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"Markowitz, Kenneth"
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Iron deficiency anemia and its impact on oral health-a literature review
2024
Oral disease interventions primarily focus on behavioral changes like dietary improvements and ensuring better oral hygiene. However, recognizing the influence of biological factors, including genetics and early-life nutrition, is crucial. Iron deficiency (ID) and its advanced form, iron deficiency anemia (IDA), affect nearly two billion people globally, especially children and pregnant women. We conducted a comprehensive search using Medline via EndNote and Web of Science, employing keywords related to iron deficiency anemia (IDA), and we identified 36 studies deemed relevant for inclusion in this literature review. IDA prevalence is notably high among pregnant women and young children. Both IDA and early-childhood caries (ECC) disproportionately affect impoverished populations, highlighting the socioeconomic dimension of this issue. IDA presents with various oral mucosal changes and is closely linked to candidiasis. Additionally, IDA can hinder tooth development and weaken the immune response. Multiple population surveys have revealed a significant association between ECC and IDA. While some studies have explored the IDA–periodontal disease link, the current evidence is relatively limited in its robustness. In conclusion, more comprehensive longitudinal studies are essential to deepen our understanding of the IDA–oral disease connection. Investigating the underlying biological mechanisms is critical to developing effective interventions, particularly for vulnerable populations affected by IDA.
Journal Article
Alternative Antibiotics in Dentistry: Antimicrobial Peptides
2022
The rise of antibiotic resistant bacteria due to overuse and misuse of antibiotics in medicine and dentistry is a growing concern. New approaches are needed to combat antibiotic resistant (AR) bacterial infections. There are a number of methods available and in development to address AR infections. Dentists conventionally use chemicals such as chlorohexidine and calcium hydroxide to kill oral bacteria, with many groups recently developing more biocompatible antimicrobial peptides (AMPs) for use in the oral cavity. AMPs are promising candidates in the treatment of (oral) infections. Also known as host defense peptides, AMPs have been isolated from animals across all kingdoms of life and play an integral role in the innate immunity of both prokaryotic and eukaryotic organisms by responding to pathogens. Despite progress over the last four decades, there are only a few AMPs approved for clinical use. This review summarizes an Introduction to Oral Microbiome and Oral Infections, Traditional Antibiotics and Alternatives & Antimicrobial Peptides. There is a focus on cationic AMP characteristics and mechanisms of actions, and an overview of animal-derived natural and synthetic AMPs, as well as observed microbial resistance.
Journal Article
Design and Initial Evaluation of a Novel Oral Hygiene Technology for a Special Needs Population: A New Way to Clean
2023
9.4 million People have swallowing problems in the US. In special needs populations, routine oral hygiene procedures such as tooth brushing can result in aspiration of microbial laden fluids leading to a significant systemic challenge. Aspiration may lead to pneumonia in susceptible populations. These circumstances indicate the need for innovative approaches to oral hygiene for special needs, convalescent, the elderly populations, and young children learning to brush who can ingest excess fluoride which causes mottled enamel. Methods include describing some of the design considerations of the new prototype fabrication and microbiological evaluation of this new device, as well a comparison study of the versions 2 and 3 of the oral care device. Results concluded that version 3.0 regarding patient ease of use was better in comparison to version 2, which was the major difference, and 90% in both groups said they would recommend the new toothbrush. In the microbiological evaluation no growth was seen on any plates containing samples from either the experimental or the control after 48 h of incubation.
Journal Article
Differential Effects of Antiseptic Mouth Rinses on SARS-CoV-2 Infectivity In Vitro
2021
Severe acute respiratory syndrome-related coronavirus (SARS-CoV-2) is detectable in saliva from asymptomatic individuals, suggesting a potential benefit from the use of mouth rinses to suppress viral load and reduce virus spread. Published studies on the reduction of SARS-CoV-2-induced cytotoxic effects by mouth rinses do not exclude antiseptic mouth rinse-associated cytotoxicity. Here, we determined the effect of commercially available mouth rinses and antiseptic povidone-iodine on the infectivity of replication-competent SARS-CoV-2 viruses and of pseudotyped SARS-CoV-2 viruses. We first determined the effect of mouth rinses on cell viability to ensure that antiviral activity was not a consequence of mouth rinse-induced cytotoxicity. Colgate Peroxyl (hydrogen peroxide) exhibited the most cytotoxicity, followed by povidone-iodine, chlorhexidine gluconate (CHG), and Listerine (essential oils and alcohol). The potent antiviral activities of Colgate Peroxyl mouth rinse and povidone-iodine were the consequence of rinse-mediated cellular damage when the products were present during infection. The potency of CHG was greater when the product was not washed off after virus attachment, suggesting that the prolonged effect of mouth rinses on cells impacts the antiviral outcome. To minimalize mouth rinse-associated cytotoxicity, mouth rinse was largely removed from treated viruses by centrifugation prior to infection of cells. A 5% (v/v) dilution of Colgate Peroxyl or povidone-iodine completely blocked viral infectivity. A similar 5% (v/v) dilution of Listerine or CHG had a moderate suppressive effect on the virus, but a 50% (v/v) dilution of Listerine or CHG blocked viral infectivity completely. Mouth rinses inactivated the virus without prolonged incubation. The new infectivity assay, with limited impacts of mouth rinse-associated cytotoxicity, showed the differential effects of mouth rinses on SARS-CoV-2 infection. Our results indicate that mouth rinses can significantly reduce virus infectivity, suggesting a potential benefit for reducing SARS-CoV-2 spread.
Journal Article
Macrophage Inflammatory Protein-1α Shows Predictive Value as a Risk Marker for Subjects and Sites Vulnerable to Bone Loss in a Longitudinal Model of Aggressive Periodontitis
2014
Improved diagnostics remains a fundamental goal of biomedical research. This study was designed to assess cytokine biomarkers that could predict bone loss (BL) in localized aggressive periodontitis. 2,058 adolescents were screened. Two groups of 50 periodontally healthy adolescents were enrolled in the longitudinal study. One group had Aggregatibacter actinomycetemcomitans (Aa), the putative pathogen, while the matched cohort did not. Cytokine levels were assessed in saliva and gingival crevicular fluid (GCF). Participants were sampled, examined, and radiographed every 6 months for 2-3 years. Disease was defined as radiographic evidence of BL. Saliva and GCF was collected at each visit, frozen, and then tested retrospectively after detection of BL. Sixteen subjects with Aa developed BL. Saliva from Aa-positive and Aa-negative healthy subjects was compared to subjects who developed BL. GCF was collected from 16 subjects with BL and from another 38 subjects who remained healthy. GCF from BL sites in the 16 subjects was compared to healthy sites in these same subjects and to healthy sites in subjects who remained healthy. Results showed that cytokines in saliva associated with acute inflammation were elevated in subjects who developed BL (i.e., MIP-1α MIP-1β IL-α, IL-1β and IL-8; p<0.01). MIP-1α was elevated 13-fold, 6 months prior to BL. When MIP-1α levels were set at 40 pg/ml, 98% of healthy sites were below that level (Specificity); whereas, 93% of sites with BL were higher (Sensitivity), with comparable Predictive Values of 98%; p<0.0001; 95% C.I. = 42.5-52.7). MIP-1α consistently showed elevated levels as a biomarker for BL in both saliva and GCF, 6 months prior to BL. MIP-1α continues to demonstrate its strong candidacy as a diagnostic biomarker for both subject and site vulnerability to BL.
Journal Article
How to Peer Review a Hypothesis - Without Killing It
2010
Dental hypothesis exists to provide the dental community with a forum for free thought and the expression of non-mainstream ideas. It is hoped that the thought provoking ideas expressed in this open access journal will lead to progress in both the scientific and clinical arenas. At first glance the idea of peer reviewing free thought may appear to be impossible. The reviewers and editorial team of Dental hypothesis can reconcile these goals by evaluating contributions for originality, plausibility, importance and clarity of expression. Although a hypothesis may reflect an author's point of view, valuable hypotheses reflect a balanced review of the literature and a reasonable grasp of the complexity of dental issues. Expert reviews are encouraged to challenge authors with alternative points of view while being respectful of the journal's mission to present ideas that many challenge existing paradigms.
Journal Article
The use of anti-inflammatory drugs to prevent bleaching-induced tooth sensitivity is ineffective and unnecessary
2020
Data sources The authors searched Medline via PubMed, Scopus, Web of Science, the Cochrane Library and ClinicalTrials.gov for published and unpublished clinical trials. Only randomised clinical trials, with either a parallel or crossover design, reporting the tooth sensitivity of participants undergoing in-office dental bleaching and comparing pain frequency and severity with oral premedication of a non-steroidal or other anti-inflammatory drug compared with a placebo were used in the review. Studies that evaluated the topical administration of drugs or desensitising agents were not reviewed.Study selection In total,5,050 randomised clinical studies were screened and 11 studies were included in the various meta-analyses. Nine studies examined the effect of pre-emptive analgesics on the risk of sensitivity and ten studies evaluated the effect of drugs on the severity of sensitivity; seven of these studies were assessed as having a low risk of bias.Data extraction and synthesis This systematic review and meta-analysis was conducted a priori and registered at the International Prospective Register of Systematic Reviews. There were two reviewers who extracted data from the study tables and independently performed quality assessments of the selected trials using the Office of Health Assessment and Translation risk of bias rating tool for human and animal studies. Risk ratios were calculated for the dichotomous sensitivity risk data and mean difference for measures of sensitivity intensity.Results The authors found no effect of the drugs on the risk of sensitivity. Using a visual analogue scale, the authors identified a small but clinically insignificant reduction in the level of sensitivity in the drug-treated group evaluated up to one hour after bleaching. This was not observed when a numerical rating scale was used to measure pain intensity. For the 24-hour pain data, the authors did not find any significant intensity difference between groups. Mean pain intensity scores were generally low in both experimental groups in all randomised controlled trials reviewed. Based on a visual inspection of the funnel plots of all outcomes, the authors concluded that there was no publication bias.Conclusions The data did not support the pre-emptive use of anti-inflammatory drugs in preventing or reducing the intensity of pain caused by in-office tooth bleaching.
Journal Article
Breaking the Chain of Early Childhood Caries Transmission
Dental disease can have devastating effects on children who lack access to dental care. The US was shocked to learn of the recent death of a child from a caries related infection. The biological basis of dental caries risk is usually considered interims of individual behavior. The role of the family and other more complex units of social organization in determining caries risk are not often appreciated. The transmission of caries causing bacteria from mothers (or other care givers having extensive contact with the child) has been well documented. In addition the age at which children are vulnerable to colonization with caries causing organisms is known. Despite the fact that the dental and scientific communities possess knowledge concerning the routs of caries transmission, efforts to implement preventive programs specifically targeting the reduction of caries transmission have been inconsistent. Working with and motivating families to prevent caries transmission should be the shared objective of researchers and clinicians. Armed with the available knowledge, caries should not the thought of as an inevitable part of life. The goal of this essay is to challenge readers to empower people at risk to make decisions that enable them to break the chain of caries infection.
Journal Article
Macrophage Inflammatory Protein-1alpha Shows Predictive Value as a Risk Marker for Subjects and Sites Vulnerable to Bone Loss in a Longitudinal Model of Aggressive Periodontitis
2014
Improved diagnostics remains a fundamental goal of biomedical research. This study was designed to assess cytokine biomarkers that could predict bone loss (BL) in localized aggressive periodontitis. 2,058 adolescents were screened. Two groups of 50 periodontally healthy adolescents were enrolled in the longitudinal study. One group had Aggregatibacter actinomycetemcomitans (Aa), the putative pathogen, while the matched cohort did not. Cytokine levels were assessed in saliva and gingival crevicular fluid (GCF). Participants were sampled, examined, and radiographed every 6 months for 2-3 years. Disease was defined as radiographic evidence of BL. Saliva and GCF was collected at each visit, frozen, and then tested retrospectively after detection of BL. Sixteen subjects with Aa developed BL. Saliva from Aa-positive and Aa-negative healthy subjects was compared to subjects who developed BL. GCF was collected from 16 subjects with BL and from another 38 subjects who remained healthy. GCF from BL sites in the 16 subjects was compared to healthy sites in these same subjects and to healthy sites in subjects who remained healthy. Results showed that cytokines in saliva associated with acute inflammation were elevated in subjects who developed BL (i.e., MIP-1[alpha] MIP-1[beta] IL-[alpha], IL-1[beta] and IL-8; p<0.01). MIP-1[alpha] was elevated 13-fold, 6 months prior to BL. When MIP-1[alpha] levels were set at 40 pg/ml, 98% of healthy sites were below that level (Specificity); whereas, 93% of sites with BL were higher (Sensitivity), with comparable Predictive Values of 98%; p<0.0001; 95% C.I. = 42.5-52.7). MIP-1[alpha] consistently showed elevated levels as a biomarker for BL in both saliva and GCF, 6 months prior to BL. MIP-1[alpha] continues to demonstrate its strong candidacy as a diagnostic biomarker for both subject and site vulnerability to BL.
Journal Article