Faculty Bibliography

PURPOSE: The purposes of this study were to: (1) evaluate the retention rates of occlusal sealants in children in an urban school-based sealant program run by a County Health Department in Alabama; and (2) assess the clinical benefits of this sealant program by comparing caries experience of a group of participants and nonparticipants. METHODS: The records of 2,097 children (mean age=8.1 +/- 1.6 years) who received sealants and had at least 1 follow-up examination were analyzed to determine the outcome of sealed and nonsealed surfaces of permanent first molars (PFM). Additionally, 103 fifth-grade students who did and did not participate in the sealant program (P=participants; NP=nonparticipants) were examined by a masked examiner who recorded their PFM condition. RESULTS: Sealants placed by the County Health Department had a retention rate of 71% over an average of 1.6 +/- 0.7 years (range=0.5-4.4 years). The patient's age at the initial visit appeared to be the only factor that influenced retention. On average, participants had at least 1 PFM that remained caries-free, compared to nonparticipants (permanent decayed, missing, and filled teeth [DMFT] in NP=1.5 +/- 1.4, P=0.5 +/- 0.8; P<.016). CONCLUSIONS: Retention rates for occlusal sealants in this public health program were similar to those reported in previous clinical studies. Furthermore, children who had sealants had significant protection from occlusal decay up to grade 5

The hypothesis that periodontal disease is associated with pre-term low birthweight was tested in a prospective follow-up study of rural prima-gravida women (N = 227) who were free of tobacco, alcohol, and drug use. Women with 3rd trimester mean probing pocket depths, plaque, and bleeding scores that were greater than the median value in the cohort were defined as 'exposed'. There were 17 (7.5%) preterm low birthweight singleton deliveries in the cohort (among 'exposed' = 12%; among 'unexposed' = 5.6%; Odds Ratio = 2.3; 95% CI = 0.9-6.3). After adjustment for the independent variables, the OR for preterm low birthweight in relation to 'exposure' was 1.9 (95% CI = 0.7-5.4). Our results are only suggestive of an association between periodontal disease and preterm low birthweight, perhaps indicating that previously reported associations may have been subjected to residual confounding due to tobacco, alcohol, and drug use

In the current literature database, information on microbiological attributes to caries outcomes in African American populations is limited and scattered. Few reports have discussed MS infection and transmission from African American mothers to their children. During the past few years, the research group at the University of Alabama at Birmingham and the Jefferson County Pubic Health Department have done a series of extensive studies to systematically investigate the prevalence of MS colonization, the time of initial MS infection as defined as "the window of infectivity," the source of MS transmission as defined as "the fidelity of transmission, and the chemotherapeutic management of MS transmission and caries prevention. The objective of this report was to summarize the main significant findings generated during a period of 15 years of study. One limitation of the studies outlined in this article is that the research populations were predominately African American families. The inclusion of white and other minorities would make the conclusions more generalizable to the US population as a whole. Nevertheless, the information presented in this report can serve as baseline knowledge for future studies of caries etiology in African American and other ethnic populations.

African Americans consistently experience higher rates of preterm and low birth weight (LBW) deliveries than do whites. LBW and preterm infants are more likely to die before their first birthday and survivors may suffer from a number of health problems. Therefore, identification of modifiable risk factors for preterm deliveries and LBW has considerable public health significance. Pregnant women's poor periodontal healtlh is emerging as one such factor. Maternal clinical periodontal status and bacteriologic and immunologic profiles related to periodontal disease have been associateted with risk of fetal growth and preterm LBW, and periodontal treatment during pregnancy has reduced the incidence of preterm deliveries. This article reviews the literature on the above association and presents data from a previously published prospective study of predominantly African Americans to show that preterm LBW deliveries are associated with higher midtrimester maternal serum antibody levels against Porphyromonas gingivalis

Two subclasses of immunoglobulin A (IgA) antibodies are produced in humans, IgA1 and IgA2, IgA2 being more resistant to digestion by bacterial proteases than IgA1. The amount of IgA in saliva has been shown to vary with age; however, little is known about the correlation between IgA subclass distribution in saliva and age. The purpose of this study was to determine whether differences exist in the levels and ratio of IgA subclasses in parotid saliva of children and adults. Parotid saliva was obtained from healthy children (age range 6-12 years, n = 14) and adults (age range 22-51 years, n = 20) using Schaefer cups. Samples were analyzed for levels of total IgA, IgA1, and IgA2 by ELISA. IgA and IgA1 levels were significantly higher in adults than in children. However, no differences were seen in the ratio of IgA1 and IgA2 in the two groups of subjects. These findings indicate that levels of IgA increase with age, whereas the IgA subclass ratio is established early in life

To evaluate the effectiveness of a low dose of soluble or liposomal (L) glucosyltransferase-enriched preparation (E-GTF) in inducing mucosal immune responses after intranasal immunization, 12 adults were immunized on days 0 and 7 by the IN route with 62.5 microg of soluble E-GTF or L-E-GTF. An increase in the mean salivary IgA anti-E-GTF response (P < 0.03) was seen in the L-E-GTF but not the soluble E-GTF group. A significant increase (P < 0.05) in the mean specific IgA antibody activity was also seen in nasal wash from both groups. Although the nasal wash responses were higher in the L-E-GTF than in the soluble E-GTF group, they were not significantly different. The soluble E-GTF immunized group showed a higher serum IgG response than the L-E-GTF immunized group on day 90 (P < 0.05). These results indicate that as little as 62.5 microg of E-GTF, when given by the intranasal route, induced an IgA response in secretions

PURPOSE: Since properly placed and retained sealants can reduce the incidence of caries lesions and save subsequent restorative costs, the purpose of this study was to compare the subsequent restorative cost in a group of predominantly African American Medicaid children who received prior sealants to that of a group of children who did not receive sealants. METHODS: Dental claims of 2 cohorts of 5- to 7-year-old children who were continuously enrolled in Alabama Medicaid from 1990 to 1997 (N=9,549) and who either did or did not receive sealants were analyzed using basic descriptive statistics, chi-square and t tests, and regression analysis. The subsequent restorative care costs related to 1-surface posterior amalgam or resin restorations were evaluated in relation to sealant status and selected independent variables. RESULTS: Only 10% of the children with at least 1 prior sealant claim obtained subsequent 1-surface posterior amalgam or resin restorations. This proportion was 33% among children without a prior sealant claim (OR=4.2, 95% CI=3.6-4.9). On average, total Medicaid reimbursement per child for sealants, plus subsequent restorative care was 56 dollars in the sealant group compared to 72 dollars for subsequent care alone in the nonsealant group. This difference was independent of the child's race, gender, or age. CONCLUSIONS: As expected, children who do not receive sealants are more likely to obtain subsequent restorative care and cost more money to the health care system. However, the modest sealant-related subsequent restorative cost savings observed among Alabama Medicaid children may be an underestimate of the real cost-benefits of sealants