Faculty Bibliography

OBJECTIVES: To study the levels of systemic markers for inflammation with parameters of periodontal diseases in older people. DESIGN: A cross-sectional study was conducted in a cohort that is being followed prospectively on the effects of aging and body composition on morbidity. SETTING: University of Pittsburgh, Pittsburgh, and University of Tennessee, Memphis. PARTICIPANTS: One thousand one hundred thirty-one participants (mean age+/-standard deviation 72.7+/-2.8); 66% white and 50% male. MEASUREMENTS: Periodontal examination, including probing depth and attachment loss, was performed. Periodontal disease extent was divided into 0% of sites with probing depth of 6 mm or more, 1% to 10% of sites with probing depth of 6 mm or more and more than 10% of sites with probing depth of 6 mm or more. Subgingival plaque samples were collected from four molar teeth, and the levels of periodontal pathogens were determined using the benzoyl-DL-arginine-naphthylamide (BANA) test. Plasma interleukin-6 (IL-6), C-reactive protein (CRP), plasminogen activator inhibitor type-1 (PAI-1), and tumor necrosis factor alpha (TNF-alpha) levels were measured in all participants. Assessments of risk factors associated with elevated levels of markers of systemic inflammation were also determined. Multiple regression analysis was employed to analyze the data. RESULTS: IL-6 levels were significantly higher in participants with more-extensive periodontal disease than in other participants. Periodontal disease extent was significantly associated with higher TNF-alpha plasma levels, controlling for established risk factors for elevated TNF-alpha levels. Participants with BANA-positive species had significantly higher CRP plasma levels when controlling for risk factors for elevated CRP levels. CONCLUSION: Periodontal disease and infection may be modifiable risk indicators for elevated levels of systemic inflammatory markers in older people

OBJECTIVE: To determine the relative contribution of genetic and environmental stimuli on dental caries traits and microbial acid production in a twin model. METHODS: Dental caries examinations and microbial acid production assays were performed on 388 pairs of twins 1.5-8 years old from the city of Montes Claros, Brazil. Genotyping 8 polymorphic DNA markers determined zygosity. Caries exams followed NIDCR criteria modified to distinguish white spot lesions from cavitated lesions. Surface-based caries prevalence rates (SBCPR) were computed and lesion severity was determined by a weighted index (LSI). Biofilm samples were collected from the tongue using a lactic acid indicator swab. Assay scores were categorized based on acid formation as 1 = low, 2 = medium, and 3 = high. Heritability analyses were performed using the SOLAR software package. RESULTS: Heritability estimates for SBCPRs, LSI and for microbial acid production were H = 76.3 (p < 0.001), H = 70.6 (p < 0.001), H = 16.2 (p = 0.0078), respectively. Treating microbial acid production as a covariate in the SBCPR and LSI models did not significantly alter the heritability estimates, i.e. H = 76.5 (p < 0.001) and H = 70.8 (p < 0.001), respectively. CONCLUSIONS: These results suggest that variation in dental caries surface traits has a significant genetic contribution and that microbial acid production is modulated by the environment

OBJECTIVE: The purpose of this study was to determine whether genetic factors influence variation in salivary levels of the mutans streptococci (MS) in preschool twins. DESIGN: The study population consisted of 48 pairs of monozygotic (MZ) twins and 54 pairs of dizygotic (DZ) twins. Genotyping eight highly polymorphic DNA markers determined zygosity. Demographic data and antibiotic exposure as reported by mothers were obtained by a face-to-face interview. Salivary levels of MS were determined by the Stripmutanstrade mark test. Test results are reported on a scale of 0-3. Regression analysis, two sample t-tests and structural equation modeling were applied to analyse the data. RESULTS: Only 6% of the participants ever visited a dentist (F component of the DMFS was 0 for this population). Average salivary scores for the mutans streptococci were significantly different between MZ (1.1+/-0.1) and DZ (0.8+/-0.1) twins (p=0.021). High salivary levels of MS (scores 2 and 3) were observed in 42% of MZ twins and in 26% of DZ twins. Regression analysis on the MS salivary levels revealed no significant effects of age, gender and antibiotic intake for MZ or DZ twins. The heritability of mutans streptococci colonisation in 48 pairs MZ and in 26 pairs of DZ twins was estimated to be 52%. The non-shared environment contribution was estimated to be 48%. CONCLUSIONS: These results suggest that variation in the salivary levels of the mutans streptococci is significantly contributed by genetic factors

Very little is known about whether parental substance-use disorders (SUDs) affect the prevalence of dental abnormalities among their offspring. This study examined the prevalence of various dental abnormalities in sons of fathers with SUDs (the high average risk, or HAR, group) versus the prevalence of these abnormalities among sons of fathers without SUDs (the low average risk, or LAR, group). A total of 385 sons and their families were comprehensively assessed at five different ages, 10-12, 12-14, 16, 19, and 22. All of these participants were participating in an ongoing longitudinal NIDA-funded center study (CEDAR) evaluating the etiology of SUDs, in collaboration with the University of Pittsburgh Dental School. The data from this study provide evidence that paternal SUDs (HAR vs. LAR status) is associated with poor dental condition, poor oral hygiene, a greater need for dental treatment, and inadequate levels of dental treatment utilization

Propolis, a flavonoid-rich product of honey comb, exhibits antibacterial and anti-inflammatory properties. In this study, we examined the tolerance of fibroblasts of the periodontal ligament (PDL) and dental pulp to propolis and compared with that of calcium hydroxide in vitro. Cells from human dental pulp and PDL were obtained from healthy third molars and subjected to various concentrations of propolis (0-20 mg/ml) and calcium hydroxide (0-250 mg/ml). The cell viability after propolis treatment was analyzed by crystal violet staining of the cells followed by spectrophotometric analysis. Data revealed that exposure of PDL cells or pulp fibroblasts to 4 mg/ml or lower concentrations of propolis resulted in >75% viability of cells. On the contrary, calcium hydroxide 0.4 mg/ml was cytotoxic and <25% of the cells were found to be viable. Further investigations may find propolis to be a possible alternative for an intracanal antimicrobial agent

OBJECTIVES: To determine the association between periodontal disease and weight loss in an elderly cohort. DESIGN: A longitudinal design was used with participants from the Health, Aging and Body Composition (Health ABC) cohort study to determine the association between periodontal disease status and weight loss of at least 5% of baseline body weight over a period of 2 years. SETTING: Participants were examined in research clinics in Pittsburgh, Pennsylvania, and Memphis, Tennessee. PARTICIPANTS: A randomly selected subset of 1,053 individuals from the Health ABC examination, aged 65 and older, ambulatory and community-dwelling at baseline. MEASUREMENTS: Periodontal disease was measured as mean pocket depth and attachment loss, extent (percentage) of pockets with at least 6 mm probing depth, extent of bleeding on probing, and tissue inflammation. RESULTS: In logistic regression models adjusting for variables that may explain weight loss, extent of periodontal pockets with at least 6 mm probing depth showed a significant association with weight loss (odds ratio=1.53, 95% confidence interval=1.32-1.77). CONCLUSION: Periodontal disease may be causally related to weight loss in the elderly and thus may increase risk of morbidity and mortality

AIMS: The antibacterial activity against Staphylococcus aureus of honey and propolis produced by Apis mellifera and Tetragonisca angustula was evaluated. Secondary aims included the study of the chemical composition of propolis and honey samples and its relationship with antibacterial activity against S. aureus. METHODS AND RESULTS: The antibacterial activity of honey and propolis was determined by the method of macrodilution. The minimum inhibitory concentration (MICs) of A. mellifera honey ranged from 126.23 to 185.70 mg ml(-1) and of T. angustula from 142.87 to 214.33 mg ml(-1). For propolis, the MIC ranged from 0.36 to 3.65 mg ml(-1) (A. mellifera) and from 0.44 to 2.01 mg ml(-1) (T. angustula). Honey and propolis were evaluated by high-performance liquid chromatography. Some typical compounds of Brazilian propolis were also identified in honey samples. Principal component analysis revealed that the chemical composition of honey and propolis samples was distinct based on the geographical location of the samples. CONCLUSIONS: Propolis samples had higher antibacterial activity against S. aureus when compared with honey. However, both propolis and honey samples had antibacterial against S. aureus. SIGNIFICANCE AND IMPACT OF THE STUDY: These antimicrobial properties would warrant further studies on the clinical applications of propolis and honey against S. aureus

This article is a critical appraisal of the literature on the oral complications of bulimia. The MEDLINE database yielded a total of 82 English-language reports published between 1966 and 2002 that were pertinent to the topic of oral manifestations and treatment of bulimia. The literature is composed primarily of reviews, letters, case reports with or without restorative management, and descriptive studies of small sample sizes. At present, retrospective case-control studies are the only studies available with levels of evidence in the vicinity of 3 to 4. From these studies it is apparent that bulimic women present with a variety of oral and pharyngeal signs and symptoms, including dental caries and tooth erosion, dental pain, increased levels of cariogenic bacteria, orthodontic abnormalities, xerostomia (the subjective complaint of a dry-mouth) and decreased saliva secretion (the objective measure), decreased salivary pH, decreased periodontal disease, parotid enlargement, and swallowing impairments. Dental erosion is the major finding associated with bulimia. Case reports describe restoration of damaged surfaces with porcelain-laminated veneers, dentin-bonded crowns with minimal tooth preparation, composites, and complete-coverage restorations. However, what is really needed is identification of oral markers of bulimic behavior for early detection of bulimic patients by dentists and by physicians that can prevent the deleterious effects of frequent vomiting on the oral/dental tissues.

PURPOSE: To evaluate, longitudinally, the effect of a chlorhexidine varnish on the proteolytic activity of dentin caries in vivo. MATERIALS AND METHODS: 20 permanent molars and 8 primary molars with carious lesions in dentin were studied in subjects 18-35 yrs old (n=20), and 5-6 yrs old (n=8) respectively. These lesions were clinically evaluated according to texture and color. Carious dentin specimens were obtained by means of biopsies performed with a #4 carbide bur at the initial visit (TO) before application of a 10% chlorhexidine varnish and 2, 4, 8, and 12 wks thereafter. The dentin biopsies were immersed in Sorensen's buffer, vortexed for 30 s, and mixed with a 1.67 mM solution of n-benzoyl-DL-arginine-naphthylamide (BANA), a substrate for proteolytic enzymes. Samples were incubated overnight at 37 degrees C and color was developed with 0.1% fast garnet. The optical density (OD) of reaction mixtures was recorded photometrically. All teeth were grouped for analysis, as Mann-Whitney tests revealed no statistically significant differences between median values for OD for both age groups. ANOVA was used to compare progressive inhibition of proteolytic activity in dentin caries samples over time. RESULTS: The average proteolytic activity at the dentin substrates (OD) at TO and 2, 4, 8 and 12 wks thereafter were 0.794+/-0.089, 0.741+/-0.071, 0.676+/-0.087, 0.600+/-0.094, and 0.508+/-0.108 respectively. The chlorhexidine varnish mediated a significant inhibition of the proteolytic activity present in dentin caries after 12 wks (P<0.0001). At T0, 100% of the carious lesions examined were characterized as soft upon exploration. After 12 wks, 54% (15/28) of the lesions were partially hardened and 46% (13/28) hardened/nonprogressing. The dentin color was yellow/light brown in 100% of the lesions at baseline, and dark brown/black in 86% (24/28) after 12 wks. CLINICAL SIGNIFICANCE: This study demonstrated that chlorhexidine varnishes arrested active caries in vivo and inhibited the proteolytic activity present in these lesions. These findings strengthen the rationale for including chlorhexidine in the overall treatment strategy for patients with high caries activity