Periodontitis and brain magnetic resonance imaging markers of Alzheimer's disease and cognitive aging.

INTRODUCTION: We examined the association of clinical, microbiological, and host response features of periodontitis with MRI markers of atrophy/cerebrovascular disease in the Washington Heights Inwood Columbia Aging Project (WHICAP) Ancillary Study of Oral Health. METHODS: We analyzed 468 participants with clinical periodontal data, microbial plaque and serum samples, and brain MRIs. We tested the association of periodontitis features with MRI features, after adjusting for multiple risk factors for Alzheimer's disease/Alzheimer's disease-related dementia (AD/ADRD). RESULTS: In fully adjusted models, having more teeth was associated with lower odds for infarcts, lower white matter hyperintensity (WMH) volume, higher entorhinal cortex volume, and higher cortical thickness. Higher extent of periodontitis was associated with lower entorhinal cortex volume and lower cortical thickness. Differential associations emerged between colonization by specific bacteria/serum antibacterial IgG responses and MRI outcomes. DISCUSSION: In an elderly cohort, clinical, microbiological, and serological features of periodontitis were associated with MRI findings related to ADRD risk. Further investigation of causal associations is warranted.

Replication of gene polymorphisms associated with periodontitis-related traits in an elderly cohort: the Washington Heights/Inwood Community Aging Project Ancillary Study of Oral Health.

AIM: We sought to replicate findings from published genome-wide association studies (GWAS), linking specific candidate gene loci with periodontitis-related clinical/microbial traits. MATERIALS AND METHODS: In the published GWAS, a total of 2196 single nucleotide polymorphisms associated with periodontitis-related traits at a p ≤ 5 × 10-6 and mapped to 136 gene loci. The replication cohort included 1124 individuals, 65-98 years old (67% female, 45% Hispanic, 30% Black, 23% White) with available genome-wide genotypes and full-mouth periodontal status. Microbial profiles using checkerboard DNA-DNA hybridization and 16SrRNA sequencing were available from 912 and 739 participants, respectively. RESULTS: Using gene-specific p-values after linkage disequilibrium pruning, the following gene/phenotype associations replicated successfully: CLEC19A with edentulism and %teeth with pocket depth (PD) ≥4 mm; IL37, HPVC1, TRPS1, ABHD12B, LDLRAD4 (C180rF1), TGM3, and GRK5 with %teeth with PD ≥4 mm; DAB2IP with presence of PD ≥6 mm; KIAA1715(LNPK), ROBO2, RAB28, LINC01017, NELL1, LDLRAD4(C18orF1), and CRYBB2P1 with %teeth with clinical attachment level (CAL) ≥3 mm; RUNX2 and LAMA2 with %teeth with CAL ≥5 mm; and KIAA1715(LNPK) with high colonization by Aggregatibacter actinomycetemcomitans. In addition, CLEC19A, IQSEC1, and EMR1 associated with microbial abundance based on checkerboard data, LBP and NCR2 with abundance based on sequencing data, and NCR2 with microbial diversity based on sequencing data. CONCLUSIONS: Several gene loci identified in published GWAS as associated with periodontitis-related phenotypes replicated successfully in an elderly cohort.

Periodontal status among elderly inhabitants of northern Manhattan: The WHICAP ancillary study of oral health.

AIM: We conducted a cross-sectional study of the prevalence, extent and severity of periodontitis in a tri-ethnic cohort of ≥65 year-old participants of the Washington-Heights Inwood Community Aging Project (WHICAP). METHODS: 1,130 individuals (57% of eligible invitees) participated in a full-mouth periodontal examination that included assessments of bleeding on probing, pocket depth and clinical attachment loss (CAL) at six sites/tooth. RESULTS: Participants had a mean age of 75.4 years (SD 6.7), were predominantly female (66.6%) and Hispanic (44.7%), and of middle/low educational attainment (~82%). The prevalence of edentulism was 14.7%, and an average of 17.1 teeth (SD 8.0) was present among the dentate. The prevalence of moderate/severe periodontitis according to the CDC/AAP definition was 77.5%. Pockets ≥6 mm were found in 50.2% of the sample, affecting an average of 5.7% of teeth/person. Corresponding figures for CAL≥5 mm were 71.4% and 23.6%, respectively. In multivariable models, male gender, being Black or Hispanic, and no dental visit within the prior year were associated with higher proportion of teeth with CAL ≥5 mm. CONCLUSIONS: The prevalence, extent and severity of periodontitis were higher than the US national average in this urban elderly sample, suggesting substantial unmet periodontal treatment needs.

Hyperspectral Mapping of Human Primary and Stem Cells at Cell-Matrix Interfaces.

Extracellular matrices interface with cells to promote cell growth and tissue development. Given this critical role, matrix mimetics are introduced to enable biomedical materials ranging from tissue engineering scaffolds and tumor models to organoids for drug screening and implant surface coatings. Traditional microscopy methods are used to evaluate such materials in their ability to support exploitable cell responses, which are expressed in changes in cell proliferation rates and morphology. However, the physical imaging methods do not capture the chemistry of cells at cell-matrix interfaces. Herein, we report hyperspectral imaging to map the chemistry of human primary and embryonic stem cells grown on matrix materials, both native and artificial. We provide the statistical analysis of changes in lipid and protein content of the cells obtained from infrared spectral maps to conclude matrix morphologies as a major determinant of biochemical cell responses. The study demonstrates an effective methodology for evaluating bespoke matrix materials directly at cell-matrix interfaces.

Poor oral health as a chronic, potentially modifiable dementia risk factor: review of the literature.

Poor oral health, including caries, tooth loss, and periodontitis, is ubiquitous worldwide, and is potentially treatable and preventable. Like adverse oral health conditions, Alzheimer disease and related disorders are also very common among aging populations. Established risk factors for Alzheimer disease include cerebrovascular disease and its vascular risk factors, many of which share associations with evidence of systemic inflammation also identified in periodontitis and other poor oral health states. In this review, we present epidemiologic evidence of links between poor oral health and both prevalent and incident cognitive impairment, and review plausible mechanisms linking these conditions, including evidence from compelling animal models. Considering that a large etiologic fraction of dementia remains unexplained, these studies argue for further multidisciplinary research between oral health conditions, including translational, epidemiologic, and possibly clinical treatment studies.

With Teeth, Broken, or Fixed: The Challenges of Linking Periodontitis, Neuroepidemiology, and Biomarkers of Disease.

Periodontitis is a chronic inflammatory, bacterially-driven disease of the tooth-supporting tissues that shares several risk factors and elements of host response with Alzheimer's disease and related dementias (ADRD). Epidemiological studies have identified relatively consistent associations between adverse oral health conditions and ADRD. In this issue of the journal, a large study from the UK Biobank further explores these relationships along with MRI cognitive biomarkers. Despite its strength due to the large sample size, challenges in the study of periodontitis and neuroepidemiology markers include potential sampling bias, appropriate assessment of exposures, and the possibility of reverse causality.

The rational development of molecularly imprinted polymer-based sensors for protein detection.

The detection of specific proteins as biomarkers of disease, health status, environmental monitoring, food quality, control of fermenters and civil defence purposes means that biosensors for these targets will become increasingly more important. Among the technologies used for building specific recognition properties, molecularly imprinted polymers (MIPs) are attracting much attention. In this critical review we describe many methods used for imprinting recognition for protein targets in polymers and their incorporation with a number of transducer platforms with the aim of identifying the most promising approaches for the preparation of MIP-based protein sensors (277 references).

Motivations of orthodontic residents in Canada and the United States to treat patients with craniofacial anomalies, cleft lip/palate, and special needs.

OBJECTIVES: To determine the motivation of orthodontic residents in Canada and the United States to treat patients with cleft lip/palate (CLP), craniofacial anomalies (CFA), and special needs (SN). METHODS: In March 2009, an e-mail with a link to a 41-item survey was sent to all orthodontic residents in Canada and the United States (n  =  944). RESULTS: Of 944 residents contacted, 339 viewed and 208 completed the survey (22.03%). Using a seven-point Likert scale, residents recognized the importance of treating patients with CLP/CFA/SN. When asked if they plan to treat patients with CLP/CFA/SN, 54.48% responded yes, 13.46% no, and 36.06% were unsure. A total of 38.05% said they would charge the same fee as a typical multiarch case, while 58.05% would charge more, and 60% of fourth-year residents would charge twice the fee. Of the respondents, 43.00% were aware of the established fellowship programs in CLP/CFA/SN. Canadian residents (67.9%) were more enthusiastic about completing a fellowship than Americans were. Of the respondents, 29.33% would complete a 1-year fellowship, while 70.67% would not. A total of 78.4% of male respondents and 77.4% of American residents indicated they would not pursue a fellowship. CONCLUSIONS: Residents supported the importance of treating patients with CLP/CFA/SN, and more than 54% indicated they plan to treat these patients. Residents who indicated that they would not treat these patients sited limited experience and inadequate expertise as the reasons. Less than 30% indicated a willingness to pursue a fellowship program.

Motivational factors and future life plans of orthodontic residents in the United States.

INTRODUCTION: The purposes of this study were to investigate factors influencing career choice and identify future life plans of orthodontic residents in the United States. METHODS: Program chairs and directors of all 65 orthodontic residency programs in the United States were contacted by e-mail and telephone for permission to e-mail their residents and invite them to take part in on online survey. A total of 335 residents from 37 programs were invited to complete an anonymous 57-item questionnaire in May 2007. Data were categorized, and basic statistics including chi-square comparative analyses were performed. RESULTS: A total of 136 (40.60%) residents completed the survey. A "passion for orthodontics" emerged as the most important factor (20.29%) influencing the decision to pursue orthodontics as a career, followed by "intellectual stimulation or challenge" (18.12%). Most residents decided to become an orthodontist before they were in dental school (44.93%). Most residents (89.05%) plan to engage in private practice, and only 2 intend to pursue primarily an academic career. The average resident debt was $165,226 at the end of their program. CONCLUSIONS: The decision to become an orthodontist is often made early in life, before dental school, and a passion for orthodontics is the motivational factor. Residents plan to enter private practice and not pursue a career in academia. The current shortage of academics and orthodontic researchers will not be resolved from the current pool of orthodontic residents. A possible solution to the academic crisis is to change the selection criteria in programs to accept orthodontic residents who develop a passion for orthodontics while in dental school or to recruit primary researchers and teachers to the specialty. Residents plan to practice in an urban setting. Rural and underserviced areas will probably continue to experience shortages of orthodontists in the future.

Location and presence of permanent teeth in a complete bilateral cleft lip and palate population.

OBJECTIVE: To describe the location and presence of permanent teeth in nonsyndromic complete bilateral cleft lip and palate patients from the Manitoba Centre for Craniofacial Difference. MATERIALS AND METHODS: Records of 1570 patients dating back to 1958 were assessed in this retrospective chart review. RESULTS: Thirty-eight patients met the inclusion criteria, providing 76 cleft site teeth: A tooth on each side of the cleft was considered to have developed from a single lateral incisor tooth bud. The pattern M was assigned when a tooth was found mesial to the cleft, D when distal, MD when mesial and distal and AB if none was found. Pattern M was noted 9.2% of the time; D, 47.4%; MD, 5.3%; and AB, 38.2%. Teeth outside the cleft site: In the maxilla, agenesis occurred in 11.9% of second premolars and 10.5% of central incisors. In the mandible, agenesis occurred in 4.0% of second premolars, 2.6% of lateral incisors, 2.6% of central incisors, and 2.6% of second molars. CONCLUSIONS: The lateral incisor was most commonly found distal to the cleft. Agenesis of the lateral incisor and teeth outside the cleft were more common than in noncleft populations.

Subgingival microbiome and clinical periodontal status in an elderly cohort: The WHICAP ancillary study of oral health.

BACKGROUND: There is a sparsity of data describing the periodontal microbiome in elderly individuals. We analyzed the association of subgingival bacterial profiles and clinical periodontal status in a cohort of participants in the Washington Heights-Inwood Columbia Aging Project (WHICAP). METHODS: Dentate individuals underwent a full-mouth periodontal examination at six sites/tooth. Up to four subgingival plaque samples per person, each obtained from the mesio-lingual site of the most posterior tooth in each quadrant, were harvested and pooled. Periodontal status was classified according to the Centers for Disease Control/American Academy of Periodontology (CDC/AAP) criteria as well as based on the percentage of teeth/person with pockets ≥4 mm deep. Bacterial DNA was isolated and was processed and analyzed using Human Oral Microbe Identification using Next Generation Sequencing (HOMINGS). Differential abundance across the periodontal phenotypes was calculated using the R package DESeq2. α- and ß-diversity metrics were calculated using DADA2-based clustering. RESULTS: The mean age of the 739 participants was 74.5 years, and 32% were male. Several taxa including Sneathia amnii-like sp., Peptoniphilaceae [G-1] bacterium HMT 113, Porphyromonas gingivalis, Fretibacterium fastidiosum, Filifactor alocis, and Saccharibacteria (TM7) [G-1] bacterium HMT 346 were more abundant with increasing severity of periodontitis. In contrast, species such as Veillonella parvula, Veillonella dispar, Rothia dentocariosa, and Lautropia mirabilis were more abundant in health. Microbial diversity increased in parallel with the severity and extent of periodontitis. CONCLUSIONS: The observed subgingival bacterial patterns in these elderly individuals corroborated corresponding findings in younger cohorts and were consistent with the concept that periodontitis is associated with perturbations in the resident microbiome.

Motivations and future plans of Canadian orthodontic residents.

INTRODUCTION: Our purposes were to investigate factors influencing career choice and to identify future plans of Canadian orthodontic residents. METHODS: All orthodontic residents in the 5 Canadian residency training programs were invited to complete an anonymous online survey in November 2006. Data were categorized by demographic variables, and basic statistics including chi-square comparative analyses were performed. RESULTS: Forty-four of the 54 residents in Canada (81.48%) completed the survey. "Intellectual stimulation/challenge" emerged as the most important factor (40%) influencing the decision to pursue specialty training in orthodontics, followed by a "passion for orthodontics" (29%). The decision to become an orthodontist was made by 42% of respondents while they were in dental school; 33% had decided after completing dental school, and 24% had already decided before starting their dental school studies. Most residents (82%) planned to work in a private practice environment. Only 2 (4.5%) indicated that they will most likely practice primarily in an academic setting. Eighty percent said that they will use self-ligating brackets in private practice, and almost 80% said they will use Invisalign (Align Technology, Santa Clara, Calif). A total of 55% indicated that orthodontic residents should be required to undertake research leading to a masters of science degree as part of their orthodontic program. A total of 77% thought that a 24- to 30-month program was too short to adequately prepare them for private practice. CONCLUSIONS: Intellectual stimulation was the major attraction of most applicants to orthodontic programs, and the decision to become an orthodontist was normally made during dental school or even earlier. Most residents intended to enter an urban or suburban private practice after graduation, with few considering academic career choices. Modern techniques such as self-ligating brackets and Invisalign are expected to be popular among future orthodontists in Canada.

Future practice plans of orthodontic residents in the United States.

INTRODUCTION: The purpose of this study was to investigate the future clinical practice plans of orthodontic residents in the United States. METHODS: All program chairs and directors of the 65 US orthodontic residency programs were contacted by e-mail and telephone and asked for permission to e-mail their residents and invite them to take part in an anonymous 57-item questionnaire online. A total of 335 e-mails from 37 programs were obtained, and the survey was sent in May 2007. Basic statistics including chi-square comparative analyses were performed by sex, age, and year of program. RESULTS: A total of 63.04% of orthodontic residents plan to use self-ligating brackets; 84.06% plan to use Invisalign (Align Technology, Santa Clara, Calif); 92.03% plan to use temporary anchorage devices, and 72.26% plan on placing them themselves; 28.26% plan to use cone-beam computerized tomography; 92.75% plan to use a digital imaging program; 45.65% plan to use indirect bonding; and 10.87% plan to use lingual orthodontics. A total of 70.07% plan to use 2-phase treatment, and 61.59% said they will use functional appliances. A total of 81.16% plan to become certified by the American Board of Orthodontics, but only 18.12% thought certification should be mandatory for licensure; 36.50% indicated that a master of science degree should be required in their program, and 77.94% believe that a 24- to 30-month program adequately prepares them for future orthodontic practice. CONCLUSIONS: Newer orthodontic technologies such as self-ligating brackets, temporary anchorage devices, and Invisalign as well as functional appliances are expected to grow in popularity in the United States because of projected future use by orthodontic residents. Two-phase orthodontic treatment with functional appliance mechanics will continue to be used. Most orthodontic residents will become certified by the American Board of Orthodontics but do not believe it should be necessary for licensure. Orthodontic residents in the United States believe that a 2-year program adequately prepares them for private practice.

Resident evaluation of orthodontic programs in Canada.

The purpose of this study was to investigate the satisfaction of Canadian orthodontic residents with their programs and determine the scope of their training. An anonymous online questionnaire was sent to all Canadian orthodontic residents in November 2006. Data were assembled and categorized by different variables, and chi-square comparative analyses were performed. Forty-four out of fifty-four residents responded, giving a participation rate of 81.48 percent. Overall, 86.36 percent of responding residents were satisfied with their program. Respondents said they felt they received the appropriate amount of formal didactic teaching sessions and dedicated and protected academic time. All residents indicated their programs offered training in numerous treatment philosophies: 93.18 percent said they have sufficient clinically based training, and 72.73 percent indicated that their research-based training was sufficient. All responding residents indicated they will complete more than thirty patients from start to finish, and 25 percent estimated completion of more than seventy patients by graduation. Residents said they will complete on average five orthognathic surgery, twenty-four extraction, thirty-one non-extraction, eight adult, and thirteen patients in the mixed dentition. Only 50 percent said their programs contained care for disabled or underserved patients. Most (86.36 percent) said they feel they will be adequately prepared to provide unsupervised orthodontic care after graduation. These orthodontic residents indicated they collaborate most with the disciplines of oral surgery, periodontics, and prosthodontics. However, only 52.27 percent indicated they have a formal interdisciplinary program for treating patients. We conclude from the study that Canadian orthodontic residents are satisfied with the didactic, clinical, and research aspects of their programs. They receive comprehensive instruction with the opportunity to complete a significant number of patients, employing a variety of treatment approaches.

In vivo bonding of orthodontic brackets to fluorosed enamel using an adhesion promotor.

OBJECTIVES: To determine the success of bracket retention using an adhesion promoter with and without the additional microabrasion of enamel. MATERIALS AND METHODS: Fifty-two teeth with severe dental fluorosis were bonded in vivo using a split-mouth design where the enamel surfaces of 26 teeth were microabraded with 50 microm of aluminum silicate for 5 seconds under rubber dam and high volume suction. Thirty-seven percent phosphoric acid was then applied to the enamel, washed and dried, and followed by placement of Scotchbond Multipurpose Plus Bonding Adhesive. Finally, precoated 3M Unitek Victory brackets were placed and light cured. The remaining teeth were bonded using the same protocol but without microabrasion. RESULTS: After 9 months of intraoral service, only one bond failure occurred in the control group where microabrasion was used. Chi-square analysis revealed P = .31, indicating no statistical significance between the two groups. CONCLUSIONS: Bonding orthodontic attachments to fluorosed enamel using an adhesion promoter is a viable clinical procedure that does not require the additional micro-mechanical abrasion step.

Diagnosis and clinical management of patients with skeletal Class III dysplasia.

This paper summarizes the current literature on the diagnosis and treatment of a patient with Class III skeletal dysplasia. It also includes a report of two siblings with Class III skeletal dysplasia, although each received different treatment due to different causes of the condition. This review illustrates that early appropriate diagnosis, including cephalometric analysis, is important for identifying the location of the dysplasia. If the dysplasia is in the maxilla, treatment may prevent the need for future orthognathic surgery. Treatment for mandibular prognathism usually involves waiting for the patient's growth to complete (this could occur past the age of 18 in women and the age of 20 in men) and performing orthognathic surgery at that time.

A comparison of the costs and patient acceptability of professionally applied topical fluoride foam and varnish.

OBJECTIVES: In Canada and the United States, professionally applied topical fluorides (PATF) are usually applied as a gel or foam. However, fluoride varnish has also been found to be effective for caries prevention and may be a preferred method because less time is required and fluoride exposure can be better controlled. The goal of this study was to compare the costs and patient acceptability of two methods of PATF (foam and varnish). METHODS: The study population was a convenience sample of high-risk children from the York Region and the city of Hamilton, Ontario, Canada, who had been identified as requiring fluoride therapy (n = 256). Children received from dental hygienists either fluoride foam applied in trays or fluoride varnish painted on tooth surfaces. An observer recorded the time to perform each procedure, adverse outcomes, and the satisfaction of children with treatment. RESULTS: The varnish technique took significantly less time compared to foam (5.81 vs 7.86 minutes; P < .0001). Significant differences between procedure times were found in all age groups, but the largest difference was for children aged 3-6 years (5.22 vs 8.61 minutes; P < .0001). Signs of gagging were observed in a lower proportion of participants who received varnish (3.8% vs 15.1%; P < .01), and this difference was largest for children aged 3-6 years (2.6% vs 29.7%; P < .01). The cost per varnish application, for children aged 3-6 years, was substantially less after labor costs were considered (dollar 3.43 vs dollar 4.43, CDN). CONCLUSIONS: Varnish applications were found to take less time and resulted in fewer signs of discomfort. These results support the use of fluoride varnish in caries prevention programs, especially for younger children.