Predicting Dental Caries Outcomes in Children: A “Risky” Concept

In recent years, unprecedented gains in the understanding of the biology and mechanisms underlying human health and disease have been made. In the domain of oral health, although much remains to be learned, the complex interactions between different systems in play have begun to unravel: host genome, oral microbiome with its transcriptome, proteome and metabolome, and more distal influences, including relevant behaviors and environmental exposures. A reasonable expectation is that this emerging body of knowledge can help improve the oral health and optimize care for individuals and populations. These goals are articulated by the National Institutes of Health as “precision medicine” and the elimination of health disparities. Key processes in these efforts are the discovery of causal factors or mechanistic pathways and the identification of individuals or population segments that are most likely to develop (any or severe forms of) oral disease. This article critically reviews the fundamental concepts of risk assessment and outcome prediction, as they relate to early childhood caries (ECC)—a common complex disease with significant negative impacts on children, their families, and the health system. The article highlights recent work and advances in methods available to estimate caries risk and derive person-level caries propensities. It further discusses the reasons for their limited utility in predicting individual ECC outcomes and informing clinical decision making. Critical issues identified include the misconception of defining dental caries as a tooth or surface-level condition versus a person-level disease; the fallacy of applying population-level parameters to individuals, termed privatization of risk; and the inadequacy of using frequentist versus Bayesian modeling approaches to derive individual disease propensity estimates. The article concludes with the notion that accurate caries risk assessment at the population level and “precision dentistry” at the person level are both desirable and achievable but must be based on high-quality longitudinal data and rigorous methodology

The diagnosis and treatment of impending coronary thrombosis

A journal article on the diagnosis and treatment of coronary thrombosis

Factors influencing micro and small enterprises’ access to finance since the adoption of multi-currency system in Zimbabwe.

Access to financial services is key to Micro and Small Enterprises’ (MSEs) operation and growth in Zimbabwe. A survey was done in a small town (Bindura), medium size city (Kadoma) and the city of Harare (large city) to determine major factors influencing MSEs’ access to finance since the adoption of the multi-currency system in Zimbabwe. A pilot study was done in the city of Gweru to 10 MSEs’. Structured questionnaires were administered to MSEs that have been operating for at least one year as well as registered with the respective town councils and a total of 115 responses were obtained in all the 3 urban areas. The model used was the Binary Logistic model. The best model selected was based on the Omnibus Tests of model coefficients, the Chi-Square tests, the Cox and Snell R-Sqaure and the Nagelkerke R-Squared values. The importance of each factor was determined using the Wald statistic value. The results showed that formality, value of assets, business sector, operating period, financial performance and size are all important factors in determining access to finance.MSEs; Finance; Multi-Currency; Logistic Regression

Exploring the genetic basis of chronic periodontitis: a genome-wide approach

Chronic periodontitis (CP) is a common-complex oral disease that affects the majority of the adult population and is a major cause of tooth loss. The disease is characterized by an oral biofilm pathological shift that contributes to cascade of events leading to periodontal destruction. Factors modulating the establishment of a dysbiotic oral microbiome or affecting the host immunity and inflammatory response are promising preventive and therapeutic targets. Although a substantial genetic component of CP is theorized and numerous candidate-gene studies have been completed, to-date no wholegenome association (GWA) studies have been performed. We performed a GWA analysis of CP in well-defined cohort of 4500 white subjects who were participants of the Atherosclerosis Risk In Communities study. Traits of interest were the three-level disease CDC/AAP classification (healthy/mild, moderate, severe CP) and a continuous extent of disease [proportion of sites exhibiting ≥3 mm attachment loss (EAL)] measure. Additionally, we examined three traits of high bacterial colonization defined as the highest quintile of the distribution of “red” and “orange” complex bacteria, and Aggregatibacter actinomycetemcomitans that were quantified using DNA-DNA checkerboard hybridization in a subset of 1020 white study subjects. Genotyping was performed using the Affymetrix 6.0 platform. Imputation to 2.5million markers was based on HapMap II-CEU and a multiple-test corrected significance threshold was applied (P<5x10-8). We detected no genome-wide significant signals. However, we found suggestive evidence of association (P<5x10-6) for CP with ten loci including NPY, NIN, WNT5A for severe, NCR2, EMR1 for moderate CP, and TBX18, ETS1, DYNC2H1, TTC26 and ZC3HAV1 for EAL. Additionally, thirteen loci including KCNK1, FBXO38, IL33, RUNX2, CAMTA1 and VAMP3 provided suggestive signals of association (P<5x10-6) with the examined “high” bacterial colonization traits. The NPY (7p15) locus was replicated in an independent cohort of whites of European descent. These genome-wide scan results from a large well-defined cohort provide information on multiple candidate regions for interrogation in genetic studies of CP. Future investigations providing further replication of these findings may lead to an improved understanding of the complex nature of host-biofilm and -bacteria interactions that characterizes states of health and disease

Pediatric obesity‐related curricular content and training in dental schools and dental hygiene programs: systematic review and recommendations

ObjectivesThe authors conducted a systematic review to determine: a) What dental schools and dental hygiene programs are doing to promote knowledge and skills related to addressing childhood obesity and to reduce consumption of sugar‐sweetened beverages (SSBs) and b) What else these schools and programs could do to better equip future oral health professionals to address childhood obesity and reduce consumption of SSBs.MethodsThe authors searched PubMed, Scopus, Education Full Text (EBSCOHost), and ERIC (EBSCOHost) to identify peer‐reviewed publications reporting on obesity or dietetic‐related curricula in dental and dental hygiene education within the last 20 years. Three studies met inclusion and exclusion criteria. Outcomes of the identified studies were abstracted and summarized independently by two investigators.ResultsThe first study describes a 2009 survey of pediatric dentistry residents. Approximately, half had received formal training yet they lacked essential knowledge or skills for managing children who were obese. The second study describes nutrition‐related coursework offered in the second year of a predoctoral dental school curriculum in Saudi Arabia, and the third study reports on the development of an “oral health rotation” dietetic internship in a pediatric dentistry clinic, in the context of interprofessional education (IPE).ConclusionsEvidence of dental schools’ and dental hygiene programs’ efforts to address obesity and SSB consumption in children in their curricula is scant, while Commission on Dental Accreditation standards make sporadic mentions of diet and nutrition. Opportunities exist to leverage existing resources and innovative, experiential approaches, including IPE, to formally, and effectively address this important issue in predoctoral oral health education.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/138365/1/jphd12236.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/138365/2/jphd12236_am.pd

Mendelian randomization studies of periodontitis:Understanding benefits and natural limitations in an applied context

Mendelian randomization (MR) is a flexible analytical tool that has been widely applied to strengthen causal inference in observational epidemiology and is now gaining attention in many areas including periodontal research. The interpretation of results drawn from MR is based on a series of assumptions, which can be unrealistic or difficult to meet faithfully in some settings. However, we argue that with care, this does not necessarily prevent valuable deployment of the approach. We argue that clarity of presentation as well as careful assessment of specific analytical conditions is a fundamental part of all MR analyses. To that end, awareness of its limitations should also guide the design of MR investigations and the presentation of results rather than rule out its use altogether. Notably, considerations similar to those known to be important in conventional epidemiological settings apply to MR. While MR studies are valuable in their contrast to other study limitations, the application of this technique must be carefully cross-examined. Specific considerations include possible confounders, recruitment strategy and phenotypic measurement and differential analysis properties across studies. In the case of periodontal research, current MR applications are limited by the available evidence base for genetic contributions to periodontitis; however, this sets a specific scene for the strategic use of MR and shines light on a need for greater research emphasis on the genetics of the condition and intermediaries. This article provides a perspective on the uses and inherent limitations of MR studies and the importance of adhering to basic epidemiological principles when designing them

Benefits of Case-Based versus Traditional Lecture-Based Instruction in a Preclinical Removable Prosthodontics Course

This study compared the acceptability and relative effectiveness of case-based learning (CBL) versus traditional lecture-based (LB) instruction in a preclinical removable prosthodontics course in the University of North Carolina at Chapel Hill School of Dentistry DDS curriculum. The entire second-year class (N=82) comprised this crossover study's sample. Assessments of baseline comprehension and confidence in removable partial denture (RPD) treatment planning were conducted at the beginning of the course. Near the end of the course, half of the class received CBL and LB instruction in an RPD module in alternating sequence, with students serving as their own control group. Assessments of perceived RPD treatment planning efficacy, comprehension, and instruction method preference were administered directly after students completed the RPD module and six months later. Analyses of variance accounting for period, carryover, and sequence effects were used to determine the relative effects of each approach using a p<0.05 statistical significance threshold. The results showed that the students preferred CBL (81%) over LB instruction (9%), a pattern that remained unchanged after a six-month period. Despite notable period and carryover effects, CBL was also associated with higher gains in RPD treatment planning comprehension (p=0.04) and perceived efficacy (p=0.01) compared to LB instruction. These gains diminished six months after the course-a finding based on a 49% follow-up response rate. Overall, the students overwhelmingly preferred CBL to LB instruction, and the findings suggest small albeit measurable educational benefits associated with CBL. This study's findings support the introduction and further testing of CBL in the preclinical dental curriculum, in anticipation of possible future benefits evident during clinical training

Systematic Review and Meta-analysis of the Association Between Exposure to Environmental Tobacco Smoke and Periodontitis Endpoints Among Nonsmokers

A systematic review was conducted to summarize the epidemiological evidence on environmental tobacco smoke (ETS) exposure and prevalent periodontitis endpoints among nonsmokers