Marcia M. Ditmyer

Analysis of oral cancer epidemiology in the US reveals state-specific trends: implications for oral cancer prevention

BackgroundDownward trends have been observed in oral cancer incidence and mortality in the US over the past 30 years; however, these declines are not uniform within this population. Several studies have now demonstrated an increase in the incidence and mortality from oral cancers among certain demographic groups, which may have resulted from increased risks or risk behaviors. This study examines the underlying data that comprise these trends, to identify specific populations that may be at greater risk for morbidity and mortality from oral cancers.MethodsOral cancer incidence and mortality data analyzed for this study were generated using the National Cancer Institutes Surveillance, Epidemiology and End Results (SEER) program.ResultsWhile oral cancer incidence and mortality rates have been declining over the past thirty years, these declines have reversed in the past five years among some demographic groups, including black females and white males. Sorting of these data by state revealed that eight states exhibited increasing rates of oral cancer deaths, Nevada, North Carolina, Iowa, Ohio, Maine, Idaho, North Dakota, and Wyoming, in stark contrast to the national downward trend. Furthermore, a detailed analysis of data from these states revealed increasing rates of oral cancer among older white males, also contrary to the overall trends observed at the national level.ConclusionThese results signify that, despite the declining long-term trends in oral cancer incidence and mortality nationally, localized geographic areas exist where the incidence and mortality from oral cancers have been increasing. These areas represent sites where public health education and prevention efforts may be focused to target these specific populations in an effort to improve health outcomes and reduce disparities within these populations.

A case-control study of determinants for high and low dental caries prevalence in Nevada youth

BackgroundThe main purpose of this study was to compare the 30% of Nevada Youth who presented with the highest Decayed Missing and Filled Teeth (DMFT) index to a cohort who were caries free and to national NHANES data. Secondly, to explore the factors associated with higher caries prevalence in those with the highest DMFT scores compared to the caries-free group.MethodsOver 4000 adolescents between ages 12 and 19 (Case Group: N = 2124; Control Group: N = 2045) received oral health screenings conducted in public/private middle and high schools in Nevada in 2008/2009 academic year. Caries prevalence was computed (Untreated decay scores [D-Score] and DMFT scores) for the 30% of Nevada Youth who presented with the highest DMFT score (case group) and compared to the control group (caries-free) and to national averages. Bivariate and multivariate logistic regression was used to analyze the relationship between selected variables and caries prevalence.ResultsA majority of the sample was non-Hispanic (62%), non-smokers (80%), and had dental insurance (70%). With the exception of gender, significant differences in mean D-scores were found in seven of the eight variables. All variables produced significant differences between the case and control groups in mean DMFT Scores. With the exception of smoking status, there were significant differences in seven of the eight variables in the bivariate logistic regression. All of the independent variables remained in the multivariate logistic regression model contributing significantly to over 40% of the variation in the increased DMFT status. The strongest predictors for the high DMFT status were racial background, age, fluoridated community, and applied sealants respectively. Gender, second hand smoke, insurance status, and tobacco use were significant, but to a lesser extent.ConclusionsFindings from this study will aid in creating educational programs and other primary and secondary interventions to help promote oral health for Nevada youth, especially focusing on the subgroup that presents with the highest mean DMFT scores.

Lipopolysaccharide and platelet-activating factor stimulate expression of platelet-activating factor acetylhydrolase via distinct signaling pathways

ObjectivesThis study was designed to investigate and characterize the ability of platelet-activating factor (PAF) to induce the expression of platelet-activating factor acetylhydrolase (PAF-AH).MethodsRibonuclease protection assays and quantitative real-time PCR were used to investigate the ability of lipopolysaccharide (LPS) and PAF to regulate PAF-AH mRNA expression in human monocyte–macrophage 6 (MM6) cells. Pharmacological inhibitors of mitogen activated protein kinases (MAPK) and PAF receptor antagonists were used to investigate the mechanism of regulation of PAF-AH.ResultsPAF-AH mRNA levels were increased upon exposure to LPS or PAF in a dose-dependent manner. LPS elicited a more potent and rapid increase in PAF-AH expression than the PAF-stimulated response. However, when administered concomitantly, PAF augmented the LPS-stimulated response. LPS-stimulated PAF-AH expression was susceptible to partial inhibition by a p38 MAPK inhibitor and PAF receptor antagonists. PAF-induced up-regulation of PAF-AH levels was solely mediated via the PAF receptor and was p38 MAPK-independent.ConclusionThe proinflammatory mediators, LPS and PAF, increased levels of PAF-AH mRNA via distinct signaling pathways.

The effect of tobacco and marijuana use on dental health status in Nevada adolescents: a trend analysis.

PURPOSE Tobacco use is the leading cause of preventable death worldwide. If current trends persist, tobacco will kill more than 8 million people worldwide by 2030 and 1 billion by the end of the century. The purpose of this study was to determine trends in tobacco/marijuana use in Nevada adolescents and their effect on dental health status. Relative comparative data were compared with nationally reported data. METHODS Retrospective data in this cohort study was from an ongoing statewide, school-based, dental health screening initiative that was conducted across 8 years (2002-2010) in public/private middle/high schools in Nevada. A total of 66,941 dental health screenings of adolescents between ages 13-18 were conducted. Self-reported data were collected on tobacco/marijuana use. Descriptive statistics and trends were reported. Means (SE) were computed for caries prevalence and severity. Effect size was reported on dental caries and use of tobacco/marijuana. RESULTS Overall, percentage prevalence of tobacco use was approximately the same as the national average; however, there were significantly higher rates of marijuana use (12.0% vs. 3.3%). Prevalence and severity of dental caries was significantly higher in those who used tobacco/marijuana than those who did not across all variables and across all 8 years controlling for gender, race/ethnicity, where they lived, and exposure to secondhand smoke. CONCLUSIONS Tobacco use negatively affected dental health status with marijuana having the largest negative effect. The findings from this study identified the need for tobacco/marijuana prevention services targeting adolescents residing in the geographic areas most at risk.

Interprofessional faculty development: integration of oral health into the geriatric diabetes curriculum, from theory to practice.

Background Health care workforce shortages and an increase demand for health care services by an older demographic challenged by oral–systemic conditions are being recognized across health care systems. Demands are placed on health care professionals to render coordinated delivery of services. Management of oral–systemic conditions requires a trained health care workforce to render interprofessional patient-centered and coordinated delivery of health care services. The purpose of this investigation was to evaluate the effectiveness of an interprofessional health care faculty training program. Methods A statewide comprehensive type 2 diabetes training program was developed and offered to multidisciplinary health care faculty using innovative educational methods. Video-recorded clinically simulated patient encounters concentrated on the oral–systemic interactions between type 2 diabetes and comorbidities. Post-encounter instructors facilitated debriefing focused on preconceptions, self-assessment, and peer discussions, to develop a joint interprofessional care plan. Furthermore, the health care faculty explored nonhierarchical opportunities to bridge common health care themes and concepts, as well as opportunities to translate information into classroom instruction and patient care. Results Thirty-six health care faculty from six disciplines completed the pre-research and post-research assessment survey to evaluate attitudes, knowledge, and perceptions following the interprofessional health care faculty training program. Post-training interprofessional team building knowledge improved significantly. The health care faculty post-training attitude scores improved significantly, with heightened awareness of the unique oral–systemic care needs of older adults with type 2 diabetes, supporting an interprofessional team approach to care management. In addition, the health care faculty viewed communication across disciplines as being essential and interprofessional training as being vital to the core curriculum of each discipline. Significant improvement occurred in the perception survey items for team accountability and use of uniform terminology to bridge communication gaps. Conclusion Attitude, knowledge, and perceptions of health care faculty regarding interprofessional team building and the team approach to management of the oral–systemic manifestations of chronic disease in older adults was improved. Uniform language to promote communication across health professionals, care settings, and caregivers/patients, was noted. Interprofessional team building/care planning should be integrated in core curricula.

Distance from source and fluoride concentrations in municipal water supply.

AIM The purpose of this study was to evaluate the concentrations of fluoride in community water at the point of source, compared to the concentration delivered to various locations within the Las Vegas Valley, to determine if the levels of fluoride change over distance. METHODS Ten samples per week over an 8-week period were taken from four locations, totaling 320 samples. The first location included the water treatment facility where fluoride is added to the municipal water to bring the concentrations to the desired amount. The other locations included three residences at an increasing distance from the source of fluoridation. The 320 samples were submitted for fluoride analysis. Repeated-measure anova was used to compare the means between the four data points. RESULTS The fluoride concentration data for the four test locations ranged from 0.73 to 0.89 mg/L. Mauchlys test of sphericity revealed no significant difference in the fluoride concentrations in Las Vegas from the point of source to distant locations. CONCLUSIONS The analysis of the collected data revealed that there was no statistical difference in the fluoride concentration in the Las Vegas municipal water supply from the source to the remote locations, and that distance does not affect fluoride concentration in the Las Vegas Valley municipal water supply.

Southern Nevada assisted living residents' perception of their oral health status and access to dental care.

OBJECTIVE Oral health is an integral component of general health, and quality of life. The purpose of this study was to determine the perceptions of oral health status and acces\s to dental care by Southern Nevada Assisted Living Facilities Residents. METHODS A cross-sectional questionnaire study design was used to survey residents between 34 and 99 years old residing in Assisted Living Facilities. Seventy respondents (42 males and 28 females) completed a survey that included personal oral hygiene, access to care, and demographic information. Data analyses included descriptive statistics and chi-square. RESULTS Mean age was 75.78 years, and the majority had a college education (n = 41). Four currently smoked cigarettes. Twenty-nine (males = 14; females = 15) reported having dental insurance. Eleven respondents had seen a dentist twice a year, while 33 reported a visit less than 6 months. Forty-one reported the facility did not provide oral health care with majority (n = 64) indicating that accessing oral health care was difficult. Self-rated response to oral hygiene, a majority (n = 64) reported their oral hygiene as fair and five reported their oral hygiene as poor. CONCLUSIONS Assisted living residents in Southern Nevada reported difficulty accessing dental services within and outside of the facility. Oral care models to address this unique population should be explored.

Preventable Emergency Department Visits for Nontraumatic Dental Conditions: Trends and Disparities in Nevada, 2009–2015

Objectives To examine trends and socioeconomic disparities for preventable dental-related emergency department (ED) visits in Nevada. Methods We pooled retrospective data containing 66 267 ED visits involving dental conditions from Nevada hospital ED databases from 2009 to 2015. The dependent variable was nontraumatic dental conditions identified by International Classification of Diseases, Ninth Revision, codes; 3 independent variables included treatment year, health insurance status, and race/ethnicity. Results Odds of ED visits for nontraumatic dental conditions increased 16% annually from 2009 to 2015 (odds ratio [OR] = 1.16; 95% confidence interval [CI] = 1.13, 1.19). Medicaid (OR = 2.16; 95% CI = 1.96, 2.39) and uninsured patients (OR = 2.75; 95% CI = 2.52, 3.00) presenting with nontraumatic dental conditions were 1 to 2 times more likely than those with private dental insurance to seek ED treatment. Black patients were more likely than White patients to seek ED treatment (OR = 1.13; 95% CI = 1.02, 1.24). Conclusions Socioeconomic and demographic factors were significantly associated with ED visits for nontraumatic dental conditions, with a steady increase in trends and a widening of socioeconomic disparities in recent years.

Can Tobacco Cessation Quitlines Improve the Use of Dental Health Care

In this issue of AJPH, McClure et al. (p. 689) describe the use of a stratified semipragmatic trial design to evaluate the effectiveness of the OralHealth4Life (OH4L)program offered in conjunction with a quitline smoking cessation program. The oral health component included oral health messaging, scripted oral health counseling, and online or mailed oral health materials. Messages included benefits of good oral health and recommendations for managing tobacco cravings through use of good oral hygiene behaviors. Participants also received a toothbrush, floss, and sugar-free gum. Referral information to local dental providers was provided. The aims of the study were to determine whether the intervention would increase smoking cessation and, at the same time, increase utilization of professional dental care. Authors report that integrating the OH4L program into the quitline infrastructure was not an effective strategy for increasing the use of professional dental care among callers.