Cortexyme, Inc. (Nasdaq: CRTX), a company advancing a pivotal trial in Alzheimer’s disease with top-line data expected in the fourth quarter of 2021 and a growing pipeline of therapeutics for degenerative diseases, announced new preclinical data demonstrating efficacious dose range finding data for its lead drug candidate atuzaginstat (COR388) in periodontal disease in conjunction with its participation at the International Association for Dental Research (IADR) 2021 General Session & Exhibition, a virtual event. Periodontal disease represents a significant unmet market of 65 million people in the U.S. alone.

New data presented at the IADR 2021 conference by Cortexyme showed its lead clinical small molecule, atuzaginstat, was able to engage and inhibit its target, lysine-gingipain from P. gingivalis, within a biofilm and disrupt the biofilm integrity. The inability of traditional antibiotics to penetrate oral biofilms at therapeutic concentrations is a major reason for their lack of efficacy in treating chronic periodontitis. The company also confirmed that a second-generation lysine-gingipain inhibitor, COR588, demonstrated biofilm penetration and target engagement similar to atuzaginstat and is planned to begin Phase I studies in the third quarter 2021. In a second presentation at IADR 2021, Cortexyme presented data from preclinical studies demonstrating that atuzaginstat was efficacious in reversing alveolar bone loss induced by oral P. gingivalis infection.

“As top-line data for our GAIN Trial rapidly approaches in the fourth quarter 2021, Cortexyme is in a unique position with a pivotal clinical study of our lead drug candidate atuzaginstat that targets the infectious pathogen P. gingivalis not only as the causative agent of Alzheimer’s disease, but also its well-established role as a keystone bacterium for periodontal disease. This presents us with the potential to provide innovative and breakthrough treatments in two high unmet clinical need areas with a first-in-class, orally administered small molecule,” said Casey Lynch, Cortexyme’s chief executive officer, co-founder and chair. “The 233-patient periodontal disease REPAIR sub-study of the GAIN Trial evaluates standard clinical endpoints of periodontitis, including gingival pocket depth, clinical attachment, and bleeding on probing. We look forward to reporting top-line data from the REPAIR sub-study in the fourth quarter 2021.”

New data will be featured in two poster sessions at IADR 2021:

• Atuzaginstat Penetrates Biofilms for Periodontal Disease Therapeutic Efficacy: At Cortexyme’s IADR 2021 poster session titled “Gingipain Inhibitors Penetrate And Inhibit Gingipains In Porphyromonas gingivalis Biofilms” (Abstract #3571509) taking place Friday, July 23, 2021, starting at 3:45 p.m. ET, new data will be presented demonstrating the efficacy of atuzaginstat and COR588 to penetrate in vitro surface attached biofilms. Biofilms are one of the primary reasons that other molecules like broad spectrum antibiotics are ineffective against P. gingivalis. Biofilm cultures demonstrated decreased potency of the broad-spectrum antibiotic amoxicillin relative to planktonic growth as expected for robust biofilms. Atuzaginstat and the company’s second generation COR588 exhibited significant time and concentration-dependent inhibition of lysine-gingipain activity, while maintaining their target selectivity within the biofilms to inhibit lysine-gingipain. Other similarly potent gingipain inhibitors were less capable of activity within the biofilm.
• Atuzaginstat Efficacious in Mouse Model of Periodontal Disease: At Cortexyme’s IADR 2021 poster session titled “Novel lysine-gingipain inhibitor atuzaginstat (COR388) is efficacious in a mouse model of periodontal disease” (Abstract #1756) taking place Friday, July 23, 2021, starting at 11:00 a.m. ET, new data will be presented that demonstrates that atuzaginstat, a first-in-class brain-penetrant lysine-gingipain inhibitor, was effective in reversing alveolar bone loss in mice after repeated oral P. gingivalis infection. Mice were orally infected with P. gingivalis for 42 days and treated from day 35 through day 70 with oral administration of atuzaginstat. Multiple studies were used to determine an effective exposure and dose regimen. A previously peer-reviewed publication established efficacy of atuzaginstat in reducing oral infection and periodontal disease in a naturally occurring aged dog model (Aratsu-Kapur et al. 2021).

KOL Webinar: Innovation in Periodontal Disease – A Major Unmet Medical Need

In conjunction with its participation at IADR 2021, Cortexyme is hosting a key opinion leader (KOL) webinar titled “Innovation in Periodontal Disease – A Major Unmet Medical Need” on Friday, July 23, 2021, at 10:00 a.m. ET. The webinar will feature KOL Mark Ryder, D.M.D., (University of California, San Francisco) who will discuss the unmet medical need in treating patients with P. gingivalis-induced periodontal disease and Cortexyme management will present new data from the company’s IADR 2021 abstracts. An update on the REPAIR Phase 2 periodontal sub-study of atuzaginstat as part of its pivotal Phase 2/3 GAIN Trial in Alzheimer’s disease will also be presented. Dr. Ryder and Cortexyme’s management will be available to answer questions following the formal presentations. To register for this webinar, please click here.

Mark Ryder, D.M.D., is a Professor of Periodontology and former Chair of Periodontology and Director of the Postgraduate program in Periodontology at the University of California, San Francisco where he has been a faculty member for the past 41 years. He received his dental and specialty training from the Harvard School of Dental Medicine. He is the author of over 190 articles, abstracts, and book chapters and has lectured extensively on a variety of research and educational topics. He serves as an Associate Editor of the Journal of Periodontal Research and is on the Editorial Board of several dental research journals. He has also served as a chair and/or reviewer on several NIH study sections and other national and international peer review grant organizations, in addition to serving as a consultant for several national and international accreditation programs for dental education. His current research interests include connections between periodontal diseases and Alzheimer’s Disease, the links between oral and systemic health in HIV patients, and basic research and clinical trials on novel periodontal therapies.

ABOUT CORTEXYME

Cortexyme, Inc. (Nasdaq: CRTX) is a clinical stage biopharmaceutical company pioneering upstream therapeutic approaches designed to improve the lives of patients diagnosed with Alzheimer’s and other degenerative diseases. The company is advancing its disease-modifying pivotal GAIN Trial in mild to moderate Alzheimer’s disease with top-line data expected in the fourth quarter of 2021, in addition to growing a proprietary pipeline of first-in-class small molecule therapeutics for Parkinson’s disease, periodontitis, and other diseases with high unmet clinical need. Cortexyme’s lead program targets a specific, infectious pathogen called P. gingivalis found in the brain and other organs and tied to degeneration and inflammation in humans and animal models. The company’s causation evidence for Alzheimer’s disease and the mechanism of its novel therapeutic has been independently replicated and confirmed by multiple laboratories around the world, as well as published in peer-reviewed scientific journals. To learn more about Cortexyme, visit www.cortexyme.com or follow @Cortexyme on Twitter.

FORWARD LOOKING STATEMENTS:

Statements in this news release contain “forward-looking statements” that are subject to substantial risks and uncertainties. Forward-looking statements contained in this news release may be identified by the use of words such as “anticipate,” “expect,” “believe,” “will,” “may,” “should,” “estimate,” “project,” “outlook,” “forecast,” or other similar words.

Examples of forward-looking statements include, among others, statements we make regarding our business plans, strategy, timeline, prospects, and milestone expectations; the timing and success of the company’s clinical trials and related data, including with respect to the GAIN and REPAIR Trials; the potential of atuzaginstat to treat Alzheimer’s disease, periodontal disease, and other potential indications; the timing of announcements and updates relating to its clinical trials and related data; the potential therapeutic benefits, safety and efficacy of the company’s product candidate or library of compounds; and statements about its ability to obtain, and the timing relating to, regulatory submissions and approvals with respect to the company’s drug product candidate.

Forward-looking statements are based on Cortexyme’s current expectations and are subject to inherent uncertainties, risks, and assumptions that are difficult to predict and could cause actual results to differ materially from what the company expects.

Further, certain forward-looking statements are based on assumptions as to future events that may not prove to be accurate. Factors that could cause actual results to differ include, but are not limited to, the risks and uncertainties described in the section titled “Risk Factors” in Cortexyme’s Annual Report on Form 10-K filed with the Securities and Exchange Commission (SEC) on March 1, 2021, its Quarterly Report on Form 10-Q filed with the SEC on May 6, 2021, and other reports as filed with the SEC. Forward-looking statements contained in this news release are made as of this date, and Cortexyme undertakes no duty to update such information except as required under applicable law.

FOR MORE INFORMATION:

Stacy Roughan
Cortexyme, Inc.
Vice President, Corporate Communications & Investor Relations
ir@cortexyme.com

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Researchers at the National Institute for Dental and Craniofacial Research (NIDCR) have catalogued 120,000 oral mucosa cells by type and function. The NIDCR believes this cell atlas will serve as a detailed community resource to help researchers answer key questions about oral biology and disease.

The NIDCR’s researchers conducted a census of oral mucosal cells from gum and inner cheek tissues of people with and without severe periodontitis. By analyzing gene expression cell by cell, they were able to catalog cells by type and function and reveal a previously unknown role for connective tissue cells in orchestrating immune responses linked to periodontitis.

“There’s been a huge international effort to create a cell by cell atlas of the human body,” said senior author Niki Moutsopoulis, DDS, PhD, a principal investigator at NIDCR.

That initiative, the Human Cell Atlas, was launched in 2016 and is led by scientists at the Broad Institute in Cambridge, Massachusetts, and the Wellcome Sanger Institute in Cambridge, United Kingdom.

“We wanted to do our part by contributing data from the oral mucosa,” said Moutsopoulos.

The oral mucosa is composed of four main types of cells. Epithelial cells form the surface layer, while endothelial cells line the blood vessels that supply nutrition and oxygen. Stromal cells give structure to the mucosa, and immune cells survey the surroundings to capture and destroy foreign particles. 

However, Moutsopoulos and her colleagues performed a deeper dive, the NIDCR said, identifying distinct subpopulations with unique traits and functions among the four cell types. One type of stromal cell, called fibroblasts, caught the researchers’ attention.

“The most striking part of the study was the prominent immune signature of fibroblasts in the oral environment,” said Moutsopoulos. “We usually think of stromal cells, such as fibroblasts, as mere producers of connective tissue. But our analyses suggest that they also play a role in immune function, particularly related to recruiting neutrophils.”

Neutrophils are immune cells that migrate into the oral cavity to defend us against pathogens and are thought to play a protective role against periodontitis. In fact, the NIDCR said, genetic deficiencies in neutrophil recruitment are linked to severe periodontitis. But neutrophils also are known to over-congregate in the gums of people with common forms of periodontitis.

Gene expression data from the new study suggests that stromal cells are wired to induce inflammatory responses and send signals that recruit neutrophils in healthy people. The same stromal cells appear to become over-activated in periodontitis, resulting in an exaggerated immune response that could contribute to disease progression.

“This new piece of information is one of the many insights that can be gleaned from the oral cell catalog,” said first author Drake Williams, DDS, PhD, a clinical research fellow at NIDCR.

“Another opportunity afforded by this atlas is that we were able to map the expression of genes linked to periodontitis susceptibility at the cell level, within the oral tissues. We envision that this information will provide clues towards understanding cell-specific functions that mediate periodontitis pathogenesis in different subsets of patients,” said Williams.

The oral cell catalog also can be used to understand oral diseases beyond periodontitis, NIDCR said. The data from healthy volunteers, who were carefully screened for oral and systemic health, serves as a baseline that can be compared against other disease states.

The researchers have contributed their cell atlas to the oral and craniofacial network of the Human Cell Atlas project. They plan to expand the catalog to include cells from patients with inherited forms of oral mucosal diseases.

“The study provided an opportunity to view the oral mucosa through a new lens,” said Moutsopoulos. “We really enjoyed putting it together and had fantastic colleagues that contributed to this effort.”

The study, “Human Oral Mucosa Cell Atlas Reveals a Stromal-Neutrophil Axis Regulating Tissue Immunity,” was published by Cell.

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More effective prevention of gum disease could save billions in healthcare costs and lead to healthier lives, according to the European Federation of Periodontology (EFP).

The EFP commissioned the Economist Intelligence Unit (EIU), which is the research and analysis division of the Economist Group, to provide a comprehensive analysis of the financial and human cost of gum disease in France, Germany, Italy, the Netherlands, Spain, and the United Kingdom.

The report makes it clear that periodontitis is largely preventable with good oral hygiene and regular dental checkups, the EFP said. But little progress has been made in the prevention and management of periodontitis in Western Europe, with prevalence remaining largely unchanged over the past 25 years. 

Many people only visit a dentist when they have a problem and avoid regular appointments because of the cost, the report said.

Also, most if not all periodontitis treatment in Spain and Italy is paid for by patients or private insurance, so periodontitis treatment for low-income families is almost unaffordable, the report said.

And while dental care appears to be free on paper in the United Kingdom and in France, the report continued, only part of the dental procedures involved in treating periodontitis are covered, and the remainder of the costs are paid for out of pocket.

After providing evidence that professional management of periodontitis is cost-effective, the EFP said, the report argues that “publicly covered dental care for periodontitis deserves a review from policymakers and commissioners Europe-wide.”

The report then seeks to capture the attention of policymakers in the six countries studied, emphasizing the economic and societal benefits of action in the early treatment of periodontitis and arguing that “given the prevalence and preventable nature of periodontitis, new ways of thinking about gum health are needed to increase awareness and action at a national level.”

The report makes four recommendations.

First, the report says that the prevention, diagnosis, and management of periodontitis is cost-effective. It called the role of home care by patients of paramount importance in preventing gingivitis and periodontitis.

Efforts to eliminate gingivitis, preventing progression to periodontitis, would save considerable costs over 10 years compared to “business as usual,” ranging from 7.8 billion Euros in the Netherlands to 36 billion Euros in Italy, the report said.

But neglecting to manage gingivitis could significantly increase costs and reduce healthy life years, the report continued, so “an emphasis on self-care and prevention is critical from both an individual and a societal perspective.”

Second, the report says that better integration of dental and general healthcare is required. Sharing information across disciplines may improve both patient care, because of the common risk factors shared by some dental and physical health conditions, and contribute significantly to dental and general health research, the report says.

Integration also may encourage shared responsibility across healthcare disciplines to address unmet oral health needs in vulnerable and marginalized communities, the report says.

Third, a synergy of societal and individual public-health campaigns is needed. One without the other would exacerbate oral health inequalities both within and across countries, the report said. Societal-level prevention is crucial to the prevention of periodontitis, as it is highly prevalent in deprived areas.

Individual public health campaigns need to pay special attention to less affluent communities and embed prevention and early intervention in community settings such as schools for the prevention of caries and health centers for the prevention of gum disease, the report says.

Finally, the report says dental care needs to be more affordable. The cost of accessing a dentist is a barrier to early treatment for many people, the report says, so they are more likely to go to the dentist when there is something wrong rather than for checkups or preventive treatment, which is essential for avoiding periodontitis.

Not all periodontitis treatment is covered by the public health system in the United Kingdom and France, and the patient pays for the remainder. In Spain and Italy, most of not all periodontal treatment is paid for by the patient or via private insurance. Periodontitis treatment for low-income families is almost unaffordable.

Professionally managed periodontitis is cost-effective, the report says, and policymakers and commissioners across Europe should review publicly covered dental care for the disease.

Few studies have modelled the economic burden of periodontitis and the return on investment (ROI) of treatment, the EFP said. The report’s authors developed a model to examine the ROI of preventing and managing periodontitis, with separate modelling for France, Germany, Italy, the Netherlands, Spain, and the United Kingdom.

The model used in the study was based on EFP treatment guidelines that outline four intervention points in the progression from health to gingivitis, undiagnosed periodontitis, and diagnosed periodontitis. The estimates for the current national situation in each country determined the number of individuals starting at each stage of the model.

The authors modelled the transition between the stages over a 10-year period according to five scenarios:

• Baseline: current prevention and treatment situation continues.
• Rate of gingivitis management falls from 95% to 10%.
• Incident gingivitis is eliminated through improved oral homecare, preventing periodontitis.
• No periodontitis is managed.
• 90% of periodontitis is diagnosed and managed.

The model calculated the impact of each scenario on total costs, ROI, and the change in healthy life years compared to the baseline. The cost of continuing with the baseline scenario ranged from 18.7 billion Euro in the Netherlands to 96.8 billion Euro in Italy over 10 years.

In all countries, reducing gingivitis management lowered healthy life years and had a negative ROI. Eliminating gingivitis led to rises in healthy life years, reduced costs, and a strong ROI in all countries.

No management of periodontitis resulted in reductions in healthy life years and a negative ROI for all countries. Diagnosing and managing 90% of periodontitis increased healthy life years in all countries, and despite cost increases, there was a positive ROI.

Eliminating gingivitis and increasing the rate of diagnosing and treating periodontitis to 90% had a positive ROI for all countries and gains in healthy life years compared to business as usual. Neglecting to manage gingivitis had the opposite effects.

The report calls for greater emphasis on self-care and prevention at the individual and societal level, including nursery-based dental care and toothbrushing workshops in schools. While the workshops would primarily target caries prevention in children, instilling good oral hygiene regimens into the daily routine from a young age also should benefit periodontitis prevention in adult years, the EFP said.

“It is hugely challenging to determine to economic and societal costs of a complex disease like periodontitis, which is why we needed an independent expert group like the EIU to undertake this modeling,” said Iain Chapple, former treasurer and secretary general of the EFP.

“Their data clearly demonstrates that by far the biggest ROI comes from the prevention of periodontitis, i.e., by treating gingivitis, something traditionally regarded as trivial and ignored, rather than with treatment being directed at periodontitis, which is of course too late for prevention,” said Chapple.

“I am delighted with the analysis presented by the EIU, highlighting the benefit to healthcare providers of treating gum disease early to realize gains in health life years, advancing the European Federation of Periodontology’s purpose of promoting periodontal health for a better life,” said EFP secretary general Nicola West.

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Researchers at the University Medical Center Greifswald have confirmed the results of a previous study that found an association between inflammatory gum disease due to periodontitis and Alzheimer’s disease.

“It is very difficult to conduct meaningful methodological studies of the effects of periodontal disease, a common severe form of gum disease,” said Dr. Christian Schwahn of the university’s Polyclinic for Dental Prosthetics, Geriatric Dentistry, and Medical Materials Science.

“Statistical models that have only recently been developed make it possible to simulate a controlled clinical study by combining available data from treated patients and untreated patients,” said Schwahn.

The long-term Study of Health in Pomerania/Life and Health in Western Pomerania (SHIP) has been examining the influence of dental diseases on the general health of people since 1997, finding that inflammatory gum disease affects 15% to 45% of people depending on age.

“For the first time, the connection between the treatment of gum disease and the onset of Alzheimer’s disease in a quasi-experimental model of 177 patients treated periodontally in the Greifswald GANI-MED study and 409 untreated participants from the SHIP study will be analyzed,” said Schwahn.

The researchers used magnetic resonance imaging (MRI) data as an indicator for the onset of Alzheimer’s disease and compared it with MRI data from the US Alzheimer’s Disease Neuroimaging Initiative so they it be used as an individual measure of the loss of brain substance typical of Alzheimer’s disease.

Periodontitis treatment carried out by a dentist specializing in gum disease showed a positive effect on the loss of brain matter, which could be assessed as moderate to severe.

The researchers said that the results were remarkable because the periodontitis patients were younger than the age of 60 at the time of the MRI examination, and the observation time between the dental treatment and the MRI exam was 7.3 years on average for the patients. 

“Our approach clearly lies in the prevention and timely treatment of gum disease, which can be triggered by a large number of germs, in order to prevent such possible consequential damage in advance,” said Thomas Kocher, director of the Polyclinic for Dental Conservation, Periodontology, Endodontology, Pediatric Dentistry, and Preventive Dentistry.

“We will continue to have to rely on observational studies that simulate a controlled clinical study in this area,” said Schwahn. “A clinical study with a placebo treatment in a patient group, i.e., with patients who have intentionally not been treated by the dentist, is not feasible for ethical and medical reasons.”

The study, “Effect of Periodontal Treatment on Preclinical Alzheimer’s Disease—Results of a Trial Emulation Approach,” was published by Alzheimer’s & Dementia.

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Oral health during pregnancy can greatly impact the mother and the fetus. While the physiological changes during pregnancy can certainly cause oral health issues, pre-existing oral health conditions can have an effect on the well-being of the mother and her unborn child.¹

Dental practitioners can help their patients by educating them about the potential impact of pre-existing dental conditions, as well as diagnose and treat dental conditions that can develop with or during pregnancy.

Pre-Existing Disease

Several pre-existing conditions can negatively impact pregnancy. When examining oral health, studies support that pregnant women with pre-existing periodontal disease are at higher risk for compromised pregnancy outcomes including preterm birth, delivery of low-birth-weight babies, and development of pre-eclampsia.²

In fact, women with periodontitis have double the risk of pre-term birth.³ Complications of pre-term birth may include developmental delays, growth reduction, and hearing impairment.⁴ But why does periodontitis cause this to happen?

The gram-negative bacteria in the gingival biofilm leads to inflammatory markers in the bloodstream. These inflammatory markers cause an immune inflammatory response in the fetal-placental unit as well as suppression of local growth factors. This response can generate uterine contractions that may result in pre-term labor and/or babies with low birth weight.^3,5

Oral Health Issues During Pregnancy

During pregnancy, the placenta produces higher levels of estrogen and progesterone. These hormonal changes may lead to increased gingivitis, gingival sensitivity to irritants, and pyogenic granulomas. This is partially due to progesterone increasing the vascular permeability.⁶

Pregnant and/or postpartum women also may neglect their own oral care to focus on the health and well-being of their baby.⁶ This leads to toxic plaque remaining on the teeth and gums long term. Not surprisingly, approximately 60% to 75% of pregnant women have gingivitis.¹

In addition, the vomiting that may occur during pregnancy causes an acidic environment in the oral cavity. The acidity may lead to erosion and decay of the tooth structure.

Lastly, many women are hesitant to visit the dentist during pregnancy. This may be because there is a lack of perceived need, or they may mistakenly believe it is unsafe to visit the dentist during pregnancy.¹

However, research supports that professional dental care during pregnancy is integral to improving oral health.⁶ Additionally, when appropriate pregnancy guidelines are followed, dental care is safe during pregnancy.¹ If possible, a full oral examination is recommended prior to pregnancy to achieve optimum oral health and encourage proper oral care habits at home.⁶

Patient Communication

Dental professionals must effectively communicate the risks of pre-existing disease, such as periodontitis, to their patients who are pregnant or wish to become pregnant. Recommended conversation starters may include:

• The bacteria in your mouth impacts the rest of your body and can actually lead to pre-term labor. Let’s work together to treat your periodontal disease so you can have a healthier pregnancy and baby.
• I know you are planning to have children soon. Did you know that the bacteria that causes your periodontal disease can negatively impact your pregnancy? With proper treatment and home care, we can work together to manage your periodontal disease

For pregnancy gingivitis, dental professionals may say something like:

• During pregnancy, your hormones may cause your gums to be more susceptible to swelling and irritation. It’s really important that you keep plaque under control. Try by brushing with an oscillating-rotating toothbrush such as the Oral-B iO and an antimicrobial paste like Crest Gum Detoxify.

The patient and dental professional must work together to stop this cycle before it begins with diligent daily oral hygiene: brushing and interdental cleaning, getting regular oral health checkups, and properly treating periodontal disease early. Oral hygiene in pregnant women can be improved by amplifying their oral care routine at home with the proper oral care products.

The primary factor for gingivitis in pregnant women, toxic plaque, can likely be ameliorated by improved hygiene including the use of antimicrobial pastes such as Crest Gum Detoxify, antimicrobial rinse like Crest Pro-Health Multi-Protection Clean Mint, and optimal mechanical plaque control via an electric rechargeable toothbrush with a round head, like the Oral-B iO.

Moreover, pastes that include stannous fluoride such as Crest Gum Detoxify can prevent the erosion that may be caused by the acidic oral environment during pregnancy. Helping your patients to take good care of their mouth, teeth, and gums during pregnancy can help them to have a healthy pregnancy and a healthy baby.

References

1. Hartnett E, Haber J, Krainovich-Miller B, Bella A, Vasilyeva A, Lange Kessler J. Oral Health in Pregnancy. J Obstet Gynecol Neonatal Nurs. 2016 Jul-Aug;45(4):565-73. doi: 10.1016/j.jogn.2016.04.005. Epub 2016 Jun 6. PMID: 27281467.
2. Daalderop LD,Wieland BV, Tomsin K, Reyes L, Kramer BW, Vanterpool SF. Periodontal disease and pregnancy outcomes: Overview of systematic reviews. JDR Clinical & Translational Research 3:10-27.
3. Manrique-Corredor EJ, Orozco-Beltran D, Lopez-Pineda A, Quesada JA, Gil-Guillen VF, Carratala-Munuera C. Maternal periodontitis and preterm birth: Systematic review and meta-analysis. Community Dent Oral Epidemiol 2019; 47:243-251.
4. Ward RM, Beachy JC. Neonatal complications following preterm birth. BJOG. 2003 Apr;110 Suppl 20:8-16. doi: 10.1016/s1470-0328(03)00012-0. PMID: 12763105.
5. Puertas A, Magan-Fernandez A, Blanc V, Revelles L, O’Valle F, Pozo E, León R, Mesa F. Association of periodontitis with preterm birth and low birth weight: a comprehensive review. J Matern Fetal Neonatal Med. 2018 Mar;31(5):597-602. doi: 10.1080/14767058.2017.1293023. Epub 2017 Feb 28. PMID: 28282773.
6. Yenen Z, Ataçağ T. Oral care in pregnancy. J Turk Ger Gynecol Assoc. 2019;20(4):264-268. doi:10.4274/jtgga.galenos.2018.2018.0139

Ms. Jordan is a graduate of Westbrook College, UNE, dental hygiene, where she worked as adjunct clinical faculty for nearly 10 years and now serves on the advisory committee. She holds a master’s degree in organizational leadership and worked in private practice until 2001, when she became an employee of Procter & Gamble (Crest + Oral-B). She has held several positions for the company and currently holds the role of global professional & scientific relations. She has contributed to the Darby Walsh dental hygiene textbooks and has lectured locally to dental professionals, as well as students and faculty. She can be reached at jordan.ba.1@pg.com.

Dr. Gans graduated from the Ohio State University’s College of Dentistry in 2013 and completed a general practice residency at Saint Vincent Charity Hospital. She practiced dentistry in her hometown of Cleveland, Ohio, prior to joining Procter & Gamble in 2018. She is currently a P&G Professional and Scientific Relations Manager for Crest + Oral-B. Her goal is to teach dental professionals about the recent advances in paste and power brush technology to help improve oral health. In her free time, she enjoys spending time with her friends and family. She has five siblings including an identical twin who is also a dentist.

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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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Overjet has received 510(k) clearance from the Food and Drug Administration (FDA) for its Dental Assist software as a medical device system, which applies artificial intelligence (AI) in real time to aid dentists and dental hygienists, according to the company. The clearance will enable Overjet to market and sell the system directly to dental practices.

Dental Assist helps dental professionals measure mesial and distal bone levels in bitewing and periapical radiographs for the diagnosis and treatment planning of periodontal disease. The condition affects about 46% of adults in the United States, including 8.9% who have severe periodontitis. Left untreated, periodontitis can lead to tooth loss and painful chewing.

“Overjet’s Dental Assist clearance by the FDA is a landmark moment for dental AI,” said Dr. Wardah Inam, PhD, CEO and cofounder of Overjet.

“All clinicians can now have at their fingertips highly accurate software to detect and measure serious dental disease and clear AI visualizations to communicate with patients. This is big for dentistry and moving toward evidence-based, patient-centric care,” Inam said.

In clinical performance testing, Dental Assist demonstrated automated measurement capabilities comparable to a team of highly skilled dentists, Overjet said.

Three experienced dentists independently measured bone levels on dental radiographs using a measuring tool. These measurements then were further adjudicated by an oral radiologist to establish an official consensus ground truth. Next, Dental Assist measurements were compared to the dentist consensus, with an average difference of only 0.3 mm.

“We’re seeing dental AI software perform at the level of a team of trained dentists with accuracy closer than the width of a needle,” said Dr. Chris Balaban, DMD, clinical director for Overjet.

“These tools unlock the ability to track the progression of disease over time for each tooth and make the case for evidence-based treatment, supported by unbiased software and clear visuals for patients,” Balaban said.

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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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COVID-19 could pass into people’s lungs from saliva with the virus moving directly from the mouth to the bloodstream, particularly if they are suffering from gum disease, according to an international team of researchers.

The blood vessels in the lungs, rather than the airways, are initially affected in COVID-19 lung disease with high concentrations of the virus in saliva and periodontitis associated with increased risk of death, the researchers said.

Dental plaque accumulation and periodontal inflammation further intensify the likelihood of the SARS-CoV-2 virus reaching the lungs and causing more severe cases of the infection, the researchers said.

This discovery could make effective oral healthcare potentially lifesaving, the researchers said, recommending that the public take simple but effective daily steps to maintain oral hygiene and reduce factors contributing to gum disease such as plaque buildup.

In fact, the researchers said, specific ingredients of some cheap and widely available mouthwash products are highly effective at inactivating the SARS-CoV-2 virus.

Use of these specific mouthwash products and other simple oral hygiene measures could help reduce the risk of transmission of the virus to the lungs in those with COVID-19 and help prevent severe instances of the infection, the researchers said.

Initial observations of lung CT scans from patients suffering from COVID-19 lung disease by radiologist Dr. Graham Lloyd-Jones of Salisbury District Hospital led to a collaboration between medical and dental researchers on the potential entry route into the bloodstream.

“This model may help us understand why some individuals develop COVID-19 lung disease and others do not. It could also change the way we manage the virus, exploring cheap or even free treatments targeted at the mouth and, ultimately, saving lives,” said coauthor Iain Chapple, professor of periodontology at the University of Birmingham.

“Gum disease makes the gums leakier, allowing microorganisms to enter into the blood. Simple measures such as careful toothbrushing and interdental brushing to reduce plaque buildup, along with specific mouthwashes, or even saltwater rinsing to reduce gingival inflammation could help decrease the virus’ concentration in saliva and help mitigate the development of lung disease and reduce the risk of deterioration to severe COVID-19,” Chapple said.

The researchers included experts from Salisbury District Hospital in the United Kingdom, the University of Birmingham in the United Kingdom, and the Mouth-Body Research Institute in Los Angeles and Cape Town, South Africa.

Their new model is based on the mouth providing a breeding ground for the virus to thrive, with any breach in oral immune defenses making it easier for the virus to enter the bloodstream.

Moving from blood vessels in the gums, the virus would pass through neck and chest veins, reaching the heart before being pumped into pulmonary arteries and small vessels in the lung base and periphery.

“Studies are urgently required to further investigate this new model, but in the meantime, daily oral hygiene and plaque control will not only improve oral health and well-being, but could also be lifesaving in the context of the pandemic,” said Chapple.

The study, “The COVID-19 Pathway: A Proposed Oral-Vascular-Pulmonary Route of SARS-CoV-2 Infection and the Importance of Oral Healthcare Measures,” was published by The Journal of Oral Medicine & Dental Research.

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