Hsin-Chia Hung

Periodontal Disease, Tooth Loss, and Incidence of Ischemic Stroke

Background and Purpose— Periodontal and other infections have been suggested as potential risk factors for stroke. This study evaluates periodontal disease and tooth loss as risk factors for ischemic stroke. Methods— The study population consisted of 41 380 men who were free of cardiovascular disease and diabetes at baseline. Periodontal disease history was assessed by mailed validated questionnaires. During 12 years of follow-up, stroke incidence was assessed and subclassified by use of medical history, medical records, and imaging reports. Hazard ratios (HRs) were adjusted for age, amount smoked, obesity, alcohol, exercise, family history of cardiovascular disease, multivitamin use, vitamin E use, profession, baseline reported hypertension, and hypercholesterolemia. Sex and socioeconomic status were inherently controlled for by restriction. Confounding variables were updated in the analyses for each 2-year follow-up interval. Results— We documented 349 ischemic stroke cases during the follow-up period. Men who had ≤24 teeth at baseline were at a higher risk of stroke compared to men with ≥25 teeth (HR=1.57; 95% CI, 1.24 to 1.98). There was little evidence of an increased risk with recent tooth loss during follow-up. A modest association was seen between baseline periodontal disease history and ischemic stroke (HR=1.33; 95% CI, 1.03 to 1.70). Addition of dietary factors to the model changed the HR only slightly. Conclusions— Our results suggest that periodontal disease and fewer teeth may be associated with increased risk of ischemic stroke.

NUTRITION AS A MEDIATOR IN THE RELATION BETWEEN ORAL AND SYSTEMIC DISEASE: ASSOCIATIONS BETWEEN SPECIFIC MEASURES OF ADULT ORAL HEALTH AND NUTRITION OUTCOMES

Recent associations between oral health and systemic disease have led to renewed interest in the mouth and its contribution to health outcomes. Many pathways for this relationship have been postulated, among them the potential mediating role of nutrition. The link between various nutrients and systemic disease has been established, but relatively little work has been done in relating oral conditions with nutrition. We searched MEDLINE, from 1966 to July, 2001, to identify articles relating specific oral measures to nutrition outcomes. We included original articles written in English with a sample size greater than 30 that used objective oral health measures. We reviewed a total of 56 articles. Only a small proportion of these studies were methodologically sound. Although many studies were small and cross-sectional, the literature suggests that tooth loss affects dietary quality and nutrient intake in a manner that may increase the risk for several systemic diseases. The impact of tooth loss on diet may be only partially compensated for by prostheses. To date, there is little information relating periodontal disease and oral pain and nutrition. A few studies suggest poorer nutrition among individuals with xerostomia and altered taste. Further, impaired dentition may contribute to weight change, depending on age and other population characteristics. There is a paucity of well-designed studies addressing oral health and nutrition. Before we can acquire a better understanding of how nutrition and oral health interrelate, however, more studies will be required to confirm these associations-preferably longitudinal studies with larger sample sizes and better control of important confounders.

Histone deacetylase 2 expression predicts poorer prognosis in oral cancer patients

Histone deacetylase 2 (HDAC2) has been implicated in the development and progression of several human tumors. We immunohistochemically examined the expression of HDAC2 protein in 20 cases of oral epithelial dysplasia (OED) and 93 cases of oral squamous cell carcinoma (OSCC). Positive HDAC2 nuclear staining was observed in 80 of the 93 (86.02%) cases of SCC and 11 of the 20 (55%) cases of ED. The labeling index (LI) for HDAC2 nuclear staining increased significantly from ED (25.8+/-26.5%) to SCCs (59.8+/-28.5%) (p<0.001). No significant correlation was found between the HDAC2 expression level and patients age, sex, oral habits in oral SCC patients. However, cancer with advanced stage, larger tumor size, or positive lymph node metastasis had higher level of HDAC2 protein expression. Kaplan-Meier curves showed oral SCC patients with high HDAC2 expression (LI>50%), advanced stage, larger tumor size, or positive lymph node metastasis had significantly shorter overall survival (p=0.0158, 0.0267, 0.0029 and 0.02514, respectively by log-rank test) than others. The results of this study show for the first time that overexpression of the HDAC protein is a frequent event in oral cancer and could be used as a prognostic factor in oral SCC.

Stability of miniplates and miniscrews used for orthodontic anchorage: experience with 492 temporary anchorage devices

OBJECTIVES The aim of this retrospective study was to evaluate systematically the potential factors that influence failure rates of temporary anchorage devices (TADs) used for orthodontic anchorage. MATERIALS AND METHODS Data on 492 TADs (miniplates, pre-drilling miniscrews, and self-drilling miniscrews) in 194 patients were collected. The factors related to TAD failure were evaluated using univariate analysis and multivariate forward stepwise logistic regression analysis. RESULTS There were no significant differences in failure rates among the TADs for the following variables: gender, type of malocclusion, facial divergency, implantation site (buccal, lingual, or crestal/midpalatal), location (anterior or posterior), method of force application (power chain or Ni-Ti coil spring), arch (upper or lower), type of soft tissue (attached gingiva or removable mucosa), and most of the cephalometric measurements that reflect dento-cranio-facial characteristics. An increased failure rate was noted for the self-drilling miniscrew type of TAD, TADs used for tooth uprighting, those inserted on bone with lower density, those associated with local inflammation of the surrounding soft tissue, those loaded within 3 weeks after insertion, and those placed in patients with greater mandibular retrusion. Failure rates of the self-drilling miniscrews installed by an oral surgeon and by an orthodontist did not differ significantly. CONCLUSIONS Inflammation of soft tissue surrounding a TAD and early loading within 3 weeks after insertion were the most significant factors predicting TAD failure. Both orthodontists and oral surgeons who install orthodontic TADs must undergo sufficient training to achieve clinical excellence.

The Association Between Fruit and Vegetable Consumption and Peripheral Arterial Disease

Background: High fruit and vegetable consumption has been associated with a lower risk of cardiovascular diseases, but few studies have focused on peripheral arterial disease. In this study, we evaluated the association of consumption of fruits and vegetables with peripheral arterial disease. Methods: In a cohort of 44,059 men initially free of cardiovascular disease and diabetes, we documented 295 cases of peripheral arterial disease during a 12-year follow-up. Fruit and vegetable consumption was assessed by food frequency questionnaire. Results: In the age-adjusted model, men in the highest quintile had a relative risk of 0.55 (95% confidence interval = 0.38–0.80) for overall fruit and vegetable intake, 0.52 (0.36–0.77) for fruit intake, and 0.54 (0.36–0.81) for vegetable intake, compared with those in the lowest quintile of intake. However, the associations were greatly weakened after adjustment for smoking and other traditional cardiovascular disease risk factors. Comparing men in the highest quintile versus the lowest quintile, relative risks and 95% confidence intervals were 0.95 (0.62–1.44) for overall fruit and vegetable intake, 0.97 (0.64–1.48) for fruit intake, and 0.76 (0.50–1.17) for vegetable intake. Conclusions: We did not find evidence that fruit and vegetable consumption protects against peripheral arterial disease, although a modest benefit cannot be excluded.

Expression of Cyr61 (CCN1) in human oral squamous cell carcinoma: An independent marker for poor prognosis.

Cysteine‐rich 61 (Cyr61 [CCN1]) has disparate functions in tumorigenesis that are dependent on the cell types. The aim of the study was to investigate its role in the growth of oral squamous cell carcinoma (SCC).