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Inna E Tchivileva,1,2 Kirk W Johnson,3 Xiyun Chai,4 Lyndsey R VanDam,3 Pei Feng Lim,1,5 Gary D Slade1,6 1Center for Pain Research and Innovation, Adams School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; 2Division of Oral and Craniofacial Health Sciences, Adams School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; 3Pain Research, Eli Lilly and Company, Indianapolis, IN, USA; 4Precision Medicine Neuroscience, AbbVie, Chicago, IL, USA; 5Division of Diagnostic Sciences, Adams School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; 6Division of Pediatric and Public Health, Adams School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USACorrespondence: Inna E Tchivileva, Center for Pain Research and Innovation, Adams School of Dentistry, University of North Carolina at Chapel Hill, CB# 7455, Chapel Hill, NC, 275199-7455, USA, Tel +1 919 537 3291, Fax +1 919 966 5339, Email inna@unc.eduObjective: To assess associations of plasma calcitonin gene-related peptide (CGRP) with chronic temporomandibular disorder (TMD) myalgia/arthralgia or frequent/chronic migraine, alone and in combination, and to evaluate relations between the CGRP concentration and clinical, psychological, and somatosensory characteristics of participants.Methods: The cross-sectional study selected four groups of adult volunteers: healthy controls (HCs), TMD without migraine, migraine without TMD, and TMD with migraine. Each group comprised 20 participants, providing 94% power to detect statistically significant associations with CGRP concentration for either TMD or migraine. TMD and headache were classified according to the Diagnostic Criteria for TMD and the International Classification for Headache Disorders, 3rd edition, respectively. Plasma CGRP was quantified with a validated high-sensitivity electrochemiluminescent Meso Scale Discovery assay. Questionnaires and clinical examinations were used to evaluate characteristics of TMD, headache, psychological distress, and pressure pain sensitivity. Univariate regression models quantified associations of the CGRP concentration with TMD, migraine, and their interaction. Univariate associations of the CGRP concentration with clinical, psychological, and pressure pain characteristics were also assessed.Results: Among 80 participants enrolled, neither TMD nor migraine was associated with plasma CGRP concentration (P = 0.761 and P = 0.972, respectively). The CGRP concentration (mean ± SD) was similar in all 4 groups: HCs 2.0 ± 0.7 pg/mL, TMD 2.1 ± 0.8 pg/mL, migraine 2.1 ± 0.9 pg/mL, and TMD with migraine 2.2 ± 0.7 pg/mL. CGRP concentration was positively associated with age (P = 0.034) and marginally with body mass index (P = 0.080) but was unrelated to other participant characteristics.Conclusion: In this well-powered study, interictal plasma concentration of CGRP was a poor biomarker for TMD and migraine.Keywords: orofacial pain, musculoskeletal pain, neuropeptide, temporomandibular joint disorders, headache

PURPOSE: This study sought to investigate problems reported by patients before and after prosthodontic treatment. MATERIALS AND METHODS: Patient-reported problems were studied using the item list contained in the German version of the Oral Health Impact Profile in a convenience sample of 107 prosthodontic patients before (T0), 1 month after (T1), and 6 to 12 months after treatment (T2). 'Frequently reported' problems were defined as impacts experienced fairly often or very often. The prevalence of frequently reported problems was compared among treatment groups and across appointments. RESULTS: At baseline, the most prevalent frequently reported problems were 'difficulty chewing' (31%), 'take longer to complete a meal' (28%), 'food catching' (26%), 'uncomfortable to eat' (24%), and 'unable to eat (because of dentures)' (23%). At T2, the most prevalent frequently reported problems were 'sore spots' (5%), 'painful gums' (4%), 'discomfort (because of dentures)' (3%), and 'sore jaw' (2%). The number of reported problems decreased from 18.0 (T0) to 7.5 (T1), and further to 4.5 (T2). The decrease was the fastest in fixed partial denture wearers and the slowest in removable partial denture wearers. Some problems emerged during or after prosthodontic treatment. The kind of pre- and posttreatment problems differed substantially. CONCLUSION: The number of problems decreased substantially after prosthodontic treatment. Fixed partial dentures more effectively influenced the problems reported before treatment than did removable partial or complete dentures. [ABSTRACT FROM AUTHOR]

PURPOSE: This study described oral health-related quality of life (OHRQoL) before and after treatment in patients with fixed, removable, and complete dentures. MATERIALS AND METHODS: OHRQoL was measured using the German version of the Oral Health Impact Profile (OHIP-G) in a convenience sample of 107 prosthodontic patients at baseline and 1 and 6 to 12 months after treatment. The sum of OHIP-G item responses (OHIP-G49, range 0 to 196) characterized OHRQoL impairment in 42 patients treated with fixed prosthodontics, 31 patients treated with removable dentures, and 34 patients treated with complete dentures. OHIP-G49 medians were compared with the OHRQoL level in a general population sample (n = 2,026). A multivariable binomial regression analysis, controlling for the effects of baseline OHRQoL and follow-up wave, was used to compare the level of impaired OHRQoL in different prosthodontic treatment groups at follow-ups. RESULTS: OHRQoL improved in 96% of the subjects. OHIP-G49 medians reached the level of OHRQoL in the general population 1 month after treatment (fixed prosthodontics patients 6 OHIP-G units; general population subjects 5 units; removable denture patients 23 units, 15 units in general population subjects; complete denture patients 13 units, 23 units in general population subjects). OHIP-G49 medians were below population norms 6 to 12 months after treatment. In patients treated with removable/complete dentures, the expected posttreatment OHIP-G49 problem rate was 1.9 times the problem rate in patients treated with fixed prosthodontics, holding baseline OHIP-G49 and follow-up wave constant. CONCLUSION: OHRQoL changed substantially comparing pretreatment scores with 1 and 6 to 12 months of follow-up in patients treated with fixed, removable, and complete dentures. [ABSTRACT FROM AUTHOR]

BACKGROUND: The extent to which welfare states may influence health outcomes has not been explored. It was hypothesised that policies which target the poor are associated with greater income inequality in oral health quality of life than those that provide earnings-related benefits to all citizens. METHODS: Data were from nationally representative surveys in the UK (n = 4064), Finland (n = 5078), Germany (n = 1454) and Australia (n = 2292) conducted from 1998 to 2002. The typology of Korpi and Palme classifies these countries into four different welfare states. In each survey, subjects completed the Oral Health Impact Profile (OHIP-14) questionnaire, which evaluates the adverse consequence of dental conditions on quality of life. For each country, survey estimation commands were used to create linear regression models that estimated the slope of the gradient between four quartiles of income and OHIP-14 severity scores. Parameter estimates for income gradients were contrasted across countries using Wald chi(2) tests specifying a critical p value of 0.008, equivalent to a Bonferroni correction of p<0.05 for the six pairwise tests. RESULTS: Statistically significant income gradients in OHIP-14 severity scores were found in all countries except Germany. A global test confirmed significant cross-national differences in the magnitude of income gradients. In Australia, where a flat rate of benefits targeted the poor, the mean OHIP-14 severity score reduced by 1.7 units (95% CI -2.15 to -1.34) with each increasing quartile of household income, a significantly steeper gradient than in other countries. CONCLUSION: The coverage and generosity of welfare state benefits appear to influence levels of inequality in population oral health quality of life. [ABSTRACT FROM AUTHOR]

Objectives: To determine predictors of untreated dental decay among 15-34-year-olds in Australia. Methods: Data were from Australia's National Survey of Adult Oral Health, a representative survey that utilized a three-stage, stratified clustered sampling design. Models representing demographic, socioeconomic, dental service utilization and oral health perception variables were tested using multivariable logistic regression to produce odds ratios. Results: An estimated 25.8% (95% CI 22.4-29.5) of 15-34-year-old Australians had untreated dental decay. After controlling for other covariates, those who lived in a location other than a capital city had 2.0 times the odds of having untreated dental decay than their capital city-dwelling counterparts (95% CI 1.29-3.06). Similarly, those whose highest level of education was not a university degree had 2.1 times the odds of experiencing untreated dental decay (95% CI 1.35-3.31). Perceived need of extractions or restorations predicted untreated coronal decay, with 2.9 times the odds for those who perceived a treatment need over those with no such treatment need perception (95% CI 1.84-4.53). Participants who experienced dental fear had 2.2 times the odds of having untreated dental decay (95% CI 1.38-3.41), while those who reported experiencing toothache, orofacial pain or food avoidance in the last 12 months had 1.9 times the odds of having untreated dental decay than their counterparts with no such oral health-related quality-of-life impact (95% CI 1.20-2.92). The multivariate model achieved a 'useful' level of accuracy in predicting untreated decay (area under the ROC curve = 0.74; sensitivity = 0.63; specificity = 0.73). Conclusions: In the Australian young adult population, residential location, education level, perceived need for dental care, dental fear, toothache, orofacial pain or food avoidance together were predictors of untreated dental decay. The prediction model had acceptable specificity, indicating that it may be useful as part of a triage system for health departments wishing to screen by means of a questionnaire for apparently-dentally healthy 15-34-year-olds. [ABSTRACT FROM AUTHOR]

BACKGROUND: The extent to which periodontitis is attributable to smoking in Australia has not been examined. OBJECTIVES: To investigate the smoking-periodontitis relationship and to estimate the public health impact of smoking on periodontitis in Australia. MATERIAL AND METHODS: The National Survey of Adult Oral Health 2004-2006 collected nationally representative oral epidemiologic data for the Australian adult population. Examiners measured probing pocket depth (PPD) and gingival recession at three sites per tooth to compute clinical attachment level (CAL). Moderate-severe cases were defined as having: >/=2 interproximal sites (not on same tooth) with >/=4 mm CAL or with >/=5 mm PPD. Smoking status was defined as never-, former- or current-smoker. Current-smokers were further classified into light-, moderate- or heavy-smoker using calculated pack-years. Age, sex and socioeconomic position were examined as potential confounders. RESULTS: Twenty-three per cent were former-smokers and 15% were current-smokers. Prevalence of periodontitis was 23%. In unadjusted analyses, former- and current-smokers had significantly higher periodontitis prevalence than never-smokers. Relative to non-smokers, adjusted prevalence ratios (95% confidence interval) for periodontitis were as follows: former-smokers: 1.22 (1.03-1.46), moderate-smokers: 1.63 (1.16-2.30); and heavy-smokers: 1.64 (1.27-2.12). The population attributable fraction of smoking for moderate-severe periodontitis was 32% (equivalent to 700,000 adults). CONCLUSION: Smoking has a significant impact on periodontal health of the Australian adults. [ABSTRACT FROM AUTHOR]

The nature of the relationship between status and health has theoretical and applied significance. To compare the shape of the socioeconomic -oral health relationship using a measure of relative social status (MacArthur Scale of Subjective Social Status) and a measure of absolute material resource (equivalised household income); to investigate the contribution of behaviour in attenuating the socioeconomic gradient in oral health status; and to comment on three hypothesised explanatory mechanisms for this relationship (material, psychosocial, behavioural). In 2003, cross-sectional self-report data were collected from 2,915 adults aged 43-57 years in Adelaide, Australia using a stratified cluster design. Oral conditions were (1) <24 teeth, (2) 1+ impact/s reported fairly often or very often on the 14-item Oral Health Impact Profile; (3) fair or poor self-rated oral health, and (4) low satisfaction with chewing ability. Prevalence ratios and 95% confidence intervals (PR, 95%CI) were calculated from a logistic regression model. Covariates were age, sex, country of birth, smoking, alcohol use, body mass index, frequencies of toothbrushing and interdental cleaning. There was an approximately linear relationship of decreasing prevalence for each oral condition across quintiles of increasing relative social status. In the fully adjusted model the gradient was steepest for low satisfaction with chewing (PR = 4.1, 95%CI = 3.0-5.4). Using equivalised household income, the shape more closely resembled a threshold effect, with an approximate halving of the prevalence ratio between the first and second social status quintiles for the adverse impact of oral conditions and fair or poor self-rated oral health. Adjustment for covariates did not attenuate the magnitude of PRs. The nature of the relationship between social status and oral conditions differed according to the measure used to index social status. Perception of relative social standing followed an approximately straight-line relationship. In contrast, there was a discrete threshold of income below which oral health deteriorated, suggesting that the benefit to oral health of material resources occurs mostly at the lower end of the across the full socioeconomic distribution. [ABSTRACT FROM AUTHOR]

OBJECTIVES: To establish incidence rates and risk factors for HIV-associated oral candidiasis (OC), oral hairy leukoplakia (OHL), and any HIV-associated oral diseases (HIV-OD). DESIGN: This prospective, cumulative case-control study followed 283 initially oral disease-free HIV-1-infected men and women for 2 years. Incidence rate ratios (IRR) and incidence proportions for OC, OHL, and HIV-OD were estimated. Multivariable analyses using Poisson regression determined the most parsimonious best-fitting model explaining the outcomes. RESULTS: Incidence rate (per 1000 person-months) was 9.3 for OC, 6.8 for OHL, and 13.5 for HIV-OD. Incidence of OC was associated with low CD4 count (adjusted IRR = 3.0 (95% CI = 1.7, 5.1)), smoking (IRR = 1.9 (1.0, 3.8)) and combination antiretroviral therapy (IRR = 0.3 (0.1, 0.8)). Incidence of OHL was associated with low CD4 count, conditional upon smoking status. Conclusions Low CD4 count and smoking are important risk factors for HIV-associated OC and OHL. Antiretroviral medications are protective for OC but not for OHL. [ABSTRACT FROM AUTHOR]

OBJECTIVES: This study examined the association between chronic medication exposure and 5-year dental caries increment among older people, using a theoretical model whereby xerogenic medication is thought to lead to increased caries by either (i) chronically lowering salivary flow, thus reducing salivary buffering of plaque acids, or (ii) producing the symptoms of dry mouth, leading to symptomatic relief through the use of cariogenic drinks and foodstuffs. METHODS: Data were obtained from participants remaining at the 5-year follow-up phase of a cohort study of community-dwelling South Australians aged 60 +. Medication information was available at baseline and at 5 years, enabling only those medications taken on both occasions to be included in the analyses. Dental examinations were conducted at baseline and 5 years, and a reversal-adjusted 5-year caries increment was computed. Multivariate modelling was used to control the effects of potential confounders. RESULTS: Of the original sample, 528 (62.3%) remained after 5 years, with those remaining tending to be younger, healthier and less medicated than those lost to follow-up. Five-year coronal caries incidence was 66.9%. The adjusted coronal caries increment (AdjCI) was higher among males and among those taking a beta-blocker or an antiasthma drug for the previous 5 years. The 5-year incidence of root surface caries was 59.3%. A lower root surface AdjCI was associated with taking daily aspirin. Of the medications shown in earlier analyses to predict dry mouth, only the antiasthma drugs were associated with higher caries experience, and they had predicted more severe xerostomia symptoms. CONCLUSIONS: This study offers no strong evidence for a medication-caries relationship, as only one of the observed medication-caries associations was explicable in terms of the theoretical model. However, it should be acknowledged that older people taking antiasthma drugs may be at higher risk of coronal caries, possibly through measures taken for the symptomatic relief of dry mouth. [ABSTRACT FROM AUTHOR]

OBJECTIVES: Cigarette smoking is a leading risk factor for periodontal disease. This cross-sectional study investigated the relation between environmental tobacco smoke (ETS) and periodontal disease in the United States. METHODS: Data were obtained from the Third National Health and Nutrition Examination Survey (1988-1994). The outcome was periodontal disease, defined as 1 or more periodontal sites with attachment loss of 3 mm or greater and a pocket depth of 4 mm or greater at the same site. Exposure to ETS at home and work was self-reported. The study analyzed 6611 persons 18 years and older who had never smoked cigarettes or used other forms of tobacco. RESULTS: Exposure to ETS at home only, work only, and both was reported by 18.0%, 10.7%, and 3.8% of the study population, respectively. The adjusted odds of having periodontal disease were 1.6 (95% confidence interval = 1.1, 2.2) times greater for persons exposed to ETS than for persons not exposed. CONCLUSIONS: Among persons in the United States who had never used tobacco, those exposed to ETS were more likely to have periodontal disease than were those not exposed to ETS. © 2002 by the United States Cancer Pain Relief Committee. [ABSTRACT FROM AUTHOR]

A response by AE Sanders, GD Slade and LL Patton to a letter to the editor about their article "National prevalence of oral HPV infection and related risk factors in the U.S. adult population" in the July 2012 issue is presented.

Abstract: Temporomandibular disorders (TMDs), collectively representing one of the most common chronic pain conditions, have a substantial genetic component, but genetic variation alone has not fully explained the heritability of TMD risk. Reasoning that the unexplained heritability may be because of DNA methylation, an epigenetic phenomenon, we measured genome-wide DNA methylation using the Illumina MethylationEPIC platform with blood samples from participants in the Orofacial Pain: Prospective Evaluation and Risk Assessment (OPPERA) study. Associations with chronic TMD used methylation data from 496 chronic painful TMD cases and 452 TMD-free controls. Changes in methylation between enrollment and a 6-month follow-up visit were determined for a separate sample of 62 people with recent-onset painful TMD. More than 750,000 individual CpG sites were examined for association with chronic painful TMD. Six differentially methylated regions were significantly ( P < 5 × 10 -8 ) associated with chronic painful TMD, including loci near genes involved in the regulation of inflammatory and neuronal response. A majority of loci were similarly differentially methylated in acute TMD consistent with observed transience or persistence of symptoms at follow-up. Functional characterization of the identified regions found relationships between methylation at these loci and nearby genetic variation contributing to chronic painful TMD and with gene expression of proximal genes. These findings reveal epigenetic contributions to chronic painful TMD through methylation of the genes FMOD , PM20D1 , ZNF718 , ZFP57 , and RNF39 , following the development of acute painful TMD. Epigenetic regulation of these genes likely contributes to the trajectory of transcriptional events in affected tissues leading to resolution or chronicity of pain., (Copyright © 2023 International Association for the Study of Pain.)

Chronic primary pain conditions (CPPCs) affect over 100 million Americans, predominantly women. They remain ineffectively treated, in large part because of a lack of valid animal models with translational relevance. Here, we characterized a CPPC mouse model that integrated clinically relevant genetic (catechol-O-methyltransferase; COMT knockdown) and environmental (stress and injury) factors. Compared with wild-type mice, Comt +/- mice undergoing repeated swim stress and molar extraction surgery intervention exhibited pronounced multisite body pain and depressive-like behavior lasting >3 months. Comt +/- mice undergoing the intervention also exhibited enhanced activity of primary afferent nociceptors innervating hindpaw and low back sites and increased plasma concentrations of norepinephrine and pro-inflammatory cytokines interleukin-6 (IL-6) and IL-17A. The pain and depressive-like behavior were of greater magnitude and longer duration (≥12 months) in females versus males. Furthermore, increases in anxiety-like behavior and IL-6 were female-specific. The effect of COMT genotype × stress interactions on pain, IL-6, and IL-17A was validated in a cohort of 549 patients with CPPCs, demonstrating clinical relevance. Last, we assessed the predictive validity of the model for analgesic screening and found that it successfully predicted the lack of efficacy of minocycline and the CB2 agonist GW842166X, which were effective in spared nerve injury and complete Freund's adjuvant models, respectively, but failed in clinical trials. Yet, pain in the CPPC model was alleviated by the beta-3 adrenergic antagonist SR59230A. Thus, the CPPC mouse model reliably recapitulates clinically and biologically relevant features of CPPCs and may be implemented to test underlying mechanisms and find new therapeutics.

Background: Fluoridation of public water systems is known as a safe and effective strategy for preventing dental caries based on evidence from non-randomized studies. Yet 110 million Americans do not have access to a fluoridated public water system and many others do not drink tap water. This article describes the study protocol for the first randomized controlled trial (RCT) of fluoridated water that assesses its potential dental caries preventive efficacy when delivered in bottles., Methods: waterBEST is a phase 2b proof-of-concept, randomized, quadruple-masked, placebo-controlled, parallel-group trial designed to estimate the potential efficacy of fluoridated versus non-fluoridated bottled water to prevent dental caries incidence in the first 4 years of life. Two hundred children living in eastern North Carolina, USA, and aged 2-6 months at screening are being allocated at random in a 1:1 ratio to receive fluoridated (0.7 mg/L F) or non-fluoridated bottled water sourced from two local public water systems. Throughout the 3.5-year intervention, study water is delivered monthly in 5-gallon bottles to each child's home with instructions to use it whenever the child consumes water as a beverage or in food preparation. Parents are interviewed quarterly to monitor children's water consumption and health. At annual visits, the presence of dental caries is evaluated with a dental screening examination. Clippings from fingernails and toenails are collected to quantify fluoride content as a biomarker of total fluoride intake. The primary endpoint is the number of primary tooth surfaces decayed, missing, or filled due to dental caries measured by the study dentist near the time of the child's fourth birthday. Tooth decay is assessed at the threshold of macroscopic enamel loss. For the primary aim, a least-squares, generalized linear model will estimate efficacy and its one-tailed, upper 80% confidence limit., Discussion: waterBEST is the first evaluation of a randomized intervention of fluoridated drinking water in bottles to prevent dental caries in the primary dentition. This innovative method of delivering fluoridated water has the potential to prevent early childhood caries in a large segment of the US population that currently does not benefit from fluoridated public water., Trial Registration: ClinicalTrials.gov NCT04893681. Registered on March 2022. Last update posted on 10 October 2023. https://clinicaltrials.gov/study/NCT04893681?cond=Dental%20Caries%20in%20Children&term=fluoride&locStr=North%20Carolina,%20USA&country=United%20States&state=North%20Carolina&distance=50&rank=1., (© 2024. The Author(s).)