AN INCREASE IN ORAL HUMAN PAPILLOMAVIRUS INFECTIONS AND CANCERS
(10/2017) The New York Times (10/16, Bakalar, Subscription Publication) “Well” blog: According to published research in the Annals of Internal Medicine “11 million men and 3.2 million women in the US have oral HPV infections.” Of those, “7 million men and 1.4 million women” have “strains that can cause cancers of the throat, tongue and other areas of the head and neck.” Time has reported that the investigators have noted “the number of men with HPV-related cancer of the oropharynx – the tongue, tonsils and back of the throat – has rapidly increased and has already surpassed the incidence of cervical cancer among women.” Additionally, this research suggests that men had a higher risk of developing oral HPV when they had oral sex with other men or also had genital HPV infections reports Reuters. CNN has said “that the study also indicates that HPV infections, overall, and high-risk HPV oral infections, in particular, were ‘significantly associated’ with cigarette and marijuana use.” Although both men and women age 11-26 can receive protection from the HPV vaccine, many infected men are over the eligibility age of 26, and younger men have had low vaccination rates.
LINK FOUND BETWEEN ALZHEIMER’S AND EXCESS SUGAR
A study published in the journal Scientific Reports from researchers at the University of Bath suggests “people who eat diets high in sugar could be at greater risk of Alzheimer’s disease.” The study’s authors also found “excess glucose damages a vital enzyme involved with inflammation response to the early stage of the disease.” Their research finds that “in the early stages of Alzheimer’s, an enzyme called MIF (macrophage migration inhibitory factor) is damaged by a process called glycation.” Noting that, “as the disease progresses, the glycation of these enzymes increases,” researchers claim that inhibition and reduction of MIF activity caused by glycation could be the ‘tipping point’ in disease progression.
INCREASED ESOPHAGEAL CANCER RISK LINKED TO ORAL BACTERIA
HealthDay (12/1, Preidt) A new study tracking the oral health of 122,000 Americans for 10 years suggests that the presence of two types of bacteria found in gum disease is associated with an increased risk for esophageal cancer. According to Dr. Anthony Starpoli, associate director of esophageal endotherapy at Lenox Hill Hospital in New York City, “What is not clear is whether the presence of these bacteria or the resultant periodontal disease is primarily responsible for the development of cancer,” Dr. Starpoli recommends that specialists should “consider a proper evaluation of the oral cavity as well as the remainder of the digestive tract in the hope of early diagnosis of esophageal cancer.” Science Daily (12/1) Dr. Jiyoung Ahn, associate director for population science at NYU Langone Health, said the study “…indicates that learning more about the role of oral microbiota may potentially lead to strategies to prevent esophageal cancer, or at least to identify it at earlier stages.”
BLOOD-BORNE DISEASE CAN BE TRANSMITTED BY STRAWS SHARED TO SNORT OPIOIDS
HealthDay (7/27) A study of 189 women pregnant women in Tennessee who were infected with hepatitis C published in Obstetrics & Gynecology confirmed that the sharing of straws to snort opioids can be a cause of hepatitis C infection and may also lead to the transmission of other blood-borne diseases such as HIV.
WEST VIRGINIANS SAY OPIOID EPIDEMIC IS TOP HEALTH ISSUE FACING THE STATE
EurekAlert (10/16) A public opinion survey by Research America found “the opioid epidemic is the most important health issue on the minds of West Virginians, above obesity, cancer, chronic obstructive pulmonary disease (COPD) and dental disease. Over 80 percent of the respondents said prescription pain medication abuse and addiction is a major problem in their community. Information for patients is available at MouthHealthy.org.
DNA AGING CAN BE SLOWED BY EXERCISE
Research published in Science Advances suggests that just moderate-intensity physical activity can keep DNA healthy and young, which could slow the aging process. Exercise can activate a factor (NRF-1) which protects DNA from aging by binding to a part on the end of chromosomes called telomeres. This process effectively lengthens telomeres; longer telomeres have been associated with a slow down of cell aging.
PRECISION MEDICINE INITIATIVE GROWING
Universities, healthcare companies, and an increasing number of other organizations will be participating in the huge nationwide project to sequence the genomes of volunteers and learn more about ways to provide personalized medical treatment to patients according to an article in Health IT Analytics (7/27). The article notes that National Institutes of Health will be providing grants to some of the institutions participating in the massive Precision Medicine Initiative project.
TOOTH FAIRY DECREASES PAYOUTS IN 2017
WWBT-TV: According to an online poll, the Original Tooth Fairy Poll, sponsored by Delta Dental, the Tooth Fairy reduced cash payouts in 2017 by 11% overall compared to 2016. The poll of 1,007 children also showed between the ages of 6 and 12, an average payout for the first tooth was $5.70 per tooth, only a minor drop from 2016 which saw a $5.72 payout. Still, according to the poll, the Tooth Fairy contributed about $271 million for lost teeth across the country.
E-CIGARETTES MAY LEAK TOXIC METALS AND HARMFUL CHEMICALS INTO THE LUNGS OF USERS
USA Today (2/23, May) A study in Environmental Health Perspectives found significant levels of highly toxic metals in vapers from e-cigarettes. The study’s samples found highly toxic arsenic, chromium, manganese, nickel, and lead. Ana María Rule, assistant scientist in the Bloomberg School’s Department of Environmental Health and Engineering, said, “It’s important for the FDA, the e-cigarette companies and users …to know that these heating coils…seem to be leaking toxic metals – which then get into the aerosols” and are inhaled. nationalacademies.org/eCigHealthEffects: Millions of Americans use e-cigarettes, even as rates of smoking combustible tobacco cigarettes continue to decline among youth and adults. In 2016 youth e-cigarette use was substantially higher than cigarette smoking or use of any other tobacco product. www.lung.org Most importantly, the Surgeon General concluded that e-cigarette use among youth is now a significant public health concern and steps must be taken by parents, educators and especially policymakers to discourage use of e-cigarettes. In December 2016, the U.S. Surgeon General issued a groundbreaking report “E-Cigarette Use Among Youth and Young Adults” that made a number of important conclusions and findings about the use of e-cigarettes among youth. These included that the flavors in e-cigarettes are one of the main reasons youth use them, e-cigarette aerosol is not safe, and that e-cigarette use is strongly associated with the use of other tobacco products among youth and young adults. Flavors in e-cigarettes are also a cause for concern because they are used to target kids and could be harmful on their own. Manufacturers and marketers claim that the flavor ingredients used in e-cigarettes are safe and have FEMA GRASTM status for use in food, but such statements are false and misleading. FEMA GRASTM status only applies to food, meaning it’s safe to eat, but does not apply to being inhaled through e-cigarettes.
The main component of e-cigarettes is the e-liquid contained in cartridges. To create an e-liquid, nicotine is extracted from tobacco and mixed with a base (usually propylene glycol), and may also include flavorings, colorings and other chemicals. Diacetyl, a buttery flavored chemical often added to food products such as popcorn, caramel, and dairy products, has also been found in some e-cigarettes with flavors. Diacetyl can cause a serious and irreversible lung disease commonly known as “popcorn lung.” Users often learn to use e-cigarettes in a way that increases their exposure to nicotine. Newer “tank” styles, with higher voltage also deliver a greater concentration of nicotine – the more nicotine used, the greater the potential for addiction. Some products that claim not to have any nicotine in them may still contain it. A 2014 study found that the amount of nicotine in e-liquid refills is often substantially different from the amount listed. The U.S. Surgeon General has found exposure to nicotine during pregnancy harms the developing fetus and causes lasting consequences for the developing brain and lung function in newborns, affects maternal and fetal health during pregnancy, and can result in low birth weights, preterm delivery, stillbirths, or cause sudden infant death syndrome. Nicotine use during adolescence and young adulthood has been associated with lasting cognitive and behavioral impairments, including effects on working memory and attention. The CDC reports that calls poison centers for e-cigarette exposure poisonings are rapidly increasing with most calls involving e-cigarette liquid poisoning from accidental ingestion of the e-cigarette or its liquid, about one-sixth of the calls are related to inhaling. Large doses of nicotine have a potential for poisoning, with symptoms beginning with nausea and vomiting in cases of acute toxicity and progressing to seizures and respiratory depression in cases of severe nicotine poisoning. The U.S. Surgeon General has concluded that ingestion of e-cigarette liquids containing nicotine can cause acute toxicity and possibly death. This is particularly true in children as calls to poison control centers have increased nationwide. The U.S. Surgeon General has also concluded that e-cigarettes can expose users to several other potentially harmful chemicals, including nicotine, carbonyl compounds and volatile organic compounds. While e-cigarettes do not contain smoke, they do expose others to secondhand emissions. Two studies have found formaldehyde, benzene and tobacco-specific nitrosamines (all carcinogens) coming from those secondhand emissions. Other studies have shown that chemicals in the emissions contain formaldehyde, acetaldehyde and other potential toxins. As reported in Pediatrics 3/5/2018, propylene oxide, acrylonitrile, crotonaldehyde, acrylamide, acrolein are found in the fruit flavored products. The American Lung Association has urgently called for FDA oversight of these products.
TOBACCO INDUSTRY BEGINS COURT-ORDERED ADS ABOUT CIGARETTES
The Hill (11/21, Hellmann) reported that the tobacco industry would begin running ads this week “detailing the negative health effects from smoking cigarettes 11 years after they were ordered to do so by a federal court.” The article reported that Phillip Morris, Altria Group, and R.J. Reynolds would begin the ads on Sunday, Nov. 26, in newspapers and on network television. The required PSA ads state that the Phillip Morris Company, R. J. Reynolds, Altria Group, Lorillard manipulated the nicotine content, filters, and papers of cigarettes to make them more addictive, and that low tar, low nicotine, and light cigarettes are no safer than regular cigarettes.
CNN (11/21, Howard) reports “the ads detail the health effects of smoking, the addictiveness of cigarettes, and the dangers of secondhand smoke and low-tar cigarettes, among other health concerns.”
REDUCING EMERGENCY ROOM DENTAL VISITS COULD SAVE MILLIONS IN HEALTHCARE COSTS
Vox (2/23) Emergency room visits for dental pain can cost between $400-$1,500 dollars. The American Dental Association’s Health Policy Institute says 79% of those visits could be accomplished in a dental office with an average cost of only $90-$200 per visit saving the healthcare system millions of dollars and providing patients the care they need. In 2015, $2 billion was spent on hospital emergency visits for dental conditions. Of the 2.2 million people who visit a hospital Emergency Department for dental pain, 41% are reimbursed through Medicaid.
MAJORITY OF AMERICANS NOT EATING ENOUGH FRUITS, VEGETABLES
TIME (11/17, Ducharme) Most Americans are not incorporating enough of fruits and vegetables into their diets, according to the CDC. The governments most recent Dietary Guidelines for Americans suggests that adults consume 1.5 to two cups of fruit per day, and two to three cups of vegetables per day. However, data compiled by the CDC demonstrates that only 12.2% of American adults consume the recommended amount of fruit, and 9.3% meet the standard consumption for vegetables. The public can find up-to-date evidenced-based information about nutrition at the ADA’s consumer website, MouthHealthy.org.
DIETARY SALT MAY CAUSE NEUROVASCULAR AND COGNITIVE DYSFUNCTION
Cleveland Clinic Wellness 212/18: Source: Dietary salt promotes neurovascular and cognitive dysfunction through a gut-initiated TH17 response: New research suggests that excess salt consumption might increase risk for dementia. In an animal study, when mice were fed a high-sodium diet for eight weeks, they had reduced blood flow to areas of the brain related to memory and learning causing poor performance on tests related to recognizing objects, finding their way through mazes, and nest building. However, when researchers put some animals back on a normal diet, their brain power was restored.
While recent research shows no association between salt intake and risk of heart disease, heart failure, or death, the American Heart Association recommends an upper limit of 2,300 mg of sodium a day and advises most adults to shoot for no more than 1,500 mg, especially adults older than 51, African Americans, and those with high blood pressure, diabetes or chronic kidney disease. Just 1/4 teaspoon of salt contains about 575 mg of sodium. Those who eat packaged and restaurant foods often consume far more than recommended levels, since these foods are usually loaded with salt. Switching to whole foods and home-cooked meals will slash sodium intake. (Read labels carefully noting the serving sizes.) Eating plenty of fruits and vegetables will increase intake of potassium, which helps to balance sodium. Experts suggest substituting herbs and spices: basil, thyme, rosemary, garlic; or use warming spices like turmeric, cumin, cardamom, cinnamon, chili peppers, or a squeeze of lemon.
RESEARCHERS IDENTIFY MOLECULAR LINK BETWEEN ALZHEIMER’S AND EXCESS SUGAR
The Telegraph (UK) (2/23, Bodkin) A study published in the journal Scientific Reports, reports “people who eat diets high in sugar could be at greater risk of Alzheimer’s disease.” Findings from research at the University of Bath “found excess glucose damages a vital enzyme involved with inflammation response to the early stage of the disease.” The researchers found that “an enzyme called MIF (macrophage migration inhibitory factor) is damaged by a process called glycation in the early stages of Alzheimer’s”, and that “as the disease progresses, the glycation of these enzymes increases.” This suggests that “reduction of MIF activity caused by glycation could be the ‘tipping point’ in disease progression”.
WOMEN’S HEALTH INITIATIVE: GUM DISEASE, TOOTH LOSS PREDICTS INCREASED MORTALITY IN OLDER WOMEN
Heartwire, Medscape. Apr 04, 2017
BUFFALO, NY — In a large study of postmenopausal women published 3/29/2017 in the Journal of the American Heart Association, information gathered from 57,001 women 50 to 79 years old who were part of the Women’s Health Initiative (WHI) Observational Study, funded by the National Heart, Lung, and Blood Institute at 40 centers across the US from 1993 through 1998, suggests periodontitis and tooth loss predict a significantly increased risk of death, but not necessarily an increase in risk for cardiovascular disease  . Prior research has shown a connection between tooth loss and an increased mortality risk in a broad population. But because menopause negatively affects oral health, and because by 2035, people aged 65 and older will make up a large age group, and “among that group, women will outnumber men two to on”, studying women was particularly important. This group of women was known to be postmenopausal and 55 years of age and older (mean age 68) with good documentation were without heart disease at the beginning of our study; half were either overweight or obese; most were non-Hispanic white, and had at least some college; there were 3589 incident cardiovascular disease events and 3816 total deaths over the follow-up period of the study.
The authors point out, having the women report on their own history of gum disease and tooth loss status is admittedly a limitation of analysis. Both conditions are prevalent among older people—64% of US adults over 60 have moderate to severe gum disease and 33% have tooth loss, according to the report. The study looked at four scenarios: tooth loss and gum disease; gum disease without tooth loss; tooth loss without gum disease; and neither tooth loss nor gum disease.In women who had both tooth loss and gum disease, their risk of dying was higher than any of the other groups. However, gum disease was not linked with CV events, although it was associated with 12% higher total mortality. Loss of all permanent teeth predicted a 17% increase in mortality. The research team hypothesized that tooth loss probably reflects more than just oral hygiene, and it could be influenced by health factors such as diet, smoking, or other conditions that have accumulated over a lifetime.
Lead author Dr. Michael J LaMonte (University at Buffalo, NY) suggests that their findings, if confirmed by prospective trials, could have substantial implications for public health in that they may support intensive oral screening in midlife and could potentially become as important for screening as cholesterol and high blood pressure for prolonging life, especially for women.
REGULATING SUGAR? SUGAR IS THE NEW TOBACCO
Consensus is building for limiting the daily intake of sugar, especially the fructose component. Researchers believe this is justified based upon its toxicity, unavoidability, and the potential for abuse. Sugar is not defined as a nutrient. Added sugar has no biological requirement for health. Optimum consumption is said to be zero. Added sugar is almost impossible for the consumer to avoid. It is often hidden in as much as 80% of processed foods, and reported on confusing food labels by many names; in the United states, almost 50% comes from foods that public doesn’t always associate with having added sugar. Thirty-three percent comes from sugary drinks, and a sixth from foods considered junk foods, such as candy, ice cream, etc. Sugar-sweetened beverages are the largest source of added sugars in the American diet. A can of regular soda packs about 35 grams of added sugars, equivalent to 8.75 teaspoons or 140 calories which is triple the 2009 upper limit intake suggested by the US Department of Agriculture for an 8-year-old child. Currently the average person consumes at least 4 to 7 times that amount daily.
Sugar is blamed for heart disease, hypertension, high cholesterol, and both the diabetes & obesity epidemics. According to the study published in JAMA: Internal Medicine, those who got 17 to 21 percent of calories from added sugar had a 38 percent higher risk of dying from cardiovascular disease compared to those who consumed 8 percent of their calories from added sugar. The relative risk was more than double for those who consumed 21 percent or more of their calories from added sugar. Experts say the consumption of just small amounts of free sugar, from all daily sources, (including fruit juice, syrups, and honey) also has had a detrimental effect on the most common global disease, tooth decay; tooth decay is the biggest cause of chronic pain and hospital admission in children; dental disease in general, is responsible for 5-10% of all health expenditures in developed countries.
Here are the important numbers to remember: there are 4 calories per gram of sugar and 4 grams per teaspoon. If the label says it has 20 grams of sugar, that’s 5 teaspoons, or about 80 calories from sugar. The American Heart Association recommends: no more than 6 teaspoons or 100 calories a day of sugar for most women; no more than 9 teaspoons or 150 calories a day for most men. Researchers suggest that the World Health Organization limit consumption to no more that 3% (about 3 teaspoons) of daily calories. The science is more than sufficient; the case against sugar is overwhelming. There is nothing wrong with the occasional treat, but sugar has no place as part of a “healthy balanced diet.” Similar to smoking, any further regulatory measures to reduce sugar consumption, such as banning of sugary drink advertising and dissociating sugary drinks with sporting events, can have a positive impact on improving population health within a short time.
The similarities between Big Tobacco and the sugar industry are disturbing. The food industry feels that the public should take a “personal responsibility” when choosing what foods to eat, which deflects blame from them in the obesity epidemic. As a recent publication in JAMA Internal Medicine showed, the sugar industry paid three influential Harvard scientists to downplay sugar’s role in heart disease and to shift the blame to fat. Last year, the New York Times exposed that the Coca-Cola Company paid millions of dollars to fund research that downplayed the role of sugary drinks in obesity and push lack of exercise as the main factor. The incorrect advocacy of a low-fat, high-carbohydrate, and high-sugar diet by morally corrupt scientists and politicians who allowed themselves to be manipulated by food suppliers is likely the cause of global obesity.
Medscape October 31, 2016
SPECIFIC ORAL BACTERIA LINKED TO MIGRAINES
October 18, 2016 – In a recent study published by the American Society for Microbiology based on research from the American Gut Project, researchers uncovered a mechanism behind nitrate-based triggers for migraines. When bacteria in the mouth break down nitrates, one of the oxygen atoms is removed, resulting in nitrites. When in the bloodstream, nitrites can be converted into nitric oxide (NO). Nitrate induced headaches can present as mild, occurring with an hour; or delayed, occurring 3-6 hours after nitrate intake. The link between nitrates and headaches has been known for a while; consuming food containing nitrates, such as wine, chocolate, and processed meats, as well as, taking certain cardiac medication containing nitrates may cause severe headaches in some people. Although migraines are associated with many other factors, including genetic and hormonal factors, researchers reported differences in oral bacterial samples of nitrate reducing bacteria from the Streptococcus and Pseudomonas genera in migraineurs vs nonmigraineurs. Although this correlation exists, causality has not been demonstrated. This research may lead to migraine treatment interventions that alter or control the bacterial flora, either by diet or chemicals.
mSystems. Published online October 18, 2016. Abstract
GUM DISEASE TIED TO RISK OF ERECTILE DYSFUNCTION
Listen-up men! A recent review of five different studies covering 213,000 participants between the ages of 20 and 80 revealed that erectile dysfunction was more common among men being treated for chronic gum disease. After accounting for diabetes, erectile dysfunction was 2.28 times more common in those younger than 40 and older than 59. Causation has not been proven, however researchers mention that both periodontal disease and erectile dysfunction have similar risk factors such as, diabetes, coronary artery disease, smoking, and aging. Since gum disease has been linked with other chronic disorders due to its contribution to systemic inflammation, reviewers suggest that it might be beneficial to inform patients with chronic gum disease about this association.
Int J Impot Res 2016
WEST VIRGINIA UNIVERSITY SCHOOL OF DENTISTRY TO BECOME A DENTISTRY INNOVATION CENTER
West Virginia University School of Dentistry will soon be one of only three schools in North America to have a dentistry Innovation Center sponsored by the Center for Research and Technology Incorporated. West Virginia University School of Dentistry has partnered with the Center for Research and Technology Inc. to build the center, which will include some of the newest dental equipment on the market. CRET is a group of more than 20 dental equipment manufacturers and suppliers. The new WVU center will be available to fourth-year students and alumni and will simulate private practice. WVU’s hope is that the center will help enhance students’ training and clinical practice. The partnership also gives students the opportunity to try out some of the equipment they will need to buy after graduation for free and allows the students to give feedback to the manufacturers about the equipment itself. CRET Innovation Centers were also opened at Loma Linda University in California and the University of Missouri-Kansas City. West Virginia University School of Dentistry is the only dental school in WV.
SUBLINGUAL VARICES ASSOCIATED WITH HYPERTENSION
Blood vessels under that lateral borders of the tongue, specifically veins with an appearance similar to varicose veins in the legs, are predictive of hypertension. Sublingual varices have earlier been related to ageing, smoking, and cardiovascular disease. In an observational clinical study among 431 dental patients tongue status and blood pressure were documented. The prevalence of sublingual varices was 26.5 % (114/431) in the study population, with 18.3 % among those having normal blood pressure, and 47.5 % among those diagnosed with hypertension. Based on the results of the current study, a patient above 40 years of age with sublingual varices has a 50 % risk of being hypertensive, and if also being a smoker the risk increases to 58 %. If sublingual varices are not present the chance of being normotensive is 80 %. A demonstrated positive correlation gives hope that a routine dental exam could be of important predictive value for hypertension screening.
BMC Oral Health. 2015;15(78)
MOUTH BACTERIA MAY BE A TRIGGER FOR JOINT INFLAMMATION IN RHEUMATOID ARTHRITIS
The association between rheumatoid arthritis (RA) and poor oral health has been known for years. The role of specific oral pathogens in initiating, amplifying, and perpetuating RA has previously been demonstrated. New research from John Hopkins University published December 2016 has identified another possible link between gum disease and rheumatoid arthritis (RA). One of the causative agents of periodontal disease, the bacterial species Aggregatibacter Actinomycetemcomitans (A.a.) raises the level of citrullinated proteins in gingival fluids by producing a toxin (LtxA) that splits open a type of white blood cell (neutrophil); this process, called citrullination, releases citrullinated proteins. Citrullination is a natural protein regulatory process in everyone. In persons with RA, the process is overactive; the proteins produced are known to trigger an immune response in people with RA causing them to make antibodies against them (anti-CCP). The study found similarities in the spectrum of protein citrullination in the gingival fluid was very similar to the protein citrullination found in the joints of individuals with RA. Previous studies have also linked another oral pathogen, Porphyromonas gingivalis (P.g.), with RA, citing a biological connection between RA and gum disease: the more teeth lost to gum disease, the greater the risk and severity of joint inflammation. Although more research is needed, this most recent study suggests that oral bacteria can be one trigger for RA, and that the oral mucosa lining the gingival crevice, may be an initiating site. The lead author of the study says the research is the closest yet to uncovering one of the root causes of RA. However, not everyone with RA has the antibodies, and not everyone with the antibodies has RA. Additionally, not everyone with gum disease develops RA, and not everyone with RA develops gum disease; it should be noted that other infective and inflammatory processes may also be contributing to the raised levels of citrullinated proteins. But, while controlling the oral bacterial population remains essential for everyone, it may be especially important for those at risk for RA or with a family history of RA as it provides hope for treatment, prevention, and risk assessment possibilities.
Science Translational Medicine. 2016.
BACTERIAL PNEUMONIA MORE PREVALENT IN THOSE LACKING ROUTINE DENTAL CARE
In findings presented at IDWeek 2016, to the joint meeting of the Infectious Diseases Society of America, the Society for Healthcare Epidemiology of America, the HIV Medicine Association, and the Pediatric Infectious Diseases Society, researchers noted that the risk of pneumonia is less in those people who customarily have routine dental check-ups. In fact, compared to those who had twice a year visits to the dentist, persons who never saw the dentist had an 86% increased risk; the analysis of national survey data also revealed that compared to persons who visited their dentist at least twice a year, those who had dental visits less than once a year had a 49% risk for pneumonia. The mechanism surmised is related to the influx of pathogenic organisms from the mouth into the lung during aspiration. Of course the content of saliva depends upon one’s overall oral health; but if there are pathogenic bacteria present, the possibility of pneumonia increases. Frequent dental care appears to be something that people can do themselves to reduce risk. This may be a relatively simple intervention that can assist in achieving pneumonia prevention. The findings further support the link between poor dental hygiene and bacterial infection.
IDWeek 2016. Abstract 678. Presented October 27, 2016.