Background: The role of oncogenic subtypes of the human papillomavirus (HPV) in the pathogenesis of cervical dysplasia, cervical cancer, anal intraepithelial neoplasia, penile intraepithelial neoplasia, vaginal intraepithelial neoplasia and oropharyngeal carcinomas (OPC) is well documented. The classification and management of HPV-positive OPC (HPV+ OPC) has been modified because of differences in the molecular, biological and clinical behaviour of this disease compared with HPV-negative OPC (HPV- OPC) and conventional oral squamous cell carcinoma (OSCC). Description: HPV+ OPC is associated with significant morbidity, mortality and cost burden on individual patients and the health care system. Preventive measures and efficient screening programs aim to reduce this burden, and oral health care providers are expected to play a pivotal role in this context. Just as they are involved in tobacco and alcohol counseling and cessation, they should support such public health initiatives as HPV screening, detection of potentially premalignant and malignant lesions, patient education about the risk of HPV infection and promotion of HPV vaccination. Practical Implications: The advent of HPV vaccines has modified the epidemiologic landscape and the management of cervical dysplasia and cancer. Similar changes are expected with HPV+ OPC. In this paper, we review HPV+ OPC and discuss how oral health care providers can be effectively involved in the fight against this disease.

Sex and gender are essential components of person-centered care. This article presents and discusses four important tenets regarding sex and gender health that should be incorporated into dental education and oral health care to foster inclusivity and improve care for all patients, including a sex and gender-diverse patient population.

Expert panelists in a think tank format were charged with addressing which ongoing trends will have major effects on dentistry in the future. With reference to literature, they identified and agreed on the following 5 trends affecting the scope of practice and professional interactions: COVID-19, changing demographic and disease patterns, converging technologies and predictive tools, interprofessional primary care, and value-based care payment models. In this article, they give their consensus on how each of these trends is likely to transform oral health care, including a consideration of how the events of 2020 to 2021 modified these trends and how dentistry should respond to them. Chief considerations were how to improve population health, access to care, and quality of care; how to reduce health care disparities and costs; and how to educate and maintain an adequate health care workforce for the future. Knowledge Transfer Statement: The results of this study can help key stakeholders, such as health care facilities, educational and research institutions, insurance companies, and governmental bodies, plan future activities and policies on dental practice and education.

Dentistry and medicine traditionally practice as separate professions despite sharing goals for optimal patient health. Many US residents experience both poor oral and general health, with difficulty accessing care. More efficient collaboration between these professions could enhance health. The COVID-19 pandemic disclosed further disparities while underscoring concerns that physician supply is inadequate for population needs. Hence, enhancing healthcare provider education to better meet the public's health needs is critical. The proposed titles “Oral Physician” or “Oral Health Primary Care Provider” (OP-PCP) acknowledge dentist's capacity to diagnose and manage diseases of the orofacial complex and provide some basic primary healthcare. The US Surgeon General's National Prevention Council and others recommend such models. Medical and dental education already overlap considerably, thus it is plausible that dental graduates could be trained as OP-PCPs to provide primary healthcare such as basic screening and preventive services within existing dental education standards. In 2018, 23 dental and medical educators participated in an expert-opinion elicitation process to review educational competencies for this model. They demonstrated consensus on educational expansion and agreed that the proposed OP-PCP model could work within existing US Commission on Dental Accreditation (CODA) standards for predoctoral education. However, there were broader opinions on scope of practice details. Existing CODA standards could allow interested dental programs to educate OP-PCPs as a highly-skilled workforce assisting with care of medically-complex patients and to helping to reduce health disparities. Next steps include broader stakeholder discussion of OC-PCP competencies and applied studies including patient outcome assessments.

In response to the increasing incidence of certain oral and oropharyngeal cancers, the Society of Behavioral Medicine (SBM) calls on healthcare providers and legislators to expand awareness of oral and oropharyngeal cancer risk factors, increase early detection, and support policies that increase utilization of dental services. SBM supports the American Dental Association's 2017 guideline for evaluating potentially malignant oral cavity disorders and makes the following recommendations to healthcare providers and legislators. We encourage healthcare providers and healthcare systems to treat oral exams as a routine part of patient examination; communicate to patients about oral/oropharyngeal cancers and risk factors; encourage HPV vaccination for appropriate patients based on recommendations from the Advisory Committee on Immunization Practices; support avoidance of tobacco use and reduction of alcohol consumption; and follow the current recommendations for evaluating potentially malignant oral cavity lesions. Because greater evidence is needed to inform practice guidelines in the primary care setting, we call for more research in collaborative health and dental services. We encourage legislators to support policies that expand Medicaid to cover adult dental services, increase Medicaid reimbursement for dental services, and require dental care under any modification of, or replacement of, the Affordable Care Act.

Background. Tobacco use is the leading preventable cause of morbidity and premature mortality and is a significant factor in the development of oral disease. Tobacco dependence education (TDE) has not, however, been consistently integrated into predoctoral education. The authors conducted a study assessing the content and extent of TDE and intervention skills in US and Canadian dental schools.Methods. In 2013, the authors contacted the academic deans of the 74 accredited US and Canadian dental schools to identify the educator who would be most appropriately described as the tobacco-use cessation "champion" at their institution. The authors e-mailed an introductory letter to each school's champion with a hyperlink to a 45-item survey; 2 follow-up emails were sent with links to the survey.Results. The response rate was 66% (N = 49). TDE was taught at 92% of dental schools; 90% of respondents indicated that faculty members were confident to extremely confident in teaching tobacco-related pathology. Only 49% reported this level of confidence in teaching students how to help patients quit tobacco. TDE is taught in periodontics (82%), oral pathology (77%), clinic (66%), oral diagnosis (59%), public health dentistry (55%), pharmacology (55%), oral medicine (52%), and other disciplines (less than 50%).Conclusions. The survey responses revealed that TDE is not a curricular component in all US and Canadian dental schools. Faculty members were most confident in teaching tobacco-related pathology but may lack the interest and skills needed to integrate TDE as part of patient care.Practice Implications. Patients who use tobacco in any form are at an increased risk of developing periodontitis, developing oral cancer, and having poorer surgical outcomes, emphasizing the need for the dental team to be well-prepared through predoctoral dental education.

Background: Caffeine is a methylxanthine which may decrease salivation through adrenergic mechanisms. Few studies have formally tested whether caffeine actually decreases saliva production. Methods: Eleven volunteers collected unstimulated 1-minute saliva production (1-MSP) after an overnight fast, followed shortly by a stimulated 1-MSP while chewing a stick of chewing gum. We then asked them to drink a beverage randomly selected to contain either regular or decaffeinated instant coffee. Caffeine content was doubleblinded. 1-MSP, both unstimulated and stimulated were then collected 30, 60, 90, and 120 minutes later. The following morning the subject followed the same protocol but drank the other kind of beverage. We used a mixedeffects linear model to analyze our data. Results: The adjusted mean difference between decaffeinated and caffeinated 1-MSP was -0.14 ml (p<0.05). Stimulation with chewing gum caused an unadjusted increase of 2.02 ml (p<0.001) and an adjusted increase of 2.01 ml (p<0.05). Variation for the unstimulated 1-MSP was much lower (SD 0.4 ml) than the stimulated 1-MSP (SD 1.01 ml), whereas variation for caffeinated 1-MSP (SD 1.29 ml) was similar to decaffeinated 1-MSP (SD 1.25 ml). Conclusion: Caffeine modestly but significantly decreased both Unstimulated and stimulated saliva production. The effect of caffeine was approximately 6.5% that of stimulation. The effect from caffeine was consistent across both stimulated and unstimulated samples. Additionally, caffeine did not increase the variability of saliva production either within or between individuals, in contrast to the effect from stimulation

Interprofessional education (IPE) is a relatively new part of dental education. Its implementation is mandated by accreditation standards, but it is also essential to good patient care. Diverse dental schools from various regions of North America outline problems they have faced in IPE and the solutions that they have found to surmount these problems. Commonalities and unique features of these problems and solutions are discussed.

Editor's note: In this month's editorial, “Vaccine Hesitancy and Unfalsifiability,” on page 491, I address the rising incidence rates of some vaccine-preventable diseases—including measles—and dentists' roles in allaying patients' fear of the unknown. Dr. Gordon is a professor of oral medicine and associate dean of academic affairs, University of Washington, School of Dentistry, 1959 NE Pacific St., HSB B-530F, Box 357480, Seattle, WA 98195-7480. Dr. MacDonald is a professor, Department of Paediatrics, Faculty of Medicine, Dalhousie University, Nova Scotia, and a staff clinician, Paediatric Infectious Diseases, IWK Health Centre in Halifax, Nova Scotia, Canada.

PURPOSE To compare prevalence of systemic health conditions (SHC) between African American and Caucasian edentulous patients presenting for complete dentures (CD) at an urban dental school. METHODS The study included patients presenting for CD 1/1-12/31/2010, ages 20 to 64 years, and either African American or Caucasian. Covariates included: age group, gender, employment status, Medicaid status, smoking history, and alcohol consumption. SHC included at least one of the following: arthritis, asthma, cancer, diabetes, emphysema, heart attack, heart murmur, heart surgery, hypertension, or stroke. RESULTS The group (n = 88) was 44.3% African American, 65.9% ≥50, 45.5% male, 22.7% employed, and 67.0% with at least one SHC. African Americans were older (p = 0.001) and more likely to have one or more SHC (p = 0.011). Patients with at least one SHC were older (p = 0.018) and more likely female (p = 0.012). The total sample logistic regression model assessing SHC yielded only gender as statistically significant (males < OR 0.32, 95% CI 0.11 to 0.92). Caucasian males were less likely to have SHC (OR 0.17, 95% CI 0.04 to 0.77), and Caucasians ≥50 were more likely (OR 5.36, 95% CI 1.19 to 24.08). African Americans yielded no significant associations. CONCLUSIONS Among selected completely edentulous denture patients at an urban dental school, two out of three patients had at least one SHC. This exploratory study suggests there may be health status differences between African American and Caucasian patients in this setting, calling for further study.

BACKGROUND Determining the potential for malignant transformation of oral lichen planus (OLP) is complicated by difficulties in diagnosis, differentiation from oral lichenoid lesions (OLLs) and the phenomenon of premalignant lesions' exhibiting lichenoid characteristics. The authors of this systematic review evaluated evidence regarding malignant transformation of OLP and characterized transformation prevalence, clinical characteristics of OLP lesions developing into squamous cell carcinoma (SCC) and time to transformation. TYPES OF STUDIES REVIEWED The authors searched PubMed, Embase and Thomson Reuters Web of Science in a systematic approach. They evaluated observational English-language studies involving human participants published in peer-reviewed journals. Inclusion required patients to have the diagnosis of OLP or OLL as confirmed with biopsy results on initial enrollment. They excluded all patients who had dysplasia on initial biopsy of OLP or OLL lesions. RESULTS Sixteen studies were eligible. Among 7,806 patients with OLP, 85 developed SCC. Among 125 patients with OLL, four developed SCC. The rate of transformation in individual studies ranged from 0 to 3.5 percent. The overall rate of transformation was 1.09 percent for OLP; in the solitary study in which investigators evaluated OLL, the rate of transformation was 3.2 percent. Patients' average age at onset of SCC was 60.8 years. The authors noted a slight predominance of female patients among those who experienced malignant transformation. The most common subsite of malignant transformation was the tongue. The average time from diagnosis of OLP or OLL to transformation was 51.4 months. PRACTICAL IMPLICATIONS A small subset of patients with a diagnosis of OLP eventually developed SCC. The most common demographic characteristics of patients in this subset were similar to the most common demographic characteristics associated with OLP in general (that is, being female, being older and being affected in areas common to this condition). It is prudent for clinicians to pursue continued regular observation and follow-up in patients with these conditions, even in patients who do not fit a traditional high-risk category for oral SCC.

Polymorphonuclear neutrophils (PMNs) produce and release copious amounts of reactive oxygen species (ROS) which target potential bacterial invaders but also contribute to the inflammation-associated organ injuries seen in sepsis. Calprotectin is an immune regulatory protein complex made of S100A8 and S100A9 that inhibits the oxidative metabolism of PMNs in vitro, an effect that can be potentiated by the controlled activation of the protease activated receptor-2 (PAR2). The aim of this study was to test the use of a dual strategy of calprotectin and PAR2 administration to mitigate the deleterious inflammation seen in sepsis. We hypothesized that exogenous calprotectin would protect against the injuries produced by lipopolysaccharides (LPS)-induced endotoxemia and that the controlled activation of PAR2 would potentiate this beneficial effect. Exogenous S100A8 and/or a PAR2 activating peptide (PAR2 AP) were administered in a mouse model of LPS induced endotoxemia. The survival rates as well as markers of inflammation and oxidative damage were measured in the lungs, kidneys, and livers of endotoxemic mice. Mice treated with S100A8 following LPS had less PMN infiltration and less severe histological changes in their lungs, kidneys, and livers. A significantly lower score of oxidative damage in the livers and lungs of S100A8/LPS treated mice was also noted when compared to mice treated with LPS alone. This protective and anti-inflammatory effect of S100A8 was potentiated by the controlled activation of PAR2. Finally, in further support to our hypothesis, the survival rate was almost doubled from 33% to 65% and 63% in mice treated by, respectively, S100A8 and PAR2 AP, whereas 85% of the mice treated with both PAR2 AP and S100A8 survived, a statistically significant higher rate. These results support an anti-inflammatory, anti-oxidative, and protective effect of S100A8 in sepsis, and warrant further studies on the role of PAR2.

This review highlights what is known regarding differences in tooth loss by sex/gender, and describes: gender-related tooth ablation (the deliberate removal of anterior teeth during life) found in skulls from history and prehistory; potential mediators of the relationship between sex/gender and tooth loss; the current epidemiology of gender differences in tooth loss (limited to North America); and risk factors for tooth loss in the general population and in women.

Salivary gland tumors are rare, clinically diverse neoplasms that represent less than 1% of all malignancies. In locoregional recurrent or metastatic disease, systemic therapy is the standard approach. While numerous small phase II studies have evaluated the activity of cytotoxic agents, either alone or in combination, the response rates are generally modest with objective response rates ranging from 15%–50%. Duration of response is cited in the range of 6–9 months. Given this, further evaluation of novel therapies is mandatory in these diseases. With the emergence of molecular targeted therapy, these tumors become optimal candidates for trials of investigational drugs and established drugs for new indications. Of note, given the often indolent nature of disease, only patients with progressive disease should be enrolled and treated on these clinical trials. Study designs must incorporate stringent inclusion criteria to enable accurate reporting of disease response and stabilization. With dedication and co-operation, patients with these rare neoplasms can be accrued to clinical trials and the establishment of new treatment guidelines will be forthcoming.