Faculty Bibliography

The Lancet Commission on Education of Health Professionals for the 21(st) Century calls for enhancing health education for the needs and challenges of the 21st century to improve health status globally. To complement the Lancet report, this article makes recommendations for including core global health competencies in the education of health care professionals and specific groups of the public who are relevant to oral health in a global context in order to tackle the burden of oral diseases. Experts from various professional backgrounds developed global oral health competencies for four target groups: Group 1 was defined as dental students, residents/trainee specialists (or equivalent), and dentists; Group 2 was community health workers, dental hygienists, and dental therapists (or the equivalent); Group 3 was health professionals such as physicians, physician assistants, nurses, nurse practitioners, and pharmacists; and Group 4 was non-health professionals in the public arena such as parents, teachers, decision makers, key opinion leaders, and health and consumer advocates. Key competencies for members of each of the four target groups are presented in a matrix. The suggested competency matrix shows that many other health professions and groups in society have potentially crucial roles in the prevention, control, and management of oral diseases globally. Workforce models including a wider range of professionals working together as a team will be needed to tackle the burden of oral diseases in an integrated way in the broader context of non-communicable diseases. Further discussion and research should be conducted to validate or improve the competencies proposed here with regard to their relevance, appropriateness, and completeness.

BACKGROUND: The use of systemic antibiotics in conjunction with scaling and root planing (SRP) may improve the clinical outcome and even could be essential for a successful treatment of periodontitis. However, the effectiveness and clinical safety of this combination of therapy remain unclear. The authors of this study reviewed the available literature related to this hypothesis, evaluating the effectiveness of the use of systemic antimicrobials in combination with SRP versus SRP alone in the treatment of chronic periodontitis (CP) or aggressive periodontitis (AgP). METHODS: The authors used 3 electronic databases and hand searched articles published from April 2001 through October 2013 in selected journals. The authors selected clinical trials with a minimum of 6 months follow-up during which patients with either CP or AgP had been treated with systemic antibiotics plus SRP in comparison with SRP alone or with placebo. The authors analyzed the gain in clinical attachment level (CAL), reduction in probing pocket depth (PPD), reduction in bleeding on probing (BOP), and patient-related variables (that is, adverse effects). RESULTS: After the selection process, the authors included 23 clinical trials in this review. Assessment of the quality of the studies revealed the risk of bias as a common finding. Overall, there was a tendency toward improvement of the measured outcomes, CAL, PPD, and BOP in studies for which systemic antibiotics were used as adjunctive therapy with SRP. CONCLUSION: Owing to the high level of heterogeneity of the studies included in this review, the authors could not establish definitive conclusions and guidelines regarding the use of adjunctive systemic antibiotics. However, within the limitations of this review, the use of systemic antibiotics with SRP may be beneficial for specific populations. Standardized clinical disease diagnostic criteria and additional randomized controlled clinical trials are necessary to verify the effectiveness of the use of adjunctive systemic antimicrobials with SRP. PRACTICAL IMPLICATIONS: Owing to methodological differences and biases among clinical trials evaluating systemic antibiotics adjunctive to SRP, clinicians should base their decisions to prescribe on the results of weighing both benefits and risks for each patient.

Program/Project Purpose: Oral health is an important component of general health. Although oral health can be regarded as a fundamental human right, inequalities in oral health continue to exist globally. Wealthy countries have witnessed a marked reduction in the experience of dental caries in children and young adults during the 1970's and 2000's. However, in the developingnations, including Kenya, oral disease is a significant health concern. Low levels of public awareness, in combination with a lack of resources including providers of oral health care services, are major contributors to the problem. This presentation will describe a health promotion program designed to improve oral and general health behaviors in school-aged children in Kenya. Structure/Method/Design: This program has 5 different educational components: (1) health education, (2) oral disease prevention techniques, (3) advocacy training, (4) preventive dental care, and (5) training of local caregivers to ensure the sustainability. The program will be evaluated in two different school populations in rural Kenya to determine the specific challenges and effectiveness in each community. While both schools serve students of extremely low socio-economic status with poor oral health and lack of access to dental care, students at one school are boarded while at other they live at home with their families. Outcomes & Evaluation: Data collection will be done through the novel University Health Network (UHN) system. The UHN is a consortium of leading research institutions, designed to allow for highly scaled infrastructure for the secure collection, storage or sharing of clinical data in a cost-effective manner. A global information system (GIS) will be used to capture geographic trends of the oral diseases in the rural villagers. This research project, besides evaluating the impact of a comprehensive program on the level of oral diseases and of oral health perception and behaviors/practices, will also assess the role of utilization of school staff and family to deliver and reinforce health-promoting behaviors. We anticipate that the lessons learned from this study will be relevant in other communities and countries in East Africa and beyond. Going Forward: As a result of our findings we will develop an educational outreach program for dental students, and their supervising faculty, from the School of Dental Medicine of the University of Nairobi. At present, the dental students and residents do not have the opportunity to work with rural impoverished communities. The goals of this project, beyond the experiential and care-provision, are also to expose dental students to the needs of these communities, and to become advocates for improving oral health services for those in Kenya in need. Thus, this program will also include leadership and advocating skills

Novel robocast poly-caprolactone- and poly-lactic acid-hydroxyapatite composites were fabricated as planar films (2D) and multi-layered scaffolds (3D) (PCL-HA and PLA-HA, respectively). These materials contained 70 wt.% HA and were tested in vitro. Cell-free in vitro testing was conducted prior to cell culture testing to determine the effect that media conditions had on each material. Scanning electron microscopy (SEM) analysis showed that 3D scaffolds had exposed HA crystals on the rods of the mesh-like structure. Electron dispersive x-ray analysis (EDX) showed that the Ca: P ratio for HA was 1.3 and that the HA was carbonate-free. X-ray diffraction analysis (XRD) showed that the HA had a random crystallite distribution. Cell culture studies showed that both 2D films and 3D scaffolds supported osteoblast attachment and growth. Cell densities after 7 d of proliferation were higher on 2D films as compared to 3D scaffolds. Higher cell densities were observed for fully-dense HA as compared to 3D scaffolds. In general, PLA-HA scaffolds had higher cell densities than PCL-HA scaffolds. SEM analysis showed osteoblast attachment (via lamellipodia and filopodia) to the scaffolds, with cell layers wrapped around the mesh structure. Both polymer-HA composites degraded, with HA-PLA scaffolds exhibiting increased formation of micron-sized pores while PCL-HA composites exhibited increased formation of surface fiber bundles interconnected between features of the scaffold

From 2008 to 2011, the Schools at Muhimbili University of Health and Allied Sciences (MUHAS) in Tanzania revised and initiated implementation of a curriculum to improve the educational process for, and competence of, its graduates. Curricular reform at the MUHAS School of Dentistry offered an opportunity to focus educational efforts on furthering the impact of its graduates on combating important national health-care problems. In particular, the treatment and prevention of oral diseases, such as periodontal disease and caries, have been neglected in part due to the extreme shortage of a dental health care workforce. The level of oral disease is high in the population, with numerous studies reporting a more than 50% of the surveyed populations reporting having a current dental health problem. As an increasing body of research has confirmed the detrimental effects of oral diseases on overall health and the interrelationships between oral and systemic diseases (including HIV and diabetes), the importance of dental education grows. To assist in curricular reform processes, an educational collaboration between MUHAS and the University of California San Francisco (UCSF) was established, the MUHAS-UCSF Academic Learning Project. Through the project, training programmes were developed for faculty to facilitate the transition to a competencybased curriculum and develop teaching methods that would enhance the effectiveness of the education and performance of graduates in traditional and new roles. The programs developed through this collaboration will be described, as will with lessons

Osteocalcin (OCN) expression is an essential osteogenic marker of successful bone regeneration therapies. This study hypothesizes that Si(4+) and Ca(2+) combinatorial released by bioactive glass enhance osteoblast biomineralization through up-regulation of OCN expression; and Mg(2+) release delays such enhancement. Osteoblasts (MC3T3-E1) were treated with ionic products of bioactive glass dissolution (6P53-b experimental bioactive glass and 45S5 commercial Bioglass). Results showed that gene expressions, including OCN and its up-stream transcription factors (Runx2, ATF4, MSX1, SP7/OSX), growth factors and signaling proteins (BMP2, BMP6, SMAD3), were enhanced in both 45S5 and 6P53-b glass conditioned mediums (GCMs). This up-regulation led to enhanced mineral formation by 45S5 glass conditioned mediums ([GCM], Si(4+)+Ca(2+)) after 20 days, and by 45S5 GCM and 6P53-b GCM (Si(4+)+Ca(2+)+Mg(2+)) after 30 days. In examining the extracellular matrix generated by cells when exposed to each GCM, it was found that 45S5 GCM had slightly elevated levels of mineral content within ECM as compared to 6P53-b GCM after 30 days while control treatments exhibited no mineral content. The formation of well-defined mineralized nodules (distinct PO4(3-) [960 cm(-1)] and CO3(2-) [1072 cm(-1)] peaks from Raman Spectra) was observed for each GCM as the soluble glass content increased. In examining the individual and combined ion effects between Si(4+), Ca(2+), and Mg(2+), it was found Mg(2+) down-regulates OCN expression. Thus, ions released from both 45S5 and 6P53-b bioactive glasses up-regulate OCN expression and biomineralization while 6P53-b GCM Mg(2+) release down-regulated OCN expression and delayed osteoblast biomineralization. These results indicate that Si(4+), Ca(2+), and Mg(2+) combinatorially regulate osteoblast OCN expression and biomineralization.