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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.

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., (© The Author(s) 2021. Published by Oxford University Press on behalf of the American Society for Nutrition.)

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.

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., (© The Author(s) 2021. Published by Oxford University Press on behalf of the International Life Sciences Institute. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

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., (Copyright © 2021 Elsevier Inc. All rights reserved.)

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., (© 2020 Wiley Periodicals LLC.)

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., (Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.)

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.

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., (© 2018 The Authors. Gerodontology published by Gerodontology Association and John Wiley & Sons Ltd.)

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 %A 1c , 95% CI: -0.08, -0.00008), and higher white blood cell count (0.74 10 9 /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., (© 2018 Wiley Periodicals, Inc.)

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.

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., (© 2017 Wiley Periodicals, Inc.)

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., (© 2017 Wiley Periodicals, Inc.)

Aim: To provide a narrative review of the role of macro- and micronutrients in relation to dental caries, gingival bleeding and destructive periodontal disease., Materials & Methods: This review is based on systematic reviews (when available) and comparative human studies., Results: Dental caries cannot develop without the presence of dietary fermentable carbohydrates, in particular sugar. The susceptibility to develop caries in the presence of carbohydrates may be influenced by genetics and micronutrients such as vitamin D. Gingival bleeding and destructive periodontal disease are sensitive markers to both abnormalities in macronutrient content (excessive carbohydrates or poly-unsaturated fat intake, deficient protein intake) and micronutrient intake (e.g. vitamin C and B12)., Conclusion: Dental caries and periodontal diseases are a sensitive alarm bell for an unhealthy diet, which predicts the future onset of the diseases of civilizations., (© 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Background: Conduct a systematic review and meta-analysis on nonsurgical treatment of patients with chronic periodontitis by means of scaling and root planing (SRP) with or without adjuncts., Methods: A panel of experts convened by the American Dental Association Council on Scientific Affairs conducted a search of PubMed (MEDLINE) and Embase for randomized controlled trials of SRP with or without the use of adjuncts with clinical attachment level (CAL) outcomes in trials at least 6 months in duration and published in English through July 2014. The authors assessed individual study bias by using the Cochrane Risk of Bias Tool and conducted meta-analyses to obtain the summary effect estimates and their precision and to assess heterogeneity. The authors used funnel plots and Egger tests to assess publication bias when there were more than 10 studies. The authors used a modified version of the US Preventive Services Task Force methods to assess the overall level of certainty in the evidence., Results: The panel included 72 articles on the effectiveness of SRP with or without the following: systemic antimicrobials, a systemic host modulator (subantimicrobial-dose doxycycline), locally delivered antimicrobials (chlorhexidine chips, doxycycline hyclate gel, and minocycline microspheres), and a variety of nonsurgical lasers (photodynamic therapy with a diode laser, a diode laser, neodymium:yttrium-aluminum-garnet lasers, and erbium lasers)., Conclusions and Practical Implications: With a moderate level of certainty, the panel found approximately a 0.5-millimeter average improvement in CAL with SRP. Combinations of SRP with assorted adjuncts resulted in a range of average CAL improvements between 0.2 and 0.6 mm over SRP alone. The panel judged the following 4 adjunctive therapies as beneficial with a moderate level of certainty: systemic subantimicrobial-dose doxycycline, systemic antimicrobials, chlorhexidine chips, and photodynamic therapy with a diode laser. There was a low level of certainty in the benefits of the other included adjunctive therapies. The panel provides clinical recommendations in the associated clinical practice guideline., (Copyright © 2015 American Dental Association. Published by Elsevier Inc. All rights reserved.)

Background: A panel of experts convened by the American Dental Association Council on Scientific Affairs presents an evidence-based clinical practice guideline on nonsurgical treatment of patients with chronic periodontitis by means of scaling and root planing (SRP) with or without adjuncts., Methods: The authors developed this clinical practice guideline according to the American Dental Association's evidence-based guideline development methodology. This guideline is founded on a systematic review of the evidence that included 72 research articles providing clinical attachment level data on trials of at least 6 months' duration and published in English through July 2014. The strength of each recommendation (strong, in favor, weak, expert opinion for, expert opinion against, and against) is based on an assessment of the level of certainty in the evidence for the treatment's benefit in combination with an assessment of the balance between the magnitude of the benefit and the potential for adverse effects., Practical Implications and Conclusions: For patients with chronic periodontitis, SRP showed a moderate benefit, and the benefits were judged to outweigh potential adverse effects. The authors voted in favor of SRP as the initial nonsurgical treatment for chronic periodontitis. Although systemic subantimicrobial-dose doxycycline and systemic antimicrobials showed similar magnitudes of benefits as adjunctive therapies to SRP, they were recommended at different strengths (in favor for systemic subantimicrobial-dose doxycycline and weak for systemic antimicrobials) because of the higher potential for adverse effects with higher doses of antimicrobials. The strengths of 2 other recommendations are weak: chlorhexidine chips and photodynamic therapy with a diode laser. Recommendations for the other local antimicrobials (doxycycline hyclate gel and minocycline microspheres) were expert opinion for. Recommendations for the nonsurgical use of other lasers as SRP adjuncts were limited to expert opinion against because there was uncertainty regarding their clinical benefits and benefit-to-adverse effects balance. Note that expert opinion for does not imply endorsement but instead signifies that evidence is lacking and the level of certainty in the evidence is low., (Copyright © 2015 American Dental Association. Published by Elsevier Inc. All rights reserved.)

Background: A panel of experts convened by the American Dental Association (ADA) Council on Scientific Affairs presents evidence-based clinical recommendations regarding professionally applied and prescription-strength, home-use topical fluoride agents for caries prevention. These recommendations are an update of the 2006 ADA recommendations regarding professionally applied topical fluoride and were developed by using a new process that includes conducting a systematic review of primary studies., Types of Studies Reviewed: The authors conducted a search of MEDLINE and the Cochrane Library for clinical trials of professionally applied and prescription-strength topical fluoride agents--including mouthrinses, varnishes, gels, foams and pastes--with caries increment outcomes published in English through October 2012., Results: The panel included 71 trials from 82 articles in its review and assessed the efficacy of various topical fluoride caries-preventive agents. The panel makes recommendations for further research., Practical Implications: The panel recommends the following for people at risk of developing dental caries: 2.26 percent fluoride varnish or 1.23 percent fluoride (acidulated phosphate fluoride) gel, or a prescription-strength, home-use 0.05 percent fluoride gel or paste or 0.09 percent fluoride mouthrinse for patients 6 years or older. Only 2.26 percent fluoride varnish is recommended for children younger than 6 years. The strengths of the recommendations for the recommended products varied from "in favor" to "expert opinion for." As part of the evidence-based approach to care, these clinical recommendations should be integrated with the practitioner's professional judgment and the patient's needs and preferences.

Vitamin D has been used to prevent and treat dental caries. The objective of this study was to conduct a systematic review of controlled clinical trials (CCTs) assessing the impact of vitamin D on dental caries prevention. Random-effects and meta-regression models were used to evaluate overall and subgroup-specific relative-rate estimates. Twenty-four CCTs encompassing 2,827 children met the inclusion criteria. Twenty-two of the 24 CCTs predated modern clinical trial design, some of which nonetheless reported characteristics such as pseudo-randomization (n = 2), blinding (n = 4), or use of placebos (n = 8). The relative-rate estimates of the 24 CCTs exhibited significant heterogeneity (P < 0.0001), and there was evidence of significant publication bias (P < 0.001). The pooled relative-rate estimate of supplemental vitamin D was 0.53 (95% CI, 0.43-0.65). No robust differences were identified between the caries-preventive effects of vitamin D(2) , vitamin D(3) , and ultraviolet radiation (Prob > F = 0.22). The analysis of CCT data identified vitamin D as a promising caries-preventive agent, leading to a low-certainty conclusion that vitamin D may reduce the incidence of caries., (© 2012 International Life Sciences Institute.)

Background: and Overview. Observational investigations provide an opportunity to document the distribution of diseases in various populations and to explore correlations between exposures and outcomes. Interpreting such correlations as causal is challenging and can lead to more harm than good when used as a basis for advising lifestyle changes or interventions to healthy people. The aim of this review is to provide a brief introduction to observational study designs and describe some of their strengths and weaknesses., Conclusions and Practice Implications: Observational findings can be useful to guide clinical research, but often they do not provide a reliable basis for clinical decision making. Caution in applying observational findings to clinical practice is particularly important when caring for healthy people.

Background: This article presents evidence-based clinical recommendations developed by a panel convened by the American Dental Association Council on Scientific Affairs. This report addresses the potential benefits and potential risks of screening for oral squamous cell carcinomas and the use of adjunctive screening aids to visualize and detect potentially malignant and malignant oral lesions., Types of Studies Reviewed: The panel members conducted a systematic search of MEDLINE, identifying 332 systematic reviews and 1,499 recent clinical studies. They selected 5 systematic reviews and 4 clinical studies to use as a basis for developing recommendations., Results: The panel concluded that screening by means of visual and tactile examination to detect potentially malignant and malignant lesions may result in detection of oral cancers at early stages of development, but that there is insufficient evidence to determine if screening alters disease-specific mortality in asymptomatic people seeking dental care., Clinical Implications: The panel suggested that clinicians remain alert for signs of potentially malignant lesions or early-stage cancers while performing routine visual and tactile examinations in all patients, but particularly in those who use tobacco or who consume alcohol heavily. Additional research regarding oral cancer screening and the use of adjuncts is needed.

Background: Our objectives were to describe the prevalence of periodontal care (a marker of periodontitis) among persons with and without diabetes and to examine the association between periodontal care and diabetes., Methods: We conducted a cross-sectional analysis, using 5 years of electronic data from a population-based cohort (N = 46,132), aged 40 to 70 years, with dental and medical insurance, and ≥ 1 dental and ≥ 1 medical visit. Periodontal care (yes/no) was defined by dental claims codes for procedures used to manage periodontitis. The association between periodontal care and diabetes was determined using logistic regression adjusted for and stratified by age, sex, insurance type, smoking status, body mass index (BMI) (in kilograms per square meter), and resource utilization band (RUB) (a measure of expected health care utilization attributable to comorbidity)., Results: Overall, 11.2% (5,153 of 46,132) met diabetes criteria. The age-adjusted prevalence of periodontal care among those with and without diabetes was 39.1% and 32.5%, respectively (P <0.0001). The association between diabetes and periodontal care decreased with increasing age (interaction, P <0.0001), adjusting for BMI and RUB. The aged-stratified, adjusted odds ratio (OR) for periodontal care associated with diabetes was highest among those aged 40 to 44 years [OR, 1.6; confidence interval (CI), 1.30 to 1.97] and lowest among those aged 60 to 64 years (OR, 0.97; CI, 0.81 to 1.15) and was significant only among those aged 40 to 54 years., Conclusion: We found that the prevalence of periodontal care was significantly higher among those with diabetes compared to those without diabetes and that the magnitude of this association decreased with increasing age.

The distribution of branded drug samples in an educational setting may obscure the line between an evidence-based and a marketing-based education. The aim of this study was to evaluate the impact of branded drug samples on clinical recommendations in a dental education setting. Survey respondents exposed (n=95) and unexposed (n=80) to a specific branded drug sample program containing non-patented ingredients responded to a brief questionnare on recommendations for dentinal hypersensitivity. The results showed that an exposure to the branded drug sample was associated with twelve-fold increased odds for recommending the brand name (95 percent confidence interval [CI]: 5.8-24.5; p<0.0001); 2.6-fold increased odds for recommending the therapeutic class to which the branded drug sample belonged (95 percent CI: 1.1-6.0; p=0.02); a 66 percent reduction in odds for considering other therapeutic classes (95 percent CI: 0.18-0.63; p=0.00015); and an 84 percent reduction in considering etiology (95 percent CI: 0.08-0.35; p<0.0001). We conclude that branded drug samples in a dental education setting were associated with increasing brand recommendation, narrowing therapeutic thinking, and decreased consideration for removing causes.

Background: In this article, the authors present evidence-based clinical recommendations regarding the use of nonfluoride caries preventive agents. The recommendations were developed by an expert panel convened by the American Dental Association (ADA)Council on Scientific Affairs. The panel addressed several questions regarding the efficacy of nonfluoride agents in reducing the incidence of caries and arresting or reversing the progression of caries., Types of Studies Reviewed: A panel of experts convened by the ADA Council on Scientific Affairs, in collaboration with ADA Division of Science staff, conducted a MEDLINE search to identify all randomized and nonrandomized clinical studies regarding the use of non fluoride caries-preventive agents., Results: The panel reviewed evidence from 50 randomized controlled trials and 15 nonrandomized studies to assess the efficacy of various nonfluoride caries-preventive agents., Clinical Implications: The panel concluded that certain nonfluoride agents may provide some benefit as adjunctive therapies in children and adults at higher risk of developing caries. These recommendations are presented as a resource for dentists to consider in the clinical decision-making process. As part of the evidence based approach to care, these clinical recommendations should be integrated with the practitioner’s professional judgment and the patient’s needs and preferences.

Objective: To assess the hypothesis that retinopathies are indicative of systemic microvascular injury., Research Design and Methods: The only U.S. national survey assessing microvascular hemorrhaging at two distinct anatomical sites was the National Health and Nutrition Examination Survey (1988-1994). The systemic microvascular injury hypothesis was assessed by modeling the association of retinal and gingival hemorrhaging and the factors that explain this association., Results: Individuals in whom one or more in five gingival sites was hemorrhaging had a 57% increased odds for retinal hemorrhaging (95% CI: 1.26-1.94). This association between retinal and gingival hemorrhaging was 51% explained by A1C concentrations. Retinal and gingival hemorrhaging exhibited the signature J-shaped prevalence patterns when plotted as a function of A1C concentrations., Conclusions: Gingival hemorrhaging reflected on retinal hemorrhaging, and both shared chronic hyperglycemia as an explanatory marker. These epidemiological findings support the hypothesis that retinopathies are reflective of systemic microvascular injury.

Background: This article presents evidence-based clinical recommendations regarding the intake of fluoride from reconstituted infant formula and its potential association with enamel fluorosis. The recommendations were developed by an expert panel convened by the American Dental Association (ADA) Council on Scientific Affairs (CSA). The panel addressed the following question: Is consumption of infant formula reconstituted with water that contains various concentrations of fluoride by infants from birth to age 12 months associated with an increased risk of developing enamel fluorosis in the permanent dentition?, Types of Studies Reviewed: A panel of experts convened by the ADA CSA, in collaboration with staff of the ADA Center for Evidence-based Dentistry (CEBD), conducted a MEDLINE search to identify systematic reviews and clinical studies published since the systematic reviews were conducted that addressed the review question., Results: CEBD staff identified one systematic review and two clinical studies. The panel reviewed this evidence to develop recommendations., Clinical Implications: The panel suggested that when dentists advise parents and caregivers of infants who consume powdered or liquid concentrate infant formula as the main source of nutrition, they can suggest the continued use of powdered or liquid concentrate infant formulas reconstituted with optimally fluoridated drinking water while being cognizant of the potential risks of enamel fluorosis development. These recommendations are presented as a resource to be considered in the clinical decision-making process. As part of the evidence-based approach to care, these clinical recommendations should be integrated with the practitioner's professional judgment and the patient's needs and preferences.

Background: This article presents evidence-based clinical recommendations developed by a panel convened by the American Dental Association Council on Scientific Affairs. This report addresses the potential benefits and potential risks of screening for oral squamous cell carcinomas and the use of adjunctive screening aids to visualize and detect potentially malignant and malignant oral lesions., Types of Studies Reviewed: The panel members conducted a systematic search of MEDLINE, identifying 332 systematic reviews and 1,499 recent clinical studies. They selected five systematic reviews and four clinical studies to use as a basis for developing recommendations., Results: The panel concluded that screening by means of visual and tactile examination to detect potentially malignant and malignant lesions may result in detection of oral cancers at early stages of development, but that there is insufficient evidence to determine if screening alters disease-specific mortality in asymptomatic people seeking dental care., Clinical Implications: The panel suggested that clinicians remain alert for signs of potentially malignant lesions or early-stage cancers while performing routine visual and tactile examinations in all patients, but particularly in those who use tobacco or who consume alcohol heavily. Additional research regarding oral cancer screening and the use of adjuncts is needed.

Background: Researchers have considered infant formula consumption a potential risk factor for enamel fluorosis in the U.S. population. The authors conducted a systematic review of controlled studies regarding the risk of developing enamel fluorosis associated with use of infant formula., Methods: One reviewer independently conducted systematic searches in eight databases. The authors then abstracted information, assessed study quality and combined odds ratios (ORs), when obtainable, by using a random-effects model., Results: After evaluating 969 potentially eligible published studies, the reviewers found that the authors of 41 studies had evaluated the effect of infant formula on enamel fluorosis risk. Authors of 14 of the 41 studies did not report their findings in their results. The authors of the remaining 27 published studies reported the findings of 19 observational studies; authors of 17 of these 19 studies reported ORs and, among these, infant formula consumption was associated with a higher prevalence of enamel fluorosis in the permanent dentition (summary OR 1.8, 95 percent confidence interval [CI] 1.4-2.3). There was significant heterogeneity among studies (I(2) 66 percent) and evidence of publication bias (P = .002). A metaregression analysis indicated that the ORs associating infant formula with enamel fluorosis increased by 5 percent for each 0.1-part-per-million increase in the reported levels of fluoride in the water supply (OR 1.05, 95 percent CI 1.02-1.09)., Clinical Implications: Infant formula consumption may be associated with an increased risk of developing at least some detectable level of enamel fluorosis, which depends on the level of fluoride in the water supply. The evidence that the fluoride in the infant formula caused enamel fluorosis was weak, as other mechanisms could explain the observed association.

Background: Knowledge of typical medication use among patients with chronic periodontitis or destructive periodontal disease is limited. The aim of this study was to associate periodontitis severity with the use of different classes of medications., Methods: Patients (N=12,631) who had medical, dental, and pharmaceutical coverage with a health maintenance organization and whose severity of destructive periodontal disease was diagnosed by a dentist or specialist were included in the study. The rate of drug use over 7 years was related to the severity of destructive periodontal disease by means of Poisson regression models., Results: Individuals with moderate to advanced periodontitis had significantly lower fill rates for the respiratory agents (antihistamines: -23%, 95% confidence interval [CI]: -10% to -34%; decongestants: -24%, 95% CI: -13% to -34%; and cough/cold medications: -12%, 95% CI: -3% to -21%) and anti-infective agents (antibiotics: -12%, 95% confidence interval: -6% to -18%; urinary anti-infectives: -36%, 95% CI: -6% to -56%; and topical antibiotics: -18%, 95% CI: -5% to -29%)., Conclusions: More severe periodontitis was a marker for reduced medication use for allergies and infections. The associations between destructive periodontal disease, infections, allergies, and the hygiene hypothesis need further exploration.

Background: Orthodontic therapy has been suggested to lead to an improved periodontal status through mechanisms such as increased ease of plaque removal and reduced occlusal trauma. The objective of the authors' systematic review was to compare contemporary orthodontic treatment with no intervention, by means of evaluating periodontal outcomes measured after end of treatment., Methods: The authors completed electronic searches in eight databases (1980-2006) and hand searches in six dental journals (1980-2006). They extracted data using standardized forms and calculated weighted mean differences., Results: Weak evidence from one randomized study and 11 nonrandomized studies suggested that orthodontic therapy was associated with 0.03 millimeters of gingival recession (95 percent confidence interval [CI], 0.01-0.04), 0.13 mm of alveolar bone loss (95 percent CI, 0.07-0.20) and 0.23 mm of increased pocket depth (95 percent CI, 0.15-0.30) when compared with no treatment. The effects of orthodontic therapy on gingivitis and attachment loss were inconsistent across studies., Conclusions: This systematic review identified an absence of reliable evidence describing positive effects of orthodontic treatment on periodontal health. The existing evidence suggests that orthodontic therapy results in small detrimental effects to the periodontium.

Introduction: The goals of this study were to describe secular trends in preadult orthodontic care for people in the United States born between 1942 and 1972, and to estimate the number of new preadult orthodontic treatment starts in 2006., Methods: Orthodontic care experience in this group was ascertained by 2 questions in the Third National Health and Nutrition Examination Survey (NHANES III)., Results: Of those in the 1942 birth cohort, 4.6% (SE 1.5) and, of those in the 1972 birth cohort, 29.7% (SE 3.8) received preadult orthodontic care. These increasing secular trends were more pronounced for people of higher socioeconomic positions (P <.03) and girls (P = .04). If the orthodontic care prevalence continues to increase yearly by 0.7 percentage point (SE 0.08), there will be 1.62 million new preadult patient starts in 2006, an increase of 26,000 over 2005., Conclusions: The prevalence of preadult orthodontic care has steadily increased for successive birth cohorts between 1942 and 1972, particularly for girls and those at higher socioeconomic positions. Linear extrapolations extending to 2006 reasonably agree with survey data, suggesting linear growth in orthodontic treatment use by those born in the latter half of the 20th century.

Aim: To evaluate whether statin use was associated with decreased tooth loss among patients with chronic periodontitis., Material and Methods: We evaluated administrative health plan data from 1996 to 2002 covering dental and periodontal treatment utilization, dental extractions, and prescription medication fills of 12,631 adults aged 48-64 in 2002. With tooth loss as the outcome, we evaluated a number of different patterns of statin prescription across time in multivariate generalized linear models., Results: Unadjusted, statin use was associated with increased tooth loss. After adjustment for potential confounders, there was no suggestion of either increased or decreased tooth loss associated with statin use., Conclusions: Statin use was not associated with either a decreased or an increased risk of tooth loss.

The goal of this study was to assess whether interruption of care for chronic periodontitis during pregnancy increased the risk of low-birthweight infants. A population-based case-control study was designed with 793 cases (infants < 2,500 g) and a random sample of 3,172 controls (infants >or= 2,500 g). Generalized estimating equation models were used to relate periodontal treatment history to low birthweight risk and to common risk factors. The results indicate that periodontal care utilization was associated with a 2.35-fold increased odds of self-reported smoking during pregnancy (95% confidence interval: 1.48-3.71), a 2.19-fold increased odds for diabetes (95% confidence interval: 1.21-3.98), a 3.90-fold increased odds for black race (95% confidence interval: 2.31-6.61), and higher maternal age. After adjustment for these factors, interruption of periodontal care during pregnancy did not lead to an increased risk for a low-birthweight infant when compared to women with no history of periodontal care (odds ratio, 0.96; 95% confidence interval, 0.60-1.52). In conclusion, women receiving periodontal care had genetic and environmental characteristics, such as smoking, diabetes and race, that were associated with an increased risk for low-birthweight infants. Periodontal care patterns, in and of themselves, were unrelated to low-birthweight risk.

The purpose of this case-control study was to determine if elderly subjects with a history of osteoporotic fractures have fewer teeth and greater residual ridge resorption than subjects without such fractures. Patients older than 60 with a panoramic radiograph were invited to a phone interview. Information was obtained regarding fracture history, smoking, and hormone replacement therapy (HRT). The number of teeth was obtained from the panoramic radiograph. The residual ridge height of the edentulous mandible was measured at the site of the mental foramen. Multiple regression models were used to assess the association between fracture status and number of teeth or residual ridge height (controlling for age, gender, HRT, smoking, height and weight). Cases (n=93) were individuals reporting osteoporotic fractures (fractures occurring after minor impact). Controls (n=394) were individuals reporting traumatic fractures (n=105) or no fractures (n=289). Fracture status in this population affect neither the number of teeth nor the residual ridge height. In the regression model, the variables that had a statistically-significant effect on the number of teeth were age (p<0.0001) and smoking (p<0.0001). There was a dose-effect of smoking on the number of teeth. In the regression model, the variables that had a significantly-significant on residual ridge height (n=95 edentulous subjects) were age and gender. Our conclusion was that in elderly dental-school patients the number of teeth and residual ridge height were not influenced by fracture status. Age and smoking had the most influence; there was no effect from HRT. The clinical implication is that a history of osteoporotic fractures is not an important cause for tooth loss and residual ridge resorption in an elderly dental-school population.

Objectives: We examined the relationships between risk factors amenable to intervention and the likelihood of dental care use during pregnancy., Methods: We used data from the Washington State Department of Health's Pregnancy Risk Assessment Monitoring System., Results: Of the women surveyed, 58% reported no dental care during their pregnancy. Among women with no dental problems, those not receiving dental care were at markedly increased risk of having received no counseling on oral health care, being overweight, and using tobacco. Among women who received dental care, those with dental problems were more likely to have lower incomes and Medicaid coverage than those without dental problems., Conclusions: There is a need for enhanced education and training of maternity care providers concerning oral health in pregnancy.

Context: Both high- and low-dose radiation exposures in women have been associated with low-birth-weight offspring. It is unclear if radiation affects the hypothalamus-pituitary-thyroid axis and thereby indirectly birth weight, or if the radiation directly affects the reproductive organs., Objective: To investigate whether antepartum dental radiography is associated with low-birth-weight offspring., Design: A population-based case-control study., Participants and Setting: Enrollees of a dental insurance plan with live singleton births in Washington State between January 1993 and December 2000. Cases were 1117 women with low-birth-weight infants (<2500 g), of whom 336 were term low-birth-weight infants (1501-2499 g and gestation > or =37 weeks). Four control pregnancies resulting in normal-birth-weight infants (> or =2500 g) were randomly selected for each case (n = 4468)., Main Outcome Measures: Odds of low birth weight and term low birth weight by dental radiographic dose during gestation., Results: An exposure higher than 0.4 milligray (mGy) during gestation occurred in 21 (1.9%) mothers of low-birth-weight infants and, when compared with women who had no known dental radiography, was associated with an adjusted odds ratio (OR) for a low-birth-weight infant of 2.27 (95% confidence interval [CI], 1.11-4.66, P =.03). Exposure higher than 0.4 mGy occurred in 10 (3%) term low-birth-weight pregnancies and was associated with an adjusted OR for a term low-birth-weight infant of 3.61 (95% CI, 1.46-8.92, P =.005)., Conclusion: Dental radiography during pregnancy is associated with low birth weight, specifically with term low birth weight.

Purpose: Periodontitis has been linked to the occurrence of various systemic diseases. The goal of this study was to explore the periodontitis-cancer association in the NHANES I Epidemiologic Follow-up Study., Methods: Data were available on 11,328 adults, age 25 to 74 years, who were diagnosed as dentate individuals with either periodontitis (n = 2092), gingivitis (n = 2603), a healthy periodontium (n = 2,671), or as individuals without teeth (edentulous n = 3,962) at the beginning of the follow-up. The main outcome measure was fatal cancer, as ascertained from death certificates., Results: Compared with individuals with a healthy periodontium, fatal cancer occurrence was positively associated with periodontitis at baseline (age and gender adjusted odds ratio = 1.55, 95% confidence interval: 1.25-1.92). Of the different cancer types, lung cancer demonstrated the strongest association. After adjustment for known risk factors for lung cancer, the magnitude of the association between periodontitis and lung cancer ranged between 1.48 (95% confidence interval: 0.88-2.50) and 1.73 (95% confidence interval: 1.01-2.97)., Conclusions: Associations between periodontitis and lung cancer mortality can be identified above and beyond adjustment for known risk factors for lung cancer. Despite these apparent unconfounded associations, there are reasons to believe that the periodontitis-cancer associations may be spurious.

Objectives: Recruitment for randomised clinical trials and community-based studies has received little attention in the dental literature. The goal of this study was to report on our experiences with direct and indirect recruitment methods for a trial to prevent tooth loss in elders., Methods: A direct approach, consisting of an introductory lecture with the help of a local contact person in each of the nine community centres, resulted in 208 recruits mostly from minority non-English speaking communities (52%), whereas the other 192 recruits who responded to newspaper announcements (48%) were, in large part, from the English-speaking community., Results: The response suggests that a more direct and culturally specific approach is more productive when recruiting elders from ethnic minority groups, whereas elders from the dominant culture can be recruited indirectly and for about half the financial cost through newspaper announcements., Conclusion: We conclude, therefore, that both direct and indirect methods are needed to recruit a multiethnic sample of subjects for a trial.