Faculty Bibliography

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

OBJECTIVE: To evaluate the cares status of Sri-Lankan Veddha children in relation to the traditional risk factors. Prevalence of dental caries is still high in certain populations, studies of which may shed additional light on the complex aetiology of caries. METHODS: Using the NIDR criteria for caries diagnosis, the Strip Mutans technique (Dentocult SM), and a questionnaire administered by a native speaker, 39 children between the ages of 2-17 years were examined in a cross-sectional study. RESULTS: Of the 2-9-year-olds, 33% were caries free in the primary dentition and 72% of 5-17-year-olds were caries free in the permanent dentition (mean dft = 2.7; SE = 0.61 and mean DMFT = 0.9; SE = 0.41). There was no correlation between caries and mutans streptococci levels. Excessive consumption of sugar or honey was significantly correlated with the mean dft levels (P = 0.007). The mother was the primary caregiver for all but two children and the children were breast-fed for an average of 2.8 years (SD = 0.82). The duration of breast-feeding was not correlated with the caries experience. CONCLUSION: Lack of professional and home care and unfavourable dietary practices may be related to the high prevalence of caries observed in this population.

OBJECTIVES: Access to oral health care and utilization of available services are important factors in minimizing the oral health disparities among underserved minorities. Our objective was to evaluate the racial and other factors related to 'realized access' to oral health care among Alabama Medicaid children. METHODS: Data were obtained from 308 538 Alabama Medicaid claims submitted in 1995-96 and analyzed using regression analyses. RESULTS: A lower proportion of Blacks (24%) and other racial groups (22%) compared to Whites (31%) and a lower proportion of 15-19-year-olds (15%) compared to younger age groups (30%) obtained dental services (P < 0.05). Odds of males obtaining care were slightly lower compared to females (OR = 0.96; 95% CI = 0.94-0.99). However, there was a significant interaction of race with other factors in determining service utilization. Subjects who were continuously eligible for Medicaid throughout the fiscal year were more likely to obtain care (OR = 2.86; 95% CI = 2.78-2.93). About one-fourth of the visits had an emergency procedure included in the treatment rendered. Availability of a participating dentist within the county of residence and the lower reimbursement-to-charge ratio were among the other related factors for underutilization of services. CONCLUSIONS: There is a significant racial disparity in utilization of dental services even among the Medicaid-eligible children. However, this was not a simple function of race, but a complex interaction of race with other factors such as age, gender, and location. ACKNOWLEDGMENT: Supported by CDC grant #U48/CCU 409679

BACKGROUND: Two important factors in the use of implant-retained overdentures are cleansability and patients' satisfaction. Limited research has been published concerning the cleansability of these overdentures On the other hand, studies have compared patients' satisfaction with conventional dentures and various designs of implant overdentures. However, no studies have compared overdentures retained by Hader bars (Sterngold, Attleboro, Mass.) and direct ERA attachments (Sterngold) in terms of both cleansability and patients' satisfaction. PURPOSE: The authors' aim was to determine the cleansability of and patients' acceptance of overdentures retained by direct ERA attachments and overdentures supported by a Hader bar with distal ERA attachments and a Hader clip. MATERIALS AND METHODS: Two groups of 10 subjects each were evaluated: Group A, consisting of patients with overdentures retained by direct ERA attachments, and Group B, consisting of patients with overdentures retained by Hader bars. The authors evaluated the subjects between 18 and 24 months after the delivery of the overdentures by means of a questionnaire and a clinical examination to score each patient on gingival, plaque and calculus indexes. RESULTS: Group A exhibited better results than Group B on calculus, plaque and gingival indexes, but the difference was not statistically significant. The authors found no significant difference between the two experimental groups in satisfaction. CONCLUSIONS: When evaluated in terms of subjects' satisfaction and calculus, plaque and gingival index scores, implant-retained overdentures supported by direct ERA attachments were similar to those supported by a Hader bar. CLINICAL IMPLICATIONS: The two types of overdentures studied are equally satisfactory and easy to clean. Other factors such as biomechanics, patients' preference and previous experience may be more critical when selecting the retention design for an overdenture supported by four implants

In a randomized clinical trial, we evaluated the effect of a 10% chlorhexidine varnish (Chlorzoin) on the mother-child transmission of Streptococcus mutans and on subsequent caries experience. Chlorhexidine (n = 38) or a placebo varnish (n = 37) was applied to the dentitions of 75 mothers at a time when their first babies were about 6 months old (approximate time of first tooth emergence). Three more applications at weekly intervals and subsequent applications at 6-month intervals followed the initial application. The mother-child pairs were followed up until the child's fourth birthday. Maternal salivary S. mutans levels in the treatment group remained significantly lower (p < 0.05) compared to the control group up to 12 months after the initial application. However, this intervention did not significantly alter the S. mutans colonization in children or the caries increment in either the mother or the child.

Strategies aimed at the prevention of Streptococcus mutans infection and dental caries include mucosal immunization, which results in salivary anti-S. mutans responses. The purpose of this study was to evaluate the effectiveness of nasal vs. tonsillar immunization with S. mutans antigens in inducing salivary immune responses. Twenty-one adult subjects were immunized twice, within a seven-day interval, with a glucosyltransferase-enriched preparation (E-GTF) administered by nasal or tonsillar topical spray. Parotid saliva, nasal wash, and serum were collected prior to and at one- to two-week intervals for 3 months following immunization and were assayed by ELISA for anti-E-GTF activity. Results were analyzed by means of the mixed-models procedure with p < 0.05 level of significance. Significantly higher anti-E-GTF responses were detected in saliva and nasal wash samples from the group immunized by the nasal compared with the tonsillar route, indicating that nasal immunization was more effective in inducing mucosal responses in adults

BACKGROUND: In Alabama, low birth weight (LBW) infants are about 20 times more likely to die before their first birthday compared to normal birth weight infants. While the rate of LBW has been consistently higher among African Americans compared to whites, there has been a gradual increase in LBW for both African Americans and whites over the last 15 years. In an attempt to identify modifiable risk factors for LBW, we have previously reported that a pregnant woman's poor periodontal health may be an independent risk factor for low birth weight. METHODS: A predominantly African American and socioeconomically homogeneous group of 448 women was followed from the second trimester of their first pregnancy. Thirty-nine LBW cases were observed at the end of follow-up. Using 17 preterm LBW cases and 63 randomly selected controls from the above cohort, the periodontal pathogen-specific maternal serum IgG levels during the second trimester of pregnancy were evaluated in relation to birth weight of the infant, while controlling for known risk factors for LBW. RESULTS: Porphyromonas gingivalis (P.g.)-specific maternal serum IgG levels were higher in the LBW group (mean 58.05, SE = 20.00 microg/ml) compared to the normal birth weight (NBW) group (mean 13.45, SE = 3.92 microg/ml; P= 0.004). Women with higher levels of P.g.-specific IgG had higher odds of giving birth to LBW infants (odds ratio [OR] = 4.1; 95% confidence interval [CI] for odds ratio = 1.3 to 12.8). This association remained significant after controlling for smoking, age, IgG levels against other selected periodontal pathogens, and race. CONCLUSIONS: Low birth weight deliveries were associated with a higher maternal serum antibody level against P. gingivalis at mid-trimester

Dental caries is an infectious disease of bacterial origin. The use of antimicrobial agents to reduce or eliminate the bacteria associated with caries follows the approach used to combat other infectious diseases of humans. Unfortunately, only a few dozen studies have sufficient resolving power to make inferences as to the anticaries efficacy of the antimicrobial approach to caries management. Here, we comment on the findings of the RTI/UNC review concerning antimicrobials, discuss additional findings not covered in that review, and make recommendations based upon both the available literature and from our own experience. Even though the studies published thus far are inconclusive or lack sufficient demonstration of efficacy to recommend a specific approach involving antimicrobial agents in routine clinical practice, several pieces of information from these studies suggest future avenues of investigation.

PURPOSE: As a national objective, 50% of US children are expected to have dental sealants on at least one permanent molar by the age of 14 years. The present study was conducted to estimate the prevalence of dental sealants among Alabama Medicaid children and to evaluate the characteristics of the sealant users and non-users so the potential barriers in meeting the year 2000/2010 sealant objectives can be identified. METHODS: Alabama Medicaid 1990-1997 claims for children (N = 3,683,842) were analyzed using basic descriptive statistics, likelihood ratio, Chi-Square and t-tests, and ANOVA. Logistic regression analysis was used in identifying the predictors of dental sealant utilization. RESULTS: Nearly 22 percent of children had at least one sealant claim by 12 to 14 years of age (white = 28.3%; Black = 19.8%; OR = 1.6, 95% CI = 1.4-1.8; female = 23.6%; male = 19.7%; OR = 1.3, 95% CI = 1.1-1.4). 5- to 9-year-olds were more likely to have sealants compared to 11- to 14-year-olds (OR = 4.1, 95% CI = 2.7-6.1). The availability of a Medicaid accepting dentist within the county of residence was a significant predictor (OR = 1.5, 95% CI = 1.1-2.2). Less than 2% of the annual amount claimed for total dental services in Alabama was related to sealants and the providers were reimbursed only for 50% to 70% of the amount claimed for sealant procedures. CONCLUSIONS: Racial and gender disparities in obtaining care, non-availability of a Medicaid-participating dentist within the county, and lower payment/claim ratio may make the national sealant objective difficult to achieve in Alabama

BACKGROUND: A major predictor of childhood atopy is the concentration of IgE in the cord blood, but whether the source of cord blood IgE is maternal or fetal remains unclear. OBJECTIVE: We sought to determine the pattern of in situ IgE production during ontogeny. METHODS: Ninety-seven fetal, 142 natal, and 96 childhood samples were analyzed by using reverse transcription PCR for transcription of VDJCepsilon, Iepsilon, and CD23. Thirty-eight fetal liver samples were analyzed for the IL4RA genotype. RESULTS: IL-4Ralpha, CD23a, CD23b, and sterile Iepsilon transcripts were present as early as 8 weeks' gestation. VDJCepsilon transcripts were found in second-trimester fetal liver and third-trimester cord blood, although they were rare. VDJCepsilon transcripts were more common in the blood of children 9 months and older. Sequence analysis suggested that fetal VDJCepsilon was the product of selection. All fetal livers actively transcribing Iepsilon, VDJCepsilon, and IL-4Ralpha contained at least one copy of the atopy-associated IL4RA*A1902G polymorphism. CONCLUSION: The human fetus contains B cells that are primed to undergo IgE class switching from the earliest stages of ontogeny and can produce endogenous IgE by 20 weeks' gestation. However, IgE-producing cells are rare until 9 months after birth