The yawning gap: Waiting for cariology to germinate whilst periodontology is fruiting.

INTRODUCTION: The aim of this study is to investigate whether periodontology and cariology receive equal emphasis in dental education at two moments in time, thirteen years apart. MATERIALS AND METHODS: An online search was conducted in Nov 2021 of all the dental schools in ten English-language speaking countries (U.S., Canada, U.K., Ireland, South Africa, Australia, New Zealand, Singapore, Hong Kong, and Malaysia) to identify departments/divisions in the disciplines of periodontology, cariology, and conservative/restorative/operative dentistry. The results were then compared against the findings of a similar investigation that was conducted from July to October 2008. RESULTS: Of the 126 dental schools identified in 2021, information was available for 93 dental schools. Of these 93 schools, only 10 listed departments/divisions/disciplines of cariology, whereas 83 and 86 schools had listed periodontology and conservative/restorative/operative dentistry, respectively. Despite a doubling of the number of dental schools with a department/division/discipline of cariology from 2008 to 2021, the absolute gap in the number of departments/divisions/disciplines in the other two disciplines compared to cariology had widened during the thirteen years. In 2008, there were 70 more departments/divisions/disciplines in periodontology compared to cariology departments/divisions/disciplines. In 2021, there were 73 more departments/divisions/disciplines in periodontology. Additional information on research output was available for 90 dental schools in 2021, where 30 schools self-identified as undertaking cariology research, whereas 68 and 47 schools undertook research in periodontology and conservative/restorative/operative dentistry, respectively. CONCLUSIONS: Dental education does not give equal emphasis to periodontology and cariology, and the discipline of cariology is grossly neglected.

Modulation of the pre-metastatic bone niche: molecular changes mediated by bone-homing prostate cancer extracellular vesicles.

Prostate cancer (PCa) is a leading male malignancy worldwide, often progressing to bone metastasis, with limited curative options. Extracellular vesicles (EVs) have emerged as key players in cancer communication and metastasis, promoting the formation of supportive microenvironments in distant sites. Our previous studies have highlighted the role of PCa EVs in modulating osteoblasts and facilitating tumor progression. However, the early pre-metastatic changes induced by PCa EVs within the bone microenvironment remain poorly understood. To investigate the early effects of repeated exposure to PCa EVs in vivo, mimicking EVs being shed from the primary tumor, PCa EVs isolated from cell line PC3MLuc2a were fluorescently labelled and repeatedly administered via tail vein injection to adult CD1 NuNu male mice for a period of 4 weeks. In vivo imagining, histological analysis and gene expression profiling were performed to assess the impact of PCa EVs on the bone microenvironment. We demonstrate for the first time that PCa EVs home to both bone and lymph nodes following repeated exposures. Furthermore, the accumulation of EVs within the bone leads to distinct molecular changes indicative of disrupted bone homeostasis (e.g., changes to signaling pathways such as Paxillin p = 0.0163, Estrogen Receptor p = 0.0271, RHOA p = 0.0287, Ribonucleotide reductase p = 0.0307 and ERK/MAPK p = 0.0299). Changes in key regulators of these pathways were confirmed in vitro on human osteoblasts. In addition, our data compares the known gene signature of osteocytes and demonstrates a high proportion of overlap (52.2%), suggesting a potential role for this cell type in response to PCa EV exposure. No changes in bone histology or immunohistochemistry were detected, indicating that PCa EV mediated changes were induced at the molecular level. This study provides novel insights into the alterations induced by PCa EVs on the bone microenvironment. The observed molecular changes indicate changes in key pathways and suggest a role for osteocytes in these EV mediated early changes to bone. Further research to understand these early events may aid in the development of targeted interventions to disrupt the metastatic cascade in PCa.

Changes in dental and medical visits before and during the COVID-19 pandemic among U.S. children aged 1-17 years.

OBJECTIVES: The COVID-19 pandemic has tremendously impacted the U.S. healthcare system, but no study has examined the impact of the pandemic on utilization of dental care among U.S. children. Changes in past-year dental versus medical visits and perceived unmet health needs between 2019 and 2020 among U.S. children aged 1-17 years were examined. METHODS: National and state representative, cross-sectional data from the National Survey of Children's Health conducted during June 2019-January 2020 (i.e. pre-pandemic, n = 28 500) and July 2020-January 2021 (i.e. intra-pandemic, n = 41 380) were analysed. Any past-year visit and perceived unmet needs (i.e. delay or inability to receive needed care) were reported by the parent proxy. Weighted prevalence estimates were compared using two-tailed chi-squared tests at p < .05. Poisson regression analyses were used to explore the relationship between having dental and/or medical unmet needs during the pandemic and indicators of poor health and social wellbeing. RESULTS: Between 2019 and 2020, a significantly reduced prevalence of past-year medical (87.2%-81.3%) and dental visits (82.6%-78.2%) among U.S. children aged 1-17 years (all p < .05) were observed. Correspondingly, perceived unmet needs increased by half for dental care (from 2.9% in 2019 to 4.4% in 2020) and almost one-third for medical care (from 3.2% to 4.2% in 2020). Subgroups with the highest prevalence of unmet dental need included those with low socio-economic status, living with their grandparents, uninsured and living with a smoker. CONCLUSIONS: Unmet health needs increased in general but increased more for dental than for medical care among U.S. children aged 1-17 years. Enhanced and sustained efforts will be needed to deliver targeted services towards disadvantaged segments of the population to narrow existing disparities.

Jean-Anthelme Brillat-Savarin's 1825 treatise on the mouth and ingestion.

This article quotes and discusses Jean-Anthelme Brillat-Savarin's musings on the mouth and ingestion as described in his book The Physiology of Taste. The book was first published in France in December 1825, and is still widely read as a key work in Gastronomy today. The mouth is intimately related to the acts of chewing, swallowing and eating and it would be interesting to report an early 19th century epicurean's views on the mouth. Passages from Brillat-Savarin's book describing the functions of the teeth and tongue and the acts of tasting, chewing, and swallowing are quoted in full. Anecdotes also include one on the horrifying punishment of having one's tongue removed and another illustrating the poor oral health found among Europeans of that era. His work offers a unique glimpse into how a 19th century gastronome viewed the oral cavity and its gastronomical functions. While some of his writings may appear archaic and antediluvian to the modern reader; others relating to, for example chewing and swallowing, are surprisingly accurate by contemporary standards. Nonetheless, the gastronomic savant seemed to know a lot right about modern stomatology!

A review of the uses of fluoride and outcomes of dental caries control in singapore.

In 1958, Singapore was the first country in Asia to implement a community water fluoridation program covering 100% of its population. There were no reports of anti-fluoridation activities or calls for referenda then; and at present, there is only mild opposition to water fluoridation. The water was initially fluoridated at 0.7 ppm but was gradually adjusted downwards to 0.6 ppm in January 1992, with a further reduction to 0.5 ppm in January 2008 where it has since remained unchanged. Fluoride varnishes and gels are also available for use by the professional for judicious application in individuals who are at high-risk of dental caries. In addition, fluoridated dentifrices and mouth rinses are also readily available over the counter for home use. In addition to the use of fluorides, the following factors also contribute to the high level of oral health in Singapore: (i) a highly educated populace; (ii) public health education to increase awareness and literacy is routinely carried out by the Health Promotion Board; (iii) the School Dental Service provides 'free' dental care to school children up to 18 years of age; and (iv) primary dental care is also readily accessible by the general public by an extensive network of private and public sector dental clinics.

Medical Support for Aircraft Disaster Search and Recovery Operations at Sea: the RSN Experience.

The maritime environment presents a unique set of challenges to search and recovery (SAR) operations. There is a paucity of information available to guide provision of medical support for SAR operations for aircraft disasters at sea. The Republic of Singapore Navy (RSN) took part in two such SAR operations in 2014 which showcased the value of a military organization in these operations. Key considerations in medical support for similar operations include the resultant casualty profile and challenges specific to the maritime environment, such as large distances of area of operations from land, variable sea states, and space limitations. Medical support planning can be approached using well-established disaster management life cycle phases of preparedness, mitigation, response, and recovery, which all are described in detail. This includes key areas of dedicated training and exercises, force protection, availability of air assets and chamber support, psychological care, and the forensic handling of human remains. Relevant lessons learned by RSN from the Air Asia QZ8501 search operation are also included in the description of these key areas. Teo KAC , Chong TFG , Liow MHL , Tang KC . Medical support for aircraft disaster search and recovery operations at sea: the RSN experience. Prehosp Disaster Med. 2016; 31(3):294-299.

Screening for caries in targeted schools in the Blue Mountains and Hawkesbury districts, New South Wales, Australia: an evaluation of the School Assessment Program.

AIM: To determine if the school dental screening program in New South Wales, the School Assessment Program, achieved its aim of being the key entry point for high-risk children to receive care. METHODS: A secondary analysis was conducted on epidemiological data gathered in 16 primary schools in New South Wales (10 for the School Assessment Program and six for the non-School Assessment Program) in 2003. The validity of the School Assessment Program targeting criteria in identifying high-risk schools was determined. Post-screening treatment outcomes were evaluated from the assessment of treatment ratios. RESULTS: There were negligible differences in the caries experience and proportions of high-risk children, irrespective of their School Assessment Program status. Sensitivity and specificity values were approximately 60% and 40%, respectively, using various case definitions of high risk applied to both children and schools. Deciduous dentition treatment ratios for School Assessment Program and non-School Assessment Program children with decayed, missing, and filled teeth (dmft) ≥1 ranged from 0.48 to 0.79 and from 0.47 to 0.73, respectively. Respective permanent dentition treatment ratios for School Assessment Program and non-School Assessment Program children with Decayed, Missing, and Filled Teeth (DMFT) ≥1 were 0.49-0.82 and 0.64-1.08. CONCLUSION: The School Assessment Program failed to identify schools with high caries-risk children or confer post-screening caries treatment benefits.