Dentists and dental hygienists on early front lines of COVID-19 report symptoms of anxiety, depression

The first known U.S. study to evaluate the mental health of frontline dentists and dental hygienists during the pandemic found that dental health care workers report anxiety and depression symptoms during peaks of transmission among the public.

Published jointly in the August issues of The Journal of the American Dental Association and the Journal of Dental Hygiene and available online at JADA.ada.org, the study indicates between June 2020 and June 2021, 17.7% of dental health care workers reported anxiety symptoms, 10.7% reported depression symptoms, and 8.3% reported symptoms of both. The one-year study conducted from June 2020 to June 2021, included 8,902 dental health care workers participating monthly in an anonymous longitudinal, web-based survey.

According to the findings, between June 2020 and June 2021, dental hygienists reported higher rates of depression symptoms than dentists at each surveyed time point, with depression symptom rates peaking in December 2020. Dental hygienists’ depression rates declined in 2021 as dentists’ rates of depression symptoms remained steady. At the end of the study period, both groups had relatively similar rates — 11.8% for dentists and 12.4% for hygienists.

“Interestingly, dental health care workers reported lower rates of anxiety and depression symptoms than the general public, despite being on the front lines and providing oral health care during the pandemic,” says author Stacey Dershewitz, J.D., Psy.D., Adjunct Professor of Clinical Psychology and Director of the Center Clinic at the George Washington University Professional Psychology Program. “As the pandemic continues, it is critically important that dental health care workers continue to develop their ability to recognize and address signs and symptoms of mental health conditions within themselves and their colleagues, promote healthy work environments, reduce the impact of stress on the profession, and make supports accessible to those who are struggling emotionally.”

Some participants’ anxiety symptoms decreased after receiving the COVID-19 vaccine. The study — also the first to examine the association between the COVID-19 vaccine and mental health — found that unvaccinated dental health care workers who intended to be vaccinated suffered significantly more anxiety symptoms (20.6%) compared to fully-vaccinated dental health care workers (14.1%). 

“The hope is that this is just the first of many steps in monitoring mental wellness of the entire oral care team,” says JoAnn Gurenlian, R.D.H, M.S., Ph.D, A.F.A.A.O.M., Director of Education and Research, American Dental Hygienists’ Association. “There is much work to be done to dismantle barriers to treatment and prioritize wellbeing in the oral care setting, as well as look at future research around contributing factors to mental illness that may be unique to these professions.”

The study is part of ongoing collaborative research efforts between the American Dental Association (ADA) and the American Dental Hygienists’ Associations (ADHA) to understand COVID-19’s impact on dental health care workers.

“As members of the dental profession, we are committed to improving the oral health of our patients and communities. Furthermore, as healthcare professionals, we must be committed to our own health and wellness to optimally care for others,” says study author Maria L. Geisinger, D.D.S, M.S., Professor and Director of the Advanced Education Program in Periodontology at the University of Alabama at Birmingham School of Dentistry. “Creating professional environments that allow for open communication about mental health among members of the dental team can reduce the stigma around mental health diagnoses and treatment for dental health care workers.”

AI technology to automate the process of denture design and enhance treatment efficiency without compromising accuracy

 

Loss of permanent teeth is usually caused by dental diseases or trauma and is common in the global population, especially among the elderly due to aging and relatively poorer oral health.

Failure to replace a missing tooth not only affects facial aesthetic and chewing function, but it may also lead to jawbone loss and shifting to teeth, which may cause malocclusion and bite irregularities that could have a significant impact on the health of the remaining teeth, gums, jaw muscles and jaw points.

Artificial teeth, also known as bridges and dentures, are prosthetic devices used to replace missing teeth. It is essential for the false teeth to resemble the patient’s original tooth so that the patient can retain his or her original appearance, chewing function, oral and physical health.

Currently, the process of designing and creating dentures is highly time-consuming as the existing computerised design process requires tedious manual inputs, teeth occlusion information collection as well as multiple denture fitting procedures due to limited accuracy of exciting technologies.

Researchers from the Faculty of Dentistry at the University of Hong Kong (HKU) and the Department of Computer Science of Chu Hai College of Higher Education, collaborated to develop a new approach using artificial intelligence to automate the design of individualised dentures, in order to enhance the treatment efficiency and improve patient experience.

The AI technology used in the process was based on 3D Generative Adversarial Network (3D-GAN) algorithm and tested on 175 participants recruited at HKU. The study shows that AI technology could reconstruct the shape of a natural healthy tooth and automate the process of false teeth design with high accuracy.

“The 3D GAN algorithm was selected due to its superior performance on 3D object reconstruction compared to other AI algorithms. In the preliminary study, 3D GAN was able to rebuild similar shapes to the original teeth for 60% of the cases. It is expected to mature with more AI training data,” co-Investigator, Dr Reinhard Chau explained.

The new approach only requires the digital model of a patient’s dentition to function. It can learn the features of an individual’s teeth from the rest of the dentition and generate a false tooth that looks like the missing tooth.

“This will facilitate the treatment workflow for dentists in replacing a missing tooth, as the preparation and fitting process will require minimal time, and a patient will not need to stay at the clinic for long hours,” said Principal Investigator Dr Walter Lam.

The study entitled “Artificial intelligence-designed single molar dental prostheses: A protocol of prospective experimental study” is published in the journal PLoS ONE. The preliminary results of the study were presented in the recent International Association of Dental Research (IADR) General Session. The study won the IADR Neal Garrett Clinical Research Prize and First runner-up in the 2022 IADR-SEA Hatton Award - Senior Category.

The research team members
HKU Faculty of Dentistry
Principal Investigator: Dr Walter Lam, Clinical Assistant Professor in Prosthodontics and Founding Member of HKU Musketeers Foundation Institute of Data Science
Co-investigators:
- Dr Reinhard Chau, Research Assistant in Restorative Dental Sciences and Applied Oral Sciences & Community Dental Care
- Professor Colman McGrath, Clinical Professor in Dental Public Health
- Dr Khaing Myat Thu, Senior Research Assistant in Restorative Dental Sciences

Chu Hai College of Higher Education
Co-investigator:
Professor Richard Hsung, Associate Professor in Department of Computer Science

The Journal “Artificial intelligence-designed single molar dental prostheses: A protocol of prospective experimental study”:
https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0268535

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JOURNAL

PLoS ONE

DOI

10.1371/journal.pone.0268535 

Studying the link between gum disease and Alzheimer’s disease

 

Fusobacterium nucleatum (F. nucleatum) is a common type of bacteria that proliferates in periodontal disease. It affects the gums and jawbone, and if untreated results in unstable teeth and tooth loss. In recent years, F. nucleatum has been linked to conditions ranging from colorectal cancer to premature delivery of babies.

Now new research published in the journal Frontiers in Aging Neuroscience by Tufts University scientists and colleagues suggests a link between F. nucleatum and Alzheimer's disease.

"In this study, our lab is the first to find that Fusobacterium nucleatum can generate systemic inflammation and even infiltrate nervous system tissues and exacerbate the signs and symptoms of Alzheimer's disease," says Jake Jinkun Chen, professor of periodontology and director of the Division of Oral Biology at Tufts University School of Dental Medicine. The first author of the paper is Hongle Wu, who was a postdoctoral fellow in the Chen Lab at the time of the study.

F. nucleatum can also generate severe generalized inflammation, which is a symptom of many chronic diseases including Type 2 diabetes and Alzheimer's disease, notes Chen, who is also a trained pathologist and professor in the Department of Developmental, Molecular and Chemical Biology at the School of Medicine and Graduate School of Biomedical Sciences.

Chen and his colleagues believe that by targeting F. nucleatum, they can slow the spread and progression of at least two epidemics—periodontal disease, which affects 47% of U.S. adults over age 30, and Alzheimer's, which afflicts 6.5 million Americans currently, and is expected to increase to over 14 million by 2060.

F. nucleatum and Immune Cells in the Brain

The latest research, done in mice, shows that F. nucleatum results in an abnormal proliferation of microglial cells, which are immune cells in the brain that normally remove damaged neurons and infections and help maintain the overall health of the central nervous system. This over-supply of microglial cells also created an increased inflammatory response, the researchers found. Chronic inflammation or infection is believed to be a key determinant in the cognitive decline that occurs as Alzheimer's disease progresses.

"Our studies show that F. nucleatum can reduce the memory and thinking skills in mice through certain signal pathways. This is a warning sign to researchers and clinicians alike," Chen says.

Possible links between periodontal disease and Alzheimer’s have been posited by scientists in the past. While the new research does not show that F. nucleatum-related periodontal disease leads directly to Alzheimer’s disease, the new study suggests that periodontal disease caused by F. nucleatum and left untreated or poorly treated could exacerbate symptoms of Alzheimer's disease, Chen believes. Conversely, treating periodontal disease effectively in those who have early-stage Alzheimer's could potentially slow Alzheimer's progression.

"Testing for bacterial load and degree of symptoms could one day become a way to measure the effects of F. nucleatum and manage treatment to slow progression of both periodontal disease and Alzheimer's," Chen says.

Their research also suggests potential drug targets that could specifically quench the local as well as systemic inflammation caused by F. nucleatum in a periodontal environment.

Oral Infections and Systemic Diseases

More broadly, Chen and colleagues are targeting their translational research at blocking the pathways between periodontal disease and not only Alzheimer’s, but other diseases linked to inflammation, including Type 2 diabetes.

Only 2% of mRNA is translated into proteins. Ninety-eight percent of RNA is "noncoding" and traditionally has been considered as no more than "junk genes." But increasingly scientists, including Chen, are uncovering important functions they possess.

In particular, his lab is focused on two noncoding RNAs. One—microRNA—regulates the production of proteins in cells. Another—lncRNA—performs other functions to regulate gene expression and could ultimately be used to treat atherosclerosis (hardening of the arteries) as well as periodontal disease, diabetes, cancer, and diabetic bone disease.

Studies by Chen's lab have shown that a molecule called microRNA-335-5P can inhibit damage done by periodontal pathogens. The molecule could also have a robust effect in targeting the pathological molecules produced in the brain that lead to Alzheimer's.

"MicroRNA in general suppresses gene expression and could stop the production of certain proteins. MicroRNA-335-5P in particular could target three 'bad' genes—DKK1, TLR-4, and PSEN-1—all believed to be related to Alzheimer's disease," he says.

His lab has also designed a small molecule called adipoAI, which has strong anti-inflammatory properties. Chen hopes to begin a clinical trial soon to study whether it is effective in treating a range of inflammatory diseases including Type 2 diabetes, Alzheimer's disease, and periodontal disease.

"Your mouth truly is the gateway to your body," he says

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