Robert Dunford's research while affiliated with University at Buffalo, The State University of New York and other places

/st> In this field trial, the authors assess the feasibility of screening for diabetes and prediabetes in dental practices and in a community health center. /st> Dental patients 45 years and older who were not aware of their diabetic status underwent evaluation for diabetes risk with an American Diabetes Association Diabetes Risk Test and with hemoglobin (Hb) A1c measurement. Participants with an HbA1c level of 5.7 percent or greater were referred to their physicians for diagnosis. /st> Of the 1,022 patients screened, 416 (40.7 percent) had an HbA1c blood level of 5.7 percent or greater and were referred for diagnosis. The HbA1c and the American Diabetes Association Diabetes Risk Test were correlated (P < .001). Of the 416 participants who were referred, 35.1 percent received a diagnosis from their physicians within one year; 78.8 percent of these patients were seen in the community health center and 21.4 percent were seen in private dental offices. The diagnoses were diabetes (12.3 percent of patients), high risk of developing diabetes (that is, prediabetes) (23.3 percent) and no diabetes (64.4 percent). /st> The study results show that screening for prediabetes and diabetes is feasible in a dental office, with acceptance by the dentist and dental office staff members, patients' physicians and patients. Patients from the community health center demonstrated good compliance with referrals to physicians; however, compliance was poor among those in the private dental offices. Practical Implications Screening for diabetes and prediabetes in the dental office may provide an important benefit to patients and encourage interprofessional collaboration to achieve a chronic care model in which health care professionals work together to care for a panel of patients.

Tannerella forsythia (Tf) is a Gram-negative anaerobe implicated in the development of periodontal disease. Bacterial surface protein A (BspA) is a surface-expressed and -secreted protein that is recognized as an important virulence factor of Tf. This study was undertaken to determine whether Tf BspA induces an antibody response in periodontal disease. We hypothesized that serum immunoglobulin (Ig)G antibody levels against BspA correlate with the disease of patients. Sera were obtained from 100 patients with cardiac disorders and periodontal disease and 73 patients who experienced myocardial infarction but were periodontally healthy. Sera samples were assayed for anti-BspA antibody (total IgG and IgG subtypes) by enzyme-linked immunosorbent assay (ELISA). Antibody levels were measured in ELISA units by using an arbitrary patient as a standard. A negative correlation was found with BspA-specific total IgG antibody titers and the severity of disease measured as the clinical attachment level (CAL) when healthy and diseased groups were analyzed separately (healthy group: [-0.23, correlation value] Student's t value [73 degrees of freedom] = 1.99; P = 0.05; diseased group: [-0.21] t [100 degrees of freedom] = 2.12; P = 0.03]). However, there was a positive correlation ([0.18 correlation value] Student's t value [173 degrees of freedom] = 2.39; P = 0.017) when healthy and diseased groups were combined. A strong positive correlation ([0.338 correlation value] Student's t value [173 degrees of freedom] = 4.69; P <0.0001) between the BspA-specific IgG titers and periodontal probing depth was observed when healthy and disease groups were combined. Data demonstrated that antibodies to Tf BspA were elicited in patients with periodontal disease, and antibody levels were associated with the disease severity. Furthermore, data suggested that anti-BspA IgG might have a protective function in periodontal disease by minimizing the loss of tooth attachment tissue.

Objective: The objective was to determine the validity of the Centers for Disease Control/ American Academy of Periodontology (CDC/AAP) whole mouth system for assessing cases of periodontal disease (Page & Eke, J Periodontol 2007;78:1387) using radiographic alveolar bone height measurement as the gold standard. Methods: We compared the CDC/AAP periodontal disease classification, modified by adding the moderate case definition to alveolar bone score obtained from standardized dental radiographs. The Erie County Periodontal Epidemiologic Study of 1,426 subjects was the source of our data (Grossi et al., J Periodontol 1995;66:23). We validated the findings using sensitivity and specificity analysis, positive and negative predicative values, as well the receiver operating curve (ROC) analysis. Results: When the severe CDC/AAP classification was compared to the moderate/severe alveolar bone score, a sensitivity of 65.1% and specificity of 85.1%, with a combined percentage of 150.2% was obtained. The positive predictive value was 67.6% and the negative predictive value was 85.1%. The area under the curve (ROC) analysis was next calculated for all combinations of the CDC/AAP classification as compared to the alveolar bone scores. The best performance was seen when the CDC/AAP severe group was compared to the moderate/severe alveolar bone score. For this combination ROC area was 0.751 (95% CI 0.722-0.781). Conclusion: The severe category of the modified CDC/AAP classification works well in predicting periodontal disease, using the combined moderate/severe alveolar bone score as the gold standard. This study helps validate the use of the periodontal probe-based CDC/AAP classification of periodontal disease, a practical, standardized methodology for population-based studies using the radiographic alveolar height as the gold standard.

Objectives: Tannerella forsythia (Tf) is an oral gram-negative anaerobe implicated in the development of periodontal disease (PD). A surface expressed and secreted protein BspA, belonging to leucine-rich repeat and Ig-like protein families, has been shown to bind to fibronectin and fibrinogen. BspA is also able to induce pro-inflammatory cytokine release by activating TLR2 receptor. Moreover, BspA expression is required for alveolar bone loss in mice. This study was undertaken to determine if BspA induces an antibody response in PD. We hypothesized that the antibody levels (IgG and IgA) against BspA will correlate with patient's disease. Methods: Sera were obtained from 54 subjects involved in the Periodontal Intervention for Cardiac Events: Pilot Trial (PAVE). Bacterial loads and patient periodontal status were determined. The sera samples were assayed for anti-BspA antibody (IgG and IgA) titers by ELISA. Briefly, 96 well plates coated with 5ng per well of rBspA were incubated with patient sera. The plates were then washed, and incubated with either peroxidase conjugated goat anti-human IgG or IgA secondary antibody, reacted with peroxidase substrate and read at 450nm. Antibody levels were calculated by, extrapolating OD values to an IgG or IgA standard curve. Results: The results showed no correlation with BspA-specific total IgG antibody concentrations and severity of disease measured as clinical attachment loss, but showed a positive correlation [(0.353) t(54) = 2.72, p=0.008] between concentrations of BspA-specific IgA and disease severity. Conclusions:Determining the IgG and IgA subclass levels in the future will help to explain the role of antibody response to BspA in PD. This study was supported by a grant from the NIDCR (DE014749).

The purpose of this study was to determine the importance of occlusal factors in recurrent headaches in children and adolescents without other signs or symptoms of temporomandibular disorders or related craniomandibular disorders. A sample of 50 children and adolescents, ages 8 to 16, who reported headaches was obtained from the University at Buffalo Orthodontic Clinic records; a control group of 50 children and adolescents, matched for age and sex, was also obtained. Plaster models, made during the routine collection of orthodontic records, were used to obtain the following occlusal trait measurements: Angle classification, overjet, anterior and posterior crossbite, scissors-bite, overbite, open bite, dental midline discrepancy, crowding, spacing, and dental development stage. Overbite, overjet, and posterior crossbite showed statistically significant associations (chi-square) with increased risk for headaches. Logistic regression analysis demonstrated that overjet was a significant factor only because of its correlation with overbite and posterior crossbite. Overjet was not significant after adjusting for the other 2 variables, whereas overbite and posterior crossbite were associated with significantly increased risk (>3:1) of headache. The combination of 2 or more of these 3 occlusal factors increased the risk of headache even more (8.5:1). Posterior crossbite and overbite > or =5 mm were associated with significantly increased risk of headache in children and adolescents.

There are several electronic shade-matching instruments available for clinical use; unfortunately, there are limited acceptable in vitro models to evaluate their reliability and accuracy. The purpose of this in vitro study was to evaluate the reliability and accuracy of a dental clinical shade-matching instrument. Using the shade-matching instrument (ShadeScan), color measurements were made of 3 commercial shade guides (VITA Classical, VITA 3D-Master, and Chromascop). Shade tabs were selected and placed in the middle of a gingival matrix (Shofu Gummy), with tabs of the same nominal shade from additional shade guides placed on both sides. Measurements were made of the central region of the shade tab inside a black box. For the reliability assessment, each shade tab from each of the 3 shade guide types was measured 10 times. For the accuracy assessment, each shade tab from 10 guides of each of the 3 types evaluated was measured once. Reliability, accuracy, and 95% confidence intervals were calculated for each shade tab. Differences were determined by 1-way ANOVA followed by the Bonferroni multiple comparison procedure. Reliability of ShadeScan was as follows: VITA Classical = 95.0%, VITA 3D-Master = 91.2%, and Chromascop = 76.5%. Accuracy of ShadeScan was as follows: VITA Classical = 65.0%, VITA 3D-Master = 54.2%, Chromascop = 84.5%. This in vitro study showed a varying degree of reliability and accuracy for ShadeScan, depending on the type of shade guide system used.

Public health and other population-based studies often depend on participants' self-reported disease status to assess prevalence, incidence, and disease trends. We sought to assess the feasibility of self-reported periodontal disease measures using dental history questions combined with demographic and medical history to predict periodontal disease. We evaluated results from two separate population-based studies carried out at the University at Buffalo, Buffalo, New York, i.e., the "Periodontal Infection and Risk for Myocardial Infarction Study," a study of 1,578 adults assessing the association between periodontal disease and myocardial infarction and the "Periodontal Disease Research Center" (the Erie County Study), an epidemiologic risk assessment study of 1,438 adults. In each study, an extensive list of oral health questions was asked, and a comprehensive medical history, blood analysis using chemistry and hematology tests, and demographic data were collected. Using a predefined measure of severity of periodontal disease, we compared patients with severe disease to all others (i.e., those with moderate and no or mild disease). We examined areas under the curve (AUC) of the receiver operating curve to determine the best models, adding one, two, or three dental variables in all possible combinations. The AUC maximized at 0.76, and the combined sensitivity and specificity maximized at 142 and were comparable in both studies. Self-reported measures of periodontal disease are moderately predictive of clinical attachment loss. The demographic variables of age, race, smoking, gender, and diabetes mellitus accounted for much of the predictive power for self-reported periodontal disease; however, increases in sensitivity and specificity in the C statistics occurred when questions, including "Gum surgery in the past?," "Sore gums in the past?," "Scaling in the past?," "Bleeding gums now?," "Periodontal surgery in the past 2 years?," and "Chewing satisfaction?," were added to the model.

A standardized radiographic series of incrementally increasing alveolar crestal defects in skulls were subjected to analyses by subtraction radiography and computer assisted quantitative densitometric analysis. Subjects were able to detect change using subtraction radiography in alveolar bone defects with bone loss in the range of 1–5 percent as measured by 125I absorptiometry. Quantitative densitometric analyses utilizing radiographic pairs adjusted for differences in contrast (gamma corrected) can be used to follow longitudinal changes at a particular alveolar bone site. Such measurements correlate with change observed by 125I absorptiometry (r= 0.82–0.94).

This present study used the conventional visualized treatment objectives (VTOs) as a tool to evaluate the predictive value of the Dolphin computer-assisted VTOs. Presurgical cephalometric tracing predictions generated by oral and maxillofacial surgeons and the Dolphin Imaging software were compared with the postsurgical outcome as seen on lateral cephalometric tracings. Sixteen measurements of the predicted and actual postsurgical hard tissue landmarks were compared statistically. A paired Student's t test showed that 7 measurements had statistically significant differences for the conventional VTOs (facial angle, P < .0001; AOC, P < .0001; SNB, P = .003; ANB, P = .004; U1-NA-degrees, P = .01; U1-NA-mm, P = .02; and N perp Pog, P < .0001), while 9 measurements were statistically significant ( P = <.0001) for Dolphin (facial angle, P = .0001; AOC, P = .005; SNB, P = .001; ANB, I = .04; U1-NA-degrees, P = .003; PogNB, P = .04; U1-NA-mm, P = .002; N perp Pog, P = .0001; UFH, P = .03; and LFH, P = .03). From these data, it appears that both VTOs demonstrated good predictive comparative outcome and are equally precise.