Millions of people in the United States experience a reduced or distorted ability to smell or taste. Chemosensory disorders such as anosmia (the inability to smell), parosmia (distorted smell), or dysgeusia (altered taste) have major impacts on health and quality of life including difficulty sensing dangers such as fire or spoilage, a diminished palatability of food and drink that can negatively influence diet and nutrition, feelings of social isolation, and an increased incidence of frailty, anxiety, and depression. Smell or taste dysfunction can also be symptoms of other health issues, including sinonasal disease, cancer, or neurodegenerative disease. Aging adults are disproportionately affected. However, smell and taste function are not regularly assessed as a part of routine healthcare despite their prevalence and impact. This is a lost opportunity, as early detection of a chemosensory disorder would enable patients to obtain needed validation, education and support for their health challenge, could direct both patient and provider to treatment options, and may suggest underlying health issues that should be addressed. To better understand the current barriers to including chemosensory testing as a regular component of health care and to identify opportunities to overcome those barriers, the conference "Towards Universal Chemosensory Testing" was convened on November 5-7, 2023, in Philadelphia, PA. This conference brought together scientists, clinicians, patients, and other experts to discuss these issues and identify collective ways to overcome barriers to testing. This white paper-which is focused primarily on the US healthcare system-is the result of those discussions.

Background Polymorphisms at positions 49, 262, and 296 in the TAS2R38 bitter taste receptor gene result in two common genetic haplotypes, PAV and AVI, named for the resulting amino acid substitutions. TAS2R38 genotype has been previously associated with caries risk in children. This study aimed to identify TAS2R38 polymorphisms among Thais and to explore any association between genotype and oral diseases. Methods Patients seeking care at Khon Kaen University Dental Hospital in Thailand were recruited to participate in the study. Saliva was collected for DNA extraction and genotyping. Patients completed a questionnaire to collect demographic variables and assess oral self-care behaviors. A calibrated dentist conducted an examination that included periodontal charting and recording of decayed, missing, and filled teeth (DMFT). Results A total of 250 patients (19–75 years) were enrolled in the study (116 males). Two haplotypes, PAV (67.2%) and AVI (32.8%) were found, resulting in 3 diplotypes; PAV/PAV (46.0%), PAV/AVI (42.4%) and AVI/AVI (11.6%). DMFT and periodontal status of 238 participants were recorded. The three diplotype groups were similar in age, sex, socio-economic indicators, oral self-care, and number of teeth. The odds of having periodontal disease, defined as at least one site with probing depth ≥ 5 mm, were lower in AVI/AVI and PAV/AVI compared with PAV/PAV. PAV/AVI tended to have less DMFT, while AVI/AVI tended to have more DMFT compared with PAV/PAV, however these trends did not reach statistical significance. Conclusions The frequency distribution of TAS2R38 genotypes was similar to that reported for other Asian populations. AVI/AVI genotype was associated with decreased prevalence of periodontal disease among Thai dental patients, whereas there was no significant association between TAS2R38 genotype and prevalence of tooth decay in this patient population.

BACKGROUND:Alaska Native children, including children of Yup'ik descent, consume large volumes of sugar-sweetened fruit drinks, which contain added sugars that contribute to obesity, diabetes, and dental caries. To date, taste preference evaluations have not been conducted on commercially available sugar-free fruit drinks.OBJECTIVE:The study tested the hypothesis that children would have equal preference for sugar-free and sugar-sweetened fruit drinks.DESIGN:This was an experimental two-alternative forced-choice paired preference test.PARTICIPANTS/SETTING:The study focused on a convenience sample of Yup'ik children, aged 7 to 10 years, recruited and enrolled from the Yukon-Kuskokwim Health Corporation dental clinic in Bethel, AK (N=89).INTERVENTION:Children evaluated four different commercially available sugar-free fruit drinks paired with the sugar-sweetened versions of each flavor. Order of flavor pair presentation was alternated across children, and order of presentation within each of the four pairs was randomized across pairs.MAIN OUTCOME MEASURES:The outcome was taste preference for the sugar-free versus the sugar-sweetened version of a fruit drink.STATISTICAL ANALYSES PERFORMED:A test of equivalence was run across all four flavors and separately for each flavor using two one-sided tests.RESULTS:The data failed to demonstrate equivalence of the sugar-free and sugar-sweetened fruit drinks across all four flavors (P=0.51) or separately for each flavor. However, this was not because of a preference for sugar-sweetened drinks. The preference for sugar-free drinks overall and for each flavor was >50%. Although the lower bounds of the 90% CIs were within the range of equivalence (40% to 60%), the upper bounds were outside the range of equivalence (>60%). According to post hoc analyses, similar preferences were observed for Yup'ik and non-Yup'ik children, boys and girls, and children of different ages.CONCLUSIONS:Taste preference findings suggest that sugar-free fruit drinks may be a well-tolerated alternative to sugar-sweetened fruit drinks for Yup'ik children in Alaska Native communities.

Purpose: The United States is typically viewed as a wealthy country, yet not all households have access to enough food for an active, healthy life. The purpose of this study was to validate a two-item written food security screen that health providers may use to identify food insecurity in their patient populations.Methods: Data were obtained from 150 parents or guardians who brought a child to a dental appointment at The Center for Pediatric Dentistry, University of Washington, Seattle, Wash., USA. The sensitivity and specificity of two written questions were determined by comparing with the United States Department of Agriculture Six-item Short Form of the Food Security Survey Module.Results: The sample consisted of 141 surveys after those with critical questions left blank were removed. The prevalence of food insecurity was found to be 31 percent at the Center for Pediatric Dentistry. The six-item screen identified 44 foodinsecure families with an affirmative response to two or more questions. Compared with the six-item screen, the two-item screen was found to have 95.4 percent sensitivity and 83.5 percent specificity.Conclusions: The two-item food security screen was found to be sensitive and reasonably specific, providing a quick and accurate method to identify food-insecure families.

To assess magnitude and characteristics of changes in chemosensory function and quality of life (QOL) for patients receiving hematopoietic stem cell transplantation (HSCT).

HYPOTHESIS:It has been hypothesized that high fungiform papillae density may be a risk factor for developing the taste and pain alterations characteristic of burning mouth syndrome. OBJECTIVE:Evaluate whether fungiform papillae density, taste sensitivity, and mechanical pain sensitivity differ between burning mouth syndrome cases and controls. STUDY DESIGN:This case-control study compared cases diagnosed with primary burning mouth syndrome with pain-free controls. METHODS:Participants (17 female cases and 23 female controls) rated the intensity of sucrose, sodium chloride, citric acid, and quinine applied separately to each side of the anterior tongue and sampled whole mouth. Mechanical pain sensitivity was assessed separately for each side of the tongue using weighted pins. Digital photographs of participants' tongues were used to count fungiform papillae. RESULTS:Burning mouth syndrome cases had increased whole mouth taste intensity. Cases also had increased sensitivity to quinine on the anterior tongue, as well as increased mechanical pain sensitivity on the anterior tongue. Fungiform papillae density did not differ significantly between cases and controls. Fungiform papillae density on the left and right sides of the tongue were correlated in controls; however, there was no left/right side correlation in cases. CONCLUSION:Cases had increased pain and taste perception on the anterior tongue. The lack of correlation between left and right fungiform papillae density in cases may be an indication of asymmetrical lingual innervation in these patients. LEVEL OF EVIDENCE:3b. Laryngoscope, 128:841-846, 2018.

This chapter describes the development of labeled magnitude (LM) scales specifically designed for assessing the pain of dentine hypersensitivity (DH). Qualitative methods were first used to identify words that describe the pain of DH. Next, magnitude estimation was used to determine the position of these words by relative magnitude along four vertical LM scales. The LM scales were then compared to a standard 100-mm visual analog scale (VAS) by asking participants to use the scales to rate different pain scenarios or water applied to sensitive teeth. As expected, participants used a wider range along the LM scales compared with the VAS for rating scenarios involving low-level pain. Use of one of the four LM scales resulted in greater differences in pain reports compared with VAS when two different temperatures of water were applied to sensitive teeth. LM scales specifically designed to assess DH were thus shown to provide some advantages compared with standard VAS scales when used to evaluate DH-associated pain as well as scenarios involving other low-level pain conditions.

•The mRNA expression of the bitter taste receptor T2R38 is differentially regulated by SNPs.•Genotype- and bacteria-specific reduction of antimicrobial peptide hBD-2 secretion is observed in the absence of T2R38.•IL-1a and IL-8 secretion is also genotype-specific for T2R38.•T2R38 modulates innate oral immunity in a genotype-specific manner.•Modulation of hBD-2 secretion via T2R38 may be the mechanism by which the PAV haplotype confers caries protection.

OBJECTIVES:We examined associations of household socioeconomic status (SES) and food security with children's oral health outcomes.METHODS:We analyzed 2007 and 2008 US National Health and Nutrition Examination Survey data for children aged 5 to 17 years (n = 2206) to examine the relationship between food security and untreated dental caries and to assess whether food security mediates the SES-caries relationship.RESULTS:About 20.1% of children had untreated caries. Most households had full food security (62%); 13% had marginal, 17% had low, and 8% had very low food security. Higher SES was associated with significantly lower caries prevalence (prevalence ratio [PR] = 0.77; 95% confidence interval = 0.63, 0.94; P = .01). Children from households with low or very low food security had significantly higher caries prevalence (PR = 2.00 and PR = 1.70, respectively) than did children living in fully food-secure households. Caries prevalence did not differ among children from fully and marginally food-secure households (P = .17). Food insecurity did not appear to mediate the SES-caries relationship.CONCLUSIONS:Interventions and policies to ensure food security may help address the US pediatric caries epidemic.

AIMS:To develop and test labeled magnitude (LM) scales that are sensitive to variations in pain associated with dentin hypersensitivity (DH).METHODS:Qualitative methods were used first to obtain words that describe the pain of DH. Magnitude estimation was then used to determine the position of these descriptive terms by relative magnitude along four vertical LM scales. To assess their DH, patients used the four LM scales following dentin stimulation with 4°C and 25°C water. The LM scales were then compared to visual analog scale (VAS) ratings by using eight pain scenarios of varying severity. Finally, participants with DH completed the four horizontal LM scales and VAS after dentin stimulation with 4°C and 25°C water. Within-subject t tests were used for comparisons between scales and water temperatures, and between-subject t tests were used for comparisons between participants with and without DH.RESULTS:Participants showed comparable differentiation between 4°C and 25°C water on VAS and three of the LM scale measures. Responses on the fourth LM scale showed better differentiation than VAS between the two water temperatures. Participants used a greater portion of the LM scales than VAS when rating low-level pain scenarios.CONCLUSION:LM scales were shown to provide some advantages compared to standard VAS when used to evaluate DH-associated pain. These advantages may be generalized to other low-level pain conditions.

BACKGROUND:Many active pharmaceutical ingredients taste bitter and thus are aversive to children as well as many adults. Encapsulation of the medicine in pill or tablet form, an effective method for adults to avoid the unpleasant taste, is problematic for children. Many children cannot or will not swallow solid dose forms. OBJECTIVE:This review highlights basic principles of gustatory function, with a special focus on the science of bitter taste, derived from studies of animal models and human psychophysics. We focus on the set of genes that encode the proteins that function as bitter receptors as well as the cascade of events that leads to multidimensional aspects of taste function, highlighting the role that animal models played in these discoveries. We also summarize psychophysical approaches to studying bitter taste in adult and pediatric populations, highlighting evidence of the similarities and differences in bitter taste perception and acceptance between adults and children and drawing on useful strategies from animal models. RESULTS:Medicine often tastes bitter, and because children are more bitter-sensitive than are adults, this creates problems with compliance. Bitter arises from stimulating receptors in taste receptor cells, with signals processed in the taste bud and relayed to the brain. However, there are many gaps in our understanding of how best to measure bitterness and how to ameliorate it, including whether it is more efficiently addressed at the level of receptor and sensory signaling, at the level of central processing, or by masking techniques. All methods of measuring responsiveness to bitter ligands-in animal models through human psychophysics or with "electronic tongues"-have limitations. CONCLUSIONS:Better-tasting medications may enhance pediatric adherence to drug therapy. Sugars, acids, salt, and other substances reduce perceived bitterness of several pharmaceuticals, and although pleasant flavorings may help children consume some medicines, they often are not effective in suppressing bitter tastes. Further development of psychophysical tools for children will help us better understand their sensory worlds. Multiple testing strategies will help us refine methods to assess acceptance and compliance by various pediatric populations. Research involving animal models, in which the gustatory system can be more invasively manipulated, can elucidate mechanisms, ultimately providing potential targets. These approaches, combined with new technologies and guided by findings from clinical studies, will potentially lead to effective ways to enhance drug acceptance and compliance in pediatric populations.

A novel delivery method is described that incorporates taste stimuli into edible strips for determining n-propylthiouracil (PROP) taster status. Edible strips that contained 400 or 600nanomoles of PROP were prepared for psychophysical studies. Using these strips, we measured taste intensity, taste hedonics, and taste quality responses in a sample of healthy volunteers (n 118). Participants were also asked to assess a single NaCl strip, a quinine strip, 3 NaCl solutions, and 3 PROP solutions. All psychophysical data were subsequently analyzed as a function of TAS2R38 genotype. The use of PROP strips for distinguishing between individuals with at least 1 PAV allele and individuals with other genotypes was assessed and compared with the use of PROP solutions for making this same distinction. For the 2 PROP strips and PROP solutions, individuals who expressed at least 1 PAV allele could perceive the bitter taste of PROP. Individuals who expressed 2 AVI alleles responded similarly to 400nanomole PROP strips and blank strips. Furthermore, individuals with 2 AVI alleles responded to 0.032 and 0.32mM PROP solutions at intensities that were similar to water, though intensity ratings to 3.2mM PROP solution exceeded water. In general, those with at least 1 PAV allele rated the bitter taste of PROP as unpleasant in both delivery methods (strips or solutions). Psychophysical data from PROP strips and solutions were consistent with TAS2R38 genotype. These results support the validity of edible taste strips as a method for assessing PROP taste perception in humans.

One in four adults reports a clinically significant fear of dental injections, leading many to avoid dental care. While systematic desensitization is the most common therapeutic method for treating specific phobias such as fear of dental injections, lack of access to trained therapists, as well as dentists' lack of training and time in providing such a therapy, means that most fearful individuals are not able to receive the therapy needed to be able to receive necessary dental treatment. Computer Assisted Relaxation Learning (CARL) is a self-paced computerized treatment based on systematic desensitization for dental injection fear. This multicenter, block-randomized, dentist-blind, parallel-group study conducted in 8 sites in the United States compared CARL with an informational pamphlet in reducing fear of dental injections. Participants completing CARL reported significantly greater reduction in self-reported general and injection-specific dental anxiety measures compared with control individuals (p < .001). Twice as many CARL participants (35.3%) as controls (17.6%) opted to receive a dental injection after the intervention, although this was not statistically significant. CARL, therefore, led to significant changes in self-reported fear in study participants, but no significant differences in the proportion of participants having a dental injection (ClinicalTrials.gov, NCT00609648).

The NIH Toolbox for Assessment of Neurological and Behavioral Function (NIH Toolbox) is a set of brief measures for the assessment of cognitive function, emotional health, motor function, and sensory function for use in clinical trials and in epidemiologic and longitudinal studies. Gustatory perception is assessed as 1 of 6 areas of sensory function. A team of 11 scientists with expertise in taste perception selected 2 gustatory measures, 1 of which can be used in young pediatric populations. The measure selected for young pediatric populations assesses sucrose (sweet) taste preference and can also be used across the age span of 5 to 85 years. For adult populations, the selected measure is a regional test, which assesses variability in perceived intensity of quinine hydrochloride (bitter) when applied to the tongue tip as well as perceived with the whole mouth. The team also recommends the regional test for assessing other tastants, such as sodium chloride (salty). Validation studies have demonstrated that the measures modified for the NIH Toolbox correlate with more traditional assessments, and can identify known population differences in gustation.

PURPOSE Increasing awareness about the importance of preventive dental care among low-income families has been considered to be key to overcoming nonfinancial access to care barriers for children. The purpose of this randomized, controlled trial was to measure the impact of postcard mailings on dental utilization by low-income children through a dental society program designed to increase access to dental care. METHODS Five thousand eight hundred and seven low-income 2- to 4-year-olds were randomly assigned to 1 of 3 groups: (1) Group 1 (n=2,014) received postcards containing information on how to enroll in the Yakima County Access to Baby and Child Dentistry program; (2) Group 2 (n=2,014) received the enrollment information as well as additional information on the availability of fluoride varnish and the need to visit the dentist by the age of 1-year-old; and (3) Group 3 (n=1,779) did not receive postcards. RESULTS Preventive services utilization rates were not different among the groups: 61% for Group 1, 62% for Group 2, and 60% for Group 3, although rates were high for a Medicaid population. CONCLUSIONS Postcard mailings did not significantly increase utilization of preventive dental services. Other strategies to increase utilization of preventive oral health measures are needed.