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Wu JP, Johnson E, Taichman LS. Contraceptive decisions among individuals with medical conditions in Michigan, USA: A qualitative explanatory model informed by the Health Belief Model and the principle of respect for patient autonomy. Contraception 2022; 113:37-41. [PMID: 35351446 DOI: 10.1016/j.contraception.2022.03.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 03/09/2022] [Accepted: 03/23/2022] [Indexed: 11/18/2022]
Abstract
OBJECTIVE We aimed to qualitatively describe the contraceptive experiences of individuals with medical conditions and develop an explanatory model of contraceptive decision-making in this context. STUDY DESIGN We conducted 41 interviews with pre-menopausal patients with a range of medical conditions from Michigan, USA. We identified themes through open coding and comparative analysis until we reached theoretical saturation. We analyzed the themes in the context of the Health Belief Model constructs and patient autonomy. To develop the explanatory model, we qualitatively mapped out relationships between constructs and how they informed contraceptive-decision making. RESULTS The model posits that contraceptive decisions are affected by the perceived impact of chronic disease on pregnancy, parenting, and contraceptive options. These perceptions were strongly affected by others, particularly health care providers (HCPs). Most worried that pregnancy could threaten their health, fetal health, or ability to parent. Active symptoms of chronic disease (e.g., pain, fatigue) amplified this perceived threat. Patients appreciated when their HCPs acknowledged, rather than dismissed, their concerns about contraceptive side effects that affected their chronic disease symptoms and management (e.g., headaches, worsening mood). Patients with medical contraindications to hormonal contraception and preferred to use coital-dependent methods (e.g. condoms) did not feel supported to do so by their HCPs. Patients who were Black, young, living on low-incomes, or considered medically "high risk" felt discriminated against by HCPs who limited or coerced their contraceptive decisions. CONCLUSIONS This explanatory model synthesizes factors that underlie, constrain, or promote reproductive and contraceptive decisions and autonomy for individuals with medical conditions. IMPLICATIONS This new explanatory model can guide the development and evaluation of interventions that support the contraceptive decisions and autonomy of individuals with medical conditions.
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Affiliation(s)
- Justine P Wu
- Department of Family Medicine, University of Michigan, Ann Arbor, MI, United States; Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI, United States; Michigan Mixed Methods Program, University of Michigan, Ann Arbor, MI, United States.
| | - Emily Johnson
- Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - L Susan Taichman
- Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
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Wu JP, Damschroder LJ, Fetters MD, Zikmund-Fisher BJ, Crabtree BF, Hudson SV, Ruffin MT, Fucinari J, Kang M, Taichman LS, Creswell JW. A Web-Based Decision Tool to Improve Contraceptive Counseling for Women With Chronic Medical Conditions: Protocol For a Mixed Methods Implementation Study. JMIR Res Protoc 2018; 7:e107. [PMID: 29669707 PMCID: PMC5932336 DOI: 10.2196/resprot.9249] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Revised: 12/18/2017] [Accepted: 02/05/2018] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Women with chronic medical conditions, such as diabetes and hypertension, have a higher risk of pregnancy-related complications compared with women without medical conditions and should be offered contraception if desired. Although evidence based guidelines for contraceptive selection in the presence of medical conditions are available via the United States Medical Eligibility Criteria (US MEC), these guidelines are underutilized. Research also supports the use of decision tools to promote shared decision making between patients and providers during contraceptive counseling. OBJECTIVE The overall goal of the MiHealth, MiChoice project is to design and implement a theory-driven, Web-based tool that incorporates the US MEC (provider-level intervention) within the vehicle of a contraceptive decision tool for women with chronic medical conditions (patient-level intervention) in community-based primary care settings (practice-level intervention). This will be a 3-phase study that includes a predesign phase, a design phase, and a testing phase in a randomized controlled trial. This study protocol describes phase 1 and aim 1, which is to determine patient-, provider-, and practice-level factors that are relevant to the design and implementation of the contraceptive decision tool. METHODS This is a mixed methods implementation study. To customize the delivery of the US MEC in the decision tool, we selected high-priority constructs from the Consolidated Framework for Implementation Research and the Theoretical Domains Framework to drive data collection and analysis at the practice and provider level, respectively. A conceptual model that incorporates constructs from the transtheoretical model and the health beliefs model undergirds patient-level data collection and analysis and will inform customization of the decision tool for this population. We will recruit 6 community-based primary care practices and conduct quantitative surveys and semistructured qualitative interviews with women who have chronic medical conditions, their primary care providers (PCPs), and clinic staff, as well as field observations of practice activities. Quantitative survey data will be summarized with simple descriptive statistics and relationships between participant characteristics and contraceptive recommendations (for PCPs), and current contraceptive use (for patients) will be examined using Fisher exact test. We will conduct thematic analysis of qualitative data from interviews and field observations. The integration of data will occur by comparing, contrasting, and synthesizing qualitative and quantitative findings to inform the future development and implementation of the intervention. RESULTS We are currently enrolling practices and anticipate study completion in 15 months. CONCLUSIONS This protocol describes the first phase of a multiphase mixed methods study to develop and implement a Web-based decision tool that is customized to meet the needs of women with chronic medical conditions in primary care settings. Study findings will promote contraceptive counseling via shared decision making and reflect evidence-based guidelines for contraceptive selection. TRIAL REGISTRATION ClinicalTrials.gov NCT03153644; https://clinicaltrials.gov/ct2/show/NCT03153644 (Archived by WebCite at http://www.webcitation.org/6yUkA5lK8).
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Affiliation(s)
- Justine P Wu
- Department of Family Medicine, University of Michigan, Ann Arbor, MI, United States
| | | | - Michael D Fetters
- Department of Family Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Brian J Zikmund-Fisher
- Department of Health Behavior and Health Education, University of Michigan, Ann Arbor, MI, United States.,Department of Internal Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Benjamin F Crabtree
- Department of Family Medicine and Community Health, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, United States
| | - Shawna V Hudson
- Department of Family Medicine and Community Health, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, United States
| | - Mack T Ruffin
- Department of Family and Community Medicine, Penn State Milton S. Hershey Medical Center, Hershey, PA, United States
| | - Juliana Fucinari
- Department of Family Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Minji Kang
- Department of Family Medicine, University of Michigan, Ann Arbor, MI, United States
| | - L Susan Taichman
- Department of Family Medicine, University of Michigan, Ann Arbor, MI, United States
| | - John W Creswell
- Department of Family Medicine, University of Michigan, Ann Arbor, MI, United States
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Decker AM, Taichman LS, D'Silva NJ, Taichman RS. Periodontal Treatment in Cancer Patients: An Interdisciplinary Approach. Curr Oral Health Rep 2018; 5:7-12. [PMID: 29910997 PMCID: PMC5998810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
PURPOSE OF REVIEW Dental care is an essential component in the comprehensive treatment for the cancer patient. As such, a review of the literature was completed to determine the relationships between periodontal and dental care in the cancer patient and provide strategic suggestions. RECENT FINDINGS Periodontal treatment must be personalized depending on the patient's current oral health status, systemic status, and progress in treatment. Oral mucositis, periodontal status, and osteonecrosis of the jaw (ONJ) remain periodontal concerns in the cancer patient. Contributing factors of ONJ include root amputation (OR= 6.64), extraction of a single tooth (OR=3.7), severe tooth mobility (OR = 3.60), and unclosed wound (OR = 2.51). SUMMARY Preventive maintenance, oral hygiene instruction, use of fluoride and chlorhexidine are all important therapeutic strategies. If extractions are required in patients who have received bone modifying drug infusions, flap management and primary wound closure is needed to reduce the risk of complications.
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Affiliation(s)
- A M Decker
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, MI, USA
| | - L S Taichman
- Department of Family Medicine, University of Michigan School of Medicine
| | - N J D'Silva
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, MI, USA
- Department of Pathology, University of Michigan, Ann Arbor, MI, USA
| | - R S Taichman
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, MI, USA
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Taichman LS, Van Poznak CH, Inglehart MR. Oral health-related concerns, behavior, and communication with health care providers of patients with breast cancer: impact of different treatments. Spec Care Dentist 2018; 38:36-45. [DOI: 10.1111/scd.12266] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- L. Susan Taichman
- Clinical Associate Professor; Department of Periodontics and Oral Medicine; School of Dentistry; University of Michigan; Ann Arbor MI USA
| | - Catherine H. Van Poznak
- Associate Professor; Department of Internal Medicine; Hematology and Oncology Division; University of Michigan; Ann Arbor MI USA
| | - Marita R. Inglehart
- Professor; Department of Periodontics and Oral Medicine; School of Dentistry & Department of Psychology; College of Literature, Science & Arts; University of Michigan; Ann Arbor MI USA
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Arnett M, Korte D, Richards PS, Saglik B, Taichman LS, Kinney JS, Gwozdek AE. Effect of Faculty Development Activities on Dental Hygiene Faculty Perceptions of and Teaching About Motivational Interviewing: A Pilot Study. J Dent Educ 2017; 81:969-977. [PMID: 28765441 DOI: 10.21815/jde.017.048] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Accepted: 02/28/2017] [Indexed: 11/20/2022]
Abstract
The aims of this pilot study were to assess dental hygiene faculty members' perceptions of the importance of motivational interviewing (MI) and their confidence in teaching students about MI and to determine the effect of MI training sessions on those perceptions. Participants were a convenience sample of all 16 dental hygiene faculty members who teach in the clinic at the University of Michigan School of Dentistry. Participants' perceptions were assessed prior to a workshop in MI (pretest), immediately after the workshop (posttest 1), and eight months after the workshop, at the end of the academic year (posttest 2). During the same period, some of the workshop participants took part in team grading sessions of audio recordings of student-patient MI interactions. The results showed that the majority of the faculty members perceived it was important to personally embrace the overall spirit of MI during patient care, and they were confident supporting students as well. Their ratings for embracing the spirit of MI increased from pretest to posttest 1, but slightly decreased at posttest 2. This trend was also seen in their assessment of the importance of and their confidence in teaching the eight MI strategies over time. Among the workshop participants, 56% were part of team grading; they reported the most helpful professional development activities overall were team grading (58%) and the workshop (25%). These results suggest the importance of making use of a variety of faculty development activities and of introducing appropriate follow-up to training sessions over time to ensure long-lasting effects. Future research using carefully designed, multi-institution, longitudinal studies is needed to determine the most effective ways to prepare dental hygiene faculty members to educate their students about MI.
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Affiliation(s)
- Michelle Arnett
- Ms. Arnett is a 2016 graduate of the Master of Science in Dental Hygiene Program and Adjunct Clinical Lecturer, Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry; Ms. Korte is Adjunct Clinical Lecturer, Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry; Dr. Richards is Clinical Professor, Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry; Dr. Saglik is Clinical Associate Professor, Department of Biologic and Materials Sciences, University of Michigan School of Dentistry; Dr. Taichman is Adjunct Clinical Associate Professor, Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry; Prof. Kinney is Director of Dental Hygiene and Clinical Associate Professor, Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry; and Prof. Gwozdek is retired Clinical Assistant Professor and Director of Dental Hygiene Graduate and Degree Completion Programs, Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry.
| | - Dina Korte
- Ms. Arnett is a 2016 graduate of the Master of Science in Dental Hygiene Program and Adjunct Clinical Lecturer, Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry; Ms. Korte is Adjunct Clinical Lecturer, Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry; Dr. Richards is Clinical Professor, Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry; Dr. Saglik is Clinical Associate Professor, Department of Biologic and Materials Sciences, University of Michigan School of Dentistry; Dr. Taichman is Adjunct Clinical Associate Professor, Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry; Prof. Kinney is Director of Dental Hygiene and Clinical Associate Professor, Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry; and Prof. Gwozdek is retired Clinical Assistant Professor and Director of Dental Hygiene Graduate and Degree Completion Programs, Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry
| | - Philip S Richards
- Ms. Arnett is a 2016 graduate of the Master of Science in Dental Hygiene Program and Adjunct Clinical Lecturer, Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry; Ms. Korte is Adjunct Clinical Lecturer, Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry; Dr. Richards is Clinical Professor, Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry; Dr. Saglik is Clinical Associate Professor, Department of Biologic and Materials Sciences, University of Michigan School of Dentistry; Dr. Taichman is Adjunct Clinical Associate Professor, Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry; Prof. Kinney is Director of Dental Hygiene and Clinical Associate Professor, Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry; and Prof. Gwozdek is retired Clinical Assistant Professor and Director of Dental Hygiene Graduate and Degree Completion Programs, Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry
| | - Berna Saglik
- Ms. Arnett is a 2016 graduate of the Master of Science in Dental Hygiene Program and Adjunct Clinical Lecturer, Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry; Ms. Korte is Adjunct Clinical Lecturer, Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry; Dr. Richards is Clinical Professor, Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry; Dr. Saglik is Clinical Associate Professor, Department of Biologic and Materials Sciences, University of Michigan School of Dentistry; Dr. Taichman is Adjunct Clinical Associate Professor, Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry; Prof. Kinney is Director of Dental Hygiene and Clinical Associate Professor, Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry; and Prof. Gwozdek is retired Clinical Assistant Professor and Director of Dental Hygiene Graduate and Degree Completion Programs, Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry
| | - L Susan Taichman
- Ms. Arnett is a 2016 graduate of the Master of Science in Dental Hygiene Program and Adjunct Clinical Lecturer, Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry; Ms. Korte is Adjunct Clinical Lecturer, Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry; Dr. Richards is Clinical Professor, Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry; Dr. Saglik is Clinical Associate Professor, Department of Biologic and Materials Sciences, University of Michigan School of Dentistry; Dr. Taichman is Adjunct Clinical Associate Professor, Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry; Prof. Kinney is Director of Dental Hygiene and Clinical Associate Professor, Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry; and Prof. Gwozdek is retired Clinical Assistant Professor and Director of Dental Hygiene Graduate and Degree Completion Programs, Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry
| | - Janet S Kinney
- Ms. Arnett is a 2016 graduate of the Master of Science in Dental Hygiene Program and Adjunct Clinical Lecturer, Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry; Ms. Korte is Adjunct Clinical Lecturer, Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry; Dr. Richards is Clinical Professor, Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry; Dr. Saglik is Clinical Associate Professor, Department of Biologic and Materials Sciences, University of Michigan School of Dentistry; Dr. Taichman is Adjunct Clinical Associate Professor, Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry; Prof. Kinney is Director of Dental Hygiene and Clinical Associate Professor, Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry; and Prof. Gwozdek is retired Clinical Assistant Professor and Director of Dental Hygiene Graduate and Degree Completion Programs, Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry
| | - Anne E Gwozdek
- Ms. Arnett is a 2016 graduate of the Master of Science in Dental Hygiene Program and Adjunct Clinical Lecturer, Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry; Ms. Korte is Adjunct Clinical Lecturer, Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry; Dr. Richards is Clinical Professor, Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry; Dr. Saglik is Clinical Associate Professor, Department of Biologic and Materials Sciences, University of Michigan School of Dentistry; Dr. Taichman is Adjunct Clinical Associate Professor, Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry; Prof. Kinney is Director of Dental Hygiene and Clinical Associate Professor, Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry; and Prof. Gwozdek is retired Clinical Assistant Professor and Director of Dental Hygiene Graduate and Degree Completion Programs, Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry
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Suminski JA, Inglehart M, Munz SM, Van Poznak CH, Taichman LS. Oral Care: Exploring Education, Attitudes, and Behaviors Among Nurses Caring for Patients With Breast Cancer
. Clin J Oncol Nurs 2017; 21:371-378. [PMID: 28524905 DOI: 10.1188/17.cjon.371-378] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Patients treated for breast cancer often experience severe oral complications, such as mucositis, xerostomia, and infections, which can result in dose reductions and treatment delays, affecting treatment outcomes.
. OBJECTIVES The purpose of this article is to explore oncology nurses' perceptions of their educational experiences, professional attitudes, and behavior related to providing oral healthcare education to patients with breast cancer.
. METHODS The Oncology Nursing Society sent an email to 5,000 nursing team members who cared for patients with breast cancer, requesting participation in a web-based survey; 194 responses were received, with 164 meeting study eligibility.
. FINDINGS More oral health-related education was received during clinical experiences than during formal or continuing education. Although patient-driven oral care and diagnostic efforts were frequent, actual behavior was less frequent. No major barriers to providing oral care were indicated. Increased oral health-related education and behavior correlated with the reported importance of increased oral health education for nurses.
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Taichman LS, Van Poznak CH, Inglehart MR. Self-reported oral health and quality of life of postmenopausal breast cancer survivors on aromatase inhibitors and women without cancer diagnoses: a longitudinal analysis. Support Care Cancer 2016; 24:4815-24. [PMID: 27455851 DOI: 10.1007/s00520-016-3336-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Accepted: 07/10/2016] [Indexed: 12/18/2022]
Abstract
INTRODUCTION Aromatase inhibitors (AIs) are a well-established component of adjuvant therapy in postmenopausal women with hormone receptor (HR) + early stage breast cancer (BCa). We explored in an 18-month cohort study whether subjective oral health (OH), subjective periodontal health (PH), and oral health-related quality of life (OHRQoL) of postmenopausal BCa survivors on AIs differ from those of women without cancer diagnoses, and whether saliva flow, OH, PH, and OHRQoL are related. METHODS Data were collected from 29 postmenopausal BCa survivors on AIs and 29 postmenopausal women without cancer diagnoses. Socio-demographic information, OH, PH, and OHRQoL were collected at baseline and 6, 12, and 18 months later. Unstimulated whole saliva volume per 15 min was determined by drooling. RESULTS The two groups did not differ in background characteristics at baseline. Women on AIs had poorer OH (p = .043), PH (p = .04), and OHRQoL (p = .017), and lower saliva flow rate (p < .001) than control respondents. BCa survivors had the poorest PH at the 18-month visit. Xerostomia was correlated with OH at baseline and with OH and PH at 18 months. However, objective saliva flow rate was not correlated with OH or OHRQoL at this visit. CONCLUSIONS This study is the first to investigate the effects of AIs on patients' subjective OH, subjective PH, and OHRQoL. The data suggest that women treated with AIs have worse OH, PH, and OHRQoL than women without cancer diagnoses. Interprofessional care is recommended so that women on AIs receive optimal supportive oral care to assure long-term OH and positive OHRQoL. TRIAL REGISTRATION ClinicalTrials.gov NCT01272570 https://clinicaltrials.gov/ct2/show/NCT01272570 .
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Affiliation(s)
- L Susan Taichman
- Department of Periodontics and Oral Medicine, School of Dentistry, University of Michigan, Ann Arbor, MI, 48109-1078, USA.
| | - Catherine H Van Poznak
- Department of Internal Medicine, Hematology and Oncology Division, University of Michigan, Ann Arbor, MI, USA
| | - Marita R Inglehart
- Department of Periodontics and Oral Medicine, School of Dentistry & Department of Psychology, College of Literature, Science & Arts, University of Michigan, Ann Arbor, MI, USA
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Eagle I, Benavides E, Eber R, Kolenic G, Jung Y, Van Poznak C, Taichman LS. Periodontal health in breast cancer patients on aromatase inhibitors versus postmenopausal controls: a longitudinal analysis. J Clin Periodontol 2016; 43:659-67. [PMID: 27062507 DOI: 10.1111/jcpe.12562] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/03/2016] [Indexed: 10/22/2022]
Abstract
AIM This study was conducted to determine periodontal changes in postmenopausal breast cancer (BCa) survivors using aromatase inhibitors (AI) as compared to postmenopausal women without BCa. METHODS An 18-month prospective examination of periodontal health in postmenopausal women (29 receiving AI therapy; 29 women without BCa) was conducted at University of Michigan. Comprehensive periodontal examinations including alveolar bone height (ABH) were conducted at baseline, 6, 12, and 18 months. Bisphosphonate, vitamin D, and calcium supplementation were collected via chart review. Linear mixed models were utilized to investigate the relationship between AI and periodontal measures. RESULTS Aromatase inhibitor users had significantly deeper probing depths, more dental plaque and clinical attachment loss as compared to controls at the 6, 12, and 18 month study visits (p < 0.05). ABH loss was seen over time within the AI group. The linear mixed model showed a significant effect of time as well as an interaction between aromatase inhibitor use and calcium supplement status. AI users taking calcium experienced less ABH loss over the study than AI users not taking calcium (p = 0.005). CONCLUSION Aromatase inhibitor therapy has a negative impact on the periodontal health of postmenopausal BCa patients. Calcium supplementation appears to mitigate ABH loss in women on AI.
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Affiliation(s)
- Iwonka Eagle
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, MI, USA
| | - Erika Benavides
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, MI, USA
| | - Robert Eber
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, MI, USA
| | - Giselle Kolenic
- Division of Obstetrics and Gynecology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Younghun Jung
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, MI, USA
| | - Catherine Van Poznak
- Hematology and Oncology Division, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - L Susan Taichman
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, MI, USA
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Taichman LS, Inglehart MR, Giannobile WV, Braun T, Kolenic G, Van Poznak C. Periodontal Health in Women With Early-Stage Postmenopausal Breast Cancer Newly on Aromatase Inhibitors: A Pilot Study. J Periodontol 2015; 86:906-16. [PMID: 25672657 PMCID: PMC4490108 DOI: 10.1902/jop.2015.140546] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
BACKGROUND Aromatase inhibitor (AI) use results in low estrogen levels, which in turn affect bone mineral density (BMD). Periodontitis, alveolar bone loss, and tooth loss are associated with low BMD. The goal of this study is to assess the prevalence of periodontitis and perceived oral health and evaluate salivary biomarkers in postmenopausal women who are survivors of early-stage (I to IIIA) breast cancer (BCa) and receive adjuvant AI therapy. METHODS Participants included 58 postmenopausal women: 29 with BCa on AIs and 29 controls without BCa diagnoses. Baseline periodontal status was assessed with: 1) periodontal probing depth (PD); 2) bleeding on probing (BOP); and 3) attachment loss (AL). Demographic and dental utilization information was gathered by questionnaire. Linear regression modeling was used to analyze the outcomes. RESULTS No differences were found in mean PD or number of teeth. The AI group had significantly more sites with BOP (27.8 versus 16.7; P = 0.02), higher worst-site AL (5.2 versus 4.0 mm; P <0.01), and more sites with dental calculus (18.2 versus 6.4; P <0.001) than controls. Linear regression adjusted for income, tobacco use, dental insurance, and previous radiation and chemotherapy exposure demonstrated that AI use increased AL by >2 mm (95% confidence interval, 0.46 to 3.92). Median salivary osteocalcin and tumor necrosis factor-α levels were significantly higher in the AI group than the control group. CONCLUSION This first investigation of the periodontal status of women initiating adjuvant AI therapy identifies this population as having an increased risk for periodontitis.
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Affiliation(s)
- L Susan Taichman
- Department of Periodontics and Oral Medicine, School of Dentistry, University of Michigan, Ann Arbor, MI
| | - Marita R Inglehart
- Department of Periodontics and Oral Medicine, School of Dentistry, University of Michigan, Ann Arbor, MI
- Department of Psychology; College of Literature, Science, and the Arts; University of Michigan
| | - William V Giannobile
- Department of Periodontics and Oral Medicine, School of Dentistry, University of Michigan, Ann Arbor, MI
| | - Thomas Braun
- Department of Biostatistics, School of Public Health, University of Michigan
| | - Giselle Kolenic
- Center for Statistical Consultation and Research, University of Michigan
| | - Catherine Van Poznak
- Department of Internal Medicine, Hematology and Oncology Division, University of Michigan
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Taichman LS, Gomez G, Inglehart MR. Oral Health-Related Complications of Breast Cancer Treatment: Assessing Dental Hygienists' Knowledge and Professional Practice. J Dent Hyg 2015; 89 Suppl 2:22-37. [PMID: 26338905 PMCID: PMC5614710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
PURPOSE Approximately 200,000 women are diagnosed with breast cancer in the U.S. every year. These patients commonly suffer from oral complications of their cancer therapy. The purpose of this study was to assess dental hygienists' knowledge and professional practice related to providing care for breast cancer patients. METHODS A pre-tested 43-item survey was mailed to a random sample of 10% of all licensed dental hygienists in the state of Michigan (n=962). The survey assessed the respondents' knowledge of potential oral complications of breast cancer treatments as well as their professional practices when treating patients with breast cancer. After 2 mailings, the response rate was 37% (n=331). Descriptive and inferential analyses were conducted using SAS. RESULTS Many dental hygienists were unaware of the recommended clinical guidelines for treating breast cancer patients and lacked specific knowledge concerning the commonly prescribed anti-estrogen medications for pre-and postmenopausal breast cancer patients. Over 70% of the respondents indicated they were unfamiliar with the AI class of medications. Only 13% of dental hygienists correctly identified the mechanism of action of anti-estrogen therapy. Dental hygienists reported increased gingival inflammation, gingival bleeding, periodontal pocketing, xerostomia and burning tissues in patients receiving anti-estrogen therapies. Less than 10% believed that their knowledge of breast cancer treatments and the potential oral side effects is up to date. CONCLUSION Results indicate a need for more education about the oral effects of breast cancer therapies and about providing the best possible care for patients undergoing breast cancer treatment.
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Taichman LS, Griggs JJ, Inglehart MR. Periodontal health, perceived oral health, and dental care utilization of breast cancer survivors. J Public Health Dent 2015; 75:148-56. [PMID: 25648337 DOI: 10.1111/jphd.12084] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2014] [Accepted: 12/19/2014] [Indexed: 11/28/2022]
Abstract
OBJECTIVES This population-based analysis examined the prevalence of periodontal diseases along with the self-perceived oral health and patterns of dental care utilization of breast cancer survivors in the United States. METHODS Data from the 1999-2004 National Health and Nutrition Surveys were utilized, examining information from 3,354 women between 50 and 85 years of age. Primary outcomes were gingivitis and periodontitis, self-perceived oral health, and dental care utilization. Logistic regression analyses were used to estimate relationships of breast cancer diagnosis and primary outcomes while controlling for confounding factors. RESULTS Breast cancer survivors were more likely to be older than 55 years, white, nonsmokers, have higher levels of education and income, and a higher prevalence of osteoporosis. Breast cancer survivors were significantly less likely to have dental insurance (P = 0.04). Utilization of dental services and reason for last dental visit did not significantly differ between groups. A history of a breast cancer diagnosis did not increase the odds of gingivitis [odds ratio (OR): 1.32; 95 percent confidence interval (CI): 0.53-3.63], periodontitis (OR: 1.82; 95 percent CI: 0.89-4.01), or poor self-perceived oral health (OR: 0.89; 95 percent CI: 0.61-1.33) after adjusting for age, race, education, dental care utilization, and smoking status. CONCLUSIONS In this sample, a history of breast cancer does not significantly impact periodontal health, self-perceived oral health, and dental care utilization. However, efforts should be made to assure that breast cancer survivors have dental insurance.
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Affiliation(s)
- L Susan Taichman
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, MI, USA
| | - Jennifer J Griggs
- Department of Internal Medicine, Hematology and Oncology Division, University of Michigan, Ann Arbor, MI, USA.,Department of Health Management Policy, School of Public Health, Ann Arbor, MI, USA
| | - Marita R Inglehart
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, MI, USA.,Department of Psychology, College of Literature, Science and Arts (LS&A), University of Michigan, Ann Arbor, MI, USA
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Affiliation(s)
- L. Susan Taichman
- Department of Periodontics and Oral Medicine; School of Dentistry; University of Michigan
| | - Russell S. Taichman
- Department of Periodontics and Oral Medicine; School of Dentistry; University of Michigan
| | - Marita R. Inglehart
- Department of Periodontics and Oral Medicine; School of Dentistry; Department of Psychology; College of Literature, Science, and Arts; University of Michigan
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Taichman LS, Taichman RS, Inglehart MR. Dentists' leadership-related educational experiences, attitudes, and past and current behavior. J Dent Educ 2014; 78:876-885. [PMID: 24882773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
The purpose of this study was to assess practicing dentists' perceptions of their leadership-related educational experiences during predoctoral education and after graduation, to investigate if these perceptions differed as a function of the respondents' graduation year and gender, and to explore the relationships between educational experiences and the respondents' understanding/perceptions of leadership, leadership-related attitudes, self-perceived effectiveness, and past and current leadership- related behavior. Of the 3,000 general dentist members of the American Dental Association who were invited to participate, 593 returned the survey for a response rate of 20 percent. Between 37 and 65 percent of the respondents indicated that their predoctoral dental education had not prepared them well on a series of factors related to being leaders in their practice, community, state, or at the national level. However, 33 to 77 percent of these dentists responded that educational experiences after graduation prepared them well for different types of leadership activities. Overall, respondents rated their predoctoral experiences significantly less positively than their experiences after graduation for each content area. The more recently the respondents had graduated, the higher they rated their leadership-related educational experiences. The better their educational experiences, the more important the respondents evaluated leadership activities in their practice, organized dentistry, and research/teaching, the more important they assessed leadership to be, and the more effective they evaluated themselves to be as leaders. The perceived quality of the respondents' predoctoral education was not correlated with their past and current leadership activities. The results of this study may suggest that improving leadership training during predoctoral education could positively affect future dentists' attitudes about leadership and ratings of their own effectiveness as leaders.
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Affiliation(s)
- L Susan Taichman
- Dr. L. Susan Taichman is Assistant Professor and Research Scientist, Department of Periodontics and Oral Medicine, School of Dentistry, University of Michigan; Dr. Russell S. Taichman is Major M. Ash Collegiate Professor of Dentistry, Department of Periodontics and Oral Medicine, School of Dentistry, University of Michigan; and Dr. Inglehart is Professor of Dentistry, Department of Periodontics and Oral Medicine, School of Dentistry, and Adjunct Professor, Department of Psychology, College of Literature, Science, and Arts, University of Michigan
| | - Russell S Taichman
- Dr. L. Susan Taichman is Assistant Professor and Research Scientist, Department of Periodontics and Oral Medicine, School of Dentistry, University of Michigan; Dr. Russell S. Taichman is Major M. Ash Collegiate Professor of Dentistry, Department of Periodontics and Oral Medicine, School of Dentistry, University of Michigan; and Dr. Inglehart is Professor of Dentistry, Department of Periodontics and Oral Medicine, School of Dentistry, and Adjunct Professor, Department of Psychology, College of Literature, Science, and Arts, University of Michigan
| | - Marita R Inglehart
- Dr. L. Susan Taichman is Assistant Professor and Research Scientist, Department of Periodontics and Oral Medicine, School of Dentistry, University of Michigan; Dr. Russell S. Taichman is Major M. Ash Collegiate Professor of Dentistry, Department of Periodontics and Oral Medicine, School of Dentistry, University of Michigan; and Dr. Inglehart is Professor of Dentistry, Department of Periodontics and Oral Medicine, School of Dentistry, and Adjunct Professor, Department of Psychology, College of Literature, Science, and Arts, University of Michigan.
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Taichman LS, Gomez G, Inglehart MR. Oral health-related complications of breast cancer treatment: assessing dental hygienists' knowledge and professional practice. J Dent Hyg 2014; 88:100-113. [PMID: 24771774 PMCID: PMC4075039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
PURPOSE Approximately 200,000 women are diagnosed with breast cancer in the U.S. every year. These patients commonly suffer from oral complications of their cancer therapy. The purpose of this study was to assess dental hygienists' knowledge and professional practice related to providing care for breast cancer patients. METHODS A pre-tested 43-item survey was mailed to a random sample of 10% of all licensed dental hygienists in the state of Michigan (n=962). The survey assessed the respondents' knowledge of potential oral complications of breast cancer treatments as well as their professional practices when treating patients with breast cancer. After 2 mailings, the response rate was 37% (n=331). Descriptive and inferential analyses were conducted using SAS. RESULTS Many dental hygienists were unaware of the recommended clinical guidelines for treating breast cancer patients and lacked specific knowledge concerning the commonly prescribed anti-estrogen medications for pre-and postmenopausal breast cancer patients. Over 70% of the respondents indicated they were unfamiliar with the AI class of medications. Only 13% of dental hygienists correctly identified the mechanism of action of anti-estrogen therapy. Dental hygienists reported increased gingival inflammation, gingival bleeding, periodontal pocketing, xerostomia and burning tissues in patients receiving anti-estrogen therapies. Less than 10% believed that their knowledge of breast cancer treatments and the potential oral side effects is up to date. CONCLUSION Results indicate a need for more education about the oral effects of breast cancer therapies and about providing the best possible care for patients undergoing breast cancer treatment.
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Taichman LS, Inglehart M, Giannobile W, Braun T, Kolenic G, Van Poznak C. Periodontal health in early-stage postmenopausal breast cancer survivors on aromatase inhibitors. J Clin Oncol 2013. [DOI: 10.1200/jco.2013.31.15_suppl.568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
568 Background: Aromatase inhibitors (AIs) are associated with profound estrogen deprivation resulting in reduced bone mineral density (BMD). Periodontal diseases and tooth loss are associated with estrogen withdrawal and decreased systemic BMD. Little is known as to the impact of AIs on oral health. To investigate oral health as a breast cancer (BCA) survivorship concern, a prospective study was initiated to determine the prevalence of periodontal diseases in postmenopausal early stage (I-IIIA) BCA survivors on adjuvant AI therapy. Baseline assessments are presented here. Methods: Women within 6 months of initiating adjuvant AI for hormone receptor positive BCA were eligible to participate in this study of serial assessments of oral health. A control group of women without BCA and not on AI underwent parallel assessments. Periodontal status was evaluated by the following established dental techniques; (1) periodontal pocket depth (PD), (2) number of teeth with bleeding on probing (BOP), (3) the number of teeth with clinical attachment loss (CAL). Questionnaires regarding socio-demographic and dental utilization were administered to all participants. Linear regression modeling was used to analyze the outcomes. Results: The study met its target accrual of 58 postmenopausal women; 29 with BCA on AI and 29 controls. Demographics were similar regarding age, education, income level, frequency of dental visits, and dental insurance status across both groups. Baseline assessments demonstrated no differences in PD (2.0 mm vs. 2.0 mm; p < 0.95) or the number of teeth (26.6 vs 26.1; p< 0.39). Interestingly, the AI group had significantly more sites of BOP (27.9 vs 16.7; p < 0.02), and higher CAL (5.2 mm vs 4.0 mm; p < 0.01) than did controls. In linear regression analysis adjusted for income, AI use increased CAL by 1 mm (95% CI: 0.15 -1.88). There was also a trend for decreased CAL in subjects with incomes over $75,000 per year (p< 0.06). Conclusions: This first investigation of the periodontal status of women initiating adjuvant AI therpay identifies this population to have signs of increased risk for periodontal disease. Serial oral health assessments are being conducted to assess AI therapy and periodontal changes over time. Clinical trial information: NCT01693731.
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Havens AM, Shiozawa Y, Jung Y, Sun H, Wang J, McGee S, Mishra A, Taichman LS, Danciu T, Jiang Y, Yavanian G, Leary E, Krebsbach PH, Rodgerson D, Taichman RS. Human very small embryonic-like cells generate skeletal structures, in vivo. Stem Cells Dev 2012; 22:622-30. [PMID: 23020187 DOI: 10.1089/scd.2012.0327] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Human very small embryonic-like (hVSEL) cells are a resident population of multipotent stem cells in the bone marrow involved in the turnover and regeneration of tissues. The levels of VSEL cells in blood are greatly increased in response to injury, and they have been shown to repair injured tissues. Adult hVSEL cells, SSEA-4(+)/CD133(+)/CXCR4(+)/Lin(-)/CD45(-), express the pluripotency markers (Oct-4 and Nanog) and may be able to differentiate into cells from all 3 germ lineages. hVSEL cells isolated from blood by apheresis following granulocyte-colony-stimulating factor mobilization were fractionated and enriched by elutriation and fluorescence activated cell sorting. Collagen sponge scaffolds containing 2,000-30,000 hVSEL cells were implanted into cranial defects generated in SCID mice. Analysis by microcomputed tomography showed that a cell population containing VSEL cells produced mineralized tissue within the cranial defects compared with controls at 3 months. Histologic studies showed significant bone formation and cellular organization within the defects compared with cellular or scaffold controls alone. Antibodies to human leukocyte antigens demonstrated that the newly generated tissues were of human origin. Moreover, human osteocalcin was identified circulating in the peripheral blood. There was evidence that some level of hVSEL cells migrated away from the defect site, using quantitative real-time polymerase chain reaction to detect for human-specific Alu sequences. This study demonstrates that hVSEL cells are able to generate human bone tissue in a mouse model of skeletal repair. These studies lay the foundation for future cell-based regenerative therapies for osseous and connective tissue disorders, including trauma and degenerative conditions, such as osteoporosis, fracture repair, and neoplastic repair.
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Affiliation(s)
- Aaron M Havens
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, Michigan 48109-1078, USA
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Taichman LS, Sohn W, Kolenic G, Sowers M. Depot medroxyprogesterone acetate use and periodontal health in 15- to 44-year-old US females. J Periodontol 2012; 83:1008-17. [PMID: 22309173 DOI: 10.1902/jop.2012.110534] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND It has been suggested that progestins may have an inflammatory component and/or increase in prostaglandin synthesis. Thus, extended progestin use may be associated with higher risk of periodontal diseases. This study investigates the association between depot medroxyprogesterone acetate (DMPA) injectable contraception and the prevalence of periodontal diseases among US premenopausal females. METHODS Data for this cross-sectional analysis comes from the 1999 to 2004 National Health and Nutrition Examination Surveys. This analysis includes 4,460 US females (15 to 44 years of age) with complete DMPA usage and periodontal status data. RESULTS Current and past DMPA use was 4.1% and 12.0%, respectively. The prevalence of gingivitis was 53.9% for females who reported having used DMPA compared with 46.1% for DMPA never-users. Females taking DMPA were more likely to be young, single, and non-white, have a history of smoking, have lower levels of education and income, and have ≥1 live births and were less likely to visit the dentist. Using logistic regression, DMPA use was associated with an increased risk of gingivitis (odds ratio [OR] =1.7; 95% confidence interval [CI] = 1.09 to 1.67) and periodontitis (DMPA, OR = 1.49; 95% CI = 1.01 to 2.22) after adjusting for age, race, education, poverty income ratio, dental care use, and smoking status. A significant interaction between smoking status and DMPA use was also found (P = 0.029). CONCLUSIONS This study suggests that DMPA use may be associated with periodontal diseases. Additional investigation is warranted as a result of the disproportionate usage of DMPA among low-income populations who are at an increased risk for poor dental health.
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Affiliation(s)
- L Susan Taichman
- Department of Periodontics and Oral Medicine, Room 3345, University of Michigan School of Dentistry, 1011 N. University Ave., Ann Arbor, MI 48109-1078, USA.
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Sohn W, Taichman LS, Ismail AI, Reisine S. Caregiver's perception of child's oral health status among low-income African Americans. Pediatr Dent 2008; 30:480-487. [PMID: 19186773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
PURPOSE This study aimed to: (1) compare caregivers' perceptions of their children's oral health status with clinical findings; and (2) investigate the influence of caregivers' attitudes, beliefs, and knowledge concerning dental caries development and oral health on caregivers' perception levels of their children's oral health status. METHODS A representative sample of low-income African American families (0- to 5-year-olds and their caregivers) in Detroit, Mich was interviewed. Caregivers were asked to assess their own and their children's oral health status. All children and their caregivers received dental examinations. This study included data from 885 caregivers with children aged 1 year or older. RESULTS Approximately 79% of caregivers rated their children's oral health as good to excellent, and 21% rated it as fair to poor. Caregivers' perception of their children's oral health was significantly associated with their children's caries experience, as measured by the number of decayed, missing, and filled tooth surfaces. It was also associated with limitations of oral functions, such as chewing difficulty. Poorer perceptions of caregivers' oral health and fatalistic attitudes toward children's oral health were significantly associated with poorer perception of their children's oral health. CONCLUSION Caregivers' perception of their children's oral health status is a significant indicator of the children's clinical caries experience.
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Affiliation(s)
- Woosung Sohn
- Department of Oral Health and Diagnostics Sciences, Division of Behavioral Sciences and Community Health, School of Dentistry, University of Michigan, Ann Arbor, Mich, USA.
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Havens AM, Chiu E, Taba M, Wang J, Shiozawa Y, Jung Y, Taichman LS, D'Silva NJ, Gopalakrishnan R, Wang C, Giannobile WV, Taichman RS. Stromal-derived factor-1alpha (CXCL12) levels increase in periodontal disease. J Periodontol 2008; 79:845-53. [PMID: 18454663 DOI: 10.1902/jop.2008.070514] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND The CXC chemokine receptor 4 (CXCR4) and its ligand, stromal cell-derived factor-1 (SDF-1alpha or CXC chemokine ligand 12) are involved in the trafficking of leukocytes into and out of extravascular tissues. The purpose of this study was to determine whether SDF-1alpha secreted by host cells plays a role in recruiting inflammatory cells into the periodontia during local inflammation. METHODS SDF-1alpha levels were determined by enzyme-linked immunosorbent assay in gingival crevicular fluid (GCF) of 24 individuals with periodontitis versus healthy individuals in tissue biopsies and in a preclinical rat model of Porphyromonas gingivalis lipopolysaccharide-induced experimental bone loss. Neutrophil chemotaxis assays were also used to evaluate whether SDF-1alpha plays a role in the recruitment of host cells at periodontal lesions. RESULTS Subjects with periodontal disease had higher levels of SDF-1alpha in their GCF compared to healthy subjects. Subjects with periodontal disease who underwent mechanical therapy demonstrated decreased levels of SDF-1alpha. Immunohistologic staining showed that SDF-1alpha and CXCR4 levels were elevated in samples obtained from periodontally compromised individuals. Similar results were observed in the rodent model. Neutrophil migration was enhanced in the presence of SDF-1alpha, mimicking immune cell migration in periodontal lesions. CONCLUSIONS SDF-1alpha may be involved in the immune defense pathway activated during periodontal disease. Upon the development of diseased tissues, SDF-1alpha levels increase and may recruit host defensive cells into sites of inflammation. These studies suggest that SDF-1alpha may be a useful biomarker for the identification of periodontal disease progression.
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Affiliation(s)
- Aaron M Havens
- Department of Periodontics and Oral Medicine, University of Michigan Dental School, 1011 N. University Avenue, Ann Arbor, MI 48109, USA
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Sohn W, Ismail AI, Taichman LS. Caries risk-based fluoride supplementation for children. Pediatr Dent 2007; 29:23-31. [PMID: 18041509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
PURPOSE The purpose of this study was to evaluate primary care physicians' recommendation of fluoride supplements based upon a child's caries risk. METHODS A representative sample of family physicians (FPs) and pediatricians (PDs) in the United States was mailed a letter and a questionnaire that described case scenarios of 2-year-old children-one with low and the other with high caries-risk -as well as questions about opinions on fluoride supplement use. The physicians' opinions were compared with CDC experts' consensus on the same scenarios. RESULTS The response rates were 43% for FPs and 52% for PDs. FPs and PDs had a high agreement level (76% ond 80%, respectively) with CDC experts regarding the need for fluoride supplementation of the high-risk child. For o low risk child, all physicians showed a significantly lower level of agreement with the CDC experts (15% for FPs; 7% for PDs). CONCLUSIONS The majority of primary care physicians follow the current fluoride supplementation guideline without considering the caries risk status of a child. If caries risk status is to be used to tailor preventive regimens, then physicians need to be educated on how to identify children with the highest need for prevention.
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Affiliation(s)
- Woosung Sohn
- School of Dentistry, University of Michigan, Ann Arbor, MI, USA.
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Taichman LS, Eklund SA. Oral contraceptives and periodontal diseases: rethinking the association based upon analysis of National Health and Nutrition Examination Survey data. J Periodontol 2005; 76:1374-85. [PMID: 16101372 DOI: 10.1902/jop.2005.76.8.1374] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Historic evidence suggests that use of high-dose combined oral contraceptives (OCs) (containing >50 microg of estrogen and>or=1mg progestin) places women at increased risk for periodontal diseases. Since the mid-1970s, OC formulations have dramatically changed. This study investigated the association between OC use and periodontal diseases among 4,930 National Health and Nutrition Examination Survey (NHANES) I and 5,001 NHANES III premenopausal U.S. women, aged 17 to 50 years, before and after the reduction of hormone levels in OCs. METHODS Data for this cross-sectional study came from the first (NHANES I, 1971 to 1974) and third (NHANES III, 1988 to 1994) NHANES studies. RESULTS The prevalence of OC use in the U.S. premenopausal female population in NHANES I was 22% and in NHANES III, 20%. Using multivariable logistic regression, a protective association between current OC use and gingivitis was suggestive but not significant in both NHANES I (odds ratio [OR]=0.65; 95% con- fidence interval [CI]: 0.42 to 1.01) and NHANES III (OR=0.80; 95% CI: 0.61 to 1.02) surveys. Current OC use was also associated with a decreased risk of periodontal disease in NHANES I (OR=0.36; 95% CI: 0.13 to 0.96) and a non-significant association in NHANES III (OR=0.73; 95% CI: 0.50 to 1.07). CONCLUSION This analysis failed to validate the theory that earlier high- or current low-dose OC use is associated with increased levels of gingivitis or periodontitis and suggests an important reexamination of the perceived association between OC use and periodontal diseases.
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Affiliation(s)
- L Susan Taichman
- Department of Periodontics, Prevention, and Geriatrics, University of Michigan Dental School, Ann Arbor, MI, USA.
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