The ability of Streptococcus mutans (S. mutans) to survive in acid is one reason that the species is the main driver of tooth decay worldwide. Past research has shown that this ability has several components including a bacterial enzyme called fatty acid biosynthase M (FabM), which when shut down, makes S. mutans almost precisely 10,000 times more vulnerable to acid damage.

In addition, early work suggests that FabM or one of its relatives may also help all Streptococci (strep) and Staphylococci (staph) infections to resist the human body’s defenses, which include immune cells that subject bacteria to acid. Between them, “strep” and “staph” bacteria are responsible for meningitis, pneumonia, sepsis, methicillin-resistant staph aureus, the “flesh-eating” infection (fasciitis), as well as infections on heart valves and around stents.

While FabM represents a major target for the design of new drugs, the focus of the next round of work is to identify and rank every one of the 2,000 known S. mutans genes that contributes to its “fitness” (ability to survive, out-compete other strains and cause disease). A research team at the University of Rochester Medical Center today announced that it has received a $3.6 million fitness profiling grant from the National Institute of Dental and Craniofacial Research (NIDCR), part of the National Institutes of Health (NIH). Grant-funded projects will seek to create a catalogue of proteins that, along with FabM, can serve as targets for a multi-pronged attack on bacteria that tend to evolve around single-thrust treatments.

“Our first goal is to force the major bacterium behind tooth decay to destroy itself with its own acid as soon as it eats sugar,” said Robert G. Quivey, Ph.D., professor of Microbiology & Immunology at the University of Rochester Medical Center and principal investigator for the grant. “After that, this line of work could help lead to new anti-bacterial combination therapies for many infections that have become resistant to antibiotics.”

Study Details

In 2002, Charles O. Rock, Ph.D., a faculty member within the Department of Infectious Diseases at St. Jude Children’s Research Hospital, published his research describing the existence of the FabM enzyme. Rock, a consultant on Quivey’s grant application, also established the role that the FabM gene plays in the construction of compounds called fatty acids in the membranes of strep bacteria, a barrier they present to surrounding world. Applying the FabM line of work to oral disease for the first time, Quivey and colleagues about two years later published research that FabM enzymes were behind dramatic changes seen, in response to increasing acidity, in the fatty acids that compose the S. mutans membrane.

S. mutans produces lactic acid as a waste product of fermentation, the process by which some ancient lifeforms convert sugar into energy for life without using oxygen. After a great many generations of exposure to its own acid waste, the membranes for this species have become “acid durable.” Quivey’s team has shown that FabM contributes to this durability by making carbon chains, the main functional feature of S. mutans membrane fatty acids, grow longer. In fact, as many as 60 percent of the fatty acids in a bacterial outer membrane undergo this change as acidity increases, Quivey said.

Researchers have already shown that such structural changes protect membranes, presumably by making it more difficult for acids to donate hydrogen ions to them, but they do not yet know why. Forcing hydrogen ions on other compounds gives acid its bad reputation. Remaining questions that the team will be seeking to solve over the next five years include how do longer fatty acids in membranes protect against acid specifically, and how do bacteria sense changes in acidity.

To help answer these questions, Quivey’s team has genetically engineered the first and only mutant form of S. mutans with the FabM gene removed.

This FabM “knockdown” mutant is a living model that shows the exact impact of the enzyme in live bacteria. Without FabM, the mutant fills its outer membrane with other, smaller fatty acids that are much less acid resistant than those normally created via FabM, but that still provide some protection from acid. Thus, a goal is to design a treatment that would prevent S. mutans from forming both straight chain and “smaller chain” fatty acids.

As Quivey and others design next-generation antibacterial drugs, they are looking not just for a single way to stop the action of a single disease-causing enzyme, but how to shut down its three or four back-up systems. The process of cutting off genetic escape routes for bacteria applies to every trait central to the ability of the bacteria to survive and cause disease. Beyond acid durability, the team will also look at the genes and proteins that enable S. mutans to stick to teeth enamel like no other, which it does by producing a sugary polymer (plaque). Tooth decay is the result of plaque combined with acid.

Quivey’s partners in the grant application were Elizabeth Grayhack, Ph.D., research associate professor of Biochemistry and Biophysics, Robert Marquis, Ph.D., professor of Microbiology and Immunology, and Eric Phizicky, Ph.D., professor of Biochemistry and Biophysics. The grant application succeeded with the NIH, Quivey said, because the team and proposal combined many years of experience in genomic projects (Grayhack and Phizicky) with extensive microbial experience (Marquis and Quivey).

As part of the grant, Grayhack and Phizicky will create a library of mutant strains for the 2,000 known S. mutans genes, with each strain having just one of the 2,000 genes shut off. They will then subject the library to acid, for example, and see which strains thrive. Knowing which gene is missing from each strain, researchers will then be able to draw conclusions about each single gene’s contribution to not only to acid durability, but also to many aspects of the strep bacteria’s ability to survive and cause disease.

“Down the road, the finished library will enable researchers to determine every bacterial protein involved in oral disease, to learn their exact structure and to tailor drugs that interfere with them,” said Marquis. “Identifying and turning off say the top four ways in which bacteria might try to resist treatment is the team’s strategy.”

Until August 2006, the state had one of the lowest Medicaid reimbursement rates nationwide, which contributed to a shortage of dentists in low-income and rural areas. Julie Watts McKee, the state’s dental director, said that in 2006, Medicaid reimbursements for children’s dental services were raised by about 30%. However, despite the increase, which was funded by cutting orthodontic benefits, reimbursement rates still are about 50% below the market rate, according to Ken Rich, the state’s dental director for Medicaid. Reimbursement rates for adult dental care are about 65% below the market rate, Rich said.

One of the leading causes of missed school days for Kentucky children is pain caused by dental problems, according to state health officials, and nearly half of the state’s children ages two to four have untreated cavities, while about 10% of state residents are missing all of their teeth, according to 2004 federal data.

Edwin Smith — a dentist who runs Kids First Dental Care, a free mobile clinic in Kentucky, and who provides no-cost care to about half of the patients at his private practice — “has seen the extremes of neglect,” according to the Times. Smith said, “The level of need is hard to believe until you see it up close” (Urbina, New York Times, 12/24/07).

Reprinted with kind permission from http://www.kaisernetwork.org. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at http://www.kaisernetwork.org/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork.org, a free service of The Henry J. Kaiser Family Foundation© 2005 Advisory Board Company and Kaiser Family Foundation. All rights reserved.

The study, published in this month’s Journal of the American Dental Association (JADA), asked 78 patients in Norway to rate their own smiles on a 100-point satisfaction scale. Later, the patients’ regular dentist and an independent periodontist rated the patients’ smiles from photographs, using the same satisfaction scale.

According to the study, patients were more satisfied with their own smiles than dentists, rating them an average 59.1 on the 100-point scale. Dentists’ ratings of the patients’ smiles were much lower, averaging 38.6 (independent periodontist) and 40.7 (patients’ own dentist).

The researchers say that it may be difficult to understand what a smile satisfaction level of 59 really means, adding it might be more accurate to say patients are “accepting of, or contented with, their smiles.”

The study participants, who were not actively seeking cosmetic dental treatments, averaged 51 years of age (range, 22-84 years) and numbered 50 women and 28 men.

“The fact that the patients had much higher opinions of their smiles than we dentists did is interesting,” the researchers state. They explained that patients expressed their opinions from memory, while the dentists made their assessments from photographs.

Had patients used the clinicians’ detailed approach to include assessing lip lines, tooth shade, spacing, and crowding, their opinions about their smiles might have been different, the researchers speculate.

“Dentists should be aware that patients who seek esthetic services may have different perceptions of their smiles than patients who do not express such desires,” concluded researchers.

This study, published in The Journal of the American Dental Association, does not necessarily reflect the policies or opinions of the American Dental Association.

About the American Dental Association

The not-for-profit ADA is the nation’s largest dental association, representing more than 155,000 dentist members. The premier source of oral health information, the ADA has advocated for the public’s health and promoted the art and science of dentistry since 1859. The ADA’s state-of-the-art research facilities develop and test dental products and materials that have advanced the practice of dentistry and made the patient experience more positive. The ADA Seal of Acceptance long has been a valuable and respected guide to consumer and professional products.

American Dental Association

The joint letter, from Dr Hamish Meldrum, Chairman of BMA Council, and Dr Susie Sanderson, Chair of the BDA’s Executive Board, is in response to the Pre-Budget Report announcement that taper relief on Capital Gains Tax will be abolished in April 2008.

Taper relief in effect means that sales of assets which have been owned for more than two years are taxed at 10%. The new arrangements would see the introduction of a flat rate of 18% regardless of how long an asset had been owned. In practice this would leave GPs and dentists who own their premises significantly worse off when they sell their property.

The Chancellor has since offered 100% tax relief on the first £100,000 of any capital gain. However, given the significant amount of capital invested in premises, the BMA and BDA still believe the proposals could jeopardise the retirement plans of thousands of their members.

Dr Susie Sanderson said:

“NHS dentistry relies on dentists investing their own money into practice buildings. This change not only disadvantages those who have made that investment over many years, but could also act as a powerful disincentive to a new generation of potential practice owners. This is a destabilising move at a time when we need more certainty in the system, not less.”

Dr Hamish Meldrum said:

“Not only is this change extremely unfair on GPs, who over the years have invested heavily in their practices to the benefit of patients, in worst case scenarios it could make it harder for patients to access services. It would be understandable if a practice partner nearing retirement brought forward that date because of this change and the government needs to realise the negative impact it could have on healthcare.”

Note:

The full text of the letter is as follows:

Dear Chancellor 16 November 2007

Autumn Pre-Budget Report – Capital Gains Tax

As organisations representing professionals in healthcare in the UK, we wanted to write to express our concern at the proposal to end Capital Gains Tax Taper Relief from April 2008, as announced in your Pre-Budget Report.

Many of our respective members have invested, over many years, significant sums in premises from which to serve their patients. Abolition of taper relief would dramatically reduce the net value of these long-term investments, making similar investment in the future less attractive. This would have particular implications for those practice owners who, having carefully planned their retirement, would be hit by a measure whose impact would be retrospective in practical terms. In worst case scenarios, it could restrict patents’ ability to access these services, particularly if practice premises owners decided to bring forward retirements to before April 2008.

In summary, we urge you to reconsider the proposal, as it will affect a very broad range of professionals in healthcare and potentially impact patient access.

We would also appreciate a meeting with you to articulate our more specific concerns and explore possible solutions.

In view of his interest in the issue and the possible adverse impact of the delivery of healthcare services, we have copied this letter to the Rt Hon Alan Johnson, Secretary of State for Health.

http://www.bda.org.uk

The Company expects significant growth of profitable revenues from this new product. AFP’s entry into the CBCT market was achieved in April 2007 through the successful acquisition of QR srl, Verona, Italy. QR has over ten years of product experience in this field. The Company is well along in integrating and expanding its domestic and foreign sales and manufacturing operations for improved, future efficiency. Management believes there is a strong future for AFP and over the next twelve months CBCT will become a major contributor to profitability. The Company estimates that the world market for Cone Beam CT scanners, over the next few years, could reach more than 4,000 new unit sales. With suggested retail price points of up to $200,000 per unit, the total world market could generate $600 to $800 million in sales, near term. The introduction of the new “VG” model positions AFP to increase its CBCT market share and become a major contributor to the growth of the Company. QR was an early pioneer in research and development of the basic CBCT technology. Vertical, CBCT patient positioning reduces the office space required for the equipment and will often replace an older, two dimensional panoramic x-ray unit. The Company’s software upgrades and product development programs are being expanded for additional medical applications. Currently, AFP has about five hundred of the original New Tom 3-D units installed, worldwide.

Since the acquisition, the Company has significantly invested in sales and marketing programs to bring these CBCT products into commerce. AFP and QR attend and demonstrate all of its x-ray imaging equipment at the major dental trade shows in the USA and internationally. Recently, the Company attended the American Dental Association (September 2007), Greater New York Dental Convention (November 2007) and will be at the Chicago Mid-Winter Exposition in February 2008. AFP also exhibits at numerous other clinical meetings with its veterinary and medical imaging product lines. Sales leads are developed by direct contact with dentists as well as through its independent representatives. The Company promotes directly to end users by advertizing, lecturing at clinical study groups and continuing educational seminars. Internationally, over the past ten years, the Company utilizes a qualified dealer network that sells, install and support our CBCT installations in the global dental marketplace.

The remarks contained in this press release and presented elsewhere by management from time to time contain forward-looking statements, which involve risks and uncertainties, including statements regarding the Company’s plans, objectives, expectations and intentions. The Company’s actual results may differ significantly from the results discussed in this press release or in other forward-looking statements presented by management. Among the factors that could cause actual results to differ materially include the failure of revenue on new products to develop as estimated, regulatory delays, loss of existing customers, the Company’s inability to meet increasing demand for its new products, general downward trends in the Company’s industry and other risk factors as described in the Company’s filings with the Securities and Exchange Commission. The Company expressly disclaims any obligation or undertaking to release publicly any updates or revisions to any such statements to reflect any change in the Company’s expectation or any change in events, conditions or circumstances on which such statement is based.

AFP Imaging Corporation

The award, open to all members of the BDA Good Practice Scheme, recognises outstanding commitment to patient care by the whole dental team. The winning 23-strong team is also a keen supporter of the charity Bridge2Aid.

The practice received the award at the second annual BDA Honours and Awards Dinner in London, sponsored by the British Dental Trade Association. The evening featured presentations by the BDA in recognition of service to dentistry and the BDA, and, for the first time, a range of new awards presented by other dental care professional associations.

“This event has become a true celebration of the dental team, giving recognition to the commitment and talent of some very special individuals. We were delighted to be joined by so many friends and colleagues from across dentistry to mark these achievements,” said Joe Rich, President of the British Dental Association.

The honours and awards presented included BDA life membership to Peter Bainton, John Black, Stanley Gelbier and Douglas Pike. (Peter Bainton was unable to attend the ceremony.) The 2007 British Association of Dental Nurses Award was presented to Paula Sleight.

Entry on the British Association of Dental Therapists Roll of Distinction was conferred upon Tracy Thompson.

BDA Fellowships were awarded to Ralph Davies, Pat Denning and Ellis Paul. (Ralph Davies and Pat Denning were unable to attend the ceremony.)

The British Dental Practice Managers’ Association Executive Award was presented to Chrissie White.

The British Dental Trade Association Award was presented to Norman Freedman.

Entry on the BDA Roll of Distinction was conferred upon Hilary Cook, Hugh Edmondson, John Taylor and the late Julia Campion.

The BDA John Tomes Medal was presented to Jim McDonald.

The Dental Technologists Association Award was presented to Tony Griffin.

Notes:

- The event was attended by 250 members of the dental community, including dentists, dental care professionals and other stakeholders.

- The BDA Good Practice Scheme was launched in 2001 and has become a recognised benchmark for the profession.

- The British Dental Association (BDA) is the professional association for dentists in the UK. It represents over 20,000 dentists working in general practice, in community and hospital settings, in academia and research, and in the armed forces.

The award, open to all members of the BDA Good Practice Scheme, recognises outstanding commitment to patient care by the whole dental team. The winning 23-strong team is also a keen supporter of the charity Bridge2Aid.

The practice received the award at the second annual BDA Honours and Awards Dinner in London, sponsored by the British Dental Trade Association. The evening featured presentations by the BDA in recognition of service to dentistry and the BDA, and, for the first time, a range of new awards presented by other dental care professional associations.

“This event has become a true celebration of the dental team, giving recognition to the commitment and talent of some very special individuals. We were delighted to be joined by so many friends and colleagues from across dentistry to mark these achievements,” said Joe Rich, President of the British Dental Association.

The honours and awards presented included BDA life membership to Peter Bainton, John Black, Stanley Gelbier and Douglas Pike. (Peter Bainton was unable to attend the ceremony.) The 2007 British Association of Dental Nurses Award was presented to Paula Sleight.

Entry on the British Association of Dental Therapists Roll of Distinction was conferred upon Tracy Thompson.

BDA Fellowships were awarded to Ralph Davies, Pat Denning and Ellis Paul. (Ralph Davies and Pat Denning were unable to attend the ceremony.)

The British Dental Practice Managers’ Association Executive Award was presented to Chrissie White.

The British Dental Trade Association Award was presented to Norman Freedman.

Entry on the BDA Roll of Distinction was conferred upon Hilary Cook, Hugh Edmondson, John Taylor and the late Julia Campion.

The BDA John Tomes Medal was presented to Jim McDonald.

The Dental Technologists Association Award was presented to Tony Griffin.

Notes:

- The event was attended by 250 members of the dental community, including dentists, dental care professionals and other stakeholders.

- The BDA Good Practice Scheme was launched in 2001 and has become a recognised benchmark for the profession.

- The British Dental Association (BDA) is the professional association for dentists in the UK. It represents over 20,000 dentists working in general practice, in community and hospital settings, in academia and research, and in the armed forces.

Research by professors José Antonio Gil Montoya and Antonio Cutando Soriano, of the at the University of Granada, advises going to the dentist when patients notice localized hair loss, in order to receive a careful examination of their oral health.

“Alopecia areata is a dermatitis which presents the following signs: The typical pattern is for one or more round bald patches to appear on the scalp, in the beard, or in the eyebrows, or to undergo a loss of eyelashes. Alopecia areata is thought to be an auto-immune disease”, stated the researchers. Hair re-grows in most patients after several months. However, in a quarter of all patients the condition recurs once or more. According to professors at the UGR, the affected hair follicles are not totally destroyed. Therefore, hair can grow back, although patients who have already suffered from alopecia areata may have recurrences.

Unpredictable development

Frequently, patients with alopecia areata have hairs with the shape of an exclamation mark on the border of the bald patch. Hairs become weak and fall out easily. Several studies suggest that alopecia areata has unpredictable development: sometimes hair grows back within a few weeks, but in some cases the disease progresses and can cause further hair loss on scalp and body.

Until the research at the UGR, which establishes for the first time a relationship between alopecia areata and dental disease, the origin of this kind of hair loss was not well known. Hair-follicle tissue inflames without cicatrisation. In alopecia areata, the affected hair follicles are mistakenly attacked by the immune system. Some of the factors that cause alopecia are: genetics, family history of alopecia, non-specific immune reactions, specific auto-immune reactions of certain organs and emotional stress.

“We have found that bald patches caused by tooth infection are not always in the same place. They normally appear on a line projected from the dental infection and can thus can be located on the face at the level of the maxillary teeth, above a line through the lip-angle to the scalp, beard, or even to the eyebrow. Nevertheless, they can also be located far from infection outbreak.” Explained Gil Montoya and Cutando Soriano.

The study, conducted in Japan, examined the effect of periodontal diseases on medical and dental costs in 4,285 patients over a 3.5 year time span. The patients were between the ages of 40-59. Researchers found that cumulative health care costs were 21% higher for those patients with severe periodontal disease than those with no periodontal disease. Severe periodontal disease, or periodontitis, involves bone loss and diminished attachment around the teeth.

“While previous studies have evaluated the potential link between periodontal diseases and other systemic conditions, this study provides an interesting analysis of total health care costs and the financial impact of having periodontal diseases,” explained JOP editor Kenneth Kornman, DDS. “The research suggests that patients with sever periodontal diseases incur higher overall health care expenses as compared to those patients with no periodontal disease. Prevention of periodontal disease may be very important in overall health, and this study suggests that it may also indirectly translate into lower total health care costs.”

“Everyone is looking for ways to reduce health care costs,” said Susan Karabin, DDS, President of the American Academy of Periodontology. “Especially those who are in an age category where they are more susceptible to periodontal diseases. Because of the relationship between the mouth and the rest of the body, treating periodontal disease may be one simple way to decrease total health care costs. If caught early, periodontal diseases can be treated using simple non-surgical techniques which can restore your mouth to a healthy state.”

The research was conducted under the Freedom of Information Act by DPAS chairman Quentin Skinner. It is the first of its kind to give such a detailed account of the delivery shortfalls of the widely criticised new General Dental Service Contracts (nGDS) following their first year of operation.

DPAS’ findings reveal that 48 percent of NHS dentists have delivered less than 96 percent of their agreed units of dental activity (UDAs) during year one of the new contracts, the threshold at which PCTs may insist on making a financial recovery to ‘claw back’ funds. A number of PCTs are known to be in the red making financial penalties for dentists all the more likely.

While some dentists may be sufficiently close to the threshold to be able to agree with their PCT that they can catch up this shortfall in year two (2007 / 08), many are in a much worse position.

The research findings show that more than 11 percent of dentists were short by between 15 percent and 25 percent of their UDA commitment, with a further 11 percent falling behind by a staggering 25 percent.

“Without doubt, there are many NHS dentists all over the country who were so behind in the delivery of their UDAs last year that their cash-strapped PCTs now have no option other than to insist on claw back,” said Quentin Skinner. “Indeed, we know from anecdotal evidence that some have already started doing so, with amounts being demanded running towards six-figure sums at some practices.”

He added: “For those dentists who have under-delivered by four percent, the contract allows this shortfall to be made up by March 31, 2008 at the latest. Such dentists will have to do more work for less money, as their year two revenue is reduced by year one claw back, as well as coping with the pressure of this year’s UDA requirements. Many will find that they have no option other than to agree with their PCT to accept a smaller UDA contract for years two and three and beyond. Thus they are in a position where their NHS earnings will be forced downwards in a one-way only direction.”

Among the average findings are significant regional variations. One PCT reported that every single one of its NHS dentists was more than four percent behind. However, the statistics were generally fairly evenly spread over the country, albeit with slightly higher shortfalls in the South West and the West Midlands. The notable exception was the London PCTs (excluding the more affluent Westminster, Kensington and Chelsea PCTs), where the performance was consistently better.

The national average was brought down significantly by the outcome in these PCTs, who reported that just 23 percent of their contracted dentists had under delivered on average – over three quarters of their dentist providers passed the 96 percent threshold (and so will avoid clawback).

Commenting on these regional variations, Mr Skinner said: “Who knows what the underlying reasons are for this, but for such a significant variation there must indeed be a reason. Perhaps it could be an act of social engineering, by means of giving easier UDA targets to the inner city areas where access is seen as poor and so to encourage the provision of NHS dentistry there, or perhaps inner city practices have a different way of working?”

Concluding, Mr Skinner added: “It’s all a very far cry from former Minister for Health Rosie Winterton’s suggestion of ‘the same money for five percent less work’, and chief dental officer Barry Cockcroft’s promises that the new contract would end the NHS treadmill and deliver guaranteed income. For those NHS dentists who fell short of the mark, the future certainly looks bleak.

“The research carried out by DPAS, together with the national statistics published on the overall total of UDAs delivered against those commissioned, would indicate that whatever the swings and roundabouts contained within the total figures, claw back amounting to over a hundred million pounds would appear to be on the cards.”

nGDS

The new general dental contract was introduced in April 2006, when PCTs were allocated ring-fenced budgets and responsibility for commissioning primary care dental services. The new contract saw the move from a fee-per-item system to one based on locally-agreed contracts between dentists and their PCTs or other primary care organisations. In announcing the new contract to NHS dentists, the chief dental officer for England Barry Cockcroft promised it would deliver an end to the NHS ‘drill and fill’ treadmill; a guaranteed income; enhanced clinical discretion; and more time for preventative work.

DPAS

DPAS is a UK leader in providing dental practices nationwide with cost-effective independent, practice-branded payment plans. Operating as a payment collection agent on behalf of dentists, DPAS’ services also include the arrangement of dental insurance.

Instrumental in the establishment and growth of private dental plans in the UK, the DPAS team is expert at supporting forward-thinking dental practices in offering a range of dental plans under the practice’s own identity and control.

DPAS has unrivalled experience in helping NHS dentists coming under increasing ‘catch-up or claw back’ pressure from their primary case trusts as a result of under-delivering their contractually agreed units of dental authority (UDAs). DPAS has pioneered a fast-track conversion process helping dentists complete the journey to independence. Similarly, DPAS has a proven track record in helping practices move from other plans to its own, more cost-effective plans.

DPAS’ flexible plan options mean a brighter future for dentists, their practices and their patients.