OBJECTIVE:The aging process may significantly impact bacteria in the oral cavity (oral microbiome), leading to notable changes in its diversity and composition, potentially influencing systemic health. This systematic review aimed to compare the oral microbiota of elderly individuals (≥60 years) with that of younger adults. DESIGN:A comprehensive search of PubMed, Medline, EMBASE and CINAHL identified 794 studies published between 2005 and May 2023. Studies were included if the investigators compared the oral microbiome of elderly with younger adults using 16S rRNA sequencing. The JBI Critical Appraisal Checklist for Analytical Cross-Sectional Studies was employed to evaluate risk of bias. Ten full-text articles met the criteria for inclusion. RESULTS:The included studies revealed inconsistent results regarding alpha and beta diversity and the abundance of bacterial phyla with aging. Some studies reported increased diversity or abundance, others showed decreases, and several found no significant differences. However, this review identified a consistent decline in the abundance of Haemophilus, Granulicatella, and Veillonella, alongside an increase in Comamonas, in elderly populations across multiple studies. These genera may play critical roles in maintaining oral health and microbial stability in elderly populations, highlighting the need for further investigation. CONCLUSIONS:The variability in microbial diversity and abudance suggests that confounding factors such as oral hygiene, systemic health, medication use, and lifestyle may complicate interpretation of results. In conclusion, future research should employ longitudinal designs with standardized methodologies and address confounding factors to better understand the aging oral microbiome and its implications for healthspan and quality of life.

Patients with movement disorders, like Parkinson’s and Huntington’s diseases, tend to have poor oral health. Although contributing factors have been proposed, the willingness and ability of dentists to treat this patient population are still unknown. Our objective is to understand the current barriers and motivations of dentists to treat this patient population as a path to improved care and quality of life. A total of 176 dentists in Texas were surveyed through a structured questionnaire which contained both closed and open-ended questions. Nearly 30% of participants reported having no barriers to treating these patients and 26.7% reported that no such patients have visited their practice. Barriers reported included lack of education on the topic (17.6%) and longer appointments than average (14.8%). A main motivation to treat these patients was more training and education on the subject (38.6%). Poor oral health in patients with movement disorders may not be due to barriers encountered by dentists, but rather encountered by patients, such as access to and use of dental treatment. General dentists are willing to provide care for adult patients with movement disorders and continuing education for these providers is preferred over referral to a specialist.

Journal of Dental EducationVolume 85, Issue S3 p. 1943-1945 ADVANCING THROUGH INNOVATION Virtually more: Summer research program grows in online-only format Cameron B. Jeter PhD, Corresponding Author Cameron B. Jeter PhD [email protected] Department of Diagnostic and Biomedical Sciences, The University of Texas Health Science Center at Houston School of Dentistry, Houston, Texas, USA Correspondence Cameron B. Jeter, Department of Diagnostic and Biomedical Sciences, The University of Texas Health Science Center at Houston School of Dentistry, 7500 Cambridge Street, Houston, TX 77054, USA. Email: [email protected]Search for more papers by this authorBrett T. Chiquet DDS, PhD, Brett T. Chiquet DDS, PhD Department of Pediatric Dentistry, The University of Texas Health Science Center at Houston School of Dentistry, Houston, Texas, USASearch for more papers by this authorGena D. Tribble PhD, Gena D. Tribble PhD Department of Periodontics and Dental Hygiene, The University of Texas Health Science Center at Houston School of Dentistry, Houston, Texas, USASearch for more papers by this author Cameron B. Jeter PhD, Corresponding Author Cameron B. Jeter PhD [email protected] Department of Diagnostic and Biomedical Sciences, The University of Texas Health Science Center at Houston School of Dentistry, Houston, Texas, USA Correspondence Cameron B. Jeter, Department of Diagnostic and Biomedical Sciences, The University of Texas Health Science Center at Houston School of Dentistry, 7500 Cambridge Street, Houston, TX 77054, USA. Email: [email protected]Search for more papers by this authorBrett T. Chiquet DDS, PhD, Brett T. Chiquet DDS, PhD Department of Pediatric Dentistry, The University of Texas Health Science Center at Houston School of Dentistry, Houston, Texas, USASearch for more papers by this authorGena D. Tribble PhD, Gena D. Tribble PhD Department of Periodontics and Dental Hygiene, The University of Texas Health Science Center at Houston School of Dentistry, Houston, Texas, USASearch for more papers by this author First published: 08 May 2021 https://doi.org/10.1002/jdd.12644Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onEmailFacebookTwitterLinkedInRedditWechat No abstract is available for this article. REFERENCES 1 American Dental Education Association eLearn Webinar Course, Spielman A. The history of dentistry: highlights from a long journey. 2020. https://www.pathlms.com/adea/courses/15366. Accessed April 3, 2021. 2Marshall G. Critiquing a research article. Radiography. 2005; 11(1): 55-59. 3 U.S. Department of Health and Human Services Office of Research Integrity. The lab: avoiding research misconduct. 2021. https://ori.hhs.gov/content/thelab 4Ihm J, An S, Seo D. Do dental students’ personality types and group dynamics affect their performance in problem-based learning? J Dent Educ. 2017; 81(6): 744-751. Volume85, IssueS3Supplement: Advancing Through InnovationDecember 2021Pages 1943-1945 This article also appears in:Advancing Through Innovation in a Challenging Time ReferencesRelatedInformation

Journal of Dental EducationVolume 85, Issue S3 p. 1909-1912 ISSUE INFORMATIONFree Access Journal of Dental Education Volume 85 Number S3/December 2021 First published: 17 December 2021 https://doi.org/10.1002/jdd.12646AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat Volume85, IssueS3Supplement: Advancing Through InnovationDecember 2021Pages 1909-1912 RelatedInformation

Patients with Parkinson’s disease (PD) are at increased risk of aspiration pneumonia, their primary cause of death. Their oral microbiota differs from healthy controls, exacerbating this risk. Our goal was to explore if poor oral health, poor oral hygiene, and dysphagia status affect the oral microbiota composition of these patients. In this cross-sectional case-control study, the oral microbiota from hard and soft tissues of patients with PD (n = 30) and age-, gender-, and education-matched healthy controls (n = 30) was compared using 16S rRNA gene sequencing for bacterial identification. Study participants completed dietary, oral hygiene, drooling, and dysphagia questionnaires, and an oral health screening. Significant differences in soft tissue beta-diversity (p < 0.005) were found, and a higher abundance of opportunistic oral pathogens was detected in patients with PD. Factors that significantly influenced soft tissue beta-diversity and microbiota composition include dysphagia, drooling (both p < 0.05), and salivary pH (p < 0.005). Thus, patients with PD show significant differences in their oral microbiota compared to the controls, which may be due, in part, to dysphagia, drooling, and salivary pH. Understanding factors that alter their oral microbiota could lead to the development of diagnostic and treatment strategies that improve the quality of life and survivability of these patients.

The department of Diagnostic and Biomedical Sciences at the University of Texas School of Dentistry at Houston (UTSD) boasts faculty and staff with a diverse array of disciplinary expertise, academic responsibilities, and professional goals. A 2019 SWOT analysis highlighted the need to improve communication, mentoring, and engagement. Measures were underway to address departmental needs using Kotter’s 8-step model1 (Figure 1)

Oral health is an often-undervalued contributor to overall health. The literature, however, underscores the myriad of systemic diseases influenced by oral health, including type II diabetes, heart disease, and atherosclerosis. Thus, assessments of oral health, called oral screenings, have a significant role in assessing risk of disease, managing disease, and even improving disease by oral care. Here we present a method to assess oral health quickly and consistently across time. The protocol is simple enough for non-oral health professionals such as students, family, and caregivers. Useful for any age of patient, the method is particularly key for older individuals who are often at risk of inflammation and chronic disease. Components of the method include existing oral health assessment scales and inventories, which are combined to produce a comprehensive assessment of oral health. Thus, oral characteristics assessed include intraoral and extraoral structures, soft and hard tissues, natural and artificial teeth, plaque, oral functions such as swallowing, and the impact this oral health status has on the patient's quality of life. Advantages of this method include its inclusion of measures and perceptions of both the observer and patient, and its ability to track changes in oral health over time. Results acquired are quantitative totals of questionnaire and oral screening items, which can be summed for an oral health status score. The scores of successive oral screenings can be used to track the progression of oral health across time and guide recommendations for both oral and overall health care.

PURPOSE The evaluation of the effectiveness of simulation training in dentistry has previously been focused primarily on psychomotor hand skills. This study explored the impact of simulated patient (SP) encounters in simulation on students' self-assessment of competency in their clinical and communication abilities with geriatric patients. METHODS Students from 2 cohorts were recruited for this study. Cohort 1 (n = 30) participated in the standard curriculum with no simulation training and served as the control group. Cohort 2 (n = 34) participated in a SP experience, simulating the initial stages of a care visit for 2 nursing home patients. Students' perceptions of competency to perform these clinical and communication tasks were assessed. A group debriefing session was held 5 weeks post-simulation where Cohort 2 completed a student feedback form. RESULTS A statistically significant change (P < 0.00001) was noted for both cohorts in their self-reported competence to perform clinical tasks following exposure to an independent clinical experience. In addition to this gain, individuals in Cohort 2 demonstrated improvements following simulation and expressed different responses of impact to questions related to treatment, pharmacology, and managing a complex medical history. CONCLUSIONS This study suggests that simulation of patient interactions using SPs can strengthen students' self-assessment of competency in their abilities, leading to more genuine interactions with actual patients. These findings will help inform the design of future SP encounters as a component of an evolving humanistic curriculum.

Department of Diagnostic and Biomedical Sciences, The University of Texas Health Science Center at Houston School of Dentistry, Houston, TX 77054, USA . ABSTRACT: For centuries, cadavers have been the traditional model of teaching gross anatomy. However, with the large time investment and high cost of maintenance associated with cadavers, studying anatomy via plastinated specimens has become increasingly attractive. Plastination is a novel technique for preservation of the human body by replacing water content with polymers, creating specimens that are dry, odorless, durable, and nontoxic. In 2016, The University of Texas Health Science Center at Houston School of Dentistry (UTSD) underwent a significant curriculum reform by replacing cadaveric specimens with plastinated prosections. Objectives: The aim of this study was to investigate our dental students’ and residents’ perceptions of learning anatomy from cadavers or plastinated specimens, and to determine if student performance in anatomy lab exams have changed since this reform. Methods: A survey was administered to dental students and residents who studied anatomy via cadavers and/or plastinated specimens. Lab exam scores from the past six years were compared in these two models of anatomy instruction. Results: More than half of students in all cohorts believed that plastinated prosections can effectively replace the need for dissection. ANOVA analysis revealed that the switch from cadavers to plastinated specimens had a significant improvement of lab exam scores. Conclusions: At UTSD, the shift in learning anatomy from cadavers to plastinated specimens increased student satisfaction with anatomy instruction and improved student performance in the course.

Introduction:Patients with Parkinson's disease (PD) suffer progressive neurodegeneration and experience motor and nonmotor symptoms. Oropharyngeal dysfunctions are increasingly recognized as nonmotor PD symptoms that negatively impact a patient's quality of life. This module was primarily created to update dental health professionals and educate dental students on the oral health needs of patients with PD, with an emphasis on interprofessional collaboration and evidence-based dentistry. The module may also benefit other health professionals from different disciplines working with patients with PD.Methods:The module was developed to be delivered in one 55-minute large-group session followed by a short assessment and case study discussion. Associated materials include PowerPoint slides with transcript, a narrated video version of the PowerPoint lecture, a quiz, and the case study. Thirty-four first-year dental students were invited to watch the narrated presentation, complete a pre-/postsurvey, and take the quiz.Results:All participants agreed dental schools should provide education regarding oral health in patients with neurological disorders, as only 29% of them had previously taken a related class. After watching the presentation, students reported that most of the information was new content and that the difficulty level met their expectations. All students reported that the lecture increased their interest in interprofessional collaboration. In a quiz taken immediately after the presentation, the class average grade was 82.7, with 94% of the class passing the quiz with a grade of 70 or more.Discussion:Educating dental professionals regarding care of patients with PD must emphasize interprofessional collaborations among health care providers.

Background. Cognitive impairment is the gradual loss of one's ability to learn, remember, pay attention, and make decisions. Cognitively impaired elderly people are a challenging patient population for dental health care professionals and may be at higher risk of developing oral health diseases. The authors systematically reviewed interventions effective at improving dental health in patients with cognitive impairment and described research gaps remaining.Types of Studies Reviewed. In a comprehensive search of multiple databases, the authors identified 2,255 studies published in the English language from 1995 through March 2016. The authors included studies if the investigators evaluated oral health measures after an intervention in patients 65 years or older with cognitive impairment or dementia. Nine full-text articles met the criteria for inclusion.Results. Only 1 study was a randomized control trial, whereas all others lacked appropriate controls. Investigators studied the effects of dental treatments, battery-powered devices for oral hygiene, and training of care staff members. Most interventions improved some aspect of the oral health of patients with dementia, and results were more pronounced when patients required assistance while performing oral hygiene tasks or had poor oral health at baseline.Conclusions and Practical Implications. A basic care plan for patients with dementia should, at the minimum, match prevention strategies recommended for healthy elderly patients. Dental health care professionals should promote oral hygiene education for caregivers for elderly patients with cognitive impairment. There is a wide gap in knowledge regarding effective methods specifically to improve oral health in patients with dementia.

Parkinson's disease (PD) is a progressive neurodegenerative disorder that primarily affects the motor system. However, non-motor symptoms such as cognitive, autonomic, sleep-related and sensory dysfunctions are often reported. A subgroup of non-motor symptoms, oropharyngeal problems, also affects these patients in ways that greatly deteriorate quality of life. Each patient may develop a different set of non-motor symptoms, making interprofessional collaboration among health care providers a must to treat patients with PD. In this review, we argue that dental health professionals must be included in this interprofessional health care team. Patients with PD are at a higher risk for developing oral health problems that can exacerbate or be exacerbated by other non-motor symptoms, such as mental health and dysphagia This accelerates decline in quality of life and even increases the risk of death by aspiration pneumonia. Dentists can create preventive oral health plans as soon as a diagnosis is made and promptly treat a patient's dental problems, preventing them from affecting other health areas. We describe major oral health concerns and how health professionals and dentists can participate and collaborate to improve the health of patients with PD.

Abstract Introduction Many people are lured by the myth that we can get more done by multitasking. This resource is a case-based lesson on the pitfalls of multitasking: how trying to focus on two or more cognitively demanding tasks results in decrements in performance, and memory, of any of the tasks. This case was created specifically for first-year health professions students with a threefold purpose to: (1) encourage students to focus in class, rather than multitask, for optimal long-term retention of material, (2) familiarize first-year students with a case-based course, and (3) teach students to make evidence-based decisions by referencing scientific articles using PubMed. Methods We introduce the case with a brief multitasking activity presented on PowerPoint to all students in a lecture room. After personally witnessing the negative consequences of multitasking, students break into small groups to discuss and complete the case. To determine the effect, if any, of this multitasking case on self-reported student multitasking behavior, we administered a three-question survey to students before this case, midsemester, and at the end of the semester in both this small-group case-based course and a traditional lecture-based course. The first two questions asked to what degree the students agreed or disagreed with the statements “I can get more done when I multitask” and “I can multitask during class and still not miss anything.” The third question asked the students to report “During class thus far today, of the following I spent the most time texting, social networking online, e-mailing, surfing the internet, or none of the above.” Results Results across the semester revealed that while students progressively believed they could not get more done/not miss anything while multitasking, reported multitasking behaviors increased by semester's end. Thus, student opinion on multitasking is not always reflected in reported behavior. As expected, self-reported multitasking behaviors were greater in a lecture than in a small-group setting. Discussion The hands-on demonstration of how multitasking can foil effective learning created a buzz among students, several of whom said they administered the task to friends and family. Students appreciated this opportunity to learn to use PubMed.

Methionine is an essential proteinogenic amino acid that is obtained from the diet. In addition to its requirement for protein biosynthesis, methionine is metabolized to generate metabolites that play key roles in a number of cellular functions. Metabolism of methionine via the transmethylation pathway generates S-adenosylmethionine (SAM) that serves as the principal methyl (-CH3) donor for DNA and histone methyltransferases (MTs) to regulate epigenetic changes in gene expression. SAM is also required for methylation of other cellular proteins that serve various functions and phosphatidylcholine synthesis that participate in cellular signaling. Under conditions of oxidative stress, homocysteine (which is derived from SAM) enters the transsulfuration pathway to generate glutathione, an important cytoprotective molecule against oxidative damage. As both experimental and clinical studies have shown that traumatic brain injury (TBI) alters DNA and histone methylation and causes oxidative stress, we examined if TBI alters the plasma levels of methionine and its metabolites in human patients. Blood samples were collected from healthy volunteers (HV; n = 20) and patients with mild TBI (mTBI; GCS > 12; n = 20) or severe TBI (sTBI; GCS < 8; n = 20) within the first 24 h of injury. The levels of methionine and its metabolites in the plasma samples were analyzed by either liquid chromatography-mass spectrometry or gas chromatography-mass spectrometry (LC-MS or GC-MS). sTBI decreased the levels of methionine, SAM, betaine and 2-methylglycine as compared to HV, indicating a decrease in metabolism through the transmethylation cycle. In addition, precursors for the generation of glutathione, cysteine and glycine were also found to be decreased as were intermediate metabolites of the gamma-glutamyl cycle (gamma-glutamyl amino acids and 5-oxoproline). mTBI also decreased the levels of methionine, α-ketobutyrate, 2 hydroxybutyrate and glycine, albeit to lesser degrees than detected in the sTBI group. Taken together, these results suggest that decreased levels of methionine and its metabolic products are likely to alter cellular function in multiple organs at a systems level.

BACKGROUND:Reports conflict as to whether Tourette syndrome (TS) confers deficits in executive function. This study's aim was to evaluate executive function in youths with TS using oculomotor tasks while controlling for confounds of tic severity, age, medication, and severity of comorbid disorders. METHOD:Four saccade tasks requiring the executive functions of response generation, response inhibition, and working memory (prosaccade, antisaccade, 0-back, and 1-back) were administered. Twenty youths with TS and low tic severity (TS-low), nineteen with TS and moderate tic severity (TS-moderate), and 29 typically developing control subjects (Controls) completed the oculomotor tasks. RESULTS:There were small differences across groups in the prosaccade task. Controlling for any small sensorimotor differences, TS-moderate subjects had significantly higher error rates than Controls and TS-low subjects in the 0-back and 1-back tasks. In the 1-back task, these patients also took longer to respond than Controls or TS-low subjects. CONCLUSIONS:In a highly controlled design, the findings demonstrate for the first time that increased tic severity in TS is associated with impaired response inhibition and impaired working memory and that these executive function deficits cannot be accounted for by differences in age, medication or comorbid symptom severity.

A molecular biomarker is an entity whose release, abundance and/or modification state is altered as a result of injury or disease, and can be used to aid diagnosis. The concentrations of injury biomarkers are typically highest within the injured organ, but may be measurable in body fluids. Injuries such as trauma often result in damage to multiple organs, requiring biomarkers that can specifically identify the organs that are injured. Biomarkers such as glial fibrillary acidic protein for brain injury, kidney injury marker-1 for kidney injury, cardiac troponin for heart damage, intestinal-type fatty acid binding protein for gut injury, and d-dimer for coagulopathy have been shown to have clinical diagnostic utility to detect injury to individual organs. The long-term objective of injury-associated biomarker research is to identify and validate a panel of biomarkers to diagnose (or exclude) injury to various organs and/or predict ensuing symptoms/outcome. Unfortunately, such a panel is not currently available. This review will critically assess the current status and related patents of individual biomarkers being investigated for the diagnosis of injury to specific organs, and discuss the feasibility of generating a panel of biomarkers that can be used to diagnose injury to multiple organs.

Mild traumatic brain injury (mTBI) results from a transfer of mechanical energy into the brain from traumatic events such as rapid acceleration/deceleration, a direct impact to the head, or an explosive blast. Transfer of energy into the brain can cause structural, physiological, and/or functional changes in the brain that may yield neurological, cognitive, and behavioral symptoms that can be long-lasting. Because mTBI can cause these symptoms in the absence of positive neuroimaging findings, its diagnosis can be subjective and often is based on self-reported neurological symptoms. Further, proper diagnosis can be influenced by the motivation to conceal or embellish signs and/or an inability of the patient to notice subtle dysfunctions or alterations of consciousness. Therefore, appropriate diagnosis of mTBI would benefit from objective indicators of injury. Concussion and mTBI are often used interchangeably, with concussion being primarily used in sport medicine, whereas mTBI is used in reference to traumatic injury. This review provides a critical assessment of the status of current biomarkers for the diagnosis of human mTBI. We review the status of biomarkers that have been tested in TBI patients with injuries classified as mild, and introduce a new concept for the discovery of biomarkers (termed symptophenotypes) to predict common and unique symptoms of concussion. Finally, we discuss the need for biomarker/biomarker signatures that can detect mTBI in the context of polytrauma, and to assess the consequences of repeated injury on the development of secondary injury syndrome, prolongation of post-concussion symptoms, and chronic traumatic encephalopathy.

The pathophysiology of traumatic brain injury (TBI) is complex and not well understood. Because pathophysiology has ramifications for injury progression and outcome, we sought to identify metabolic cascades that are altered after acute human mild and severe TBI. Because catabolism of branched-chain amino acids (BCAAs; i.e., valine, isoleucine, and leucine) leads to glucose and energy metabolism, and neurotransmitter synthesis and availability, we investigated BCAA metabolites in plasma samples collected within 24 h of injury from mild TBI (Glasgow Coma Scale [GCS] score >12), severe TBI (GCS ≤8), orthopedic injury, and healthy volunteers. We report decreased levels of all three BCAAs in patients with mild TBI relative to healthy volunteers, while these BCAAs levels in patients with severe TBI were further reduced compared with all groups. Orthopedic patients exhibited reductions in BCAA comparable to those in patients with mild TBI. The decrease in patients with mild and severe TBI persisted for derivatives of BCAA catabolic intermediates. Only plasma levels of methylglutarylcarnitine, a derivative of a leucine metabolite, were increased in patients with severe TBI compared with all other groups. Notably, logistic regression combination of three BCAA metabolites whose levels were changed by 24 h post-injury provided prognostic value (area under the curve=0.92) in identifying patients with severe TBI in whom elevated intracranial pressure (≥25 mm Hg) developed. These changes suggest alteration of BCAA metabolism after TBI may contribute to decreased energy production and neurotransmitter synthesis and may contribute to TBI pathophysiology. Supplementation of BCAAs and/or their metabolites may reduce TBI pathology and improve outcome.