Association between oral health and gastric precancerous lesions.

Although recent studies have suggested that tooth loss is positively related to the risk of gastric non-cardia cancer, the underlying oral health conditions potentially responsible for the association remain unknown. We investigated whether clinical and behavioral measures of oral health are associated with the risk of gastric precancerous lesions. We conducted a cross-sectional study of 131 patients undergoing upper gastrointestinal endoscopy. Cases were defined as those with gastric precancerous lesions including intestinal metaplasia or chronic atrophic gastritis on the basis of standard biopsy review. A validated structured questionnaire was administered to obtain information on oral health behaviors. A comprehensive clinical oral health examination was performed on a subset of 91 patients to evaluate for periodontal disease and dental caries experience. A total of 41 (31%) cases of gastric precancerous lesions were identified. Compared with non-cases, cases were significantly more likely to not floss their teeth [odds ratio (OR) = 2.89, 95% confidence interval (CI): 1.09-7.64], adjusting for age, sex, race, body mass index, smoking status, educational attainment and Helicobacter pylori status in serum. Among participants who completed the oral examination, cases (n = 28) were more likely to have a higher percentage of sites with gingival bleeding than non-cases [OR = 2.63, 95% CI: 1.37-5.05 for a standard deviation increase in bleeding sites (equivalent to 19.7%)], independent of potential confounders. Our findings demonstrate that specific oral health conditions and behaviors such as gingival bleeding and tooth flossing are associated with gastric precancerous lesions.

Relationships of the Microbial Communities with Rumen Epithelium Development of Nellore Cattle Finished in Feedlot Differing in Phenotypic Residual Feed Intake.

The objective of this study was to examine the relationships among ruminal microbial community, rumen morphometrics, feeding behavior, feedlot performance, and carcass characteristics of Nellore cattle, classified by residual feed intake (RFI). Twenty-seven Nellore yearling bulls with an initial body weight (BW) of 423.84 ± 21.81 kg were fed in feedlot for 107 d in individual pens to determine the RFI phenotype. Bulls were categorized as high RFI (>0.5 SD above the mean, n = 8), medium RFI (±0.5 SD from the mean, n = 9), and low RFI (<0.5 SD below the mean, n = 10). At harvest, whole rumen content samples were collected from each bull to evaluate ruminal microbial community, including bacteria and protozoa. The carcass characteristics were determined by ultrasonography at the beginning and at the end of the experimental period, and behavior data were collected on d 88. As a result of ranking Nellore bulls by RFI, cattle from low-RFI group presented lesser daily dry matter intake (DMI), either in kilograms (p < 0.01) or as percentage of BW (p < 0.01) than high-RFI yearling bulls, resulting in improved gain:feed (G:F). However, variables, such as average daily gain (ADG), final BW, hot carcass weight (HCW) and other carcass characteristics did not differ (p > 0.05) across RFI groups. The eating rate of either dry matter (DM )(p = 0.04) or neutral detergent fiber (NDF) (p < 0.01) was slower in medium-RFI yearling bulls. For ruminal morphometrics an RFI effect was observed only on keratinized layer thickness, in which a thinner layer (p = 0.04) was observed in low-RFI Nellore yearling bulls. Likewise, Nellore yearling bulls classified by the RFI did not differ in terms of Shannon's diversity (p = 0.57) and Chao richness (p = 0.98). Our results suggest that the differences in feed efficiency of Nellore bulls differing in phenotypic RFI should be attributed to metabolic variables other than ruminal microorganisms and epithelium, and deserves further investigation.

Caries experience among Chinese-American children in Manhattan Chinatown.

There is little research on the oral health status of Chinese-American (CA) children in the U.S. and Asian/Pacific Islanders in general. The purpose of this study was to characterize the dental caries experience of a CA child population in Manhattan Chinatown, New York City. A five-year chart review of 545 initial dental exams of patients aged 2 to 11 was conducted at a community clinic serving an immigrant CA population. DMFT/dft were compared to National Health and Nutrition Examination Survey (NHANES) and analyzed for associations among birthplace, language and untreated tooth decay at recall. Subject mean dft was higher compared to NHANES data both in aggregate and ethnic/race subgroups. Subjects had lower DMFT ccmpared to the national data. Significant difference was found between U.S. and non-U.S.-born mean dft. Asian Pacific Islander Americans include a fast-growing immigrant pediatric population at high risk for tooth decay.

Ruminal Fermentation Pattern, Bacterial Community Composition, and Nutrient Digestibility of Nellore Cattle Submitted to Either Nutritional Restriction or Intake of Concentrate Feedstuffs Prior to Adaptation Period.

Beef cattle are key contributors to meat production and represent critical drivers of the global agricultural economy. In Brazil, beef cattle are reared in tropical pastures and finished in feedlot systems. The introduction of cattle into a feedlot includes a period where they adapt to high-concentrate diets. This adaptation period is critical to the success of incoming cattle, as they must adjust to both a new diet and environment. Incoming animals are typically reared on a variety of diets, ranging from poor quality grasses to grazing systems supplemented with concentrate feedstuffs. These disparate pre-adaptation diets present a challenge, and here, we sought to understand this process by evaluating the adaptation of Nellore calves raised on either grazing on poor quality grasses (restriction diet) or grazing systems supplemented with concentrate (concentrate diet). Given that nutrient provisioning from the diet is the sole responsibility of the ruminal microbial community, we measured the impact of this dietary shift on feeding behavior, ruminal fermentation pattern, ruminal bacterial community composition (BCC), and total tract digestibility. Six cannulated Nellore bulls were randomly assigned to two 3 × 3 Latin squares, and received a control, restriction, or concentrate diet. All cohorts were then fed the same adaptation diet to mimic a standard feedlot. Ruminal BCC was determined using Illumina-based 16S rRNA amplicon community sequencing. We found that concentrate-fed cattle had greater dry matter intake (P < 0.01) than restricted animals. Likewise, cattle fed concentrate had greater (P = 0.02) propionate concentration during the adaptation phase than control animals and a lower Shannon's diversity (P = 0.02), relative to the restricted animals. We also found that these animals had lower (P = 0.04) relative abundances of Fibrobacter succinogenes when compared to control animals during the pre-adaptation phase and lower abundances of bacteria within the Succinivibrio during the finishing phase, when compared to the control animals (P = 0.05). Finally, we found that animals previously exposed to concentrate were able to better adapt to high-concentrate diets when compared to restricted animals. Our study presents the first investigation of the impact of pre-adaptation diet on ruminal BCC and metabolism of bulls during the adaptation period. We suggest that these results may be useful for planning adaptation protocols of bulls entering the feedlot system and thereby improve animal production.

The association of immigration and acculturation attributes with oral health among immigrants in New York City.

OBJECTIVES: We examined associations between immigration and acculturation attributes and oral disease among immigrants. METHODS: We conducted a large cross-sectional study of 1318 immigrants in New York City. We performed comprehensive interviews and oral examinations of the participants and used linear regression models to assess differences in oral disease levels among immigrant subgroups. We also constructed proportional odds models to evaluate the association of oral disease level with length of stay in the United States, age at immigration, and language preference. RESULTS: After we controlled for most known risk factors, country of birth and age at immigration were associated with variations in oral disease prevalence and need for oral health care. Length of stay was inversely associated with need for treatment of dental caries but not with any other indicator of oral disease. Language preference was not associated with any indicator of oral disease. CONCLUSIONS: Immigrants' country of birth, length of stay in the United States, and age at immigration played important roles in their oral disease prevalence, independently of most known risk factors for oral diseases. Our findings emphasize the need for more studies to elucidate the complex relationships of ethnicity, socioeconomic status, and culturally influenced factors that impact immigrants' oral health.

The cultural and social context of oral and pharyngeal cancer risk and control among Hispanics in New York.

New York City (NYC) has one of the highest incidence and mortality rates of oral and pharyngeal cancer (OPC) for Hispanics of any major U.S. city. This qualitative assessment explores OPC awareness, attitudes, and screening practices among at-risk Hispanics, health care providers, and community leaders in a Hispanic neighborhood of NYC. Four focus groups (N=39) were conducted with at-risk Hispanics. Structured interviews were conducted with ten health care providers (four physicians, four dentists, two dental hygienists) and three key community leaders. Results showed major gaps in OPC awareness across all key stakeholders. Focus group participants expressed difficulty in accessing appropriate health care. Health care providers were not familiar with OPC prevention and early detection practices. Community leaders lacked the knowledge and resources necessary for advocating prevention and early detection for their constituencies. All participants reported cultural, social, and structural barriers to prevention. There is a need for developing a comprehensive, culturally competent health communication program that targets all key stakeholders in the at-risk Hispanic community of NYC.

Oral and pharyngeal cancer incidence and mortality among Hispanics, 1996-2002: the need for ethnoregional studies in cancer research.

OBJECTIVES: We investigated whether oral cavity and pharyngeal cancer (OPC) incidence and mortality statistics among Hispanics in New York State differed from those among Hispanics in the United States as a whole. METHODS: OPC incidence and mortality statistics for 1996-2002 were obtained from the New York State Cancer Registry and compared with national statistics released by the Surveillance, Epidemiology, and End Results (SEER) program for the same period. RESULTS: Among Hispanic men, OPC incidence rates were approximately 75% and 89% higher in New York State and New York City, respectively, than national rates reported by the SEER program. No notable differences were identified among Hispanic women. Incidence rates among New York State Hispanic men were 16% higher than those of their non-Hispanic White counterparts. The difference was twice as high (32%) among Hispanic men in New York City. Mortality rates among both men and women exhibited patterns similar to the incidence patterns. CONCLUSIONS: Ethnoregional differences exist in the incidence and mortality rates of OPC in the United States. New York State Hispanic men exhibit much higher incidence and mortality rates than US Hispanics as reported by the SEER program.

Preventing and detecting oral cancer. Oral health care providers' readiness to provide health behavior counseling and oral cancer examinations.

BACKGROUND: The authors conducted a study to examine oral cancer prevention and early detection practice patterns in a population-based random sample of practicing oral health care professionals in New York state. METHODS: The authors surveyed a population-based, self-weighting, stratified random sample of dentists (n = 1,025) and dental hygienists (n = 1,025) in New York state. They assessed the subjects' readiness to offer tobacco-use cessation and alcohol-abuse counseling and oral cancer examinations. RESULTS: The effective response rates were 55 and 66 percent for dentists and dental hygienists, respectively. In terms of readiness to perform oral cancer examinations for patients aged 40 years and older, the large majority (82 percent of dentists and 72 percent of dental hygienists) were in the maintenance stage of behavior, indicating that oral cancer examinations were a routine part of their practice. In terms of readiness to offer tobacco-use cessation counseling, only 12 percent of dentists and 21 percent of dental hygienists were in the maintenance stage, and only 2 percent of dentists and 4 percent of dental hygienists were in the maintenance stage of offering alcohol-abuse counseling. CONCLUSIONS: Oral cancer examinations seem to have been adopted as a standard of practice by most oral health care providers in New York state, but cancer prevention services, such as counseling regarding cessation of tobacco use and alcohol abuse, are lacking. CLINICAL IMPLICATIONS: Oral health care providers should be trained in oral cancer prevention services such as tobacco-use cessation and alcohol-abuse counseling and encouraged to include these services, along with continued provision of oral cancer examinations, as a standard aspect of care.

Latino oral health: A research agenda toward eliminating oral health disparities.

BACKGROUND: The Hispanic population has become the largest minority group in the United States, resulting in an increase in oral health care demands. Developing a research agenda and promoting collaboration on Latino oral health issues are crucial. METHODS: The Hispanic Dental Association and the University of Puerto Rico, School of Dentistry, San Juan, convened a workshop of health care providers and other experts to examine the current state of Hispanic oral health research and identify gaps in existing data and research methods. Participants were asked to break out into small groups to discuss research priorities. RESULTS: The participants discussed the following research areas: population-based studies, social and behavioral sciences, health promotion and communications, gene-environment interactions, and research training and workforce development. Participants emphasized the importance of understanding variations among subgroups within the Hispanic population in the development of future studies. CONCLUSIONS: Participants recommended collaborative research studies to advance existing oral disease prevention and oral health promotion efforts, with a stronger focus on the development of a multidisciplinary pipeline of researchers participating in Latino oral health research to address the growing needs of this population. Practice Implications. Building an infrastructure for research training and workforce development would supply researchers with the necessary tools to develop new studies that could affect the overall oral health of the Latino population. The translation and dissemination of these research findings will benefit clinicians by leading to a better understanding of new trends and specific population needs, as well as appropriate targeted interventions.

Community-based, culturally appropriate oral health promotion program for immigrant pregnant women in New York City.

Pre- and postnatal prevention programs may significantly improve the oral health of mother and child. The overall aim of this project was to assess the need for and develop an oral health promotion program for low-income immigrant pregnant women in New York City. Results from the baseline survey showed very low awareness of the importance of maternal oral health and its relationship to an infant's general and oral health among the participants. Based on these results, we developed culturally appropriate educational materials and workshops to promote oral health among pregnant women. As of September 2005, we had conducted more than 500 workshops, distributed educational packages to close to 10,000 women and disseminated about 20,000 brochures in four languages to health care centers and maternal health centers across New York State.

Oral cancer risk perception among participants in an oral cancer screening program.

Oral cancer screening provides an opportunity for early detection and for education to high-risk tobacco and alcohol users. To plan interventions that would motivate oral cancer screening and risk reduction, we surveyed oral cancer risk perception and risk behaviors among participants in a free oral-cancer screening. Participants (N = 803) were racially diverse; 43% had a history of smoking and 9%, a history of alcohol abuse. Current smokers and those with higher lifetime tobacco exposure perceived themselves to be at higher risk for cancer than nonsmokers or those with less lifetime tobacco exposure (all ps, <0.01). Alcohol use was unrelated to oral cancer risk perception (p > 0.05). Compared with women, men (p = 0.01) felt more at risk; compared with other racial groups, Asians (p < 0.05) felt less at risk. Demographic differences were explained by differences in risk behaviors. Current smoking status (beta, 0.196; p < 0.001) and level of tobacco exposure (beta, 0.100; p < 0.05) were the only significant independent predictors of heightened risk perception (R(2) = 0.09). Those with alcohol abuse histories, and older smokers, may need increased education. These findings support the need for health education materials that incorporate the oral cancer risk perception of high-risk individuals.

Oral cancer knowledge, risk factors and characteristics of subjects in a large oral cancer screening program.

BACKGROUND: Screening people who are at high risk of developing oral cancers is a promising tool for decreasing morbidity and mortality attributable to this cancer. METHODS: A consortium led by the New York University College of Dentistry conducted a three-day oral cancer screening during June 1999. As part of the screening intake, the authors conducted a survey to assess the sociodemographic characteristics, level of knowledge of risk factors and predictors of oral cancer awareness among the subjects. The authors performed bivariate and multivariate analyses using two indicators of oral cancer awareness as dependent variables. RESULTS: The 803 subjects were racially and ethnically diverse, 66 percent were 40 years of age or older, 43 percent had a history of smoking, and 9 percent were likely to have had a history of alcohol abuse. Race/ethnicity, education level and knowledge of risk factors for oral cancer were predictors of awareness of an oral cancer examination, whereas only knowledge and possible history of alcohol abuse were predictors of having a history of examinations. CONCLUSIONS: This screening program attracted a diverse sample of people at high risk of developing oral cancer due to smoking and likely history of alcohol abuse. Consistent with other national and international studies, the authors found a lack of knowledge of the risk factors associated with oral cancer and a low rate of histories of oral cancer examinations among the subjects. CLINICAL IMPLICATIONS: Oral cancer screening programs represent potential opportunities not only for early detection of oral cancer but to raise awareness and educate the public about the disease.

Dental caries prevalence among a sample of African American adults in New York City.

According to available limited epidemiology studies, the prevalence of oral disease is much greater in American minorities (Blacks, Hisoanics, Asians, Native Americans) than in the majority population. The purpose of this article is to describe the oral health status and current treatment needs of a group of African-American (AA) adults in New York City. The convenience sample consisted of 951 AA adults (M = 662, F = 289) recruited through community- or faith-based institutions, and the in-house screening conducted by the Research Center for Minority Oral Health in dedicated dental clinics at the New York University College of Dentistry. The age of participants ranged from 18 to 64 years, (mean age 42, SD = 11.04). Calibrated examiners performed the clinical examinations utilizing National Institute of Dental and Craniofacial Research (NIDCR) diagnostic criteria. The DMFT, DMFS, DFS, and %D/DFS indices were obtained and results indicated the following. For the 18 to 34 age group (n = 246), the mean DMFT was 8.83, the mean DMFS was 21.36, the mean DFS was 12.10, and the mean %D/DFS was 30. For the 35 to 49 age group (n = 523), the mean DMFT was 14.03, the mean DMFS was 48.21, the mean DFS was 18.76, and the mean %D/DFS was 29. For the 50 to 64 age group (n = 182), the mean DMFT was 15.38, the mean DMFS was 64.48, the mean DFS was 17.98, and the mean %D/DFS was 29. For all age groups, the findings indicated a high prevalence of dental decay and greater number of filled surfaces compared with the United States national surveys.

Dental health status and indicators of treatment needs of four Hispanic subgroups in New York City.

This article presents the results of a study of four Hispanic subgroup residents of New York City. Utilizing National Institute of Dental and Craniofacial Research criteria and a specially designed survey instrument, the authors conducted oral examinations and interviews on 1,010 Hispanic adults. Results showed that the oral health status and the indicators of treatment needs differed among the subgroups. When conducting needs assessment and providing oral health care services for this population, differences among the subgroups must be considered.

An academic dental center grapples with oral cancer disparities: current collaboration and future opportunities.

This article reviews the epidemiology of oral cancer in the United States, explores the complex reasons for its disproportionate burden in minority groups, and describes the efforts of New York University's College of Dentistry to address these oral cancer disparities. These efforts include the development of state and regional consortia and networks, public education and community screening efforts, undergraduate dental curriculum development, professional education, intensive research efforts, and significant dental-medical collaborations. Future directions include the need to develop and assess oral cancer education/awareness programs, specifically customized to the various dental-medical professionals/trainees and to populations at risk. Improving the quality of life of patients during and following treatment for oral cancer is another important area that has great opportunity for dental-medical collaboration.

Oral cancer. Practical prevention and early detection for the dental team.

Approximately 2,000 patients a year are diagnosed with oral cancer in New York State. In an effort to control this deadly disease, Governor George Pataki has taken a leadership role in the United States by mandating and funding training for dentists in the prevention and early detection of oral cancer. The purpose of this article is to highlight the epidemiology of oral cancer, to show how the dental profession can contribute to the health of the citizens of New York State, and to provide practical guidelines for both tobacco cessation intervention and utilization of existing technology for the early detection of oral cancer and precancerous conditions in the general dental practice setting.

Dental caries prevalence and treatment need among racial/ethnic minority schoolchildren.

A study was undertaken to estimate dental caries prevalence and treatment need among racial/ethnic minority schoolchildren in the Bronx. Oral examinations were conducted on 148 second graders, 193 fourth graders and 299 sixth graders in three different schools. A single examiner trained to use the DMFS index according to National Institute of Dental and Craniofacial Research (NIDCR) diagnostic criteria and procedures examined all the children between November 1999 and July 2000. The study revealed that 39% of the children exhibited dental caries experience in their permanent dentition (mean DMFS = 1.45), treatment need (D/DMFS = 28%); 26.4% of children in their primary dentition (mean dfs = 1.01) and treatment need (d/dfs = 18%). Hispanic children (mean DMFS = 1.71) had higher dental caries experience compared to African-Americans (mean DMFS = 1.14). This was found to be statistically significant (p = 0.004). Treatment need in Hispanics was (30%, 17%) and in African-Americans (30%, 18%) in permanent and primary dentition respectively. Treatment need was highest among sixth grade African-Americans in their permanent dentition and in second grade Hispanics in the primary dentition. The study showed a difference in dental caries prevalence, but the treatment need percentages did not differ between Hispanics and African-Americans in both dentition.

Determinants of oral health care utilization among diverse groups of immigrants in New York City.

BACKGROUND: Few studies have examined utilization of oral health care services among immigrants. The authors examined the determinants of utilization of oral health care among a diverse group of immigrants in New York City. METHODS: The authors examined and interviewed 1,417 foreign-born people, aged 18 to 65 years, who were residents of New York City. They conducted examinations by using criteria established by the National Institute of Dental and Craniofacial Research, Bethesda, Md. The authors used unconditional logistic regression to estimate odds ratios (ORs) and 95 percent confidence intervals for having visited a dentist within the previous year for each of the independent variables. RESULTS: More than 70 percent of the participants lacked dental insurance and only about 31 percent reported that they had visited a dentist within the previous year. Flossing (OR = 1.18), dental insurance (OR = 1.58), having a regular source of dental care (OR = 4.76) and more filled teeth (1.33) were independent predictors of utilization of services. CONCLUSIONS: Having a regular source of dental care and having dental insurance are important predictors of immigrants' utilization of oral health care services in New York City. CLINICAL IMPLICATIONS: The study results suggest the importance of establishing affordable, culturally appropriate, community-based oral health care services to improve the oral health of vulnerable populations.

A deficit in biopsying potentially premalignant oral lesions in Puerto Rico.

BACKGROUND: Intraoral lesions clinically suspicious for cancer/precancer should be biopsied and diagnosed histopathologically. We evaluated whether the frequency of oral cancer (OC) cases diagnosed in Puerto Rico (PR) is disproportionately high relative to the frequency of persons with histopathologic diagnoses that would have appeared clinically suspicious for OC/precancer at biopsy. METHODS: All pathology reports for oral (ICD-O-3 C01-C06) soft tissue biopsies generated during 1/2004-5/2005 by seven PR and two New York City (NYC) pathology laboratories were reviewed. The analysis was restricted to persons diagnosed with invasive oral squamous cell carcinoma (OSCC), epithelial dysplasia, or hyperkeratosis/epithelial hyperplasia (HK/EH), i.e., diagnoses associated with lesions clinically suspicious for OC/precancer. The OC relative frequency measured the percentage of persons diagnosed with OSCC among persons with OSCC, dysplasia, or HK/EH. OC relative frequencies for PR and NYC laboratories were compared. RESULTS: Overall, the OC relative frequency was 67% in PR and 40% and 4% in the NYC general and oral pathology laboratories, respectively (each p<0.001). In PR, the OC relative frequency was highest for males (80%). When OC relative frequencies were stratified by pathology laboratory type (general/oral) and compared across PR and NYC, age/gender-specific OC relative frequencies were always higher in PR; however, differences were consistently statistically significant for males only. CONCLUSION: A disparity in the OC relative frequency exists in PR vs. NYC indicating a shortfall in biopsying potentially precancerous oral lesions in PR. PR residents with intraoral lesions suspicious for oral cancer/precancer are most likely to be biopsied only after developing an invasive OC.