sensing cold, which can trigger pain in teeth; but scientists have also found a way to block the pathway to cold-sensitive teeth

MASSACHUSETTS GENERAL HOSPITAL

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IMAGE: THIS ARTIST'S ILLUSTRATION DEPICTS HOW, CENTURIES AGO, PEOPLE BELIEVED THAT SMALL WORMS LIVING WITHIN THE TOOTH CAUSED EXCRUCIATING PAIN VIA THEIR COLD BREATH. PROOF OF TOOTH WORMS CAME WHEN AN... view more 

CREDIT: COPYRIGHT KATHARINA ZIMMERMANN, MD, PHD

BOSTON -- Researchers report in Science Advances that they have uncovered a new function for odontoblasts, the cells that form dentin, the shell beneath the tooth's enamel that encases the soft dental pulp containing nerves and blood vessels. "We found that odontoblasts, which support the shape of the tooth, are also responsible for sensing cold," says pathologist Jochen Lennerz, MD, PhD, one of the paper's senior authors and medical director of the Center for Integrated Diagnostics at Massachusetts General Hospital (MGH). "This research contributes a new function to this cell, which is exciting from a basic-science standpoint. But we now also know how to interfere with this cold-sensing function to inhibit dental pain."

Teeth that hurt from exposure to cold can occur for many reasons. Many people have experienced intense pain from cold when they have a hole in a tooth from an untreated cavity, for example. But teeth can also become very sensitive to cold from gum erosion due to aging. Some cancer patients treated with platinum-based chemotherapies have extreme cold sensitivity all over their bodies. "A breeze on the face registers as extreme pain in the teeth, which may even cause some patients to stop therapy," says Lennerz.

Tooth pain has been notoriously difficult to study. A tooth's hardness makes it a challenging tissue to study and inducing tooth pain in humans requires opening the tooth. The team of researchers, therefore, conducted experiments on mice whose molars were drilled under anesthesia. Mice with dental injuries manifest pain with their behavior; they drink up to 300% more sugar water than their litter mates without dental injuries, for example. In previous research, the team of investigators had discovered TRCP5, a protein encoded by the TRCP5 gene that is expressed in nerves in many parts of the body. Their earlier discovery allowed the researchers to zero in on TRCP5 as a mediator of pain from cold.

By studying genetically altered mice that did not have the TRCP5 gene, the researchers found that the mice with injured teeth did not manifest the increased drinking behavior and behaved like mice without dental injuries.

"We now have definitive proof that the temperature sensor TRCP5 transmits cold via the odontoblast and triggers nerves to fire, creating pain and cold hypersensitivity," says Lennerz. "This cold sensitivity may be the body's way to protect a damaged tooth from additional injury."

Specifically, in response to cold, the TRCP5 protein opens channels in the membrane of odontoblasts, enabling other molecules, such as calcium, to enter and interact with the cell. If the tooth's pulp is inflamed from a deep cavity, for example, TRCP5 is overabundant, causing increased electrical signaling via the nerves emerging from the root of the tooth and running to the brain, where pain is perceived. When gums recede from aging, teeth can become hypersensitive because the odontoblasts are sensing cold in a newly exposed region of the tooth. "Most cells and tissues slow their metabolism in the presence of cold, which is why donor organs are put on ice," says Lennerz. "But TRPC5 makes cells more active in cold, and the odontoblasts' ability to sense cold via TRPC5 makes this discovery so exciting."

Lennerz confirmed the presence of the TRPCS protein in extracted human teeth, which was a technical tour de force. "Our teeth aren't meant to be cut into ultra-thin layers so they can be studied under the microscope," says Lennerz, who first had to decalcify the teeth and put them in epoxy resin before slicing them and identifying the TRPC5 channels in the odontoblasts.

The research team also identified a pharmacological target for minimizing tooth sensitivity to cold. For centuries, oil of cloves has been used as a remedy for tooth pain. The active agent in oil of cloves is eugenol, which happens to block TRCP5. Toothpastes containing eugenol are already on the market, but the findings of this study may lead to more potent applications to treat teeth that are hypersensitive to cold. And there may be novel applications for eugenol, such as treating patients systemically for extreme cold sensitivity from chemotherapy. "I'm excited to see how other researchers will apply our findings," says Lennerz.

Modifying an implant: Dental implant biomaterials

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Announcing a new article publication for BIO Integration journal. In this review article the authors Oliver K. Semisch-Dieter, Andy H. Choi and Martin P. Stewart from the University of Technology Sydney, Ultimo, NSW, Australia discuss the use of biomaterials in dental implants.

Biomaterials have become essential for modern implants. A suitable implant biomaterial integrates into the body to perform a key function, whilst minimizing negative immune response. Focusing on dentistry, the use of dental implants for tooth replacement requires a balance between bodily response, mechanical structure and performance, and aesthetics. The authors address the use of biomaterials in dental implants with significant comparisons drawn between Ti and zirconia.

Attention is drawn to optimizing surface modification processes and the additional use of coatings. Alternatives and novel developments are addressed, providing potential implications of combining biomaterials to form novel composites that combine and synergize the benefits of each material.

Article reference: Oliver K. Semisch-Dieter, Andy H. Choi and Martin P. Stewart, Modifying an Implant: A Mini-review of Dental Implant Biomaterials. BIO Integration, 2021, https://doi.org/10.15212/bioi-2020-0034

BIO Integration is fully open access journal which will allow for the rapid dissemination of multidisciplinary views driving the progress of modern medicine.

As part of its mandate to help bring interesting work and knowledge from around the world to a wider audience, BIOI will actively support authors through open access publishing and through waiving author fees in its first years. Also, publication support for authors whose first language is not English will be offered in areas such as manuscript development, English language editing and artwork assistance.

New survey finds stress-related dental conditions continue to increase

More than 70 percent of dentists surveyed by the American Dental Association (ADA) Health Policy Institute are seeing an increase of patients experiencing teeth grinding and clenching, conditions often associated with stress. This is an increase from ADA data released in the fall that showed just under 60 percent of dentists had seen an increase among their patients.

"Our polling has served as a barometer for pandemic stress affecting patients and communities seen through the eyes of dentists," said Marko Vujicic, Ph.D., chief economist and vice president of the ADA Health Policy Institute. "The increase over time suggests stress-related conditions have become substantially more prevalent since the onset of COVID-19."

The survey also found a little more than 60 percent of dentists saw an increase in other stress-related dental conditions including chipped and cracked teeth and TMD (temporomandibular joint disorder) symptoms such as headaches and jaw pain.

"As the pandemic continues, dentists are seeing stress-related dental conditions more and more," said Marcelo Araujo, D.D.S., M.S., Ph.D., ADA chief science officer. "It's more important than ever for people to maintain their dental health, including seeing the dentist regularly to address any issues that could have long-term impact."

Despite speculation from recent news reports that frequent mask-wearing may impact dental health and cause "mask mouth," the survey found no meaningful change in the prevalence reported for conditions such as bad breath and dry mouth compared to pre-pandemic.

Presence and prevalence of salivary gland ectasia and oral disease in COVID-19 survivors

INTERNATIONAL & AMERICAN ASSOCIATIONS FOR DENTAL RESEARCH

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Alexandria, Va., USA -- The clinical picture of COVID-19 in various target organs has been extensively studied and described, but relatively little is known about the characteristics of oral cavity involvement. The study "Frequent and Persistent Salivary Gland Ectasia and Oral Disease After COVID-19" published in the Journal of Dental Research (JDR), investigated the presence and prevalence of oral manifestations in COVID-19 survivors.

Researchers at the Università Vita Salute San Raffaele, Milan, Italy, profiled the oral involvement in 122 COVID-19 survivors, hospitalized and followed up at a single referral visit after a median 104 days from hospital discharge. The researchers found that oral manifestations, specifically salivary gland ectasia, were unexpectedly common being detectable in 83.9% and 43% of COVID-19 survivors, respectively. Salivary glands were defined as being ectasic when they appeared swollen, with a patent duct, and no pus leaking. Salivary gland ectasia reflected the hyperinflammatory response to SARS-CoV-2, as demonstrated by the significant relationship with C-reactive protein and lactate dehydrogenase (LDH) levels at hospital admission, and with the use of antibiotics during acute disease. Both LDH levels and antibiotic administration survived as independent predictors of salivary gland ectasia in a multivariable analysis. Temporomandibular joint abnormalities, facial pain and masticatory muscle weakness were also common.

"This retrospective and prospective cohort study of COVID-19 survivors revealed that residual damage of the oral cavity persists in the vast majority of the more severely affected patients far beyond clinical recovery," said JDR Editor-in-Chief Nicholas Jakubovics, Newcastle University, England. "This suggests that the oral cavity represents a preferential target for SARS-CoV-2 infection. Further studies are needed to clarify the connection between SARS-CoV-2 infection and oral disorders."

School-based dental program reduces cavities by more than 50%

 

Study of nearly 7,000 elementary school students demonstrates success of school-based model and its potential to reduce health disparities and save federal dollars

NEW YORK UNIVERSITY

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IMAGE: A NEW STUDY FINDS THAT SCHOOL-BASED DENTAL CARE REDUCES CAVITIES BY MORE THAN 50 PERCENT. view more 

CREDIT: ©SOREL: COURTESY OF NYU PHOTO BUREAU

A school-based cavity prevention program involving nearly 7,000 elementary school students reduced cavities by more than 50 percent, according to a study led by researchers at NYU College of Dentistry. The findings are published March 1 in the Journal of the American Dental Association.

"The widespread implementation of oral health programs in schools could increase the reach of traditional dental practices and improve children's oral health--all while reducing health disparities and the cost of care," said Richard Niederman, DMD, professor and chair of the Department Epidemiology & Health Promotion at NYU College of Dentistry and the study's senior author.

Dental cavities are the most common chronic disease in children, and one in five elementary school children have at least one untreated cavity. While cavities can be prevented with dental visits and good at-home oral hygiene, some families experience barriers to seeing a dentist, including cost and parents having to take time off of work.

"School-based cavity prevention programs eliminate these barriers by bringing basic dental care to children, rather than bringing children to care," said Niederman.

The study was conducted in 33 public, high-need elementary schools in Massachusetts, where dental hygienists provided care to 6,927 children. The services were provided at no cost to families.

Twice-yearly visits involved dental examinations followed by cavity prevention and treatment, including fluoride varnish, sealants, and minimally invasive fillings to stabilize cavities without drilling. Students also received oral hygiene instructions, toothbrushes, and fluoride toothpaste to take home. If more complex care was required, students were referred to local dentists. Notably, the procedures used do not create aerosols, which limits the risk of transmitting viruses through the air.

After six visits, the prevalence of untreated cavities decreased by more than 50 percent. In one group of schools, cavities were reduced from a baseline of 39 percent to 18 percent, and in a second group, cavities decreased from 28 percent to 10 percent. The prevention program reduced cavities in both baby and permanent teeth.

"In 2010, the federal government set a goal of reducing the prevalence of cavities in children by 10 percent by 2020. Our study shows that this is not only feasible, but also that a comprehensive school-based program can reduce cavities by five times their goal," said Niederman.

Recent economic analyses of school-based cavity prevention programs by researchers at NYU College of Dentistry, including one focusing on this program in Massachusetts, demonstrate that they are cost-effective and could save federal dollars. If this school-based program was implemented nationally, it could reduce Medicaid spending on children's oral health by as much as one-half.

The COVID-19 pandemic has interrupted most school-based dental care because of school closures and fear of creating aerosols, even as oral health care in dental practices has safely resumed with additional infection control measures in place. The researchers stress the importance of safely continuing school-based care, given its ability to prevent cavities using aerosol-free procedures.