Faculty Bibliography

ARTICLE TITLE AND BIBLIOGRAPHIC INFORMATION: Local and systemic biomarkers in gingival crevicular fluid increase odds of periodontitis. Fitzsimmons TR, Sanders AE, Bartold PM, Slade GD. J Clin Periodontol 2010;37(1):30-6. REVIEWER: Ananda P. Dasanayake, BDS, MPH, PhD, FACE PURPOSE/QUESTION: The authors attempted to study the independent and combined effects of local (IL-1beta) and systemic (CRP) inflammatory biomarkers in gingival crevicular fluid (GCF) on the risk of periodontitis. SOURCE OF FUNDING: Government: National Health and Medical Research Council (NHMRC) of Australia and NHMRC Sidney Sax Public Health Fellowship. TYPE OF STUDY/DESIGN: Case-control study. LEVEL OF EVIDENCE: Level 2: Limited-quality, patient-oriented evidence STRENGTH OF RECOMMENDATION GRADE: Not applicable

BACKGROUND: Because of delays in diagnosis, oral cancer usually presents for therapy at a late stage. Patients are unaware of having lesions as they are mostly asymptomatic and physicians generally do not examine the mouth sufficiently. People in rural areas or are underserved may not frequently visit the dentist who can easily pick up these lesions early. Screening programs are useful in that regard. Such programs in general are conducted by either inviting people to come to a screening center or by health care workers visiting the individual households. However, those who work during the day may not visit screening centers or be at home during the day of the screening by a visiting health care worker. Workplace screening overcomes these challenges. METHODS: To assess the feasibility of a screening program to detect potentially pre-malignant oral disorders in a workplace in India, clinically visible mucosal lesions were compared with the clinical photographs of the same lesions assessed by an expert. Role of smoking, alcohol, and chewing betel quid and tobacco in the etiology of those lesions were assessed. RESULTS: Sixty-nine percent of the eligible subjects participated in the screening (n=1613). Prevalence of leukoplakia was 5%. Bidi (OR=35.6), and cigarette smoking (OR=22.8), alcohol (OR=17.6), and tobacco and areca nut chewing (OR=7.5), were significantly associated with leukoplakia and erythroplakia (all P< 0.05). CONCLUSIONS: Conduction of a screening program by valid visual inspection to detect potentially malignant oral disorders within a workplace is not only feasible but also effective.

In Latin America, mate is consumed as a beverage regularly. Among the cancers that are associated with mate drinking is oral and oro-pharyngeal cancer, incidence of which is high in the region. In order to further understand this association between mate drinking and the risk of oral and oro-pharyngeal cancer, we performed a systematic review and meta-analysis of related studies. All relevant studies published in English as original articles up to June 2009 were identified through a literature search using PubMed and Medline and by reviewing the references from the retrieved articles. Four case-control studies done in Latin America were identified. There were 879 mate users and 1128 non- or low-mate users in those studies with a total of 566 oral and oro-pharyngeal cancers. The adjusted association between mate drinking and oral and oro-pharyngeal cancer was significant within 3 of those studies. Meta-analysis yielded a significant summary odds ratio (OR) of 2.11 (95% confidence interval=1.39-3.19). Population Attributable Risk for mate drinking was 16%. While the epidemiological data indicate that mate users have an increased risk of oral and oro-pharyngeal cancer, little is known about whether this increased risk is due to the high temperature of the beverage when it is consumed or due to certain carcinogenic constituents that are present in mate. More human and animal studies are needed before a conclusion can be made on the oral and oro-pharyngeal carcinogenic risk of mate to humans

Periodontal disease is treated by various approaches, including simple oral hygiene practices, professional mechanical debridement, antimicrobial therapy and periodontal surgery. There is evidence to associate periodontal disease with several systemic diseases and conditions, including myocardial infarction, adverse pregnancy outcomes, diabetes mellitus, and respiratory disease. This article reviews the published literature that describes the effects of periodontal treatment on cardiovascular diseases, adverse pregnancy outcomes, diabetes mellitus, and respiratory disease. While some progress has been made, further research is required to understand the value of periodontal interventions in the prevention of systemic diseases

Alcohol and drug abuse are detrimental to general and oral health. Though we know the effects of these harmful habits on oral mucosa, their independent and combined effect on the dental caries experience is unknown and worthy of investigation. We compared 363 'alcohol only' abusers to 300 'alcohol and drug' abusers to test the hypothesis that various components of their dental caries experience are significantly different due to plausible sociobiological explanations. After controlling for the potential confounders, we observe that the 'alcohol and drug' group had a 38% higher risk of having decayed teeth compared to the 'alcohol only' group (P < .05). As expected, those who belonged to a higher social class (OR = 1.98; 95% CI = 1.43-2.75) and drank wine (OR = 1.85; 95% CI = 1.16-2.96) had a higher risk of having more filled teeth. We conclude that the risk of tooth decay among 'alcohol only' abusers is significantly lower compared to 'alcohol and drug' abusers

The associations of inflammation/immune responses with clinical presentations of Alzheimer's disease (AD) remain unclear. We hypothesized that TNF-alpha and elevated antibodies to periodontal bacteria would be greater in AD compared to normal controls (NL) and their combination would aid clinical diagnosis of AD. Plasma TNF-alpha and antibodies against periodontal bacteria were elevated in AD patients compared with NL and independently associated with AD. The number of positive IgG to periodontal bacteria incremented the TNF-alpha classification of clinical AD and NL. This study shows that TNF-alpha and elevated numbers of antibodies against periodontal bacteria associate with AD and contribute to the AD diagnosis.

The purpose of this study was to test the efficacy of an educational program aimed at improving oral health knowledge and behaviors in junior high school students in indigenous communities in Taiwan. Two junior high schools were randomly selected. Students in the intervention school received an oral health education program. Both groups received structured questionnaires to assess their oral health practices and risk behaviors at baseline and after the intervention. The intervention group had statistically significant positive changes in their oral health knowledge (p<.001), an increase in tooth-brushing frequency (p<.001), and a decrease in tobacco use (p=.01). Most (87%) students considered the educational program excellent or good. Carefully designed health education programs delivered within schools in areas with limited access to health care can improve the students' knowledge and reduce their risk behaviors which may prove to be a mechanism that ultimately reduces health disparities