Faculty Bibliography

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

OBJECTIVE.: To profile the subgingival oral microbiota abundance and diversity in never-treated, new-onset rheumatoid arthritis (NORA) patients. METHODS.: Periodontal disease (PD) status, clinical activity and sociodemographic factors were determined in patients with NORA, chronic RA (CRA) and healthy subjects. Massively parallel pyrosequencing was used to compare the composition of subgingival microbiota and establish correlations between presence/abundance of bacteria and disease phenotypes. Anti-P. gingivalis antibodies were tested to assess prior exposure. RESULTS.: The more advanced forms of periodontitis are already present at disease onset in NORA patients. The subgingival microbiota of NORA is distinct from controls. In most cases, however, these differences can be attributed to PD severity and are not inherent to RA. The presence and abundance of P. gingivalis is directly associated with PD severity as well, is not unique to RA, and does not correlate with anti-citrullinated peptide antibody (ACPA) titers. Overall exposure to P. gingivalis is similar in RA and controls, observed in 78.4% and 83.3%, respectively. Anaeroglobus geminatus correlated with ACPA/RF presence. Prevotella and Leptotrichia species are the only characteristic taxa in the NORA group irrespective of PD status. CONCLUSIONS.: NORA patients exhibit a high prevalence of PD at disease onset, despite their young age and paucity of smoking history. The subgingival microbiota of NORA patients is similar to CRA and healthy subjects of comparable PD severity. Although colonization with P. gingivalis correlates with PD severity, overall exposure is similar among groups. The role of A. geminatus and Prevotella/Leptotrichia species in this process merits further study.

This study compared the anatomical features of the tongue in nine pairs of twins - six monozygotic and three dizygotic. The aim of the project was to determine if tongues, like any other anatomical structure, could be used to reliably predict relatedness given that tongue shape, presentation and surface can be influenced by environment. Using the method of forced choice, 30 subjects were asked to match the photographs of tongues from twins. Our data indicate that, based on visual assessment, monozygotic twins have highly similar tongues (60% matches); similarly, dizygotic twins were matched 31% of the time, which is a higher probability than would be expected from random selection. This study should help identify baseline and control data in future behavioral studies of taste, which has a genetic basis

Purpose: The etiology of RA remains unknown, but genetic and environmental factors have been implicated. An infectious trigger has been sought but conventional microbiologic techniques have been uninformative. The human intestine contains a dense, diverse and poorly characterized (>=80% uncultured) bacterial population whose collective genome (microbiome) is >=100 times larger than its human host. We (DRL) have recently shown in mice that gut-residing bacteria drive autoimmune arthritis via Th17 cell activation (Immunity 2010). Multiple lines of investigation also suggest a link between RA and oral microbes. Methods: As part of an NIH ARRA grant, the NYU Microbiome Center for Rheumatology and Autoimmunity was established to study gut and oral microbiota in RA and related conditions. A cross-sectional study and prospective proof-of-concept antibiotic intervention trial are ongoing. Fecal samples are collected, periodontal status assessed and oral samples obtained by subgingival biofilm collection. To date, oral/intestinal microbiomes have been analyzed in 8 RA patients, 3 psoriatic arthritis (PsA) patients and 9 healthy controls. Periodontal status was characterized in 30 RA, 4 PsA and 8 controls. DNA was purified and variable 16s rRNA gene regions amplified. PCR products were pyrosequenced (454 Life Sciences), and DNA sequences compared to the RDP and BLAST catalogs. rDNA-based phylogenetic trees were created, and the UNIFRAC metric used to compare bacterial communities across individuals. Sera from all subjects were evaluated for anti-citrullinated peptide antibodies (ACPA). Results: Prevotellaceae family was significantly overrepresented in fecal microbiota from ACPA+ RA patients (range 13%-85%; mean=38%) vs ACPA-individuals (mean=4.3%); p=0.003. One ACPA+ healthy individual and 1 ACPA+ PsA patient shared similar microbiomes with ACPA+ RA. Subgingival microbiomes in patients with new-onset drug-naive RA exhibited overabundance of the Spirochetaceae/Prevotellaceae/Porphyromonaceae families (mean=53%) compared to chronic-active RA and healthy controls (mean=18.5%). Periodontal assessment revealed 78% of examined sites bled upon probing in RA patients (mean age 39; 73% female), significantly more than controls (38% PsA, 12% healthy; p<0.001 vs RA); 66% of RA patients also presented with moderate periodontitis compared to PsA (25%) and controls (12%). Conclusions: This is the first study using high-throughput technologies to assess oral and intestinal microbiota in RA. Our data corroborate prior reports demonstrating an underappreciated high prevalence of periodontal disease at a young age in patients with RA. Moreover, our preliminary data suggest that ACPA generation may be associated with larger populations of Prevotellaceae in both oral and intestinal microbiomes. In response to such altered microbial flora, certain predisposed individuals may develop auto-inflammatory disease, through mechanisms that may include the generation of cyclic citrullinated peptides or Th17 cell activation in the intestinal mucosa. Thus, the oral and intestinal microbiota merit further investigation as potential triggers for autoimmunity and clinical RA