According to a statewide Delta Dental of Virginia survey, 35% of adults still feel hesitant to return to the dentist. Also, more than half of Virginians postponed or missed dental visits as a result of the pandemic last year.

With decreasing mask mandates and the gradual return to normalcy, though, Delta Dental said it is encouraging Virginians to return to the dentist to guard against the potentially painful consequences of neglected preventive care.

“We spent the last year with our smiles covered. Now, as many of us begin to remove our masks, it’s a perfect reminder that we need to take care of those smiles,” said Dr. Brad Guyton, chief dental officer for Delta Dental of Virginia.

“Preventive care is crucial to maintaining physical, mental, and emotional well-being, and putting off a routine visit is doing more harm than good. Dentist offices are safer than ever, and there is really no reason to postpone that visit,” said Guyton.

Conducted on May 26 and May 27, the survey also found that despite lingering COVID-19 concerns, nearly 73% of Virginians do plan to visit the dentist two or more times over the next 12 months, and nearly 94% plan to visit at least once.

Those with dental insurance are more likely to visit the dentist, with 79% of insured Virginians saying they plan to visit the dentist two or more times over the next 12 months, while 57% of those who are uninsured plan to do so. Meanwhile, 17% of the uninsured said they do not plan to visit the dentist at all.

According to Delta Dental’s 2020 State of America’s Oral Health Report, only about one in two Americans understand that oral health is closely linked to several medical conditions, including strokes, diabetes, dementia, and high blood pressure. The report also notes that:

• The average number of cavities per child increased from one to two.
• Children missed 4.5 days of school due to oral health issues in the past 12 months.
• 77% of parents worry that oral health issues will have a negative impact on their child’s confidence.
• 51% of adults faced unwanted consequences as a result of oral health issues, including lost sleep and missed work.
• 26% said that not having dental insurance was the reason they failed to visit the dentist in 2020.

Most dental plans cover regular checkups at 100%, Guyton said, so there is really no reason for people with insurance to skip those visits. Meanwhile, 77% of Virginians feel that having dental insurance is a good motivation to maintain positive oral health.

“For many Virginians, employer-sponsored dental benefits may not be an option,” said Guyton. “Carriers, such as Delta Dental and others, offer individual plans at various price points, and the uninsured should certainly check out the federal health benefits exchange for other options.”

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Nearly 70% of Americans who sleep with a bed partner report that their partner snores while sleeping, according to a 2021 survey by the American Academy of Sleep Medicine (AASM), which notes that snoring may be an indicator of obstructive sleep apnea (OSA).

“While not everyone who snores has sleep apnea, snoring is a warning sign that should be taken seriously,” said AASM president Dr. Kannan Ramar.

“If your bed partner snores, or if you’ve been told that you snore, then it is important to talk to a medical provider about screening or testing for sleep apnea. Treatment for obstructive sleep apnea can improve overall health and quality of life,” Ramar said.

Nearly 30 million adults in the United States have OSA, the AASM said, and about 23.5 million of those cases are undiagnosed.

According to the survey, 26% of Americans weren’t familiar with OSA at all, and 48% acknowledged that they don’t know its symptoms, which include:

• Snoring: Snoring between apneas is typically noticed by a bed partner.
• Choking or gasping during sleep: When snoring is paired with choking, gasping, or silent breathing pauses during sleep, it’s a reliable indicator of sleep apnea.
• Fatigue or daytime sleepiness: Excessive daytime sleepiness often occurs because sleep apnea causes numerous arousals throughout the night, preventing the body from getting the high-quality sleep it needs.
• Obesity: An adult with a body mass index of 30 higher is considered obese, and the risk of sleep apnea increases with the amount of excess body weight.
• High blood pressure: Between 30% and 40% of adults with high blood pressure also have sleep apnea.

Other common symptoms of OSA include unrefreshing sleep, insomnia, morning headaches, nocturia, difficulty concentrating, memory loss, decreased sexual desire, irritability, or difficulty staying awake while watching TV or driving.

“Delaying treatment for sleep apnea can lead to more serious health problems,” said Ramar. “Fortunately, many of the damaging effects of sleep apnea can be stopped, and even reversed, through diagnosis and treatment by the sleep team at an accredited sleep center, where patients receive care in safe and comfortable accommodations.”

Sleep apnea typically is treated with continuous positive airway pressure as well as oral appliance therapy, positional therapy, and surgery. Treatment can improve quality of life by improving sleep quality; boosting daytime alertness, concentration, and mood; decreasing medical expenses; and improving brain and heart health.

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Dental sleep medicine appears in many guises for the treatment of sleep-disordered breathing, including obstructive sleep apnea (OSA).

These treatment protocols include mandibular advancement devices, palatal expansion appliances, surgical approaches such as maxillo-mandibular advancement, and oral myofunctional therapy as alternatives to other non-dental methods, such as continuous positive airway pressure (CPAP).

By treating upper airway, breathing, and sleep issues using innovative new dental sleep medicine therapies, the dental profession can vastly improve patients’ overall health, both directly and indirectly.

During sleep, control of upper airway patency is crucial in preventing the upper airway’s collapse since intermittent hypoxia associated with OSA increases sympathetic activity and may cause systemic inflammation.

In fact, OSA is a major predisposing factor for several systemic diseases, such as hypertension, stroke, dementia, behavioral issues, metabolic dysfunction, obesity, diabetes, systemic inflammation, and erectile dysfunction.¹

Perhaps surprisingly, dental professionals may provide initial screenings for OSA because snoring, excessive daytime sleepiness, and other oral signs and symptoms such as TMJ issues, oral tori, and bruxism are associated with OSA.

In these cases, dental professionals can guide patients to seek a definitive diagnosis prior to any treatment to improve overall health. Dentists, therefore, have an important role in screening, detecting, and preventing systemic diseases such as OSA.

Hypertension

Hypertension is a major health problem in many developed countries, including the United States. To prevent cardiovascular diseases, atherosclerosis, coronary artery disease, strokes, renal failure, and possible blindness, dentists can address untreated hypertension by prescribing oral devices that have been demonstrated to be effective in treating OSA.²

In one study, oral appliance therapy for OSA was shown to be successful in patients with a history of hypertension and cardiovascular disease.³ Another study showed that a reduction in the apnea-hypopnea index and blood pressure was achieved in patients with mild to moderate OSA after oral appliance therapy, improving both their cardiovascular condition and cognitive capability.⁴

Therefore, while dentists routinely take blood pressure readings on many patients, they may also help to treat these types of conditions, albeit indirectly, through the provision of oral appliance therapies for OSA.

Obesity

Regular patient visits to the dental office provide an opportunity for dental professionals to screen for pediatric and adult obesity, which is an epidemic in the United States and elsewhere. In fact, it is well known that both obesity and diabetes are associated with OSA.

General dentists can play a role in raising awareness of the risks associated with being overweight in adults, as well as lifestyle behaviors that increase obesity risk in children.⁵ Specifically, it is known that an unhealthy diet that includes high-fructose corn syrup raises the risk of both childhood obesity and adults being overweight.

In turn, obesity is associated with cardiovascular pathologies, increased cancer risk, and other systemic conditions, such as diabetes. Obesity also has modifying effects on agents used for conscious sedation in certain dental procedures. A dentist can therefore take an interdisciplinary approach to both obesity and diabetes prevention because of the relationships between obesity and breathing.⁶

Diabetes

The association between obesity and diabetes is well described in the medical literature, and dentists must screen for it.

Diabetes is reaching epidemic proportions in the United States. Dentists also are aware that some inflammatory responses in periodontitis can lead to hyperglycemia, which can contribute to the development of pre-diabetes, Type 2 diabetes, and gestational diabetes.

In addition, because periodontitis and diabetes share the same risk factors, periodontal treatment regulates pre-diabetes and Type 2 diabetes in individuals by improving glycemic control.⁷

Dentists can identify and reduce risk factors by advising their patients to quit smoking tobacco, decrease their sugar intake, and get sufficient quality sleep in an effort to improve their overall health.

The relationship between diabetes and OSA is becoming much more apparent, and dentists can address mild to moderate OSA by prescribing oral appliance therapy.

Sleep

Inadequate sleep suppresses immunity and promotes inflammation. In one study, children with shorter sleep duration had higher salivary glucose levels, and both of these parameters are associated with increased gingival inflammation.⁸ Pediatric OSA is associated with behavioral and learning difficulties, nocturnal enuresis,⁹ and possibly growth delay.

On the other hand, studies have shown that pediatric nocturnal enuresis can be corrected using palatal expansion, which improves the quality of life for these children as they develop. Pediatric OSA also overlaps with attention deficit hyperactivity disorder (ADHD). These children often exhibit palatal narrowing, snoring, and sleep fragmentation.¹⁰ Therefore, palatal expansion may also be useful in children with ADHD and other behavioral issues.

In adults, neurocognitive decline and dementia are associated with both aging and impaired sleep. There may also be an association between periodontal disease and OSA since systemic inflammation and oxidative stress are associated with shorter sleep duration, which is a predisposing factor for periodontitis. Furthermore, OSA is thought to increase the risk of burning mouth syndrome, and dental therapies that address OSA directly with dental sleep medicine protocols might be warranted.

Oral, Systemic, and Cognitive Health

In the absence of quality sleep, dental patients can exhibit a wide range of oral, systemic, and cognitive health problems. Treatment with CPAP has been shown to improve levels of inflammatory markers, such as CRP and TNF-α, but adherence with CPAP is known to be poor.

Because of this, dentists are in a unique position to identify and treat mild to moderate OSA. In addition, research findings suggest some oral structures in neonates and children can later lead to OSA in adults.

Oral health professionals are in a position to recognize the vital relationship between sleep and overall health, identify sleep concerns during routine dental health assessments, and utilize sleep questionnaires and assessments to determine referrals for definitive diagnosis prior to treatment.

Thus, collaboration between dental and medical professionals in areas like dental sleep medicine is deeply needed, as well as a greater appreciation of the oral-systemic health link in the wider healthcare community.

References

1. Madani M, Madani F. Epidemiology, pathophysiology, and clinical features of obstructive sleep apnea. Oral Maxillofac Surg Clin North Am. 2009;21(4):369–75. doi:10.1016/j.coms.2009.09.003
2. Bavitz JB. Dental management of patients with hypertension. Dent Clin North Am. 2006;50(4):547–62. doi:10.1016/j.cden.2006.06.003
3. Ishikawa C, Shigeta Y, Ogawa T, et al. Investigation of trends and characteristics in patients with obstructive sleep apnea. J Indian Prosthodont Soc. 2010;10(1):57-63. doi:10.1007/s13191-010-0012-2
4. Gupta A, Tripathi A, Sharma P. The long-term effects of mandibular advancement splint on cardiovascular fitness and psychomotor performance in patients with mild to moderate obstructive sleep apnea: a prospective study. Sleep Breath. 2017;21(3):781–89. doi:10.1007/s11325-017-1534-1
5. Tavares M, Dewundara A, Goodson JM. Obesity prevention and intervention in dental practice. Dent Clin North Am. 2012;56(4):831–46. doi:10.1016/j.cden.2012.07.009
6. Godlewski AE, Veyrune JL, Nicolas E. Obesity and oral health: risk factors of obese patients in dental practice. Odontostomatol Trop. 2008;31(123):25-32. French.
7. Borgnakke WS, Genco RJ, Eke PI, Taylor GW. Oral health and diabetes. In: Cowie CC (ed). Diabetes in America. 3rd ed. Bethesda, MD: National Institute of Diabetes and Digestive and Kidney Diseases (US); 2018.
8. Alqaderi H, Tavares M, Hartman M, Goodson JM. Effect of sleep and salivary glucose on gingivitis in children. J Dent Res. 2016;95(12):1387–93. doi:10.1177/0022034516661509
9. Foltyn P. Ageing, dementia and oral health. Aust Dent J. 2015;60 Suppl 1:86-94. doi:10.1111/adj.12287
10. Al-Jewair TS, Al-Jasser R, Almas K. Periodontitis and obstructive sleep apnea’s bidirectional relationship: a systematic review and meta-analysis. Sleep Breath. 2015;19(4):1111–20. doi:10.1007/s11325-015-1160-8

Dr. Singh is the founder of Vivos Therapeutics and has served as its chief medical officer and director since September 2016. He received a grant from the British Society for Developmental Biology and was appointed to the Board of Examiners of the Royal College of Surgeons of England. In the United States, he led a program of clinical craniofacial research funded by the National Institutes of Health. Currently, he is a board member of the American Sleep and Breathing Academy and member of the World Sleep Society. His research into epigenetic influencers on craniofacial growth and development led to the development of the patented DNA appliance and mRNA appliance technologies. He holds a DDSc in orthodontics, a PhD in craniofacial development, and a DMD in dentistry. He is currently collaborating with Stanford University in the development of a craniofacial facility.

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As more research shows links between oral and systemic health, dentists and physicians are collaborating to improve care.

Awareness

Reputable medical and dental journals feature numerous studies peering into the awareness among dentists of the link between oral and systemic health. After peeling through many of them, there is no doubt that the knowledge is there.

One study in 2019 exploring dentists’ awareness about the link between oral and systemic health addresses common knowledge topics like the “associations between oral disease including periodontal disease and chronic systemic diseases such as diabetes, coronary artery disease, adverse pregnancy outcomes, and rheumatoid arthritis (RA).”¹

Although these topics are becoming common knowledge among medical and dental providers, there is still a need for medical professionals to step in with focused effort to continue updating their knowledge and educate patients about these oral-systemic tie-ins, regularly.

Patient Education

Creating this awareness for patients will no doubt open the door to greater motivation when it comes to home healthcare and seeking professional oral healthcare. Patients are severely limited in their ability to act without knowing that their periodontal health has systemic implications. In fact, it may still surprise some patients to learn that periodontal disease is a great example of an oral manifestation of systemic disease.

With the limiting belief that the mouth is separate from the body, patients are unaware of the impact that their oral health has on their overall quality of life, nor do they know just how “at risk” they might be for things like heart disease and diabetes related to poor oral health.

One of the ways in which medical professionals are collaborating to improve care is by doing the research so that information relayed to patients is evidence-based and consistent, but we have yet to fully integrate patient education into the plan.

Research

Through research, medical professionals have learned that many cross-referenced oral and systemic ailments are related through inflammation. Studies suggest that periodontal disease elicits regulatory molecules via the inflammatory cascade.

As the cascade progresses, these pro-inflammatory mediators as well as oral bacteria and lipopolysaccharides infiltrate other parts of the body, perpetuating the body’s inflammatory response (chronic inflammation) to disease and infection.

One study looked at the relationships between tooth loss, systemic inflammation, and periodontal pathogens in patients with cardiovascular disease and confirmed that periodontal disease could cause or worsen cardiovascular disease. The study suggests that Porphyromonas gingivalis, a known gram-negative, subgingival, and virulent periodontal bacteria “accelerated abdominal aortic aneurysm and arteriosclerosis in mice.”²

The Journal of Family Medicine & Primary Care offers a systematic review of the literature highlighting the fact that periodontal pathogens that protect the body against periodontal disease have been found in both crevicular fluid and in synovial joint fluid in the case of patients with RA, suggesting the role of periodontal bacteria in the etiology of RA.³

One of the most discussed bidirectional relationships is between diabetes and periodontal disease. “The two-way relationship between diabetes and periodontitis has established that diabetes increases the risk for periodontitis, and periodontal inflammation negatively affects glycemic control.”⁴ The good news is that stabilization of periodontal disease results in greater glycemic control on this two-way street.

Being Proactive

As medical professionals continue to dive into conducting research and versing themselves on these common oral and systemic health relationships, the next step is integrating holistic healthcare and the approach to patient education into graduate programs as well as educating patients in the dental office.

At Delta Dental of Arizona, for example, we have awarded grants to specifically tackle the integration of dental and medical care across the state. Among the programs we’ve supported through our Foundation:  

• The El Rio Community Health Center Pediatric Dental Integration Program provides direct screening, varnish treatments, and oral health education by embedding dental hygiene teams in five El Rio locations throughout southern Arizona. Additionally, the dental health outreach team engages in collaborative, community outreach events (some on hold or modified due to COVID-19) to connect with families who may not have a dental health home.
• The North Country Healthcare Medical-Dental Integration Program imbeds basic screening, fluoride applications, and dental education into existing pediatric and obstetric appointments across northern Arizona. The program also provides referral to dental care, as appropriate, with intent to provide dental homes for those who do not have an established relationship.
• The United Community Health Center (UCHC) Dental Program for Kids integrates oral health services and education into 500 low-income children’s medical well visits at UCHC pediatric clinics per year. The program aims to engage low-income and underserved pediatric patients in southern Arizona who receive medical care with dental services and educate patients about the importance of oral health.
• The Tohono O’Odham Nation Health Care Medical-Dental Collaboration Program, which is a medical-dental collaboration with the Tohono O’Odham Tribal Community, integrates a registered dental hygienist (RDH) into all acute and well pediatric medical visits providing dental education, screenings, fluoride applications, caries identification, and silver diamine fluoride (SDF) treatment in the medical clinic.
• The University of Arizona OHPEN (Oral Health Prevention and Education) Wide Program is a full-spectrum family medicine mobile clinic that provides free critical services to vulnerable populations in Tucson and Pima County. As a part of its care to low-income communities, the mobile unit provides dental screenings, fluoride varnish treatments, and oral health education to children and pregnant women.
• The Barrow Cleft and Cranial Facial Center Post-Surgery Education Program distributes jaw surgery kits and hosts a required oral health education workshop prior to surgery. Patients, parents, and all who will be part of the patient’s care are invited to the workshop to understand and prepare for what is to come following surgery. They also learn how each item in the kit needs to be used properly to care for the oral cavity for the critical two weeks following surgery to have a successful outcome.

As a final example, earlier this year Delta Dental of Arizona partnered with Neighborhood Outreach Access to Health (NOAH) and HonorHealth Foundation on Delta Dental of Arizona Dental Connect to support uninsured patients who visit an HonorHealth emergency room for dental issue across Greater-Phoenix.

It is my and Delta Dental of Arizona’s belief that we need to work together and continue innovating programs like these to improve both the smiles and lives of patients. We are all in this together, and there is much more to be done.

References

1. Nazir MA, Izhar F, Akhtar K, Almas K (n.d.). Dentists’ awareness about the link between oral and systemic health. Journal of Family & Community Medicine. doi:https://dx.doi.org/10.4103%2Fjfcm.JFCM_55_19
2. Aoyama N, Suzuki J, Kobayashi N, Hanatani T, Ashigaki N, Yoshida A, et al (2017). Associations among tooth LOSS, systemic inflammation and antibody TITERS To Periodontal pathogens in Japanese patients with cardiovascular disease. Journal of Periodontal Research, 53(1), 117-122. doi:10.1111/jre.12494
3. Arana P, Salazar D, Amaya S, Medina M, Moreno-Correa S, Moreno F, et al (2018). Periodontal microorganisms in synovial fluid of patients with rheumatoid Arthritis. systematic review of the literature – 2017. Revista Colombiana De Reumatología (English Edition), 25(4), 271-286. doi:10.1016/j.rcreue.2018.06.002
4. Lakshmanan R, Mahtani A, Jacob C (2020). Prevalence of diabetes among patients and the assessment of the awareness of the bidirectional relation between diabetes and periodontal disease. Journal of Family Medicine and Primary Care, 9(6), 2774. doi:10.4103/jfmpc.jfmpc_63_2
   

Dr. Schneider is the dental director at Delta Dental of Arizona. She has more than 19 years of experience in dental administration, dental education, and clinical dentistry.

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The American Academy of Oral Medicine (AAOM) has recognized Cesar Migliorati, DDS, MS, PhD, with its Samuel Charles Miller Lecture Award. Migliorati is a professor in the Department of Oral & Maxillofacial Diagnostic Sciences at the University of Florida College of Dentistry (UFCD).

Awarded annually since 1960, the Samuel Charles Miller Lecture Award honors the founder of the AAOM, whose vision was to integrate medicine and dentistry to promote optimal health.

Migliorati served as associate dean for clinical affairs and quality at the college from 2017 until March 2021. He played a crucial role in UFCD’s response to the COVID-19 pandemic, the college said, coordinating efforts with UF Health experts in infection control and epidemiology, ensuring access to personal protective equipment for dental students, providers, and staff, and enacting new infection control protocols.

During his four years as associate dean, Migliorati also made important and lasting contributions to UFCD and broader community, the college said. In addition to a wealth of experience and insights, the college said, he applied a data-driven approach to make meaningful enhancements to patient care, safety, and quality.

Under his leadership and with great support from his team, UFCD continued, the college reorganized its clinical administration to improve workflow and efficiency. Working closely with Luisa Echeto, DDS, MS, and other colleagues, Migliorati implemented a new DMD-patient screening process to standardize patient selection and centralized sterilization processes to enhance quality.

Migliorati’s current research collaborations focus on supportive care in cancer and the oral complications of cancer therapy. He also has a comprehensive clinical background, UFCD said, having worked in clinical dentistry during his entire career both academically and in private practice.

Migliorati joined UFCD in March 2017 after serving as chair of diagnostic sciences and oral medicine and director of oral medicine at the University of Tennessee College of Dentistry for eight years. In May 2019, he was appointed president of the American Board of Oral Medicine and served a one-year term.

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Individuals with diabetes are at greater risk of developing oral health problems such as gum disease, yet care for these issues are usually split between primary care and dental care. Yet researchers at the University of Amsterdam have developed an intervention that provides primary care-based oral health information and dental referrals for patients with diabetes.

In a cluster randomized controlled trial, 764 patients from 24 primary care practices received either the oral health support or standard primary care. Participants were asked to rate their oral health quality of life as well as their general health and any oral health complaints at the start and end of the study.

Analysis showed that individuals who received the primary care-based oral health support intervention had a significant increase in their self-reported oral health quality of life when compared with the control group.

The researchers concluded that patients who have type 2 diabetes and who attend primary diabetes care can benefit from additional attention to their oral health. Also, they said, their findings further reflect the connections between oral health and systemic health.

The study, “Implementation of an Oral Care Protocol for Primary Diabetes Care: A Pilot Cluster-Randomized Controlled Trial,” was published by Annals of Family Medicine.

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Research may be essential to every dental school, but it can cost a lot of money. The National Institutes of Health (NIH) awards grants to schools to perform this research, prompting the nonprofit Blue Ridge Institute for Medical Research (BRIMR) to break down the numbers and rank which schools got the most NIH money in 2020.

According to the BRIMR, 47 dental schools collectively received 647 NIH awards totaling $245,681,511 in fiscal year 2020. The total value of this funding has increased nearly 22% over the past decade, from 2011’s $201 million total awarded to 49 dental schools. The top 10 dental schools receiving NIH funding in 2020 include:

• The University of California San Francisco (UCSF) School of Dentistry: $25,903,058
• The University of Michigan School of Dentistry: $22,528,704
• The New York University (NYU) College of Dentistry: $15,454,032
• The University of Maryland School of Dentistry: $15,231,514
• The University of Southern California (USC) Herman Ostrow School of Dentistry: $13,704,027
• Penn Dental Medicine: $13,051,654
• The University of Connecticut (UConn) School of Dental Medicine: $9,404,408
• The University of California Los Angeles (UCLA) School of Dentistry: $8,458,963
• The University of Alabama Birmingham (UAB) School of Dentistry: $7,012,258

Together, these 10 schools accounted for about 60% of all NIH dollars awarded to dental schools in 2020, up from about 50% in 2011. Also, seven of 2020’s top 10 schools were among the top 10 in 2011 as well.

The BRIMR bases its rankings on official year-end data published by the NIH, which awarded more than $34 billion across 60,000 awards to universities and other grantee organizations of all types in 2020.

The great majority of awards come from the NIH’s National Institute for Dental and Craniofacial Research (NIDCR), which issued its own list of dental institutions receiving funding in fiscal year 2020, though substantial amounts also are awarded by the National Cancer Institute (NCI) and National Institute of Allergy and Infectious Diseases. The NIDCR’s top 10 for 2020 includes:

• The University of Michigan School of Dentistry: $20,235,326
• The UCSF School of Dentistry: $14,462,569
• Penn Dental Medicine: $7,044,981
• The USC Herman Ostrow School of Dentistry: $6,826,721
• The University of Florida College of Dentistry: $6,651,742
• The University of Pittsburgh School of Dental Medicine: $6,494,850
• NYU Dentistry: $6,491,454
• The Forsyth Institute: $6,339,889
• UAB Dentistry: $5,942,116
• The UCLA School of Dentistry: $5,712,070

The NIDCR’s two largest awards to dental schools in 2020, $6.3 million and $3.9 million, supported research into regenerative medicine at the University of Michigan and USC, respectively.

Topics of other large NIH research awards from $1.5 million to $3.5 million a year each included clinical management of postoperative pain, oral health disparities in Appalachia or among young children, and searching for molecular mechanisms and new targets for treatment of chronic pain.

“Included among the 647 awards in 2020 were more than 15 that funded institutional research training programs, four to support specialized research centers, and 90 career-development awards to individual trainees who aim to pursue investigative careers in dental, oral, or craniofacial research,” said Tristram G. Parslow, MD, PhD, associate director at BRIMR.

Yet BRIMR, which was founded by its scientific director, Dr. Robert Roskowski Jr., notes that there are limitations in focusing only on NIH awards.

“NIH is the world’s largest funder of biomedical research, but there are many other important ones, including other federal agencies, philanthropic foundations, individual donors, and universities’ own internal funds. However, reliable, comprehensive, annual data on those latter sources are not generally available,” said Parslow.

“Also, although most research nowadays involves collaborations among multiple investigators or even multiple institutions, the NIH credits only one ‘lead’ investigator and his/her institution with each award, so collaborations are not well reflected in its dataset,” Parslow continued.

“Most importantly, BRIMR’s rankings focus only on research funding, without regard for the many other vital roles of dental schools in the profession and in society,” Parslow said.

“Still, for schools that choose to pursue research, NIH funds are recognized as one of the best available measures of success, in part because the decision to award them is made through an open, transparent, nationwide competition that is judged by expert peer-reviewers from across the country and reflects the nation’s highest goals and priorities in health-related research,” Parslow said.

“So, BRIMR’s rankings are widely cited as a measure of a school’s research vigor, featuring prominently in annual reports, strategic plans, recruitment ads, et cetera,” said Parslow. 

The UCSF School of Dentistry

“UCSF’s mission is to make the world a better place through our singular focus on health: education, patient care, service, and, of course, research,” said Dr. Stuart Gansky, associate dean for research.

“The UCSF School of Dentistry has been ranked first or second in NIH funding among schools of dentistry for nearly three decades. We expect and challenge ourselves to address some of the most pressing health issues through systematic inquiry, investigation, and innovation. UCSF’s environment and culture fosters and impels us to collaboratively tackle research challenges to improve health,” Gansky said.

The school’s faculty includes world-renowned researchers in many areas, Gansky said, particularly cancer biology, craniofacial development, dental materials, health disparities and equity, laser imaging, nociception, salivary glands, Sjögren’s syndrome, and tobacco regulatory science.

“In a nutshell, our focus goes from cells to clinics to communities,” said Gansky, who spotlighted several key researchers and projects:

• Dr. Daniel Clark and the impact of the aging immune system on periodontal disease
• Dr. Andrew Jheon and context-dependent roles of Isl1 during mouse incisor renewal
• Dr. Cristin Kearns and overcoming barriers to implementing policies to reduce sugar consumption for dental caries prevention
• Dr. Ophir Klein and using human intestinal organoids to model IBD pathogenesis
• Dr. Caroline Shiboski and Sjögren’s International Collaborative Clinical Alliance Next Generation studies
• Dr. Torsten Wittman and the wide-field super-resolution spinning disk confocal microscope

Also, the UCSF School of Dentistry recently appointed its first assistant dean for basic science research, Dr. Sarah Knox.

“Her work as an inspired researcher in salivary gland research has been highlighted in UCSF’s festivities celebrating completion of its $6.2 billion development campaign,” Gansky said.

Meanwhile, Klein has multiple concurrent NIH awards in areas including craniofacial development, tissue plasticity, and dental stem cells. He was one of the two recipients of the NIDCR’s inaugural Sustaining Outstanding Achievement in Research or SOAR Awards as well.

And, Dr. Elizabeth Mertz and Dr. Joel White are co-leads on a National Institute on Minority Health and Health Disparities (NIMHD) award to evaluate evidence-based preventive care in Oregon as a way to reduce oral health inequities in childhood caries. They have published their methodologies and will begin disseminating evaluations and findings shortly, Gansky said.

The University of Michigan

While the University of Michigan is honored to be among the leaders in NIH funding, said associate dean for research Dr. Vesa M. Kaartinen, the work does go on. Kaartinen cited the school’s efforts in tissue engineering and regenerative medicine; cancer biology and therapeutics; clinical, population, and educational research; and craniofacial and skeletal biology and disease.

“Research is a vital component of our school’s mission of advancing health through education, service, research, and discovery,” said Kaartinen. “Documenting and promoting basic, translational, clinical, and health services research is a constant focus for us. We want to encourage discoveries and their implementation into practice. This effort can be seen in the range, diversity, and significant output of literature our faculty publish each year.”

Led by Dr. David Kohn, the school considers its Regenerative Medicine Resource Center its flagship research project because of its broad mission and scope, both within the university and in tandem with other schools around the country. In 2020, the center received a five-year, $31.4 million NIDCR grant. The center currently funds 13 interdisciplinary translational projects, helping to move them toward FDA approval for clinical trials.

“We are excited to advance to the next stage of this unique program and pleased that the NIDCR has the confidence in us to invest further in this initiative,” said Kohn, who is a professor in the dental school’s Department of Biologic and Materials Sciences and a professor in biomedical engineering at the university’s College of Engineering.

“It allows us to use the structure and processes we have developed so far to guide the projects to successful translation for patients and/or commercialization. We have nurtured projects related to many areas of critical need in the dental, oral, and craniofacial space and have helped many projects advance along the translational pipeline, which is complex, time-consuming, and costly,” Kohn said.

Another team led by Dr. Yu Leo Lei published the results of its investigation of head and neck tumor development associated with the human papillomavirus (HPV). This research revealed the mechanism that HPV uses to shut down the innate immune system and avoid being targeted by the body’s immune cells. Further, Kaartinen noted Dr. Marco Bottino’s work in periodontal reconstruction and Dr. Isabelle Lombaert’s work in salivary gland regeneration.

NYU Dentistry

“Research is central to NYU College of Dentistry’s mission, and we are pleased to be among the top dental schools in NIH funding,” said Louis Terracio, PhD, vice dean for academic affairs and research at the school.

“NYU College of Dentistry is home to a diverse group of scientists studying oral health and other areas that illustrate the important connection between oral health and overall health,” Terracio said, and the funding reflects that diversity.

In 2020, NYU Dentistry received funding from multiple branches of the NIH including NIDCR, NCI, and NIMHD, as well as the National Institute on Aging (NIA), the National Institute of Diabetes and Digestive and Kidney Diseases, and the National Institute of Neurological Disorders and Stroke.

“Our scientists have a strong record of attracting funding for their work, ranging from clinical research on how to prevent tooth decay in children to basic science research on the biology of bone and tooth enamel. Two exciting and growing areas of research pertain to pain and the microbiome,” said Terracio.

Partly funded by the NIH’s HEAL Initiative to stem the opioid crisis, researchers led by Dr. Brian Schmidt and Nigel Bunnett are investigating alternatives to opioids for treating chronic pain and oral cancer pain. They are developing strategies for pain relief targeting specific genes and using nanoparticles to more precisely deliver therapies.

Also, Dr. Deepax Saxena and Dr. Xin Li have used NIDCR and NCI funding to discover that vaping changes the oral microbiome, potentially putting people at risk for inflammation and infection, Terracio said.

“NIDCR has funded their work on periodontal disease and bone loss, which has led to the development of an oral strip and gel for people with type 2 diabetes,” Terracio said. “Dr. Li also received NIA funding to study the interplay between inflammation, aging, and the microbiome.”

Saxena and Li additionally have received NCI funding to create and test probiotics that alter the gut microbiome to see if they can enhance the efficacy of immunotherapy in treating pancreatic cancer.

The Ostrow School of Dentistry

“It shows an incredible amount of trust for us to be able to get this support, which enables us to carry out innovative research projects that can truly benefit our patients,” said Ostrow’s associate dean of research, Yang Chai, PhD, noting how the school jumped from thirteenth place on NIDCR’s list in 2019 to fourth in 2020.

Grants to Ostrow’s researchers supported FaceBase III, a central repository for craniofacial datasets and tools meant to advance craniofacial science that the school said it has been leading since 2014. Also, funding has supported:

• A project examining the role of herpesvirus in oral inflammatory diseases such as periodontitis, peri-implantitis, and mucositis
• A project seeking to better understand the mechanisms whereby immune-compromised individuals develop malignant tumors from Kaposi’s sarcoma-associated herpesvirus and Epstein virus in an effort to one day prevent them
• A training grant to support PhD students and postdoctoral fellows in their research.

But it was the funding provided for the Center for Dental, Oral and Craniofacial Tissue and Organ Regeneration (C-DOCTOR), whose third phase launched during the pandemic, that helped propel Ostrow to number four on NIDCR’s list, the school said.

Led by USC, C-DOCTOR is a consortium of California academic institutions whose mission is to become a sustainable, comprehensive national center that enables the clinical translation of innovative regenerative therapies to replace dental, oral, and craniofacial tissues or organs lost to congenital disorders, traumatic injuries, disease, and medical procedures.

Chai is a principal investigator at C-DOCTOR, alongside UCSF’s Jeffrey Lotz. Project director Bridget Samuels contributed significantly to the C-DOCTOR grant application and manages the endeavor on a daily basis, a Herculean task that Chai credits for C-DOCTOR’s success.

“C-DOCTOR has been an incredible opportunity for us to work with so many talented people,” said Chai, who also is a professor, the George and MaryLou Boone Chair in Craniofacial Biology, and the director of the Center for Craniofacial Molecular Biology (CCMB).

“We have eight different institutions working together to identify these interdisciplinary translation research projects, foster their development, and help them move into an FDA filing. It allows us to really translate innovative discoveries into patient care,” Chai said.

When the pandemic led to shutdowns across California in early 2020, research efforts at CCMB and the Norris Dental Science Center temporarily slowed, the school said, with individual scientists dropping in to make sure equipment was running and animal studies were undisturbed.

In June 2020, USC said it ramped up its research operations to 30% occupancy and eventually to 50%, thanks in part to health and safety guidelines created by an Ostrow task force led by Chai.

At the time, the university had tasked each school with putting together a back-to-work plan that comported with guidelines developed by the Centers for Disease Control, the County of Los Angeles, and USC.

Ostrow’s task force, which included faculty members from the USC Chan Division of Occupational Science and Occupational Therapy and the USC Division of Biokinesiology and Physical Therapy, put together a plan so comprehensive that parts of it were adopted university-wide, Ostrow said.

Today, research efforts are back at 100%, with all necessary COVID-19 mitigation efforts in place, which also includes late-night shift work. During each phase of the reopening, Ostrow’s team was incredibly resilient and adaptable, Chai said.

“Never did people say, ‘Oh, you know what? This is not convenient for me.’ It was always ‘When can I come in? When is it my turn?’” Chai said. “That’s how we were able to publish all these studies and carry out new research projects like the ones funded by C-DOCTOR. That’s been truly remarkable, to see how innovative people have been to come up with ways to deal with restrictions.”

UConn School of Dental Medicine

The $9.4 million that the UConn School of Dental Medicine (SDM) received represents the highest total of NIH funding in the school’s history as well as its highest showing on the Blue Ridge ranking. In 2019, the school ranked 16^th and received $5.37 million from the NIH.

Total research funding to the school from all sources has grown significantly over the last several years, UConn said. It averaged $9.58 million per year over the last three years and is on track to reach $11 million for the current fiscal year.

“This highest-ever national ranking provides objective evidence of the growth and success of our research programs,” said Dr. Rajesh Lalla, associate dean for research.

“It demonstrates the excellence of the SDM research community, including our faculty, trainees, and staff who contribute to conducting and supporting research. This growth, success, and excellence enables us to achieve our research missions of generation of new knowledge to benefit humanity and training the next generation of researchers,” said Lalla.

UConn noted the competitive nature of NIH funding, with a success rate for NIH grant applications typically ranging between 10% and 20%. UConn also has almost doubled its number of extramural grant applications from 52 in 2016 to 97 in 2020.

Also, UConn noted that these rankings are based only on funding from the NIH and are not adjusted for school size. The UConn School of Dental Medicine, with one of the smallest class sizes in the country, is ranked alongside larger, research-intensive schools, UConn said.

“The discovery, dissemination, and application of new knowledge is one of the core values of an academic dental center. This achievement is a reflection of the outstanding work of our faculty, students, residents, and staff and a reminder that we remain committed to the pursuit of excellence and innovation,” said Dr. Steven Lepowsky, dean of the School of Dental Medicine.

UConn called research one of the cornerstones of the School of Dental Medicine’s mission. Its research programs span a broad spectrum of basic and clinical areas, UConn continued, such as behavioral sciences, biomedical engineering, skeletal development, and regeneration.

Additional active research areas include periodontal disease, the oral microbiome, oral-systemic connections, temporomandibular joint disease, tooth movement, dental implants, diagnostic imaging, and oral side effects of cancer therapies.

The School of Dental Medicine has had 40 years of continuous NIH funding for graduate-level research training, UConn said, making it nationally known as a training ground for new dental faculty. Research opportunities are available to predoctoral students include its DMD/PhD combined program and summer research program.

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“Gum diseases are preventable” is the slogan for Gum Health Day 2021, a worldwide initiative on May 12 promoted by the European Federation of Periodontology (EFP). The event aims to educate the public about detecting and preventing gum diseases such as gingivitis, periodontitis, and peri-implantitis and explain why continuing to visit the dentist during the pandemic is important to overall health.

In addition to causing tooth loss and other oral problems, gum diseases are linked to major systemic health issues including diabetes, cardiovascular disease, chronic kidney disease, rheumatoid arthritis, Alzheimer’s disease, some cancers, pregnancy complications, and erectile dysfunction, the EFP said.

Recent research also has linked gum diseases COVID-19 transmission as well as severe COVID-19 complications and outcomes, suggesting that establishing and maintaining gum and oral health may become an important part of patient care, the EFP said.

“Gum Health Day 2021 aims to remind people that gum health is a key factor for health and well-bring even if, unfortunately, it’s still sometimes overlooked,” said Henrik Dommisch, coordinator of Gum Health Day 2021.

“Gum diseases that could be effectively prevented and treated still affect hundreds of millions of adults worldwide. It’s time to take decisive action against gum diseases. We can beat them just by keeping a good oral hygiene and going regularly to visit our dentist, periodontitis, or hygienist,” said Dommisch.

The awareness initiative will be celebrated in more than 40 countries in Europe, the Americas, Africa, Asia, the Middle East, and Australasia by EFP-affiliated societies of periodontology and by other scientific societies, dental organizations, hospitals, dental practices, universities, and companies.

Among the Gum Health Day 2021 materials that the EFP has produced are four short animated videos showing how among other factors bad breath, sensitive or loose teeth, and smoking can either trigger or be a sign of gum disease.

Most adults in developed countries are affected by gum disease at some point in their lives, the EFP said, even if they are not aware of it because gum diseases are usually painless and often go unnoticed for a time.

The EFP is inviting all members of the dental community to join this awareness day by disseminating Gum Health Day 2021 messages and materials, particularly on social media, and by signing the EFP Manifesto “Perio & General Health,” an international call to dentists and medical professionals to be more proactive in terms of the prevention, early detection, and treatment of gum disease and to acknowledge it as a major public health issue.

Besides activities organized at the national level, the EFP is holding a Gum Health Day 2021 Perio Talks live session at the EFP’s Instagram page, @perioeurope, on May 12 at 7 pm CET. It will be open to everyone and led by Dommisch with representatives from some EFP-affiliated societies.

The speakers will exchange ideas and experiences during the session and answer questions and suggestions from participants about how to educate the population to prevent and tackle the threat posed by gum diseases.

“Gum Health Day 2021 is a major EFP global initiative to get the public informed every year of the value of healthy gums as an integral part of a healthy life. Prevention of diseases is the best approach to a healthy life, and Gum Health Day 2021 will greatly get closer to our vision of periodontal health for a better life for everybody,” said Lior Shapira, EFP president.

“New associations between gum disease and COVID-19 are now being identified,” said Shapira.

“A new paper published in the Journal of Clinical Periodontology has found that the dental biofilm of symptomatic coronavirus patients can harbor ribonucleic acid (RNA) molecules of the SARS-CoV-2 virus and might act as a potential reservoir with an essential role in the transmission of COVID-19,” said Shapira.

“This reveals a previously unknown and unexplored human habitat of the viral RNA and could open a door to further research in developing COVID-19 containment strategies,” Shapira said.

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Oral health in Brazil needs better promotion and more accessible public dental services before it can help in the fight against chronic obstructive pulmonary disease (COPD), which is the country’s third leading cause of adult death, according to the University of Birmingham.

Despite poor oral health being associated with worse clinical outcomes in COPD, many patients and primary healthcare professionals in Brazil do not know enough about the link between a lack of oral hygiene and the killer disease, the researchers said.

Interviewing COPD patients and healthcare professionals in São Paulo, researchers from the University of Birmingham discovered that many of those with the disease viewed tooth loss and decay as normal and seldom practice preventive oral health.

Working with Brazilian partners, the researchers further noted that a lack of oral health advice relating to COPD, alongside poor oral hygiene practices and difficulties accessing free dental care, has worsened the problem.

“There is a clear desire for greater integration between medical and dental services to promote preventative oral health,” said lead co-author Amber Swann, an intercalating medical student at the University of Birmingham.

“This could be through developing educational programs or integrating oral health protocols into the primary care pathway for COPD patients,” Swann said.

“Dentists felt that the problem lay with patients avoiding preventative care, whilst patients highlighted significant barriers to accessing oral healthcare,” said co-lead Matthew Riley, who also is on the intercalating course, which enables students to carry out research before graduating.

“Our research indicates that incorporating preventative oral health into COPD management and expanded public dental services would help this group of vulnerable patients,” Riley said.

COPD is a long-term incapacitating respiratory condition and the fourth leading cause of death worldwide, the researchers said. Caused mainly by smoking and exposure to air pollution, it is more common in low- and middle-income countries (LMICs) with disadvantaged populations most affected.

Worsening of COPD symptoms is a common and costly complication, often associated with irreversible loss of lung function, hospitalization, and death. Up to half of such COPD “flareups” may result from bacterial infections, the researchers said, and recent evidence suggests a significant decrease in flareups following periodontal treatment.

When Brazil introduced its universal healthcare system in 1988, oral health was a low priority, and services were limited. The 2004 Oral Health National Policy aimed to expand access to public services, but more than 50% of 65- to 74-year-olds in Brazil are missing teeth, while the remainder have some degree of periodontal disease, the researchers said.

Caried out with the São Paulo Faculty of Medicine of ABC, the São Paulo Department of Community Health, and the Brazilian Society of Family and Community Medicine, the research is linked to the £2 million NIHR Global Health Research Group on Global COPD in Primary Care and its Breathe Well project.

Formed in June 2017, the group has partnered with teams in Brazil, China, Georgia, and the Republic of North Macedonia and the International Primary Care Respiratory Group. It will publish key research findings this year, based on projects in primary care settings evaluating the accuracy of COPD screening strategies, promoting smoking cessation and improving disease management.

“COPD is a global killer, and we’re working with partners in Brazil to improve healthcare outcomes for people with COPD,” said project leader Dr. Rachel Jordan, reader in epidemiology and primary care at the university.

“We are strengthening local research capacity in partner countries, co-creating local plans for finding the best ways to prevent, identify, and treat COPD in the community,” Jordan said. “This allows us to build robust platforms for collaborative research with partner countries and other LMICs.”

The study, “Knowledge, Attitudes and Practices of Patients and Healthcare Professionals Regarding Oral Health and COPD in Sao Paulo, Brazil: A Qualitative Study,” was published by npj Primary Care Respiratory Medicine.

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Americans prioritized their oral health as part of maintaining their overall health during the COVID-19 pandemic, according to the Delta Dental Plans Association 2020 State of America’s Oral Health Report.

The nationwide analysis of consumer opinions and behaviors relating to oral health was based on findings from two surveys of more than 2,000 American adults and parents of children age 12 and under. According to the report:

• Most adults prioritized oral healthcare in 2020, with 74% visiting a dentist, despite widespread challenges driven by the pandemic.
• 90% of American adults believe that maintaining their oral health has been essential to protecting their overall health throughout the pandemic.
• 94% of parents believe that maintaining their children’s oral health has been essential to protecting their children’s overall health throughout the pandemic.
• Only approximately one in two Americans agree that oral health is closely linked to several medical conditions including strokes and high blood pressure.

“Amid the challenges presented by the pandemic, Americans embraced oral health in 2020,” said James W. Hutchinson, president and CEO of the Delta Dental Plans Association.

“As the research shows, the vast majority of people understand that oral health is critically important to overall health, but we still have a great opportunity to educate the public about the connection,” Hutchinson said.

“The more Americans know about the impact of oral health on overall health, the more likely they are to approach their health holistically and continue the strong oral health habits that many adopted during the pandemic,” he said.

“The insights from this report will act as a catalyst to ensure that the broader healthcare conversation includes oral health, which is a vital part of physical, mental, and emotional well-being,” he continued.

“We are in a new era of healthcare, and as American society reexamines its healthcare practices in the wake of the pandemic, the oral health community must redouble its efforts to demonstrate the importance of oral health, partner with communities, and expand access to care,” he concluded.

As showcased by the findings, Delta Dental said, Americans increasingly recognize the value of good oral health and are taking action to achieve it. Nearly all survey respondents plan to prioritize oral health either by visiting the dentist, securing dental insurance if they are uninsured, or paying closer attention to their oral care habits in 2021, the company said.

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