Microbiota signature of oral chronic graft-versus-host disease 6+ years after transplantation.

Not available.

Dental evaluation and clearance prior to allogeneic hematopoietic cell transplantation.

INTRODUCTION: Dental examination and stabilization are performed prior to allogeneic hematopoietic cell transplantation to decrease infection risk during neutropenia. Burden of dental disease and treatment need is not well characterized in this population. OBJECTIVES: This report describes the dental status of a cohort of patients within the Chronic Graft-versus-Host Disease Consortium and treatment rendered prior to transplant. METHODS: The cohort included 486 subjects (Fred Hutchinson: n = 245; Dana-Farber: n = 241). Both centers have institutional-based dental clearance programs. Data were retrospectively abstracted from medical records by calibrated oral health specialists. RESULTS: The median age at transplant was 55.9 years, 62.1% were male, and 88% were white. Thirteen patients were edentulous (2.7%). The mean teeth among dentate patients before clearance was 26.0 (SD, 4.6). Dental findings included untreated caries (31.2%), restorations (91.6%), endodontically treated teeth (48.1%), and dental implants (5.7%). Pretransplant procedures during clearance included endodontic therapy (3.6%; mean = 0.1 teeth), restorations (25.1%; mean = 0.7), dental prophylaxis (59.2%), scaling/root planing (5.1%), and extraction (13.2%; mean = 0.3). The mean teeth after clearance was 25.6 (SD, 5.0). CONCLUSIONS: Retrospective analysis of pre-AlloHCT dental data in subjects at two large transplant centers identified low levels of dental need. Findings suggest high access to care.

Private Interests and the Start of Fluoride-Supplemented High-Carbohydrate Nutritional Guidelines.

Fluoride has no tangible health benefits other than preventing dental caries and there is a small difference between its minimum effective dose and its minimum toxic dose. Leading global organizations currently recommend fluoride supplementation because they recommend high-carbohydrate diets which can cause dental caries. Low-carbohydrate diets prevent dental caries making such fluoride recommendations largely unnecessary. A dental organization was among the first to initiate the public health recommendations which started fluoride-supplemented high-carbohydrate nutritional guidelines. This start required expert panels at this dental organization to reverse on three key scientific points between 1942 and 1949: (1) that topical fluoride had potential harms, (2) that dental caries was a marker for micronutrient deficiencies, and (3) that low-carbohydrate diets are to be recommended for dental caries prevention. Internal documents show that private interests motivated the events which led these expert panels to engage in pivotal scientific reversals. These private interests biased scientific processes and these reversals occurred largely in an absence of supporting evidence. It is concluded that private interests played a significant role in the start of public health endorsements of fluoride-supplemented high-carbohydrate nutritional guidelines.

Vitamin C and scar strength: analysis of a historical trial and implications for collagen-related pathologies.

A double-blind controlled trial initiated in 1944 has led to the common narrative that a 10-mg daily vitamin C intake is adequate to prevent and treat impaired wound healing, and by inference, other collagen-related diseases such as heart disease or stroke. The WHO relies on this narrative to set the recommended nutrient intake for vitamin C. This narrative, however, is based on what is known as the eyeball method of data assessment. The 1944 trial published individual participant data on scar strength providing an opportunity to statistically probe the validity of the 10-mg narrative, something which has not yet been done. The findings show that a vitamin C intake that averages to 10 mg/d over a mean follow-up of 11.5 mo was associated with a 42% weakened scar strength when compared with 80 mg vitamin C intake/d (P < 0.001). The observed dose-response curve between scar strength and vitamin C intake suggests that the daily vitamin C intake needed to prevent collagen-related pathologies is in the range recommended by the National Academy of Medicine and the European Food Safety Authority (75 to 110 mg/d), not the WHO recommendation (45 mg/d). The findings also show that a vitamin C intake that averages to 65 mg/d over a mean follow-up of 6.5 mo failed to restore the normal wound-healing capacity of vitamin C-depleted tissues; such tissues had a 49% weaker scar strength when compared with nondepleted tissues (P < 0.05). Thus, average daily vitamin C intakes ∼50% higher than the WHO recommends may fail to treat existing collagen-related pathologies. It is concluded that the prior lack of statistical analyses of a landmark trial may have led to a misleading narrative on the vitamin C needs for the prevention and treatment of collagen-related pathologies.

How a Nutritional Deficiency Became Treated with Fluoride.

Ignoring evidence on causes of disease such as smoking can harm public health. This report explores how public health experts started to ignore evidence that pediatric vitamin D deficiencies are associated with dental caries. Historical analyses show that an organization of clinical specialists, the American Dental Association (ADA), initiated this view. The ADA was a world-leading organization and its governing bodies worked through political channels to make fluoride a global standard of care for a disease which at the time was viewed as an indicator of vitamin D deficiencies. The ADA scientific council was enlisted in this endeavor and authorized the statement saying that "claims for vitamin D as a factor in tooth decay are not acceptable". This statement was ghost-written, the opposite of what the ADA scientific council had endorsed for 15 years, and the opposite of what the National Academy of Sciences concluded. Internal ADA documents are informative on the origin of this scientific conundrum; the ADA scientific council had ignored their scientific rules and was assisting ADA governing bodies in conflicts with the medical profession on advertising policies. The evidence presented here suggests that professional organizations of clinical specialists have the power to create standards of care which ignore key evidence and consequently can harm public health.

NO EVIDENCE THAT PERIODONTAL DISEASES CAUSE LUNG CANCER.

ARTICLE TITLE AND BIBLIOGRAPHIC INFORMATION: Relationship between periodontal disease and lung cancer: A systematic review and meta-analysis. Wang J, Yang X, Zou X, Zhang Y, Wang J, Wang Y. J Periodontal Res. 2020 Oct;55(5):581-593. doi:10.1111/jre.12772. Epub 2020 Jun 25. PMID: 32,583,879. SOURCE OF FUNDING: National Natural Science Foundation of China and Scientific Research foundation of the Health Planning Committee of Sichuan. TYPE OF STUDY/DESIGN: Systematic review with meta-analysis of cohort and case-control studies.

Bleeding tendency and ascorbic acid requirements: systematic review and meta-analysis of clinical trials.

CONTEXT: The World Health Organization set the recommended daily vitamin C intake, henceforth referred to as ascorbic acid (AA), on the basis of scurvy prevention. Double-blind AA depletion-repletion studies suggest that this recommended AA dose may be too low to prevent microvascular fragility. OBJECTIVES: (1) To conduct a systematic review and meta-analysis of controlled clinical trials on whether AA supplementation leads to a reduced gingival bleeding tendency, a manifestation of microvascular fragility; and (2) to relate AA plasma levels to retinal hemorrhaging, another manifestation of microvascular fragility. DATA SOURCES: Data were reviewed from 15 trials conducted in 6 countries with 1140 predominantly healthy participants with measures of gingival bleeding tendency, and from the National Health and Nutrition Examination Survey (NHANES) III of 8210 US residents with measures of retinal hemorrhaging. RESULTS: In clinical trials, AA supplementation reduced gingival bleeding tendency when estimated baseline AA plasma levels were < 28 µmol/L (standardized mean difference [SMD], -0.83; 95%CI, -1.16 to -0.49; P < 0.002). Supplementation with AA did not unequivocally reduce gingival bleeding tendency when baseline estimated AA plasma levels were >48 µmol/L or unknown (respective standardized mean differences: -0.23, 95%CI, -0.45 to -0.01, P < 0.05; and -0.56; 95%CI: -1.19 to 0.06, P < 0.08). In NHANES III, prevalence of both retinal hemorrhaging and gingival bleeding tendency increased when AA plasma levels were within the range that protects against scurvy (11-28 µmol/L; respective prevalence ratios adjusted for age and sex: 1.47; 95%CI: 1.22-1.77; and 1.64; 95%CI: 1.32-2.03; P < 0.001 for both). CONCLUSION: Consistent evidence from controlled clinical trials indicates that setting human AA requirements based on scurvy prevention leads to AA plasma levels that may be too low to prevent an increased gingival bleeding tendency. Gingival bleeding tendency and retinal hemorrhaging coincide with low AA plasma levels and thus may be reflective of a systemic microvascular pathology that is reversible with an increased daily AA intake.

Effect of birth season on anthropometrics and diseases of bone mineralization in the US population.

OBJECTIVES: Birth season has been inconsistently associated with anthropometrics, bone fractures, and malocclusion. Our aim was to assess the association between birth season and anthropometrics (height, weight, birth weight), bone fractures and dental malocclusion in the United States. METHODS: US surveys conducted between 1963-1973 assessed 16 152 6-to-21-year-old participants. Prevalence ratios and mean differences were estimated using linear models using fall as reference. RESULTS: Participants born in spring, when compared to fall, were of similar height (mean difference (MD) in height-adjusted Z score 0.03, 95% Confidence Interval (CI): -0.01 to 0.08; P-value = .17), weight (MD for weight-adjusted Z-score 0.00, 95% CI: -0.05 to 0.04; P-value =0.83), had similar rates of bone fractures (Prevalence Rate [PR] 1.07; 95% CI: 0.94 to 1.22; P-value = .28) and similar rates of dental malocclusion (MD of malocclusion index HLD -0.16; 95% confidence interval - 0.39 to 0.07; P = .18). CONCLUSION: We did not find an impact of birth season on anthropometrics, bone fractures, and dental malocclusions.

Estimating the Impact of Verification Bias on Celiac Disease Testing.

GOAL: The goal of this study was to estimate the impact of verification bias on the diagnostic accuracy of immunoglobulin A tissue transglutaminase (IgA tTG) in detecting celiac disease as reported by an authoritative meta-analysis, the 2016 Comparative Effectiveness Review (CER). BACKGROUND: Verification bias is introduced to diagnostic accuracy studies when screening test results impact the decision to verify disease status. MATERIALS AND METHODS: We adjusted the sensitivity and specificity of IgA tTG reported by the 2016 CER with the proportion of IgA tTG positive and negative individuals who are referred for confirmatory small bowel biopsy. We performed a systematic review from January 1, 2007, to July 19, 2017, to determine these referral rates. RESULTS: The systematic review identified 793 articles of which 9 met inclusion criteria (n=36,477). Overall, 3.6% [95% confidence interval (CI): 1.1%-10.9%] of IgA tTG negative and 79.2.2% (95% CI: 65.0%-88.7%) of IgA tTG positive individuals were referred for biopsy. Adjusting for these referral rates the 2016 CER reported sensitivity of IgA tTG dropped from 92.6% (95% CI: 90.2%-94.5%) to 57.1% (95% CI: 35.4%-76.4%) and the specificity increased from 97.6% (95% CI: 96.3%-98.5%) to 99.6% (95% CI: 98.4%-99.9%). CONCLUSIONS: The CER may have largely overestimated the sensitivity of IgA tTG due to a failure to account for verification bias. These findings suggest caution in the interpretation of a negative IgA tTG to rule out celiac disease in clinical practice. More broadly, they highlight the impact of verification bias on diagnostic accuracy estimates and suggest that studies at risk for this bias be excluded from systematic reviews.

Fluoride Varnish and Dental Caries in Preschoolers: A Systematic Review and Meta-Analysis.

The aim of this study was to assess the effectiveness of fluoride varnish (FV) in reducing dentine caries at the patient, tooth, and surface levels as well as caries-related hospitalizations in preschoolers. We performed a systematic review of clinical trials of FV, alone or associated with an oral health program, compared with placebo, usual care, or no intervention. Bibliographical search included electronic searches of seven databases, registers of ongoing trials, and meeting abstracts, as well as hand searching. We performed random-effects meta-analyses and calculated confidence and prediction intervals. The search yielded 2,441 records; 20 trials were included in the review and 17 in at least one meta-analysis. Only one study had low risk of bias in all domains. We found no study reporting on caries-related hospitalizations. At the individual level, the pooled relative risk was 0.88 (95% confidence interval [CI] 0.81, 0.95); this means that in a population of preschool children with 50% caries incidence, we need to apply fluoride varnish in 17 children to avoid new caries in one child. At the tooth level, the pooled weighted mean difference was -0.30 (95% CI -0.69, 0.09) and at the surface level -0.77 (95% CI -1.23, -0.31). Considering the prediction intervals, none of the pooled estimates were statistically significant. We conclude that FV showed a modest and uncertain anticaries effect in preschoolers. Cost-effectiveness analyses are needed to assess whether FV should be adopted or abandoned by dental services.

Breastfeeding and handedness: a systematic review and meta-analysis of individual participant data.

This study aims to determine whether breastfeeding duration affects the prevalence of nonrighthandedness in later life. A systematic search for studies on this topic was completed in 2018, and risk of bias was assessed by means of the Newcastle-Ottawa scale. Seven national surveys in five countries with Individual Participant Data (IPD) were identified (n = 62,129 mother-child dyads). These surveys had low risk of bias. An IPD meta-analysis showed that breastfeeding for < 1 month, 1 to 6 months, and > 6 months, when compared to bottle feeding, was associated with a 9%, 15% and 22% decreased prevalence of nonrighthandedness, respectively (Prevalence Ratio (PR) = 0.91, 95% confidence interval (ci): 0.83, 1.00; p-value = 0.05, PR = 0.85, 95% CI: 0.79, 0.92; p-value < 0.0001 and PR = 0.78; 95% CI: 0.71, 0.85; p-value < 0.0001). This dose-response relationship was significant (p < 0.001). No significant heterogeneity across surveys was detected (p-value > 0.54). Breastfeeding for longer than 9 months was not associated with further reductions in the prevalence for nonrighthandedness (p > 0.58). It is concluded that the critical age window for establishing hemispheric dominance in handedness includes the first 9 months of infancy and is in part determined by nurture.

Historical perspectives on advertising and the meme that personal oral hygiene prevents dental caries.

The consensus of a leading scientific panel in 1930 was that oral hygiene products could not prevent dental caries. Their view was that dental caries prevention required the proper mineralisation of teeth and that vitamin D could achieve this goal. Over a hundred subsequent controlled trials, conducted over seven decades, largely confirmed that this scientific panel had made the right decisions. They had, in 1930, when it comes to dental caries, correctly endorsed vitamin D products as dental caries prophylactics and oral hygiene products as cosmetics. And yet, despite this consistent scientific evidence for close to a century, an opposing conventional wisdom emerged which thrives to this day: oral hygiene habits (without fluoride) protect the teeth from dental caries, and vitamin D plays no role in dental caries prevention. This historical analysis explores whether persistent advertising can deeply engrain memes on dental caries prevention which conflict with controlled trial results. The question is raised whether professional organisations, with a dependence on advertising revenues, can become complicit in amplifying advertised health claims which are inconsistent with the principles of evidence-based medicine.

Personal oral hygiene and dental caries: A systematic review of randomised controlled trials.

OBJECTIVE: To conduct a systematic review of randomised trials assessing the association between personal oral hygiene and dental caries in the absence of the confounding effects of fluoride. BACKGROUND: Dental caries continues to affect close to 100% of the global population. There is a century-old conflict on whether dental caries is caused by poor oral hygiene or poorly formed teeth (ie, teeth with dental defects). Resolving this conflict is of significant public health importance as these two hypotheses on dental caries aetiology can lead to different prevention strategies. METHODS: A systematic search for randomised trials was conducted using predefined criteria in 3 databases. The impact of personal oral hygiene interventions on coronal dental caries incidence was evaluated using random-effects models. RESULTS: Three randomised studies involving a total of 743 participants were included. Personal oral hygiene interventions failed to influence the incidence of dental caries (Δ Decayed, Missing and Filled Surfaces (DFMS) = -0.11; 95% confidence interval: (-0.91, 0.69; P-value < .79)) despite meticulous deplaquing of teeth. There was no significant heterogeneity in the trial results (heterogeneity chi-squared = 1.88, P = .39). The findings were robust to sensitivity analyses, including consideration of the results of nonrandomised studies. CONCLUSION: Personal oral hygiene in the absence of fluorides has failed to show a benefit in terms of reducing the incidence of dental caries.

Resonance frequency analysis: Comparing two clinical instruments.

BACKGROUND: Numerous studies indicate implants placed immediately after extraction or with minimally invasive procedures have excellent long-term success and survival rates. There is general agreement that implants must be stable after implant placement. This study evaluated implant stability changes from the time of implant placement to second stage (prior to restoration). Resonance frequency analysis (RFA) was determined for two commercially available units (Osstell, Osstell USA, Columbia, MD and Penguin, Penguin Integration Diagnostics, Sweden). The unit of measurement was the implant stability quotient (ISQ). MATERIALS AND METHODS: Prior to treatment patients were given medical and dental evaluations. Periapical and panogram radiographs were taken Computerized tomography images were taken for sites where adequate bone volume or quality were uncertain. Thirty patients were enrolled in this study (13 females, 17 males, mean age 73.4 years, (maximum age 90, minimum 47 year total of 38 implants were placed. One implant was lost. Computerized implant planning (Nobel Clinician) Nobel Biocar United States (Nobel Biocare, Yorba Linda, CA) was performed for all patients. Implants were placed utilizing a surgical guide. Using Resonance Frequency anal this study compared two RFA systems for determining implant stability (ISQ; Osstell and Penguin). Measurement pegs were screwed into the implants, and RFA measurements were taken at mesial, distal, lingual, and buccal implant surfaces. Stability measurements were taken at implant placement and at second stage. Clinical data and RFA measurements were recorded on data sheets. The average interval between first and second stages was 144.1 days (range 21.3) RESULTS: Average interval between implant placement and second stage was 141.1 days. One implant was lost prior to second stage. The results are based on 30 patients with 38 implants. At second stage, the RFA measures were slightly higher than first stage with a mean increase of 1.15, SE = 0.3, P-.067. The Penguin RFA values were marginally higher than Osstell (mean increase 1.10, SE = 0.64, P < .08). CONCLUSIONS: RFA values between implant placement and second stage differed slightly between implant placement and second stage (P < 0.10). These differences were not clinically or statistically significant. At second stage, Penguin RFA values were slightly higher when compared with the Osstell device (P < 0.67). Bone quality appears to be an important factor when determining RFA readings. Type I bone had significantly higher readings when compared with other less dense bone types (P < .029) Resonance frequency evaluation data were similar for both instruments, indicating their reliability in determining implant stability. Neither instrument predicted implant failure. While subjective, Penguin was less cumbersome to utilize and the window revealing the readings was very easier to read. Further, the pegs are magnetized making insertion easy.

Dental enamel defects predict adolescent health indicators: A cohort study among the Tsimane' of Bolivia.

OBJECTIVES: Bioarchaeological findings have linked defective enamel formation in preadulthood with adult mortality. We investigated how defective enamel formation in infancy and childhood is associated with risk factors for adult morbidity and mortality in adolescents. METHODS: This cohort study of 349 Amerindian adolescents (10-17 years of age) related extent of enamel defects on the central maxillary incisors (none, less than 1/3, 1/3 to 2/3, more than 2/3) to adolescent anthropometrics (height, weight) and biomarkers (hemoglobin, glycated hemoglobin, white blood cell count, and blood pressure). Risk differences and 95% confidence intervals were estimated using multiple linear regression. Enamel defects and stunted growth were compared in their ability to predict adolescent health indicators using log-binomial regression and receiver operating characteristics (ROCs). RESULTS: Greater extent of defective enamel formation on the tooth surface was associated with shorter height (-1.35 cm, 95% CI: -2.17, -0.53), lower weight (-0.98 kg, 95% CI: -1.70, -0.26), lower hemoglobin (-0.36 g/dL, 95% CI: -0.59, -0.13), lower glycated hemoglobin (-0.04 %A1c , 95% CI: -0.08, -0.00008), and higher white blood cell count (0.74 109 /L, 95% CI: 0.35, 1.14) in adolescence. Extent of enamel defects and stunted growth independently performed similarly as risk factors for adverse adolescent outcomes, including anemia, prediabetes/type II diabetes, elevated WBC count, prehypertension/hypertension, and metabolic health. CONCLUSIONS: Defective enamel formation in infancy and childhood predicted adolescent health outcomes and may be primarily associated with infection. Extent of enamel defects and stunted growth may be equally predictive of adverse adolescent health outcomes.

Handedness and lower face variability: Findings in three national surveys.

Lower face variability in modern humans has been associated with a series of phenotypic characteristics including body architecture and handedness. The aim of this study was to provide a systematic review of lower face variability and handedness in national health surveys conducted in the United States. Three informative surveys with a total of 13,663 participants were identified. Lower face variability was described as one of six facial phenotypes and related to handedness using logistic regression models while adjusting for sex, ancestry, geography, and income. The results on 13,536 participants with complete information showed that bilateral retrognathism-a marker for a lower face phenotype characterized by a convex facial profile and slender jaws-was associated with a 25% increased odds for non-right-handedness (odds ratio, 1.250; 95% confidence interval: 1.076-1.453, p-value < .004). This association between non-right-handedness and a convex facial profile may unexpectedly find its origin in the genetic polymorphisms which determine tuberculosis susceptibility.

Malnutrition-related early childhood exposures and enamel defects in the permanent dentition: A longitudinal study from the Bolivian Amazon.

OBJECTIVES: We investigated the relationship between early childhood malnutrition-related measures and subsequent enamel defects in the permanent dentition. MATERIALS AND METHODS: This cohort study included 349 Amerindian adolescents (10-17 years, 52% male) from the Bolivian Amazon. Exposures included: stunted growth (height-for-age z-scores), underweight (weight-for-age z-scores), anemia (hemoglobin), acute inflammation (C-reactive protein) and parasitic infection (hookworm). We measured the occurrence (no/yes) and extent (<1/3, 1/3-2/3, >2/3) of enamel defects. We estimated associations between childhood exposures and enamel defect measures using log-binomial and multinomial logistic regression. RESULTS: The prevalence of an enamel defect characterized by an orange peel texture on a large central depression on the labial surface of the central maxillary incisors was 92.3%. During childhood (1-4 years), participants had a high prevalence of stunted growth (75.2%), anemia (56.9%), acute inflammation (39.1%), and hookworm infection (49.6%). We observed associations between childhood height-for-age (OR = 0.65; P = 0.028 for >2/3 extent vs. no EH) and gastrointestinal hookworm infection (OR = 3.43; P = 0.035 for >2/3 extent vs. no defects or <1/3 extent) with enamel defects. DISCUSSION: The study describes a possibly novel form of enamel hypoplasia and provides evidence for associations of malnutrition-related measures in early childhood, including stunted growth and parasitic helminth infection, with the observed enamel defects.

Lower face asymmetry as a marker for developmental instability.

OBJECTIVES: Fluctuating asymmetries in the craniofacial skeleton have been shown to be predictive for mortality from degenerative diseases. We investigate whether lower face asymmetries are a potential marker for the developmental origins of health and disease. METHODS: The lower face of a representative sample of 6654 12- to 17-year old United States (US) adolescents (1966-1970, National Health Examination Survey III) was classified as asymmetric when the mandibular teeth occluded prognathically (forward) or retrognathically (backward) on one side of the face only. It was investigated whether these lower face asymmetries were directional (preferentially to the left or the right) or fluctuating (random left-right distribution) in the US population. RESULTS: Lower face asymmetries affected 1 in 4 of the US adolescents. Unilateral retrognathic dental occlusions were fluctuating asymmetries, had a US prevalence of 17.0% (95% confidence interval: 15.5-18.4) and were associated with race/ethnicity (P < .0001), not with handedness (P < .7607). Unilateral prognathic dental occlusions were directional asymmetries (P < .0001), had a US prevalence of 7.6% (95% confidence interval: 6.4-8.7) and were associated with large household size (P < .001) and handedness (P < .0223). Lower face asymmetries were not associated with distinct heritable traits such as color blindness. CONCLUSIONS: The findings suggest that lower face asymmetries are a marker for environmental stress and cerebral lateralization during early development.