The herpesvirus protease: mechanistic studies and discovery of inhibitors of the human cytomegalovirus protease

This paper is a review of the literature on the possible association between osteoporosis and oral bone loss, with an emphasis on radiological studies. Such an association was first suggested in 1960. Subsequent histomorphometric and microradiographic studies showed that after the age of 50 there was a marked increase in the cortical porosity of the mandible, with this increase being greater in the alveolar bone than the mandibular body; and that with this increase in porosity, there was a concomitant decrease in bone mass, which appeared to be more pronounced in females than in males, with the loss in bone mineral content estimated to be 1.5% per year in females and 0.9% in males. These studies also demonstrated a considerable amount of variation in the amounts of cortical and trabecular bone within and among individuals. Subsequent clinical studies reported associations between the bone densities of jaws and (1) metacarpals, (2) forearm bones, (3) vertebrae and (4) femurs. These studies indicated that women had lower mandibular bone mineral content (BMC) than men and that age-related loss of bone was more pronounced in women after the age of 50 years than in men of the same age, as was the case for the rest of the body. It was suggested that systemic factors responsible for osteoporotic bone loss may combine with local factors (periodontal diseases) to increase rates of periodontal alveolar bone loss. Although not all studies found associations between osteoporosis and oral bone loss, the conclusion of this review is that such an association exists; yet additional longitudinal investigations are needed to confirm this, and before the implications of this association could be fully utilized in clinical dentistry, inexpensive methods must be developed for sensitive and specific measures of oral bone loss.     

Alcohol and smoking. The risk factors for the oral cavity

A higher risk for the development of oral cancer was associated with heavy smoking and heavy drinking, but alcohol drinking and tobacco smoking are also correlated with other oral cavity disease. Tobacco is the most important factor of leukoplakia, but other diseases like ANUG, periodontitis, median rhomboid glossitis, chronic hyperplastic candidiasis and others are also correlated to cigarette smoking. It was observed that smokers have more plaque than non-smokers, even if no difference in the bacteria composition was found between smokers and non-smokers samples, and the vascular reaction associated with plaque induced gingivitis is suppressed in smokers. Periodontitis are generally considered to be a consequence of an unfavourable host-parasite interaction, but personal factors that diminish the efficiency of the host defence, like tobacco smoking and alcohol drinking, can play an important role in the development of periodontal diseases. Cigarette smoking may be considered a major risk factor for periodontitis and it can also increase its severity; therefore, alveolar bone loss increases with tobacco smoking. Recent investigations show that smokers respond less favourably than no smokers to the different modalities of periodontal therapy, as surgical and non surgical, or guided tissue regeneration. Moving from these observations the authors critically analyze the literature concerning these important risk factors which appear to be strongly correlated with periodontal diseases.     

Restoration of rat liver L-threonine dehydratase activity by pyridoxamine 5''-phosphate: the half-transaminating activity of L-threonine dehydratase and its regulatory role

OBJECTIVE: The objective of this study is to estimate the risk of subarachnoid hemorrhage produced by oral contraceptive use. METHODS: Studies published since 1960 were identified using MEDLINE, Cumulated Index Medicus, Dissertation Abstracts On-line, and bibliographies of pertinent articles. Two independent reviewers screened published cohort and case-control studies that evaluated the risk of subarachnoid hemorrhage associated with oral contraceptives. Eleven of 21 pertinent studies met predefined quality criteria for inclusion in the meta-analysis. Relative risk (RR) estimations evaluating subarachnoid hemorrhage risk in oral contraceptive users compared with nonusers were extracted from each study by two independent reviewers. Study heterogeneity was assessed by design type, outcome measure (mortality versus incidence), exposure measure (current versus ever use), prevailing estrogen dose used, and control for smoking and hypertension. RESULTS: The overall summary RR of subarachnoid hemorrhage due to oral contraceptive use was 1.42 (95% CI, 1.12 to 1.80; p = 0.004). When the two study results failing to control for smoking were excluded from the analysis, a slightly greater effect was seen, with an RR of 1.55 (95% CI, 1.26 to 1.91; p < 0.0001). In the six studies controlling for smoking and hypertension the RR was 1.49 (95% CI, 1.20 to 1.85; p = 0.0003). High-estrogen oral contraceptives appeared to impart a greater risk than low-dose preparations in studies controlling for smoking, but the difference was not significant (high-dose RR, 1.94; 95% CI, 1.06 to 3.56; low-dose RR, 1.51; 95% CI, 1.18 to 1.92). CONCLUSIONS: This meta-analysis of observational studies suggests that oral contraceptive use produces a small increase in the risk of subarachnoid hemorrhage.     

Immunologic and clinical evaluation of postsurgical necrotizing sclerocorneal ulceration

The effect of active and passive cigarette smoking on CYP1A2-mediated phenacetin disposition was evaluated in a controlled study of 36 healthy Chinese subjects. Each subject was administered a single oral dose of phenacetin (900 mg), and frequent blood samples were taken for up to 12 hours for simultaneous high-pressure liquid chromatography determinations of plasma concentrations of phenacetin and metabolically derived paracetamol. Compared with values observed in controls not exposed to cigarette smoking, subjects who smoked 7 to 40 (median, 20) cigarettes per day exhibited a 2.5-fold higher phenacetin apparent oral clearance (7.2, 4.3-12.0 L x h(-1) x kg(-1) vs 2.9, 1.8-4.6 L x h(-1) x kg(-1) [geometric means, 95% confidence intervals]; n = 12, p < 0.05). In subjects exposed to passive smoking, phenacetin's apparent oral clearance (3.6, 2.0-46.6 L x h(-1) x kg(-1), n = 12) was intermediate between the values observed in the two other groups. Plasma paracetamol levels were moderately lower in active smokers than in passive smokers and controls. These results demonstrated that, in contrast to results found in previous studies, Chinese subjects were fully susceptible to the inducing effect of cigarette smoke on CYP1A2 activity.     

Health hazards when using snuff

Snuff taking produces a white to yellowish, wrinkled lesion of the oral mucosa at the site where the quid is placed. The lesion is reversible, and only rarely exhibits dysplasia. Gingival recession and loss of attachment may occur in conjunction with the mucosal lesion. The risk of oral cancer varies greatly among the different published studies, from a relative risk of 48 to no increase in risk at all. Case control studies have found no association between oral tobacco and bladder cancer, whereas cigarette smoking carries a relative risk of about two. There appears to be no evidence for an association between oral snuff and cancer in general when the analysis takes into account confounders such as occupation, smoking and alcohol. The epidemiological evidence for an association with cardiovascular disease is contradictory. Snuff may probably cause hypertension, and one large study has reported a relative risk of 2 for dying of ischaemic heart disease. Biochemical evidence disfavors the hypothesis that snuff is atherogenic. In conclusion, the health hazards of oral moist snuff seem modest, and very much smaller than those of cigarette smoking.     

Dentition, diet, tobacco, and alcohol in the epidemiology of oral cancer

Interview and dental examination data were gathered on 584 males with cancer of the oral cavity and on 1,222 control patients with nonneoplastic diseases at Roswell Park Memorial Institute, Buffalo, New York. No dietary characteristics distinguished cancer patients from controls. However, a higher risk of developing oral cancer was associated with heavy smoking, heavy drinking, and poor dentition. When controlled for the other factors, each factor carried a higher risk. Moreover, heavy smokers and heavy drinkers with poor dentition and males with all three traits had a substantially higher risk than would have been expected, if the traits were considered additively. The risk for males with all three traits was 7.7 times that of men with none of these traits.     

Occupational health promotion programs to reduce cardiovascular risk.

This article surveys the literature on worksite health-promotion programs that target cardiovascular risk factors. We review findings in the areas of health-risk appraisal, hypertension control, smoking cessation, weight reduction, and exercise. Programs that address multiple risk factors are also discussed. In each area we discuss what is currently known, highlight exemplary studies, and identify both problems and priorities for future research. Increased attention needs to be paid to motivational and organizational issues that may influence participation in and outcomes of health promotion programs. The initial results in several areas (e.g., smoking cessation, hypertension control) are promising, but additional controlled research is needed to substantiate the optimistic claims that have been made about occupational health promotion. In particular, studies that evaluate impact on all employees in an organization are recommended. Clinicians and researchers also need to appreciate the unique political, logistical, and methodological issues posed by worksite programs. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Association between marginal bone loss around osseointegrated mandibular implants and smoking habits: a 10-year follow-up study

While many factors are conceivable, occlusal loading and plaque-induced inflammation are frequently stated as the most important ones negatively affecting the prognosis of oral implants. Currently, little is known about the relative importance of such factors. The aim of this study was to analyze the influence of smoking and other possibly relevant factors on bone loss around mandibular implants. The participants were 45 edentulous patients, 21 smokers and 24 non-smokers, who were followed for 10-year period after treatment with a fixed implant-supported prosthesis in the mandible. The peri-implant bone level was measured on intraoral radiographs, information about smoking habits was based on a careful interview, and oral hygiene was evaluated from clinical registration of plaque accumulation. Besides standard statistical methods, multiple linear regression models were constructed for estimation of the relative influence of some factors on peri-implant bone loss. The long-term results of the implant treatment were good, and only three implants (1%) were lost. The mean marginal bone loss around the mandibular implants was very small, about 1 mm for the entire 10-year period. It was greater in smokers than in non-smokers and correlated to the amount of cigarette consumption. Smokers with poor oral hygiene showed greater marginal bone loss around the mandibular implants than those with good oral hygiene. Oral hygiene did not significantly affect bone loss in non-smokers. Multivariate analyses showed that smoking was the most important factor among those analyzed for association with peri-implant bone loss. The separate models for smokers and non-smokers revealed that oral hygiene had a greater impact on peri-implant bone loss among smokers than among non-smokers. This study showed that smoking was the most important factor affecting the rate of peri-implant bone loss, and that oral hygiene also had an influence, especially in smokers, while other factors, e.g., those associated with occlusal loading, were of minor importance. These results indicate that smoking habits should be included in analyses of implant survival and peri-implant bone loss.     

The association between cigarette smoking and selected HIV-related medical conditions

OBJECTIVE: To clarify the effect of cigarette smoking on the development of conditions associated with HIV infection. DESIGN: Prospective and retrospective cohort study, with interview and examination twice a year since 1988. METHODS: Data on 516 HIV-infected men from cohorts of homosexual and bisexual men in San Francisco, Denver and Chicago, who were repeatedly interviewed and examined between 1988 and 1992, were analysed. After excluding men who did not have well-defined dates of seroconversion and those who were classified as ex- or intermittent smokers, 232 men remained for analysis: 106 were smokers and 126 were non-smokers. Univariate and Kaplan-Meier survival analyses were performed to assess the relationship between cigarette smoking and loss of CD4+ T-lymphocytes, diagnosis of any AIDS-defining illness, and specific diagnosis of Kaposi's sarcoma, Pneumocystis carinii pneumonia (PCP), oral candidiasis, hairy leukoplakia, and community-acquired pneumonia. RESULTS: By univariate analyses, cigarette smoking was not associated with clinical AIDS, loss of CD4+ cells, Kaposi's sarcoma or PCP, but was significantly associated with oral candidiasis [relative risk (RR), 1.32; 95% confidence interval (CI), 1.02-1.70], hairy leukoplakia (RR, 1.51; 95% CI, 1.15-1.99), and community-acquired pneumonia (RR, 2.62; 95% CI, 1.30-5.27). Dose-response effect was also evident for these three conditions (all P < 0.01). Kaplan-Meier survival analysis indicated no association between cigarette smoking and time of progression to clinical AIDS, Kaposi's sarcoma (KS), or PCP (P = 0.62, 0.54 and 0.11, respectively) but showed that cigarette smokers developed oral candidiasis, hairy leukoplakia, and pneumonia more quickly than non-smokers (P = 0.031, 0.006 and 0.009, respectively). CONCLUSIONS: Cigarette smoking was not associated with an increased likelihood or rate of developing KS, PCP or AIDS, but was associated with developing community-acquired pneumonia, oral candidiasis, and hairy leukoplakia in these HIV-infected men.     

A study of the prevalence of and risk factors for ear diseases and hearing loss in primary school children in Hat Yai, Thailand

2,184 primary school children in Hat Yai Municipality, Southern Thailand were screened for ear diseases and hearing loss using screening audiometry, portable tympanometry and otoscopy to identify children with possible ear problems, 754 children failed the initial screen, 728 were retested and a group of 243 were referred for ENT examination and standard audiometry-tympanometry. Children with hearing loss and otitis media were thus identified. A questionnaire to identify possible risk factors was administered. The prevalence of otitis media in this population was found to be 3.25 per cent (AOM 0.69%, OME 1.14%, COM 1.74%). No risk factor identified as significant were found. Non-significant factors included sex, age, URI last month, father smoking, mother smoking and method of transport to school as an indication of social status. This study contrasts with a previous study in 1990 which showed a 3.5 per cent prevalence of COM.     

Informatics in the service of health, a look to the future

Recent studies have demonstrated that smoking is associated with periodontal destruction. The majority of these studies have focused on periodontal disease groups with moderate or severe periodontal destruction. Additionally, there have been few reports investigating the relationship between smoking and gingival recession. The goal of this report was to investigate the effect of smoking on periodontal destruction and recession in subjects with minimal or no interproximal attachment loss. This is a cross-sectional study of 142 non-smoking subjects and 51 smoking subjects. Subjects could have no more than one tooth with a site of interproximal attachment loss > or =2 mm. Subjects could, however, have attachment loss associated with recession. For three different methods of summarizing attachment loss measurements at a subject level, including average attachment loss, percentage of teeth with one site of 2 mm of attachment loss, and the percentage of teeth with one site of 5 mm of attachment loss, smoking subjects had approximately twice as much attachment loss than their non-smoking counterparts. Smoking subjects also had significantly greater recession (P < 0.05) [0.056+/-0.017 mm] than non-smoking subjects (0.025+/-0.005 mm). Recession sites occurred primarily on the facial surface of maxillary molars and bicuspids and mandibular central incisors and bicuspids. The results suggest a strong association between smoking and both attachment loss and recession in subjects who have minimal or no periodontal disease.     

Cigarette smoking, bacterial pneumonia, and other clinical outcomes in HIV-1 infection. Terry Beirn Community Programs for Clinical Research on AIDS

Cigarette smoking has been associated with impaired immune defenses and an increased risk of certain infectious and neoplastic diseases in HIV-1 seronegative populations. We examined the relationship between cigarette smoking and clinical outcome in a prospective cohort of 3221 HIV-1-seropositive men and women enrolled in the Terry Beirn Community Programs for Clinical Research on AIDS. Differences in clinical outcomes between never, former, and current cigarette smokers were assessed using proportional hazards regression analysis. After adjustment for CD4+ cell count, prior disease progression, use of antiretroviral therapy, and other covariates, there was no difference between current smokers and never smokers in the overall risk of opportunistic diseases [relative hazard (RH) = 1.05; 95% confidence interval (CI) 0.90-1.23; p = 0.52] or death (RH = 1.00; 95% CI 0.86-1.18; p = 0.97). However, current smokers were more likely than never smokers to develop bacterial pneumonia (RH = 1.57; 95% CI 1.14-2.15; p = 0.006), oral candidiasis (RH = 1.37; 95% CI 1.16-1.62; p = 0.0002), and AIDS dementia complex (RH = 1.80; 95% CI 1.11-2.90; p = 0.02). In addition, current smokers were less likely to develop Kaposi's sarcoma (RH = 0.58; 95% CI 0.39-0.88; p = 0.01) and several other non-respiratory tract diseases. If confirmed by other studies, these findings have important clinical implications.     

Parental influences on adolescents' oral health behavior: two-year follow-up of the Norwegian Longitudinal Health Behavior Study participants

This study explores the influences of parents' behavior and the parent-child relationship upon adolescents' smoking, oral hygiene performance and intake of sugared foods. In 1993 (Time 1), a representative sample of 709 16-yr-old adolescents in Hordaland County, Norway and their parents completed questionnaires at home. A postal follow-up 2 yr later (Time 2) provided 781 answers. The present analyses included 597 cohort participants who responded on both occasions, and 460 mothers and 399 fathers who replied in 1993. Influence of the parent-child relationship was assessed in terms of two scales: parental support and parental control of the youngsters. Multivariate regression analyses indicated that adolescents' oral health behaviors at Time 1, were each powerful predictors of their corresponding behaviors at Time 2. When the Time 1 parental behavior and the Time 2 parent-child relationship scales were added, mothers' oral hygiene performance and sugar intake accounted for a significant amount of the variance in the corresponding behaviors of adolescents at Time 2. Fathers' smoking and the parental control scale contributed to the prediction of adolescents' Time 2 smoking. These results extend previous ones obtained from cross-sectional studies and give further support to the importance of including the family in prevention campaigns aimed at adolescents.     

Compliance with cardiovascular disease prevention strategies: a review of the research

The efficacy of cardiovascular risk-reduction programs has been established. However, the extent to which risk-reduction interventions are effective may depend on adherence. Non-compliance, or non-adherence, may occur with any of the recommended or prescribed regimens and may vary across the treatment course. Compliance problems, whether occurring early or late in the treatment course, are clinically significant, as adherence is one mediator of the clinical outcome. This article, which is based on a review of the empirical literature of the past 20 years, addresses compliance across four regimens of cardiovascular risk reduction: pharmacological therapy, exercise, nutrition, and smoking cessation. The criteria for inclusion of a study in this review were: (a) focus on cardiovascular disease risk reduction; (b) report of a quantitative measure of compliance behavior; and (c) use of a randomized controlled design. Forty-six studies meeting these criteria were identified. A variety of self-report, objective, and electronic measurement methods were used across these studies. The interventions employed diverse combinations of cognitive, educational, and behavioral strategies to improve compliance in an array of settings. The strategies demonstrated to be successful in improving compliance included behavioral skill training, self-monitoring, telephone/mail contact, self-efficacy enhancement, and external cognitive aids. A series of tables summarize the intervention strategies, compliance measures, and findings, as well as the interventions demonstrated to be successful. This review reflects the progress made over two decades in compliance measurement and research and, further, advances made in the application of behavioral strategies to the promotion of cardiovascular risk reduction.     

Knowledge and beliefs regarding the consequences of cigarette smoking and their relationships to smoking status in a biracial sample.

198 men and 413 women responded to random telephone surveys in Fargo, North Dakota and Memphis, Tennessee. Each S was given the Smoking Attitudes Survey, which assesses generalized health beliefs and health-related problems associated with smoking. Ss' knowledge of smoking-associated diseases and diseases not associated with smoking was also assessed. Stepwise regression analysis of composite knowledge scores revealed 4 predictors of the health consequences of smoking: education, race, smoking status, and income. Smokers reported less knowledge and less concern about health consequences of smoking, were more likely to be male, and were more concerned about health consequences of cholesterol. The best predictor of smokers who had never attempted cessation was their greater concern over weight control, compared with smokers with a history of smoking-cessation attempts. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Tobacco and smoking: environmental factors that modify the host response (immune system) and have an impact on periodontal health

This review summarizes the current data on the effects of smoking and tobacco on the immune system and its potential impact on periodontal health. Smokers are 2.5-6 times more likely to develop periodontal disease than non-smokers, and there is evidence for a direct correlation between the number of cigarettes smoked and the risk of developing disease. Tobacco users also tend to exhibit increased severity of periodontal disease. Direct correlations between tobacco use and increased attachment loss and pocket depth and reduced bone crest height have been reported. Although the correlation between tobacco use and periodontal disease is quite strong, the role of tobacco in the pathogenesis of periodontal disease is uncertain. Recent studies indicate that one potential mechanism is that tobacco use exacerbates periodontal disease because it alters the immune response to periodontal pathogens. Indeed, smokers exhibit increased numbers of peripheral blood mononuclear phagocytes which appear to be functionally compromised. Inadequate phagocyte activity could reduce the clearance of pathogens from the oral cavity and thereby facilitate the development of periodontal disease. Tobacco-exposed B- and T-lymphocytes exhibit reduced proliferative capacities which could limit the production of protective immunoglobulins against oral pathogens. The risk factors for periodontal disease can be broadly classified as genetic, environmental, host-response factors, and host-related factors such as age. Tobacco, an environmental factor, undermines the host response and may facilitate the development and progression of periodontal disease. This review highlights the inter-relatedness of two of the risk factors associated with periodontal disease.     

Preventing substance abuse with children and adolescents.

Reviews research, from 1977 to 1984, on the prevention of tobacco, alcohol, and drug abuse with children and adolescents. The review is organized according to an intervention focus on the agent, environment, and host. A study, involving 193 6th graders and skills and attention-placebo interventions, examined methods and results of host-oriented skills intervention to prevent cigarette smoking. Results suggest that attention-placebo interventions (e.g., oral quizzes, games, debates) were insufficient to prevent smoking. Based on the review, conceptual and methodological progress in substance abuse prevention research is noted. Suggestions for future research include technological improvements necessary to implement preventive interventions on a wide scale. Highlighted are the importance of careful designs: manipulation checks on independent variables; process data collection; multimodal measures of self-report, behavioral, and physiological variables; and multivariate statistical analyses in studies on interventions to prevent tobacco, alcohol, and drug abuse with children and adolescents. (75 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Women as dental patients: are there any gender differences?

There is an increasing awareness that gender differences affect both health and disease. This review looks at gender differences as they pertain to the mouth. Not only does pregnancy, the menstrual cycle and the menopause affect the oral tissues but there are also gender differences in regard to patterns of dental disease as women access dental care differently and react to health promotion in a more positive manner. Women live longer and are therefore more likely to be on drugs which complicate treatment. Care must also be taken in prescribing drugs during pregnancy and lactation and attention must be paid to the interaction of drugs with oral contraceptives. Certain systemic diseases such as Sj?grens syndrome, rheumatoid arthritis and anorexia nervosa which have specific oral manifestations are especially common in women. Although oral cancer is mainly a problem among men the rise in smoking among young women poses a problem for the future. HIV/AIDS can be diagnosed on the basis of oral lesions and this may be of great importance in the event of a pregnancy. Although facial pain and facial arthromyalgia (temporomandibular joint dysfunction) pain are common in the population, women come forward for treatment much more frequently. Burning syndrome is especially common among post menopausal women and urgently needs more research.     

The efficacy of motivational interviewing: A meta-analysis of controlled clinical trials.

A meta-analysis was conducted on controlled clinical trials investigating adaptations of motivational interviewing (AMIs), a promising approach to treating problem behaviors. AMIs were equivalent to other active treatments and yielded moderate effects (from .25 to .57) compared with no treatment and/or placebo for problems involving alcohol, drugs, and diet and exercise. Results did not support the efficacy of AMIs for smoking or HIV-risk behaviors. AMIs showed clinical impact, with 51% improvement rates, a 56% reduction in client drinking, and moderate effect sizes on social impact measures (d=0.47). Potential moderators (comparative dose, AMI format, and problem area) were identified using both homogeneity analyses and exploratory multiple regression. Results are compared with other review results and suggestions for future research are offered. (PsycINFO Database Record (c) 2010 APA, all rights reserved)