Epigenetics and its implications for oral health

Background

Over the last decade, we have been able to understand the role of various genetic processes involved in the oral diseases. However, In past few years, much of stresses has been paid to understand the regulation of these genetic processes controlled by the epigenetic mechanisms. Epigenetic processes regulate the gene activity without altering underlying DNA sequences, through mechanisms including DNA methylation, histone modifications, and non-coding RNAs. These epigenetic processes are significantly associated with various oral health problems including periodontitis, oral cancer.

Prion disease: possible implications for oral health care

BACKGROUND: Prion diseases are a group of rare fatal neurodegenerative disorders in humans and animals that are histopathologically characterized by spongiform change within the central nervous system. TYPES OF STUDIES REVIEWED: The author reviewed all available case reports and any studies of the oral aspects of prion diseases published in peer-reviewed journals and available via PubMed. He then outlined the risk of nosocomial transmission of prions in dental health care. RESULTS: Sporadic Creutzfeldt-Jakob disease, or sCJD, is the most common of the acquired human prion disorders, and it typically affects elderly people and leads to rapid death. In contrast, variant CJD, or vCJD, has affected young adults from Europe, giving rise to a slow onset disorder comprising both psychiatric and neurological upset. Oral neurological manifestations are rare and seem to occur only in people with vCJD; there are no oral mucosal or gingival manifestations of prion disease. Prions can be detected in the oral tissues--usually the gingivae and dental pulp--of animals experimentally infected with prions. In contrast, prions have not been detected in the pulpal tissue of people with sCJD, and there are no data of pulpal infection in vCJD. There also are no data suggesting that prions are transmitted easily in the dental setting, but there remains the rare risk of such transmission if appropriate infection control measures are not adhered to. CLINICAL IMPLICATIONS: Few people in the United States and worldwide have prion disease. Oral manifestations are rare. Evidence suggests that the risk of transmission and acquisition of a prion infection as a result of dental treatment is rare, if appropriate infection control measures are maintained.     

Polyphenols,oral health and disease: A review

Objective

Polyphenols (PPs) are reactive metabolites abundant in plant-derived foods, particularly fruits, seeds and leaves. In the tissues of the digestive tract, particularly the oral mucosa, active PPs reach the highest concentration. Although excessively high and monotonic intake may be toxic (such an effect is countered by salivary proline-rich proteins), PPs exert preventive activity against infectious and degenerative diseases and may also help prevent oral diseases, via mechanisms like antioxidant activity and neutralisation/modulation of human/bacterial/viral proteins/enzymes. This review seeks to investigate the preventive PP activity against oral diseases.

Methods

Studies published during the last 15 years were searched using MEDLINE, PUBMED, EMBASE. The quality of evidence was rated using the three-point scale used by the US Preventive Services Task Force to assess the merits of preventive measures.

Results

Consistent, well-designed, epidemiological, animal and in vitro studies directly and indirectly support the preventive PP effect against oral cancer with good evidence. Consistent studies showing that PPs inactivate periodontal pathogens and increase antioxidant capacity of oral fluids, suggest a preventive effect against periodontal disease with fair evidence. Animal and in vitro studies showing that PPs decrease mutans streptococci virulence and dental plaque accumulation, suggest a preventive effect against dental caries with fair evidence. Meta-analysing clinical trials on subjects refraining from oral hygiene, PP-containing mouthrinses decrease mutans streptococci level by almost 50% and Plaque Index score.

Conclusions

Regular and frequent PP intake may help protect against oral cancer, while human studies are needed to confirm the promising preventive activity against periodontal disease and caries.     

Asthma and oral health: a review

Asthma is a chronic inflammatory condition that causes the airways to constrict and produce excess mucus, making breathing difficult. It is characterized by the obstruction of airflow which is variable over a short period of time. This condition is reversible, either spontaneously or can be controlled with the help of drugs. Asthma medication comprises bronchodilators, corticosteroids and anticholinergic drugs. Most of these drugs are inhaled using various forms of inhalers or nebulizers. The effect of these drugs on oral health is the subject of debate among dental practitioners. Patients taking asthma medication may be at risk of dental caries, dental erosion, periodontal diseases and oral candidiasis. Hence, patients with bronchial asthma on medication should receive special prophylactic attention. This article reviews the correlation between asthma and oral health, and suggests various measures to counter possible oral health problems related to asthma.     

Infant oral health care: a survey of general dentists, pediatric dentists, and pediatricians in Virginia

PURPOSE: This study's purpose was to examine the current knowledge, attitudes, and experiences related to infant oral health for dental and medical providers in Virginia. METHODS: A survey of infant oral health care was sent to: (a) 300 randomly selected general dentists; (b) 300 randomly selected pediatricians; and (c) all pediatric dentists in Virginia. Survey respondents were tabulated, and percent frequency distributions for responses to each item were computed. RESULTS: The surveys return rate was 48%. A total of 100% of pediatric dentists treated infants and were more likely to recommend that children be seen by age 1 (P < .001). All pediatricians treated infants as well, while only 5% referred for the first dental visit by 1 year of age. Forty-five percent of general dentists surveyed treated infants, and only 12% referred for the first dental visit by 1 year of age. The logistic regression results indicated that there were differences between practitioner type regarding the recommended age of the first dental visit and years in practice. CONCLUSIONS: The majority of pediatricians and general dentists are not advising patients to see the dentist by 1 year of age. There is a need for increased infant oral health care education in the medical and dental communities.     

The oral health of children of dentists

ABSTRACT – In order to assess the long term effect of dental health education, the gingival state and dental conditions of 68 dentists' children aged 11.4 ± 3.4 years were compared with those of their age- and sex-matched classmates from (a) parents with anoUier academic education of corresponding length, and (b) parents with no academic or high school education. A tendency for bleeding of the gingival margins at pressure was observed most often in children with non-academic parents and was least frequent in dentists' children. The reported frequency of toothbrushing being the same in all three groups, it was suggested that the efficacy of the brushing among the dentists' children must be superior to that of the others. Also the DMF scores were found to be lowest in the group of dentists' children. The non-academic children correspondingly presented the lowest frequency of intact first molars. The study confirmed the already accepted view that the educational level of the parents correlates positively with the dental health of their children. The finding that dentists' children are even better off than children of other academic parents was concluded to justify an intensification of dental health education in future dental care.     

Bariatric surgery and implications for oral health: a case report

PURPOSE: A case representative of issues dental practitioners may face when providing care to patients with a history of bariatric surgery is reviewed. Meta-analysis shows that, following bariatric surgery, 43 to 79% of diabetes, hyperlipidemia and hypertension in patients resolved to normal levels or no longer required therapy. However, bariatric surgery side effects have implications for oral health, including nutrient deficiencies impacting healing of oral tissues and gastroesophageal reflux, resulting in tooth erosion. Patients who have undergone bariatric surgery are seen with increasing frequency in dental offices and dental professionals need to be familiar with the challenges these patients present.     

Successful aging: implications for oral health

The past few years have seen a growing emphasis in gerontology on the concept of “successful” or “robust” aging. This represents a major paradigm shift in the field from a focus on declines in physical and social functioning, assumptions of the aging process as a downward spiral, and studies on how to manage these declines. Leading the way toward this new perspective on aging, the MacArthur Studies of Successful Aging asked the fundamental question: “What genetic, biomedical, behavioral, and social factors are crucial to maintaining health and functional capacities in the later years?” These studies examined longitudinally a large cohort of independent elders on several physical, cognitive, emotional, and social parameters. Other researchers have focused on the theme of robust aging; however, common predictors have emerged, such as remaining active physically and cognitively, maintaining social contacts, and avoiding disease. This research is timely, given the expanding population of the oldest old, and with successive cohorts demonstrating the “compression of morbidity” phenomenon. Such a paradigm shift is critical in geriatric dentistry as well, where successful aging is evident in the growing number of older adults who have retained their natural dentition into advanced old age. This presentation draws parallels between successful aging at the systemic and oral health levels, with illustrations from epidemiologic studies that demonstrate trends in improved health and quality of life among newer cohorts of older adults.     

Osteoporosis and oral bone resorption: a review

This paper is a summary of the published studies on the possible association between osteoporosis and alveolar bone loss. Osteoporosis and low bone mass are considered as a major public health problem. The mandible like other bones of the body has a series of anatomical landmarks that can serve as radiographic indicators. Using these indicators it is possible to evaluate changes in bone with respect to its quantity or quality by different methods of taking images. Higher bone resorption was detected in women with a higher number of pregnancies. Also, the higher educated the patient, the less bone resorption. Women with a background of backaches had more bone resorption to those who did not have this backache background. Finally, it was recognized that it would be possible to clear the quality dimension of the process of mandibular bone resorption. If we can identify the osteoporotic process using a basic panoramic radiography measurement technique, then it is possible to intercept the progress of the disease through early warning and treatment. From the results of this study, it can be concluded the thickness of the mandibular angular cortex can be used as an index for bone resorption. A healthy lifestyle has multiple benefits for the mouth and throughout the body. Dental professionals can play a role in preventing osteoporosis by reinforcing this message.     

Screening for traditional risk factors for cardiovascular disease: a review for oral health care providers

BACKGROUND: Cardiovascular disease, or CVD, is associated with a very high rate of morbidity and mortality among people in the United States. Primary and secondary prevention measures will help reduce cardiovascular events and increase the overall health of the patient population. METHODS: The author conducted MEDLINE and Internet searches and reviewed publications from professional organizations for the most up-to-date information on CVD and associated risk factors. RESULTS: More than 450,000 articles and monographs on CVD were published in English between January 1990 and May 2001. Of these, approximately 45,000 discussed CVD and risk factors. The author selected and reviewed more than 550 publications on the basis of their relevance to epidemiology, etiology, and primary and secondary prevention of CVD. CONCLUSIONS: Recent information regarding the pathogenesis and treatment of CVD suggests that oral health care providers can perform screening for risk factors and aid in monitoring of specific conditions that put people at an increased risk of developing and exacerbating existing CVD. Dentists need to take a proactive role in this endeavor. CLINICAL IMPLICATIONS: As with most medical conditions, oral health care providers play an important function as it relates to the overall health of their patients. This article provides a timely update on CVD and the relationship between CVD and its risk factors, and offers suggestions for oral health care providers as to when they should interact with patients and patients' primary health care providers to possibly reduce the mortality and morbidity of CVD.     

Determinants of physical and mental health complaints in dentists: a systematic review

Occupational determinants of ill health in dentists were systematically reviewed in literature. The methodological quality of the studies was evaluated. Studies were included if they evaluated health‐related risk factors in dental practice by means of quantitative methods and statistical analysis of collected data. Despite all the factors affecting dentists' physical and mental health, evidence of the predictive value of all these risk factors remains scarce. More than one‐third (37%) of the studies appraised were found to be low quality research (weak or invalid). Results from studies investigating the factors associated with ill health in dentists do not allow for conclusions at the meta‐level. More prospective and retrospective case‐control studies should be conducted and attention should be paid to measuring outcomes with validated instruments to enable comparative studies and statistical summation of findings.     

Assessment of mastication with implications for oral rehabilitation: a review

During chewing, food is reduced in size, while saliva moistens the food and binds the masticated food into a bolus that can be easily swallowed. Characteristics of the oral system, like number of teeth, bite force and salivary flow, will influence the masticatory process. Masticatory function of healthy persons has been studied extensively the last decades. These results were used as a comparison for outcomes of various patient groups. In this review, findings from literature on masticatory function for both healthy persons and patient groups are presented. Masticatory function of patients with compromised dentition appeared to be significantly reduced when compared with the function of healthy controls. The influence of oral rehabilitation, e.g. dental restorations, implant treatment and temporomandibular disorder treatment, on masticatory function will be discussed. For instance, implant treatment was shown to have a significant positive effect on both bite force and masticatory performance. Also, patient satisfaction with an implant-retained prosthesis was high in comparison with the situation before implant treatment. The article also reviews the neuromuscular control of chewing. The jaw muscle activity needed to break solid food is largely reflexly induced. Immediate muscle response is necessary to maintain a constant chewing rhythm under varying food resistance conditions. Finally, the influence of food characteristics on the masticatory process is discussed. Dry and hard products require more chewing cycles before swallowing than moist and soft foods. More time is needed to break the food and to add enough saliva to form a cohesive bolus suitable for swallowing.     

Eating disorders and their implications on oral health--role of dentists

Eating disorders (EDs) are primary psychological conditions, often associated with severing medical complications. EDs are characterized by perturbed eating behavior patterns. Their increasing incidence and prevalence is causing concerns to healthcare professionals. Because eating disorders are a complex issue, a multidisciplinary approach to treatment is required and this team includes Psychiatrists, Psychologists and Nutritionists. The purpose of this paper is to review the role of the dentists especially the pediatric dentist and orthodontist in identifying oral manifestations of EDs, which may be utilized for oral diagnosis, referral and management of underlying psychiatric condition and also secondary oral conditions.     

Determinants of oral health behaviour among Iranian dentists

AIM: To study the oral health behaviour of Iranian dentists. DESIGN: A cross-sectional study. Setting: Two annual dental meetings in Tehran, Iran. PARTICIPANTS: 1,033 dentists responded, 980 were eligible for this study. METHOD: Data were collected using a self-administered questionnaire which covered dentists' oral self-care, dental attendance, and smoking. Recommended oral self-care (ROSC) included tooth brushing > 1/day, eating sugary snacks < daily, and regularly using fluoride toothpaste. Knowledge of preventive dental care was assessed by nine Likert-scale statements. Dentist's gender, age, and professional reading were recorded. Statistical evaluation was by the Chi-square test and logistic regression. RESULTS: In total, 59% of respondents reported brushing their teeth at least 2/day, 59% consumed sugary snacks < daily, 74% used fluoride toothpaste regularly, and 76% were non-smokers. Of all, 27% followed ROSC. Women reported desirable behaviours more frequently than did the men (p < 0.01). Female gender (OR 1.4-2.3), being a non-smoker (OR 1.3-1.5), and wider professional reading (OR = 1.2) were the major factors that contributed to dentists' desirable oral health behaviour. CONCLUSIONS: That only a small number of Iranian dentists follow the ROSC calls for more attention to behavioural contributions to oral diseases and its consequences with general and oral health, regarding both dental curriculum and continuing education.