Faculty Bibliography

The role of genetic and environmental factors on dental caries progression in young children was determined. A detailed caries assessment was performed in 2 examinations on 314 pairs of twins initially 1.5 to 8 years old. Surface-based caries prevalence rates (SBCPR) and lesion severity (LSI) were computed. Heritability estimates were calculated by SOLAR software. Analyses were performed on all ages combined and by age group (1.5-< 4; 4-6; > 6). Overall heritability estimates (H) of net increments SBCPRs were H = 30.0 (p < 0.0001), and were greatest for the youngest (H = 30.0) and oldest groups (H = 46.3). Overall LSI heritability estimates [H = 36.1 (p < 0.0001)] were also greatest for the youngest (H = 51.2) and oldest groups (H = 50.6). Similar findings were found for net increments of occlusal surfaces and deep dentinal lesions SBCPRs (H = 46.4-56.2). These findings are consistent with a significant genetic contribution to dental caries progression and severity in both emerging primary and permanent dentitions

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

OBJECTIVES: This cross-sectional study was designed to determine the caries status and provide a general evaluation of the level of dental treatment need of Pennsylvania public school children in grades 1, 3, 9, and 11 on a statewide and regional basis. METHODS: Between September 1998 and May 2000, caries status and treatment need were assessed using a school-based dental examination, performed on a representative sample (n=6,040) of public school children in grades 1, 3, 9, and 11 (age range=6 to 21 years). Children's caries status in the primary and permanent dentition was assessed. Need for treatment was scored on a three-level categorical scale--no treatment need identified, routine treatment need, and urgent treatment need--and was based on the presence and severity of caries and other oral conditions. Population estimates of the prevalence of untreated dental caries, DMFT and dft scores, and treatment need were calculated by grade and geographically, using the six Pennsylvania health districts and the cities of Pittsburgh and Philadelphia. The inequality of caries distribution in the population was assessed for both permanent and primary caries using Lorenz curves and Gini coefficients. RESULTS: Dental caries has remained highly prevalent among Pennsylvania's public school children. Caries levels varied considerably by health districts and city. Urgent treatment needs were significant and also varied by health district and city. CONCLUSIONS: Dental caries remains the most prevalent disease affecting Pennsylvania's schoolchildren. Caries status varies significantly by region of the state, suggesting that environmental, social, and demographic contextual factors may be important determinants of disease prevalence

BACKGROUND: Edentulism may affect dietary intake in older adults, but the relation between edentulism and nutritional status is not completely understood. OBJECTIVE: The present study examined whether edentulism is associated with nutritional status and whether there is an interaction between race and edentulism on nutritional status among well-functioning, community-dwelling elderly. DESIGN: The study cohort included 3075 elderly aged 70-79 y (52% women, 42% black) in the Health, Aging, and Body Composition Study. Dietary intake, anthropometric variables, weight change, and serum albumin and lipid concentrations were compared between edentate and dentate participants by the use of multiple linear and logistic regressions. RESULTS: Edentulism was not associated with total energy or food intake but was associated with the food groups consumed, particularly fat, micronutrients, and hard-to-chew foods. Edentulism was more strongly linked to dietary intake in whites than in blacks. Unlike black edentate elderly, white edentate elderly consumed significantly lower energy-adjusted amounts of vitamin A and beta-carotene, higher amounts of energy-adjusted total and saturated fat and cholesterol, and higher percentages of energy from fat than did white dentate elderly. Anthropometry and biochemical indexes were not significantly different by edentulism status in both races. Edentulism was associated with weight gains of >5% in 1 y in both races. CONCLUSIONS: Edentulism was associated with differences in the nutritional status of well-functioning, community-dwelling elderly, more so in whites than blacks. Edentate elders may benefit from dental, medical, and nutrition interventions targeted to addressing these findings

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

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

BACKGROUND: Information technology, or IT, applications for dental practice continue to develop rapidly. More than 85 percent of all dentists use computers in their offices, and the number of clinical uses for the computer is on the rise. This article discusses the state of the art of several technologies, provides an integrative view of a technologically well-equipped office and offers several guidelines for technology purchasing decisions. CONCLUSIONS: Most administrative applications are relatively mature and are required for the smooth functioning of today's dental offices. Clinical applications--such as dental and medical health histories, charting, digital imaging, diagnostic and treatment applications, and decision support--vary in their degree of maturity. Most Internet applications-such as Internet-based scheduling and e-mail communication with patients--still are an optional adjunct for dental practices. PRACTICE IMPLICATIONS: Practitioners should develop a comprehensive plan for implementing or updating the IT infrastructure in their offices. Issues to be considered in technology purchasing decisions include usability, integration, work flow support, cost-benefit analysis and compliance with standards

The purpose of this study was to access current medication usage by HIV/AIDS patients and its effects on dental caries and on unstimulated salivary flow rates. Thirty females and 127 males (mean age = 39.6 +/- 7.4 years), of whom 46% were White/Non-Hispanic, 39% African-American, and 15% Hispanic, were examined and interviewed at the Bering Dental Clinic, Houston, Texas. The mean time in years after seroconversion was 5.4 +/- 4.1. Calibrated examiners performed dental caries examination (DMFS) with dental explorers and bitewing radiographs. Interviews were carried out with pretested questionnaires, and medication usage was assessed by illustrative examples of HIV/AIDS medications. Salivary flow rates were determined gravimetrically (mL/min). Bivariate analysis and analysis of variance (ANOVA) were used to analyze the data. Because there were no race or gender effects on dental caries outcome variables or salivary flow rates, separate logistic regression models for medication usage were generated, which were adjusted for age and CD4+ cell counts. Patients who, currently, were receiving antiretroviral therapy (ART) had a lower occurrence of dental caries than patients not taking these medications. An unexpected finding in the lower caries rate group was a decrease in salivary flow rates, which was a probable oral side effect of ART. It appears from this cross-sectional study that systemic medication for the management of HIV disease has no significant detrimental effect on the dentition