MedicalResearch.com Interview with:
Jiyoung Ahn, PhD, RD, MS
Associate Professor of Population Health
Associate Director of Population Sciences,
NYU Perlmutter Cancer Center and
Brandilyn Peters (post-doctoral fellow, lead author)
NYU Langone School of Medicine
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Oral bacteria play important roles in oral health, and can influence the health of other body systems as well. We were interested in studying how cigarette smoking affects oral bacteria. To do this, we examined the oral bacteria in mouthwash samples from 112 current smokers, 571 former smokers, and 521 people who never smoked. We found that the mouth bacterial composition of current smokers differed dramatically from those who never smoked. However, the mouth bacterial composition of former smokers was similar to that of never smokers, suggesting that quitting can restore the oral bacteria back to a healthy state.
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MedicalResearch.com Interview with:Dr. Huizhi WangAssistant Professor
Department of Oral Immunology and Infectious Diseases
University of Louisville School of Dentistry
Louisville, KYMedicalResearch.com: What is the background for this study? What are the main findings?Dr. Wang: Esophageal cancer is the eighth most frequent tumor and sixth leading cause of cancer death worldwide, characterized by rapid development and poor prognosis, including high mortality. Whereas the majority of cases occur in Asia, particularly in central China, recent data suggest that the frequency of new cases is rising in Western Europe and the USA. Mounting evidence suggests a causal relationship between specific bacterial infections and the development of certain malignancies. However, the possible role of the keystone periodontal pathogen, Porphyromonas gingivalis, in esophageal squamous cell carcinoma (ESCC) was unknown before our study. We found P. gingivalis infects epithelium of cancerous tissues up to 61%, as compared with 12% of adjacent tissues and non-infected in normal esophageal mucosa. A similar distribution of lysine-specific gingipain, a catalytic endoprotease uniquely secreted by P. gingivalis, and P. gingivalis DNA was observed. Moreover, we found infection of P. gingivalis was positively associated with the multiple clinicopathologic characteristics, including differentiation status, metastasis, and overall survival rate.(more…)
MedicalResearch.com Interview with:
Dr. Robert Friedland MD
Mason C. and Mary D. Rudd Endowed Chair In Neurology
Professor, Dept. of Neurology
University of Louisville Health Care Outpatient Center
Louisville, KY 40292
Medical Research: What is the background for this study? What are the main findings?
Dr. Robert Friedland: Oral infectious diseases are associated with stroke. Previous research by this group has shown that oral bacteria, cnm-positive Streptococcus mutans, was associated with cerebral microbleeds and intracerebral hemorrhage. We developed this study to investigate the roles of this bacteria in patients entering the hospital for all types of stroke. Among the patients who experienced intracerebral hemorrhage (ICH), 26 percent were found to have a specific bacterium in their saliva, cnm-positive S. mutans. Among patients with other types of stroke, only 6 percent tested positive for the bacterium. We also evaluated MRIs of study subjects for the presence of cerebral microbleeds (CMB), small brain hemorrhages which may cause dementia and also often underlie ICH. We found that the number of CMBs was significantly higher in subjects with cnm-positive S. mutans than in those without.(more…)
MedicalResearch.com Interview with:
Jo Freudenheim, PhD
UB Distinguished Professor and Interim Chair
Department of Epidemiology and Environmental Health
School of Public Health and Health Professions
University at Buffalo
Buffalo, NY
Medical Research: What is the background for this study? What are the main findings?
Dr. Freudenheim: There have been a number of studies that have shown an association between periodontal disease and chronic diseases, particularly stroke and heart attacks. There is also some newer evidence that periodontal disease is associated with cancer, particularly cancers of the gastrointestinal tract. Ours is the first large prospective study of periodontal disease and breast cancer.
This was part of a study of more than 70,000 postmenopausal women from throughout the United States, the Women’s Health Initiative. Women provided information about their health and other related factors and then those women were followed to see who developed certain diseases.
We found that women who had been told that they had periodontal disease were more likely to develop breast cancer. In particular, women who were former smokers (quit within the last 20 years) and who had periodontal disease were at increased breast cancer risk. There was a similar increase in risk for current smokers with periodontal disease but it was not statistically significant. (There was a relatively small number of current smokers in the WHI study.)
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MedicalResearch.com Interview with:
Koji Kawakami, MD, PhD
Professor and Chair, Department of Pharmacoepidemiology and Clinical Research Management
Graduate School of Medicine and Public Health
Director, Science for Innovation Policy Unit, Center for Promotion of Interdisciplinary Education and Research
Kyoto University Kyoto city
Kyoto Japan
Medical Research: What is the background for this study? What are the main findings?
Dr. Kawakami: The prevalence of caries in deciduous teeth in developed countries remains high, while established measures for caries prevention in young children is limited to sugar restriction, oral fluoride supplementation and fluoride varnish. In this study of 76920 children in Japan, exposure to tobacco smoke at 4 months of age, which was experienced by half of all children of that age, was associated with an increased risk of caries in deciduous teeth by approximately 2-fold.
Medical Research: What should clinicians and patients take away from your report?Dr. Kawakami: Our findings would support extending public health and clinical interventions to reduce secondhand smoke. For example, the chance of education on the harm of secondhand smoke would increase if dentists become aware of the caries risk due to secondhand smoke as well as tobacco smoking of their patients.
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MedicalResearch.com Interview with:
Boxi Zhang PhD Student
School of Health and Medical Sciences
Örebro University Medical Research: What is the background for this study? What are the main findings?
Response: In the past decade, many studies raise concerns about the increased prevalence of cardiovascular disease and mortality among patients with periodontitis. Porphyromonas gingivalis is the major pathogen causing periodontal disease. This bacterium also plays a significant role in the pathogenesis of atherosclerosis. In this study, we infect human aortic smooth cells with P. gingivalis and show that this periodontal pathogen affects gene and protein expression in human aortic smooth muscle cells associated with increased inflammation and atherosclerosis.
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MedicalResearch.com Interview with:
Daniel Grenier, Ph.D.
Professeur titulaire
Oral Ecology Research Group, Faculty of Dentistry, and Institute of Nutrition and Functional Foods, Université Laval
Quebec City, QC, Canada
Medical Research: What is the background for this study? Dr. Grenier: Periodontal diseases (gingivitis and periodontitis) are major public health problems because of their high prevalence and incidence in all regions of the world. According to epidemiological studies, approximately 5% of North Americans suffer from severe generalized periodontitis, which can lead to tooth loss, while mild to moderate periodontitis affects up to 35% of adults. Given emerging data indicating that there is a relationship between periodontal diseases and systemic health problems such as diabetes, cardiovascular diseases, and preterm birth, studies on preventive and therapeutic strategies targeting periodontal diseases are highly relevant.
Medical Research: What are the main findings?Dr. Grenier: Using various in vitro models, we brought clear evidence that a blueberry extract enriched in proanthocyanidins can act on the two etiological components of periodontal disease. We first showed that these polyphenols inhibit the growth of Fusobacterium nucleatum as well as its ability to form a biofilm, which can provide to the bacterium a resistance to antimicrobial agents and immune cells. Interestingly, F. nucleatum has been associated with various forms of periodontitis as well as to a number of extra-oral infections, including endocarditis, inflammatory bowel disease, and brain abscesses. Moreover, the blueberry extract attenuated the inflammatory response of human macrophages challenged with F. nucleatum, resulting in a decreased secretion of inflammatory cytokines (IL-1β, IL-6, TNF-α) and tissue destructive enzymes (MMP-8, MMP-9). Evidence was brought that this property is likely related to the ability of the blueberry polyphenols to block the activation of the NF-κB signaling pathway that play a key role in inflammatory reactions.
Over the last decade, my laboratory has been investigating the potential benefits of various classes of polyphenols for oral health. Polyphenols are a large group of natural substances found in plants and characterized by the presence of more than one phenol unit per molecule. Given that wild blueberries (Vaccinium angustifolium Ait), a popular berry fruit in Quebec, are particularly rich in a specific class of polyphenols, called proanthocyanidins, we tested their effect on the two major etiological factors involved in the pathogenesis of periodontitis: a limited group of Gram negative anaerobic bacteria, and an uncontrolled host immune response to these pathogens that results in the secretion of high amounts of inflammatory mediators which modulate the progression and severity of periodontitis.
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MedicalResearch.com Interview with: Xiaodan Mai MBBS
University at Buffalo, The State University of New York
Buffalo, NY
MedicalResearch: What is the background for this study? What are the main findings?
Response: Periodontal disease is a condition that is highly prevalent amongst the elderly, and is characterized by chronic polymicrobial infection and inflammation of gum tissue. Periodontal disease has been associated with increased cancer risk, and these findings may be partially explained by extra-oral translocation of subgingival bacteria that subsequently modulates host cell environment and function. However, there is limited research on whether the presence of certain subgingival bacteria influences cancer risk. .
Oral bacteria have been categorized into color-coded complexes by their timing of colonization and strength of association with periodontal disease. Using data from an ancillary study of the Women’s Health Initiative conducted in Buffalo, New York (a cohort of 1300 postmenopausal women), we therefore investigated the associations between the presence of three early-colonizing periodontal pathogens (Fusobacterium nucleatum, Prevotella intermedia, and Campylobacter rectus, i.e., "orange complex" bacteria moderately associated with PD), the presence of two late-colonizing periodontal pathogens (Porphyromonas gingivalis, Tannerella forsythia, i.e., "red complex" bacteria strongly associated with PD) in dental plaque and cancer risk. We found borderline associations between presence of any early-colonizing pathogens and increased risk of total cancer and lung cancer. Individual pathogens were not associated with total cancer or site-specific cancers when analyzed singly. Presence of any pathogens or presence of any late-colonizing pathogens was not associated with total or site-specific cancer.
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MedicalResearch.com Interview with: Judith Haber, PhD, APRN, BC, FAAN
Associate Dean, Graduate Programs
The Ursula Springer Leadership Professor in Nursing
New York, NY 10003
Medical Research: What is the background for this study? What are the main findings?
Dr. Haber: The background of the project originally aligns with publication of the Surgeon General's Report (2000), challenging health providers to think about the "mouth as a window to the body". More recent Institute of Medicine (IOM) reports, Advancing Oral Health in America (2011) and Improving Access to Oral Health Care for Vulnerable and Underserved Populations (2011) highlighted the extant problems with oral health access, oral health disparities and outcomes and the potential role of the primary care workforce in addressing this population health issue. However, there is a dearth of curricular focus on oral health in the curriculum of health professionals. The IOM challenged the Health Resource and Service Administration (HRSA) to convene an Expert Panel to develop interprofessional oral health core clinical (IPOHCC) competencies; the report, Integrating Oral Health and Primary Care Practice, delineating the IPOHCC competencies, was published in 2014. Our HRSA funded initiative, Teaching Oral-Systemic Health (TOSH), focuses on building interprofessional oral health workforce capacity with a special focus on the nursing, medical and dental professions. We have operationalized the IPOHCC competencies by transforming the HEENT component of the health history, physical exam, risk assessment, diagnosis, and management plan, including collaboration and referral, to the HEENOT approach. When a health professional uses the HEENOT approach, he or she cannot forget about oral health.
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MedicalResearch.com Interview with:
Philip Riley
Cochrane Oral Health Group, School of Dentistry
The University of Manchester
Manchester, UK
Medical Research: What is the background for this study? What are the main findings?
Response: As tooth decay is still so prevalent worldwide, despite being entirely preventable, it is worth assessing the evidence for other adjunctive ways for the public to help prevent the disease. Manufacturers of xylitol products commonly make the claim that this natural sweetener prevents tooth decay, and we felt that the public deserved to know if the best quality evidence backs up such claims.
We found that there was a lack of evidence from randomised controlled trials (the best type of study design for testing the effects of interventions) to prove that xylitol products can prevent tooth decay. We found some low quality evidence suggesting that xylitol added to fluoride toothpaste may reduce tooth decay in children’s permanent teeth by 13% over a 3 year period when compared to fluoride toothpaste without xylitol. However, these findings should be interpreted with caution and may or may not be generalizable to other populations. There was insufficient evidence to conclude that xylitol in chewing gums, lozenges, candies/sweets, syrups and wipes can prevent tooth decay in children or adults
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MedicalResearch.com Interview with:Sylvie Babajko, PhD
Centre de Recherche des Cordeliers
Inserm UMR_S 1138
Laboratoire de Physiopathologie Orale Moléculaire
75006 Paris cedex 06
MedicalResearch:What is the background for this study? What are the main findings?Dr. Babajko: The environment has become increasingly contaminated by various pollutants. This has led to an increase in the incidence and gravity of known pathologies and/or the emergence of new pathologies. In 2001, a distinct enamel pathology called molar incisor hypomineralization (MIH) was described. It is diagnosed by white to brown creamy lesions affecting permanent first molars and frequently permanent incisors too. These teeth are sensitive and susceptible to caries. MIH prevalence turns around 15-18 % of 6 to 9 years-old children in studied populations all over the world. To date, MIH etiology remains unclear. However, given that MIH affects those teeth that are undergoing mineralization around the time of birth, MIH is indicative of some adverse event(s) occurring during early childhood that impact on enamel development. Interestingly, susceptibility to BPA in human is the highest during the same period of time.
Our experimental data (1, 2) showed that BPA may be a causal agent of MIH and that BPA irreversibly impacts amelogenesis via steroid hormone pathway. (more…)
MedicalResearch.com Interview with:
Dr. Francisco Mesa
Department of Periodontics,
School of Dentistry, University of Granada, SpainMedical Research: What is the background for this study? What are the main findings?Dr. Mesa: The size of an acute myocardial infarct (AMI) is one of the determinants of its severity, i.e., the degree of myocardial necrosis. This necrosis is indicated by peak troponin I levels in the blood. Among the acute myocardial infarct patients in our study, mediated regression analysis demonstrated that troponin I levels were higher, i.e., the infarct size was larger, in those with chronic periodontitis.
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MedicalResearch.com Interview with: Brendan J. Perry, BSc, MBBS
Princess Alexandra Hospital
Brisbane, Queensland, Australia
MedicalResearch: What is the background for this study? What are the main findings?Dr. Brendan J. Perry:Oral cavity cancer is usually attributed to the “Five S’s” - smoking, spirits (alcohol), spices, syphillis and sharp (or septic) teeth. Cigarettes and alcohol are the most important recognised factors. Spices, such as betel nut, and syphillis are known carcinogens but are not commonly seen in western practice. The role of chronic dental trauma on the mucosa of the mouth to cause cancer has only been examined in a limited number of studies previously and its importance has not been elucidated and has never really affected clinical practice.
This retrospective review examined the position in the oral cavity where cancers occurred with respects to smoking status and other variables over a 10 year period in a major Australian hospital. The edge of the tongue, a site of potential dental trauma, was the most common site affected, accounting for 35% of oral cavity cancers in smokers. However, in lifelong non-smokers without other significant risk factors, 65% of cancers occurred on the edge of the tongue. A significant number also occurred on the buccal mucosa (inner lining of cheek) which is also exposed to dental trauma, but to a much lesser degree than the more mobile tongue. The floor of the mouth and the alveolar ridge (gums) were also common sites of cancer, but tended to occur in an older age group. This is possibly due to irritation caused by the movement of dentures in this age group against these areas of the mouth. In recent years, dentists have been recommending clients to get removable denture nyc to tackle down on discomfort.
We also found that males had an equal chance of developing oral cavity versus oropharyngeal cancer (255 cases vs 265). However, females are almost twice as likely to develop an oral cavity cancer than an oropharyngeal cancer (135 cases vs 69), and this ratio jumps to 4 times the risk for lifelong non-smoking females (53 vs 12). Although a lot of attention has been given to HPV in causing oropharyngeal cancer, for non-smokers, especially females, it appears that oral cavity cancer is a more common disease, and also that chronic dental trauma may be a significant contributing factor.
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MedicalResearch.com Interview with: Professor Aubrey Sheiham
Emeritus Professor of Dental Public Health
Department of Epidemiology & Public Health,
University College London, WC1E 6BT. UK.
Medical Research: What are the main findings of the study?Prof Sheiham: There is a robust log-linear relationship of caries to sugar intakes from zero to 10% of sugars as a proportion of total energy intake. Furthermore our analyses showed that sugar intakes of 10%E sugars intake that is currently recommended as an upper limit for free sugars by the WHO and the Scientific Advisory Committee on Nutrition in England would induce a very costly burden of caries in most populations. Second, we found that free sugars* in the diet should make up no more than 3% of total energy intake. Above that level they cause a significant level of tooth decay across the lifecourse of most people in the developed world. Third, we were able to show that despite widescale fluoride use from both toothpastes and drinking water the mean numbers of decayed, missing and filled teeth (DMFT) and decayed and filled surfaces (DFS) for adults increased with sugar use despite the presence of fluoride.
*Free sugars are defined by the World Health Organisation Nutrition Guidance Adivisory Group as follows: “Free sugars include monosaccharides and disaccharides added to foods by the manufacturer, cook or consumer, and sugars naturally present in honey, syrups, fruit juices and fruit concentrates.” (more…)
MedicalResearch.com Interview with: Faleh Tamimi, BDS, PhD
Assistant Professor,
Faculty of Dentistry
Strathcona Anatomy & Dent,
Montreal, Quebec Canada
Medical Research: What are the main findings of the study?Dr. Tamimi: The main finding was that SSRIs usage was associated with an increased risk of dental implants failure.
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MedicalResearch.com Interview with: Donna Warren Morris, RDH, Med
Professor, Dean's Academy of Distinguished Teaching Scholars
Houston, TX 77054
Medical Research: What are the main findings of the study?Answer: Power toothbrushes can harbor microorganisms that have been shown to cause disease and infections. A solid-head design was found to have less growth of microorganisms than two others with hollow head designs.
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MedicalResearch.com Interview with:Dr Ola Vedin
University of Uppsala, Sweden
MedicalResearch.com: What are the main findings of the study?Dr. Vedin:That self-reported tooth loss as a marker of periodontal disease is common in patients with established coronary heart disease and is associated with higher levels of LDL cholesterol, glucose levels, systolic blood pressure and waist circumference as well as diabetes and smoking, i.e. risk factors for coronary heart disease. Gum bleeding, another marker of periodontal disease, was associated with higher levels of LDL cholesterol and systolic blood pressure. In summary, patients with few remaining teeth and gum bleeding demonstrated a heavier burden of cardiovascular risk factors.
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MedicalResearch.com Interview with: Dr. Panos N. Papapanou:
Professor of Dental Medicine;
Chairman, Section of Oral and Diagnostic Sciences
Director, Division of Periodontics Section of Oral and Diagnostic Sciences,
College of Dental Medicine, Columbia University, New York, NY
MedicalResearch.com: What are the main findings of the study?Dr. Papapanou: Gene expression signatures in gum tissues obtained from patients with periodontitis identified two fairly robust clusters, suggesting potential differences in pathobiologic processes between the two groups. In addition, the two clusters displayed differences in important features of the disease (e.g., the extent and severity of periodontitis, and the level of colonization by periodontal bacteria). These findings indicate that gene expression patterns may form the basis for a novel, pathobiology-based classification of periodontitis.
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MedicalResearch.com Interview with:Dr. Kendra J. Grim
Department of Anesthesiology
Mayo Clinic, Rochester, MN 55905
MedicalResearch.com: What are the main findings of the study? Dr. Grim: “The current guidelines say that if possible, treating the dental problems that patients have before heart surgery is best, to try to prevent both early and late heart infections. But the data is very unclear, because it’s very difficult to study. We found in our study that their risk of serious complications after having teeth removed may be higher than we thought. We were primarily looking at stroke, heart attack, renal failure and death. We found that actually the incidence of having one of those major morbidities was 8 percent. Of that 8 percent, we had six patients, or 3 percent, of the total group who died between their dental surgery and scheduled heart surgery, so these patients never made it to their heart surgery. An additional 3 percent of patients died after heart surgery. “
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MedicalResearch.com Interview with: Ayse Basak Cinar, Assistant Professor
The Department of Odontology
The Faculty of Medical and Health Resources
2200 Copenhagen N Denmark
MedicalResearch.com: What are some of the unique or enlightening findings of this study that haven’t been published before?Answer: To our knowledge, this is the first randomized controlled intervention study comparing the impact of individualized Health Coaching (HC) to formal Health Education (HE); applying HC as a holistic intervention for management of more than one specific type of chronic disease, namely oral health and diabetes management.
The present study has two phases [the Turkish Phase, Turkey (2010-2012) and the Danish Phase, Denmark (2012- ...)]. The unique/enlightening figures from the Turkish phase as follows:
The HC group compared to the HE group had significantly higher improvement at;
HbA1c* (reduction: 0, 8% vs. 0%), and Periodontal Attachment Loss (PAL) (56% vs. 26%), (p≤0.01)
Tooth Brushing Self-Efficacy (TBSE) (increase: 61% vs.25%) and stress (reduction: 16% vs. 1%), (p≤0.01).
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MedicalResearch.com Interview with:Mine Tezal, DDS, PhD
Oral Biology
University at Buffalo
NYS Center of Excellence in Bioinformatics and Life Sciences
MedicalResearch.com: What are the main findings of the study? Dr. Tezal: We observed an inverse association between dental caries and head and neck cancer (HNSCC), which persisted among never smokers and never drinkers. Besides untreated caries, two other objective measures of long-standing caries history (endodontic treatments and crowns) were also inversely associated with HNSCC with similar effect sizes, supporting the validity of the association. Missing teeth was associated with increased risk of HNSCC in univariate analyses, but after adjustment for potential confounders, its effect was attenuated and was no longer statistically significant.
(more…)
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