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Cecchin-Albertoni C, Deny O, Planat-Bénard V, Guissard C, Paupert J, Vaysse F, Marty M, Casteilla L, Monsarrat P, Kémoun P. The oral organ: A new vision of the mouth as a whole for a gerophysiological approach to healthy aging. Ageing Res Rev 2024; 99:102360. [PMID: 38821417 DOI: 10.1016/j.arr.2024.102360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Revised: 05/07/2024] [Accepted: 05/28/2024] [Indexed: 06/02/2024]
Abstract
This article brings a new perspective on oral physiology by presenting the oral organ as an integrated entity within the entire organism and its surrounding environment. Rather than considering the mouth solely as a collection of discrete functions, this novel approach emphasizes its role as a dynamic interphase, supporting interactions between the body and external factors. As a resilient ecosystem, the equilibrium of mouth ecological niches is the result of a large number of interconnected factors including the heterogeneity of different oral structures, diversity of resources, external and internal pressures and biological actors. The manuscript seeks to deepen the understanding of age-related changes within the oral cavity and throughout the organism, aligning with the evolving field of gerophysiology. The strategic position and fundamental function of the mouth make it an invaluable target for early prevention, diagnosis, treatment, and even reversal of aging effects throughout the entire organism. Recognizing the oral cavity capacity for sensory perception, element capture and information processing underscores its vital role in continuous health monitoring. Overall, this integrated understanding of the oral physiology aims at advancing comprehensive approaches to the oral healthcare and promoting broader awareness of its implications on the overall well-being.
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Affiliation(s)
- Chiara Cecchin-Albertoni
- Oral Medicine Department and CHU de Toulouse, Toulouse Institute of Oral Medicine and Science, Toulouse, France; RESTORE Research Center, Université de Toulouse, INSERM, CNRS, EFS, ENVT, Université P. Sabatier, Toulouse, France
| | - Olivier Deny
- Oral Medicine Department and CHU de Toulouse, Toulouse Institute of Oral Medicine and Science, Toulouse, France; RESTORE Research Center, Université de Toulouse, INSERM, CNRS, EFS, ENVT, Université P. Sabatier, Toulouse, France
| | - Valérie Planat-Bénard
- RESTORE Research Center, Université de Toulouse, INSERM, CNRS, EFS, ENVT, Université P. Sabatier, Toulouse, France
| | - Christophe Guissard
- Oral Medicine Department and CHU de Toulouse, Toulouse Institute of Oral Medicine and Science, Toulouse, France; RESTORE Research Center, Université de Toulouse, INSERM, CNRS, EFS, ENVT, Université P. Sabatier, Toulouse, France
| | - Jenny Paupert
- RESTORE Research Center, Université de Toulouse, INSERM, CNRS, EFS, ENVT, Université P. Sabatier, Toulouse, France
| | - Frédéric Vaysse
- Oral Medicine Department and CHU de Toulouse, Toulouse Institute of Oral Medicine and Science, Toulouse, France
| | - Mathieu Marty
- Oral Medicine Department and CHU de Toulouse, Toulouse Institute of Oral Medicine and Science, Toulouse, France; LIRDEF, Faculty of Educational Sciences, Paul Valery University, Montpellier CEDEX 5 34199, France
| | - Louis Casteilla
- RESTORE Research Center, Université de Toulouse, INSERM, CNRS, EFS, ENVT, Université P. Sabatier, Toulouse, France
| | - Paul Monsarrat
- Oral Medicine Department and CHU de Toulouse, Toulouse Institute of Oral Medicine and Science, Toulouse, France; RESTORE Research Center, Université de Toulouse, INSERM, CNRS, EFS, ENVT, Université P. Sabatier, Toulouse, France; Artificial and Natural Intelligence Toulouse Institute ANITI, Toulouse, France
| | - Philippe Kémoun
- Oral Medicine Department and CHU de Toulouse, Toulouse Institute of Oral Medicine and Science, Toulouse, France; RESTORE Research Center, Université de Toulouse, INSERM, CNRS, EFS, ENVT, Université P. Sabatier, Toulouse, France.
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Giri S, Takada A, Paudel D, Uehara O, Kurashige Y, Kuramitsu Y, Furukawa M, Matsushita K, Arakawa T, Nagasawa T, Abiko Y, Furuichi Y. Oral infection with Porphyromonas gingivalis augmented gingival epithelial barrier molecules alteration with aging. J Oral Biosci 2024; 66:126-133. [PMID: 38336260 DOI: 10.1016/j.job.2024.01.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 01/26/2024] [Accepted: 01/29/2024] [Indexed: 02/12/2024]
Abstract
OBJECTIVE Disruption of the gingival epithelial barrier is often mediated by aging or the pathogen Porphyromonas gingivalis. This study examined the combined effects of aging and P. gingivalis exposure on gingival epithelial barrier molecules. METHODS In vitro experiments involved treating young- and senescence-induced primary human gingival epithelial progenitor cells (HGEPp) with P. gingivalis lipopolysaccharide (LPS). Transepithelial electrical resistance (TER) and paracellular permeability were measured. In vivo, male C57BL/6J mice aged 10 (young) and 80 (old) weeks were divided into four groups: young, old, young with P. gingivalis (Pg-Young) inoculation, and old with P. gingivalis (Pg-Old) inoculation. P. gingivalis was inoculated orally thrice a week for 5 weeks. The mice were sacrificed 30 days after the last inoculation, and samples were collected for further procedures. The junctional molecules (Claudin-1, Claudin-2, E-cadherin, and Connexin) were analyzed for mRNA expression using qRT-PCR and protein production using western blotting and immunohistochemistry. The alveolar bone loss and inflammatory cytokine levels in gingival tissues were also assessed. RESULTS LPS-treated senescent cells exhibited a pronounced reduction in TER, increased permeability to albumin protein, significant upregulation of Claudin-1 and Claudin-2, and significant downregulation of E-cadherin and Connexin. Furthermore, the Pg-Old group showed identical results with aging in addition to an increase in alveolar bone loss, significantly higher than that in the other groups. CONCLUSION In conclusion, the host susceptibility to periodontal pathogens increases with age through changes in the gingival epithelial barrier molecules.
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Affiliation(s)
- Sarita Giri
- Division of Periodontology and Endodontology, Department of Oral Rehabilitation, School of Dentistry, Health Sciences University of Hokkaido, Hokkaido, Japan
| | - Ayuko Takada
- Division of Biochemistry, Department of Oral Biology, School of Dentistry, Health Sciences University of Hokkaido, Hokkaido, Japan
| | - Durga Paudel
- Advanced Research Promotion Center, Health Sciences University of Hokkaido, Hokkaido, Japan
| | - Osamu Uehara
- Division of Disease Control and Molecular Epidemiology, Department of Oral Growth and Development, School of Dentistry, Health Sciences University of Hokkaido, Hokkaido, Japan
| | - Yoshihito Kurashige
- Division of Pediatric Dentistry, School of Dentistry, Health Sciences University of Hokkaido, Hokkaido, Japan
| | - Yasuhiro Kuramitsu
- Advanced Research Promotion Center, Health Sciences University of Hokkaido, Hokkaido, Japan
| | - Masae Furukawa
- Department of Oral Disease Research, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Kenji Matsushita
- Department of Oral Disease Research, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Toshiya Arakawa
- Division of Biochemistry, Department of Oral Biology, School of Dentistry, Health Sciences University of Hokkaido, Hokkaido, Japan
| | - Toshiyuki Nagasawa
- Division of Advanced Clinical Education, Department of Integrated Dental Education, School of Dentistry, Health Sciences University of Hokkaido, Hokkaido, Japan
| | - Yoshihiro Abiko
- Division of Oral Medicine and Pathology, Department of Human Biology and Pathophysiology, School of Dentistry, Health Sciences University of Hokkaido, Japan
| | - Yasushi Furuichi
- Division of Periodontology and Endodontology, Department of Oral Rehabilitation, School of Dentistry, Health Sciences University of Hokkaido, Hokkaido, Japan.
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Xu KH, Li L, Jia SL, Li Q, Hao JX, Ma S, He ZK, Wan QQ, Cai YF, Li ZT, Tay F, Niu LN. Association of Tooth Loss and Diet Quality with Acceleration of Aging: Evidence from NHANES. Am J Med 2023; 136:773-779.e4. [PMID: 37075877 DOI: 10.1016/j.amjmed.2023.04.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 03/27/2023] [Accepted: 04/01/2023] [Indexed: 04/21/2023]
Abstract
BACKGROUND Although tooth loss is widely recognized as a typical sign of aging, whether it is associated with accelerated aging, and to what extent diet quality mediates this association are unknown. METHODS Data were collected from the National Health and Nutrition Examination Survey. The missing tooth counts were recorded as the number of edentulous sites. Phenotypic accelerated aging was calculated using 9 routine clinical chemistry biomarkers and chronological age. Healthy Eating Index 2015 (HEI-2015) score was used to evaluate diet quality. Multivariate logistic regression and linear regression were used to analyze the association between tooth loss and accelerated aging. Mediation analyses were used to examine the mediation role of diet quality in the association. RESULTS The association between tooth loss and accelerated aging was confirmed. The highest quartile of tooth loss showed a positive association with accelerated aging (β=1.090; 95% confidence interval, 0.555 to 1.625; P < .001). Diet quality decreased with increase number of missing teeth and showed a negative association with accelerated aging. Mediation analysis suggested that the HEI-2015 score partially mediated the association between tooth loss and accelerated aging (proportion of mediation: 5.302%; 95% confidence interval, 3.422% to 7.182%; P < .001). Plant foods such as fruits and vegetables were considered the key mediating food. CONCLUSIONS The association between tooth loss and accelerated aging, as well as the partially mediating role of dietary quality in this association was confirmed. These findings suggested that more attention should be paid to the population with severe tooth loss and the changes of their dietary quality.
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Affiliation(s)
- Ke-Hui Xu
- State Key Laboratory of Military Stomatology & National Clinical Research Center for Oral Diseases & Shaanxi Key Laboratory of Stomatology, School of Stomatology, The Fourth Military Medical University, Xi'an, China
| | - Ling Li
- State Key Laboratory of Military Stomatology & National Clinical Research Center for Oral Diseases & Shaanxi Key Laboratory of Stomatology, School of Stomatology, The Fourth Military Medical University, Xi'an, China
| | - Shuai-Lin Jia
- State Key Laboratory of Military Stomatology & National Clinical Research Center for Oral Diseases & Shaanxi Key Laboratory of Stomatology, School of Stomatology, The Fourth Military Medical University, Xi'an, China; The Third Affiliated Hospital of Xinxiang Medical University, China
| | - Qihong Li
- Department of Stomatology, the Fifth Medical Centre, Chinese PLA General Hospital, Dongda Street, Beijing, China
| | - Jia-Xin Hao
- State Key Laboratory of Military Stomatology & National Clinical Research Center for Oral Diseases & Shaanxi Key Laboratory of Stomatology, School of Stomatology, The Fourth Military Medical University, Xi'an, China; Shanxi Medical University School and Hospital of Stomatology, Taiyuan, China
| | - Sai Ma
- State Key Laboratory of Military Stomatology & National Clinical Research Center for Oral Diseases & Shaanxi Key Laboratory of Stomatology, School of Stomatology, The Fourth Military Medical University, Xi'an, China
| | - Zi-Kang He
- State Key Laboratory of Military Stomatology & National Clinical Research Center for Oral Diseases & Shaanxi Key Laboratory of Stomatology, School of Stomatology, The Fourth Military Medical University, Xi'an, China
| | - Qian-Qian Wan
- State Key Laboratory of Military Stomatology & National Clinical Research Center for Oral Diseases & Shaanxi Key Laboratory of Stomatology, School of Stomatology, The Fourth Military Medical University, Xi'an, China
| | - Yun-Fan Cai
- State Key Laboratory of Military Stomatology & National Clinical Research Center for Oral Diseases & Shaanxi Key Laboratory of Stomatology, School of Stomatology, The Fourth Military Medical University, Xi'an, China; Taihe Hospital of Hubei University of Medicine, Shiyan, China
| | - Zhi-Ting Li
- State Key Laboratory of Military Stomatology & National Clinical Research Center for Oral Diseases & Shaanxi Key Laboratory of Stomatology, School of Stomatology, The Fourth Military Medical University, Xi'an, China; Taihe Hospital of Hubei University of Medicine, Shiyan, China
| | - Franklin Tay
- The Dental College of Georgia, Augusta University
| | - Li-Na Niu
- State Key Laboratory of Military Stomatology & National Clinical Research Center for Oral Diseases & Shaanxi Key Laboratory of Stomatology, School of Stomatology, The Fourth Military Medical University, Xi'an, China.
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van der Putten GJ, de Baat C. An Overview of Systemic Health Factors Related to Rapid Oral Health Deterioration among Older People. J Clin Med 2023; 12:4306. [PMID: 37445340 DOI: 10.3390/jcm12134306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 06/12/2023] [Accepted: 06/19/2023] [Indexed: 07/15/2023] Open
Abstract
The oral health of older individuals can be negatively impacted by various systemic health factors, leading to rapid oral health deterioration. This paper aims to present an overview of the published evidence on systemic health factors that contribute to rapid oral health deterioration in older individuals, and to explore the implications of these factors for both general healthcare and oral healthcare provision. Older people are at risk of experiencing adverse reactions to medications due to multimorbidity, polypharmacy, and changes in pharmacokinetics and pharmacodynamics. Hyposalivation, a significant side effect of some medications, can be induced by both the type and number of medications used. Frailty, disability, sarcopenia, care dependency, and limited access to professional oral healthcare can also compromise the oral health of older people. To prevent rapid oral health deterioration, a comprehensive approach is required that involves effective communication between oral healthcare providers, other healthcare providers, and informal caregivers. Oral healthcare providers have a responsibility to advocate for the importance of maintaining adequate oral health and to raise awareness of the serious consequences of weakened oral health. By doing so, we can prevent weakened oral health from becoming a geriatric syndrome.
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Affiliation(s)
- Gert-Jan van der Putten
- Orpea Dagelijks Leven, 7327 AA Apeldoorn, The Netherlands
- Department of Dentistry, Radboud University Nijmegen Medical Centre, 6525 GA Nijmegen, The Netherlands
| | - Cees de Baat
- Fresh Unieke Mondzorg, 2411 NT Bodegraven, The Netherlands
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Hu J, Song J, Chen Z, Yang J, Shi Q, Jin F, Pang Q, Chang X, Tian Y, Luo Y, Chen L. Reverse causal relationship between periodontitis and shortened telomere length: Bidirectional two-sample Mendelian random analysis. Front Immunol 2022; 13:1057602. [PMID: 36601105 PMCID: PMC9806346 DOI: 10.3389/fimmu.2022.1057602] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 12/05/2022] [Indexed: 12/23/2022] Open
Abstract
Background Observational studies have demonstrated a link between shortened telomere lengths(TL) and chronic periodontitis. However, whether the shortened TL is the cause or the result of periodontitis is unknown.Therefore, our objective was to investigate a bidirectional causal relationship between periodontitis and TL using a two-sample Mendel randomized (MR) study. Methods A two-sample bidirectional MR analysis using publicly available genome-wide association study (GWAS) data was used. As the primary analysis, inverse variance weighting (IVW) was employed. To identify pleiotropy, we used leave-one-out analysis, MR-Egger, Weighted median, Simple mode, Weighted mode, and MR pleiotropy residual sum and outlier (MR-PRESSO). Results In reverse MR results, a genetic prediction of short TL was causally associated with a higher risk of periodontitis (IVW: odds ratio [OR]: 1.0601, 95% confidence interval [CI]: 1.0213 to 1.1002; P =0.0021) and other complementary MR methods. In the forward MR analysis, periodontitis was shown to have no significant effect on TL (IVW: p = 0.7242), with consistent results for the remaining complementary MR. No pleiotropy was detected in sensitivity analysis (all P>0.05). Conclusion Our MR studies showed a reverse causal relationship, with shorten TL being linked to a higher risk of periodontitis, rather than periodontitis shorten that TL. Future research is needed to investigate the relationship between cell senescence and the disease.
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Affiliation(s)
- Jiaxin Hu
- Guiyang Hospital of Stomatology, Stomatology Hospital of Guizhou University, Guiyang, Guizhou, China,School of Stomatology, Zunyi Medical University, Zunyi, Guizhou, China
| | - Jukun Song
- The Affiliated Stomatological Hospital & Stomatology of Guizhou Medical University, Guizhou Medical University, Guiyang, China
| | - Zhu Chen
- Guiyang Hospital of Stomatology, Stomatology Hospital of Guizhou University, Guiyang, Guizhou, China
| | - Jing Yang
- Guiyang Hospital of Stomatology, Stomatology Hospital of Guizhou University, Guiyang, Guizhou, China
| | - Qianhui Shi
- Guiyang Hospital of Stomatology, Stomatology Hospital of Guizhou University, Guiyang, Guizhou, China
| | - Fuqian Jin
- Guiyang Hospital of Stomatology, Stomatology Hospital of Guizhou University, Guiyang, Guizhou, China,School of Stomatology, Zunyi Medical University, Zunyi, Guizhou, China
| | - Qiyuan Pang
- Guiyang Hospital of Stomatology, Stomatology Hospital of Guizhou University, Guiyang, Guizhou, China
| | - Xingtao Chang
- School of Stomatology, Zunyi Medical University, Zunyi, Guizhou, China
| | - Yuan Tian
- Guizhou Provincial People's Hospital, Guiyang, Guizhou, China
| | - Yi Luo
- Guiyang Hospital of Stomatology, Stomatology Hospital of Guizhou University, Guiyang, Guizhou, China,School of Stomatology, Zunyi Medical University, Zunyi, Guizhou, China,*Correspondence: Yi Luo, ; Liming Chen,
| | - Liming Chen
- Guiyang Hospital of Stomatology, Stomatology Hospital of Guizhou University, Guiyang, Guizhou, China,School of Stomatology, Zunyi Medical University, Zunyi, Guizhou, China,*Correspondence: Yi Luo, ; Liming Chen,
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6
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Liu J, Dan R, Zhou X, Xiang J, Wang J, Liu J. Immune senescence and periodontitis: From mechanism to therapy. J Leukoc Biol 2022; 112:1025-1040. [PMID: 36218054 DOI: 10.1002/jlb.3mr0822-645rr] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 08/12/2022] [Accepted: 08/23/2022] [Indexed: 12/24/2022] Open
Abstract
Periodontitis is one of the most prevalent infectious inflammatory diseases, characterized by irreversible destruction of the supporting tissues of teeth, which is correlated with a greater risk of multiple systemic diseases, thus regarded as a major health concern. Dysregulation between periodontal microbial community and host immunity is considered to be the leading cause of periodontitis. Comprehensive studies have unveiled the double-edged role of immune response in the development of periodontitis. Immune senescence, which is described as age-related alterations in immune system, including a diminished immune response to endogenous and exogenous stimuli, a decline in the efficiency of immune protection, and even failure in immunity build-up after vaccination, leads to the increased susceptibility to infection. Recently, the intimate relationship between immune senescence and periodontitis has come into focus, especially in the aging population. In this review, both periodontal immunity and immune senescence will be fully introduced, especially their roles in the pathology and progression of periodontitis. Furthermore, novel immunotherapies targeting immune senescence are presented to provide potential targets for research and clinical intervention in the future.
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Affiliation(s)
- Jiaqi Liu
- Laboratory for Aging Research, State Key Laboratory of Biotherapy & National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, Sichuan, China.,State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases; Department of Orthodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China
| | - Ruichen Dan
- Laboratory for Aging Research, State Key Laboratory of Biotherapy & National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, Sichuan, China.,State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases; Department of Orthodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China
| | - Xueman Zhou
- Laboratory for Aging Research, State Key Laboratory of Biotherapy & National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, Sichuan, China.,State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases; Department of Orthodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China
| | - Jie Xiang
- Laboratory for Aging Research, State Key Laboratory of Biotherapy & National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, Sichuan, China.,State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases; Department of Orthodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China
| | - Jun Wang
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases; Department of Orthodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China
| | - Jin Liu
- Laboratory for Aging Research, State Key Laboratory of Biotherapy & National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, Sichuan, China
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7
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Song W, Yang J, Niu Z. Association of periodontitis with leukocyte telomere length in US adults: A cross-sectional analysis of NHANES 1999 to 2002. J Periodontol 2020; 92:833-843. [PMID: 32996594 DOI: 10.1002/jper.20-0269] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 08/30/2020] [Accepted: 09/10/2020] [Indexed: 01/11/2023]
Abstract
BACKGROUND This study examines the association of periodontitis with telomere length (TL) and effect modification by population characteristics. METHODS We analyzed data from 3,478 participants from the 1999 to 2002 National Health and Nutrition Examination Survey. Probing depth, attachment loss, and bleed on probing (BOP, available for 1,973 participants only) were examined on the distal, mesial, or mid-facial site of each tooth in two randomly selected quadrants. We defined periodontitis severity according to the Centers for Disease Control/American Academy of Periodontology guideline. TL from leukocytes was measured with qPCR. We used linear and logistic regression to examine the adjusted association of different severity of periodontitis and BOP with continuous TL (bp) and dichotomized short TL (<median), respectively. To assess effect modification, we stratified the analyses by a priori selected population characteristics including sex, age, body weight status, smoking, and cardiometabolic comorbidity. RESULTS Moderate BOP (<10% bleeding sites) was significantly associated with a shorter continuous TL (β = -89.0, SE = 37.8). Moderate to severe periodontitis was significantly associated with 47% (95% confidence interval [IL], 1.04 to 2.09) higher odds of shorter TL, compared with those with mild or no periodontitis. The association was stronger in those who were female (adjusted OR, 1.76; 95% CI, 1.10 to 2.83), overweight or obese (adjusted OR, 1.64; 95% CI, 1.12 to 2.41), or had cardiometabolic comorbidities (adjusted OR, 2.13; 95% CI, 1.38 to 3.29). CONCLUSIONS Periodontitis was associated with TL, a biomarker of cellular aging. The association was stronger in females, overweight or obese, or those with cardiometabolic diseases. Treatment on periodontitis could potentially protect individuals from aging-related diseases.
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Affiliation(s)
- Weihong Song
- Department of Stomatology, The Fifth Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Jianzhen Yang
- Department of Endodontics, Southern Medical University Hospital of Stomatology (Guandong Stomatology Hospital), Guangzhou, China
| | - Zhongzheng Niu
- Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, the State University of New York at Buffalo, Buffalo, New York, USA
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8
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Aquino-Martinez R, Khosla S, Farr JN, Monroe DG. Periodontal Disease and Senescent Cells: New Players for an Old Oral Health Problem? Int J Mol Sci 2020; 21:E7441. [PMID: 33050175 PMCID: PMC7587987 DOI: 10.3390/ijms21207441] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 09/30/2020] [Accepted: 10/07/2020] [Indexed: 12/19/2022] Open
Abstract
The recent identification of senescent cells in periodontal tissues has the potential to provide new insights into the underlying mechanisms of periodontal disease etiology. DNA damage-driven senescence is perhaps one of the most underappreciated delayed consequences of persistent Gram-negative bacterial infection and inflammation. Although the host immune response rapidly protects against bacterial invasion, oxidative stress generated during inflammation can indirectly deteriorate periodontal tissues through the damage to vital cell macromolecules, including DNA. What happens to those healthy cells that reside in this harmful environment? Emerging evidence indicates that cells that survive irreparable genomic damage undergo cellular senescence, a crucial intermediate mechanism connecting DNA damage and the immune response. In this review, we hypothesize that sustained Gram-negative bacterial challenge, chronic inflammation itself, and the constant renewal of damaged tissues create a permissive environment for the abnormal accumulation of senescent cells. Based on emerging data we propose a model in which the dysfunctional presence of senescent cells may aggravate the initial immune reaction against pathogens. Further understanding of the role of senescent cells in periodontal disease pathogenesis may have clinical implications by providing more sophisticated therapeutic strategies to combat tissue destruction.
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Affiliation(s)
- Ruben Aquino-Martinez
- Department of Medicine, Division of Endocrinology, Mayo Clinic College of Medicine, Rochester, MN 55905, USA; (S.K.); (J.N.F.); (D.G.M.)
| | - Sundeep Khosla
- Department of Medicine, Division of Endocrinology, Mayo Clinic College of Medicine, Rochester, MN 55905, USA; (S.K.); (J.N.F.); (D.G.M.)
- Robert and Arlene Kogod Center on Aging, Mayo Clinic, Rochester, MN 55905, USA
| | - Joshua N. Farr
- Department of Medicine, Division of Endocrinology, Mayo Clinic College of Medicine, Rochester, MN 55905, USA; (S.K.); (J.N.F.); (D.G.M.)
- Robert and Arlene Kogod Center on Aging, Mayo Clinic, Rochester, MN 55905, USA
| | - David G. Monroe
- Department of Medicine, Division of Endocrinology, Mayo Clinic College of Medicine, Rochester, MN 55905, USA; (S.K.); (J.N.F.); (D.G.M.)
- Robert and Arlene Kogod Center on Aging, Mayo Clinic, Rochester, MN 55905, USA
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9
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Gomaa N, Tenenbaum H, Glogauer M, Quiñonez C. The Biology of Social Adversity Applied to Oral Health. J Dent Res 2019; 98:1442-1449. [PMID: 31547748 DOI: 10.1177/0022034519876559] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Biological embodiment is a concept derived from Engel's biopsychosocial model to health, theorized as the process by which adverse social exposures trigger neuroendocrine and immune responses, leading to disease and/or increased disease susceptibility. This critical review discusses the biopsychosocial model as applied to oral health and its relevance to oral health policy while deciphering some of the pathobiological processes underlying social adversity. In periodontal disease, for example, such processes can occur via the activation of the hypothalamic-pituitary-adrenal axis and the consequent release of the chronic stress hormone cortisol. The latter contributes to a proinflammatory immune state that increases the risk for periodontal inflammation. Recent research shows that cortisol relates to an elevated oral inflammatory load, demonstrated as hyperactive neutrophils that are pivotal to periodontal tissue damage. Consistent with the biopsychosocial model, this relationship is amplified in those of lower income and higher financial stress. Similarly, among children from lower socioeconomic backgrounds, cortisol is linked to a higher cariogenic bacterial load. Such findings implicate the stress pathway as key in the oral pathogenic process, particularly under social/socioeconomic adversity. Collectively, this work emphasizes the importance of addressing social factors in alleviating oral disease burden and reducing the social gaps therein.
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Affiliation(s)
- N Gomaa
- Neuroscience and Mental Health, SickKids Research Institute, The Hospital for Sick Children, Toronto, ON, Canada.,Paediatrics, Faculty of Medicine, University of Toronto, ON, Canada
| | - H Tenenbaum
- Periodontology, Faculty of Dentistry, University of Toronto, Toronto, ON, Canada.,Centre for Advanced Dental Research and Care, Department of Dentistry, Mount Sinai Hospital, Toronto, ON, Canada
| | - M Glogauer
- Periodontology, Faculty of Dentistry, University of Toronto, Toronto, ON, Canada.,Department of Dental Oncology, Princess Margaret Hospital, Toronto, ON, Canada
| | - C Quiñonez
- Dental Public Health, Faculty of Dentistry, University of Toronto, Toronto, ON, Canada
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Inflammation and Vascular Ageing: From Telomeres to Novel Emerging Mechanisms. High Blood Press Cardiovasc Prev 2019; 26:321-329. [DOI: 10.1007/s40292-019-00331-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Accepted: 07/12/2019] [Indexed: 12/20/2022] Open
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11
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Sociodemographic correlates of change in leukocyte telomere length during mid- to late-life: The Multi-Ethnic Study of Atherosclerosis. Psychoneuroendocrinology 2019; 102:182-188. [PMID: 30576944 PMCID: PMC6445551 DOI: 10.1016/j.psyneuen.2018.12.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Revised: 12/05/2018] [Accepted: 12/06/2018] [Indexed: 11/22/2022]
Abstract
Although epidemiologic studies of telomere length have become increasingly common, few population-based, multi-ethnic studies include data on telomere shortening, which may be a better predictor of morbidity and mortality than a single measure of telomere length. This study used stored blood samples from 1169 participants in the Multi-Ethnic Study of Atherosclerosis (MESA) to examine age, sex, race/ethnicity, marital status, income, and education as predictors of change in telomere length over a 10-year period in linear mixed effects models. Mean age at baseline was 61 years, and the sample was 54% female, 27% white, 30% African-American, and 43% Hispanic. At baseline, 58% of the sample was married; 32% had household income below $25,000 per year, 35% had income between $25,000 and $49,999 per year, and 34% had income above $50,000 per year; 41% had a high school education or less, 30% had some college, and 29% had a college degree or more. Relative telomere length (T/S ratio) was measured by the quantitative polymerase chain reaction method. In general, ten-year telomere attrition was greater for groups that had longer telomere length at baseline, including younger people, whites, and women. After adjusting for baseline telomere length, race/ethnic differences in telomere attrition were attenuated, and age and sex differences were reversed, such that older people and men showed greater telomere shortening. There were no significant differences in telomere attrition by marital status, income, or education. There is not yet a consensus in the field regarding whether to adjust for baseline telomere length in models examining predictors of telomere attrition. To ensure comparability across studies, researchers should report results both with and without adjustment for baseline telomere length.
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12
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Willis M, Reid SN, Calvo E, Staudinger UM, Factor-Litvak P. A scoping systematic review of social stressors and various measures of telomere length across the life course. Ageing Res Rev 2018; 47:89-104. [PMID: 30048807 PMCID: PMC6195444 DOI: 10.1016/j.arr.2018.07.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Revised: 07/10/2018] [Accepted: 07/18/2018] [Indexed: 12/20/2022]
Abstract
Numerous studies examine the relationship between social stressors and telomere length (TL). Beyond considering methods and major findings, this scoping systematic review takes a novel approach as it groups studies according to the types of social stressor considered and by age groups. Following PRISMA guidelines, we searched PubMed, Web of Science, Embase, and Scopus. We included all English-language human subject research articles that modeled any measure of TL as a dependent variable and exposure to a social stressor as an independent variable. For the sample of 105 articles, we summarized methods and findings by type of social stressor (socioeconomic stressors, stressful life events, work-related stressors, and neighborhood stressors) and by age of the study population (infants/children, middle-aged adults, older adults, and mixed samples of middle-aged and older adults). We found more variation in TL measurement methodology in studies of infants/children and older adults than in studies focusing on middle-aged adults. The most consistent finding was a relationship between early-life stressors and shorter TL. Work and neighborhood stressors, and older populations, are currently understudied. Across all stressors, limited evidence suggests that the stress-TL relationship may be moderated by characteristics such as age, sex, and race/ethnicity. We conclude with specific suggestions for future research.
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Affiliation(s)
- Margaret Willis
- Department of Epidemiology, Mailman School of Public Health, Columbia University, United States.
| | - Shaina N Reid
- Department of Epidemiology, Mailman School of Public Health, Columbia University, United States
| | - Esteban Calvo
- Department of Epidemiology, Mailman School of Public Health, Columbia University, United States; Robert N. Butler Columbia Aging Center, Columbia University, United States; Society and Health Research Center, Facultad de Humanidades, Universidad Mayor, Chile; Laboratory on Aging and Social Epidemiology, Universidad Mayor, Chile
| | - Ursula M Staudinger
- Robert N. Butler Columbia Aging Center, Columbia University, United States; Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, United States
| | - Pam Factor-Litvak
- Department of Epidemiology, Mailman School of Public Health, Columbia University, United States
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13
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Preshaw PM, Henne K, Taylor JJ, Valentine RA, Conrads G. Age-related changes in immune function (immune senescence) in caries and periodontal diseases: a systematic review. J Clin Periodontol 2018; 44 Suppl 18:S153-S177. [PMID: 28266110 DOI: 10.1111/jcpe.12675] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/23/2016] [Indexed: 12/17/2022]
Abstract
AIM To systematically review the evidence regarding immune senescence in the pathogenesis of periodontitis and dental caries. METHODS A systematic search of electronic databases utilizing medical subject headings (MeSH terms) supplemented by screening of review articles and other relevant texts was undertaken. RESULTS Seventy-three articles were included (43 for periodontitis, 30 for caries). Study results were found to be generally heterogeneous. Regarding periodontitis, human studies suggest evidence for altered neutrophil function and increased production of pro-inflammatory mediators (e.g. interleukin-1β, interleukin-6 and prostaglandin E2 ) in older compared to younger subjects, and animal experiments suggest increased expression of genes that contribute to a pro-inflammatory state in older compared to younger animals. Regarding dental caries, research relating to changes in immune functioning and the impact of ageing is in its infancy. A small number of studies have reported components of innate and adaptive immunity that affect the composition of saliva and dental biofilms with possible impacts on caries progression. CONCLUSION There is evidence that immune functioning related to periodontitis and (less investigated) dental caries alters with increasing age. In both conditions, age-associated mechanistic changes in immune functioning are complex and incompletely understood and it is not clear how these relate to disease susceptibility.
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Affiliation(s)
- Philip M Preshaw
- School of Dental Sciences, Newcastle University, Newcastle upon Tyne, UK.,Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK
| | - Karsten Henne
- Division of Oral Microbiology and Immunology, Department of Operative Dentistry, Periodontology and Preventive Dentistry, RWTH Aachen University Hospital, Aachen, Germany
| | - John J Taylor
- School of Dental Sciences, Newcastle University, Newcastle upon Tyne, UK.,Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK
| | - Ruth A Valentine
- School of Dental Sciences, Newcastle University, Newcastle upon Tyne, UK.,Human Nutrition Research Centre, Newcastle University, Newcastle upon Tyne, UK
| | - Georg Conrads
- Division of Oral Microbiology and Immunology, Department of Operative Dentistry, Periodontology and Preventive Dentistry, RWTH Aachen University Hospital, Aachen, Germany
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14
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Keogh RH, Seaman SR, Bartlett JW, Wood AM. Multiple imputation of missing data in nested case-control and case-cohort studies. Biometrics 2018; 74:1438-1449. [PMID: 29870056 PMCID: PMC6481559 DOI: 10.1111/biom.12910] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Revised: 04/01/2018] [Accepted: 04/01/2018] [Indexed: 12/18/2022]
Abstract
The nested case-control and case-cohort designs are two main approaches for carrying out a substudy within a prospective cohort. This article adapts multiple imputation (MI) methods for handling missing covariates in full-cohort studies for nested case-control and case-cohort studies. We consider data missing by design and data missing by chance. MI analyses that make use of full-cohort data and MI analyses based on substudy data only are described, alongside an intermediate approach in which the imputation uses full-cohort data but the analysis uses only the substudy. We describe adaptations to two imputation methods: the approximate method (MI-approx) of White and Royston (2009) and the “substantive model compatible” (MI-SMC) method of Bartlett et al. (2015). We also apply the “MI matched set” approach of Seaman and Keogh (2015) to nested case-control studies, which does not require any full-cohort information. The methods are investigated using simulation studies and all perform well when their assumptions hold. Substantial gains in efficiency can be made by imputing data missing by design using the full-cohort approach or by imputing data missing by chance in analyses using the substudy only. The intermediate approach brings greater gains in efficiency relative to the substudy approach and is more robust to imputation model misspecification than the full-cohort approach. The methods are illustrated using the ARIC Study cohort. Supplementary Materials provide R and Stata code.
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Affiliation(s)
- Ruth H Keogh
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, U.K
| | | | | | - Angela M Wood
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, U.K
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15
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FEATURES OF STOMATOLOGIC STATUS, TELOMERE LENGTHS AND PHENOTYPE OF IMMUNOCOMPETENT CELLS OF PERIPHERAL BLOOD IN CHILDREN – RESIDENTS OF UKRAINIAN TERRITORIES, CONTAMINATED WITH RADIONUCLIDES. EUREKA: HEALTH SCIENCES 2017. [DOI: 10.21303/2504-5679.2017.00438] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Objective of research. To analyze features of stomatological status indexes, relative length of telomeres and phenotype of immunocompetent cells of peripheral blood in children with chronological enamel hypoplasia – residents of Ukrainian territories, contaminated with radionuclides after the Chornobyl NPP accident.
Materials and methods. The object of research is chronological enamel hypoplasia (CEH) of permanent teeth, and lymphocytes of peripheral blood (PB). The subject of research is the state of oral cavity hygiene, caries intensity, gingivitis severity degree, relative telomere length (RTL), and phenotype of immunocompetent cells (ICC) of peripheral blood (PB). Methods of the research: stomatological, immunological (flow cytofluorometry), molecular genetic (fluorescence in situ hybridization-flow cytometry – flow-FISH), statistical.
Results. Two types of the analysis of the stomatologic status, RTL and phenotype of PB ICC were carried out: the first is the comparison of indexes of the combined group of children with anamnesis complicated by radiation (group No. 1 with CEH + group No. 2 without CEH) comparing with the control group No. 3; the second is the analysis of indeces of the group No. 1 comparing with the same markers in children of the groups No. 2 and No. 3. The first stage of the analysis shows thesignificant worsening of oral hygien indices , high DMFTand DMFS in children with permanent dentition, higher degree of gums inflamation and moresignificant RTL shortening in children of the combined group (No. 1 + No. 2) comparing with the control. Changes of the same character, but more expressed observed during the another analysis concerning the children with anamnesis complicated by radiation and CEH comparing with the control. Reliable changes in the content of PB ICC subpopulations in the examined children of all groups were not identified.
Conclusions.
1. Inchildren with CEH, complicated by ionizing radiation (IR) influence in low doses diapason the highest degree of stomatological status disorders comparing with the examined reference and control groups was determined: unsatisfactory and poor oral cavity hygiene according to OHI-S (1.76±0.41, р˂0.0001 and р˂0.0001, respectively) and Silness-Loe index (1.73±0.45, р˂0.0001 and р˂0.0001, respectively); very high intensity of dental caries ((DMFT=7.0±2.29, р=0.003and р˂0.0001; DMFS=8.74±2.58, р=0.0004 and р˂0.0001, respectively); mean degree of gingivitis severity (РМА 47.55±14.27 %, р˂0.0001 and р˂0.0001, respectively).
2. At CEH, which occurs due to the complex of negative factors during first years of life, including IR in residents of territories with effective doses more than 1.0 mSv/year, reliable shortening of relative telomeres length of PB lymphocytes comparing with the control group (15.17±3.20, р=0.0002) was found. Reliable differences in the content of peripheral blood immunocompetent cells when compared the examined groups were not identified.
3. Results of indices of the groups No. 1, No. 2 and No. 3 comparison are agreed with the data, obtained in result of dispersive analysis that allowed to separate the most informative indices concerning stomatological examination of children: OHI-S index (F=34.92; р˂0.001); Silness-Loe index (F=27.01; р˂0.001); dft+DMFT (F=82.23; р˂0.001); dfs+DMFS (F=49.41; р˂0.001); DMFT (F=13.94; р˂0.001); DMFS(F=19.41; р˂0.001); РМА (F=41.25; р˂0.001); RTL (F=7.53; р=0.001).
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16
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Tokita M, Kennedy SR, Risques RA, Chun SG, Pritchard C, Oshima J, Liu Y, Bryant-Greenwood PK, Welcsh P, Monnat RJ. Werner syndrome through the lens of tissue and tumour genomics. Sci Rep 2016; 6:32038. [PMID: 27559010 PMCID: PMC4997333 DOI: 10.1038/srep32038] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2016] [Accepted: 08/01/2016] [Indexed: 12/11/2022] Open
Abstract
Werner syndrome (WS) is the canonical adult human progeroid ('premature aging') syndrome. Patients with this autosomal recessive Mendelian disorder display constitutional genomic instability and an elevated risk of important age-associated diseases including cancer. Remarkably few analyses of WS patient tissue and tumors have been performed to provide insight into WS disease pathogenesis or the high risk of neoplasia. We used autopsy tissue from four mutation-typed WS patients to characterize pathologic and genomic features of WS, and to determine genomic features of three neoplasms arising in two of these patients. The results of these analyses provide new information on WS pathology and genomics; provide a first genomic characterization of neoplasms arising in WS; and provide new histopathologic and genomic data to test several popular models of WS disease pathogenesis.
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Affiliation(s)
- Mari Tokita
- Department of Medicine Division of Medical Genetics, University of Washington, Seattle, WA USA
| | - Scott R. Kennedy
- Department of Pathology, University of Washington, Seattle, WA USA
| | - Rosa Ana Risques
- Department of Pathology, University of Washington, Seattle, WA USA
| | - Stephen G. Chun
- Department of Radiation Oncology, MD Anderson Cancer Center, Houston, TX USA
| | - Colin Pritchard
- Department of Laboratory Medicine, University of Washington, Seattle, WA USA
| | - Junko Oshima
- Department of Pathology, University of Washington, Seattle, WA USA
- Department of Medicine, Chiba University, Chiba, Japan
| | - Yan Liu
- Department of Pathology, University of Washington, Seattle, WA USA
| | - Peter K. Bryant-Greenwood
- Department of Pathology, John Burns School of Medicine, University of Hawaii at Manoa, Honolulu, HI USA
| | - Piri Welcsh
- Department of Pathology, University of Washington, Seattle, WA USA
| | - Raymond J. Monnat
- Department of Pathology, University of Washington, Seattle, WA USA
- Department of Genome Sciences, University of Washington, Seattle, WA USA
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17
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18
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Thomson WM, Zeng J, Broadbent JM, Foster Page LA, Shalev I, Moffitt TE, Caspi A, Williams SM, Braithwaite AW, Robertson SP, Poulton R. Telomere length and periodontal attachment loss: a prospective cohort study. J Clin Periodontol 2016; 43:121-7. [PMID: 26713854 DOI: 10.1111/jcpe.12499] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/22/2015] [Indexed: 01/08/2023]
Abstract
AIM The aim of the study was to examine the association between telomere erosion and periodontitis in a long-standing prospective cohort study of New Zealand adults. Specific hypotheses tested were as follows: (i) that exposure to periodontitis at ages 26 and 38 was associated with accelerated leucocyte telomere erosion and (ii) that accelerated leucocyte telomere erosion was associated with higher rates of periodontitis by ages 26 and 38. MATERIALS AND METHODS Periodontal attachment loss data were collected at ages 26 and 38. Blood samples taken at the same ages were analysed to obtain estimates of leucocyte telomere length and erosion over a 12-year period. RESULTS Overall, the mean telomere length was reduced by 0.15 T/S ratio (adjusted) from age 26 to 38 among the 661 participants reported on here. During the same period, the mean attachment loss increased by 10%, after adjusting for sex, socio-economic status and smoking. Regression models showed that attachment loss did not predict telomere length, and that telomere erosion did not predict attachment loss. CONCLUSIONS Although both periodontitis and telomere length are age-dependent, they do not appear to be linked, suggesting that determination of leucocyte telomere length may not be a promising clinical approach at this age for identifying people who are at risk for periodontitis.
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Affiliation(s)
- William Murray Thomson
- Sir John Walsh Research Institute, School of Dentistry, The University of Otago, Dunedin, New Zealand
| | - Jiaxu Zeng
- Department of Preventive and Social Medicine, Dunedin School of Medicine, The University of Otago, Dunedin, New Zealand
| | - Jonathan M Broadbent
- Sir John Walsh Research Institute, School of Dentistry, The University of Otago, Dunedin, New Zealand
| | - Lyndie A Foster Page
- Sir John Walsh Research Institute, School of Dentistry, The University of Otago, Dunedin, New Zealand
| | - Idan Shalev
- Department of Biobehavioral Health, Pennsylvania State University, University Park, PA, USA
| | - Terrie E Moffitt
- Department of Psychology and Neuroscience, Duke University, Durham, NC, USA.,Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC, USA.,Social, Genetic, and Developmental Psychiatry Centre, Institute of Psychiatry, King's College, London, UK
| | - Avshalom Caspi
- Department of Psychology and Neuroscience, Duke University, Durham, NC, USA.,Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC, USA.,Social, Genetic, and Developmental Psychiatry Centre, Institute of Psychiatry, King's College, London, UK
| | - Sheila M Williams
- Department of Preventive and Social Medicine, Dunedin School of Medicine, The University of Otago, Dunedin, New Zealand
| | - Antony W Braithwaite
- Department of Pathology, School of Medicine, University of Otago, Dunedin, New Zealand
| | - Stephen P Robertson
- Department of Paediatrics and Child Health, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Richie Poulton
- Dunedin Multidisciplinary Health and Development Research Unit, Department of Psychology, University of Otago, Dunedin, New Zealand
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19
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Affiliation(s)
- Anne E Sanders
- Department of Dental Ecology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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