Changes in Oral Health Behavior According to Dental Calculus Removal Health Insurance in Korea.

BACKGROUND: Periodontal disease is a chronic disease that is increasing year by year. Korea also recognizes the seriousness of periodontal disease and has been applying preventive scaling in the National Health Insurance since 2013 to prevent it. Studies confirming the effectiveness of such insurance coverage are very scarce. Therefore, this study intended to confirm the effect of such policy by comparing and analyzing the oral health characteristics and oral health behavior of the South Koreans before and after the scaling insurance. METHODS: For all the analyses, complex sampling analysis with the stratification variable, clustering variable, and weight was applied. For a total of 40,945 people, the demographic characteristics, oral health characteristics, dental clinic use, brushing, and use of oral care supplies were compared through chi-square tests. RESULTS: Scaling insurance showed a positive effect (p < 0.05) on the unemployed and elderly people, who had lost their previous economic status; on smoking and willingness to quit smoking as well as on consultation on drinking problems; on dental-clinic use and oral examination in terms of utilization of dental clinics; and on brushing after lunch, before breakfast, and before sleeping. CONCLUSIONS: The study results showed that the scaling rate was universalized, and there was a positive effect on willingness to quit smoking and undergo oral examination. An active reimbursement policy for oral health education is needed, however, if a substantial change in oral health behavior is to be achieved.

Analysis of Quantitative Light-Induced Fluorescence Images for the Assessment of Bacterial Activity and Distribution of Tongue Coating.

This study aimed to verify and to validate the correlation between, and validate the assessment of, bacterial activity and the distribution of tongue coating, by analyzing quantitative light-induced fluorescence (QLF) images for the diagnosis of oral malodor. Oral malodor was measured using the Twin Breasor II, and bacterial activity and the distribution of tongue coating were investigated using QLF images. Bacterial activity and the distribution of tongue coating were quantitatively analyzed by dividing the tongue into six areas using the TB01 1.05 software. ROC curves were generated using MedCalc® software to validate the diagnosis of oral malodor, the testing of bacterial activity, and the distribution of tongue coating. Bacterial activity and the distribution of tongue coating showed a very strong association with each other (r = 0.937, p < 0.01), and were significantly higher in the oral malodor group (p < 0.05). The distribution of tongue coating was highly correlated with H2S (r = 0.223, p < 0.01) but not associated with CH3SH. Sensitivity, specificity, and the area under the curve confirmed the high accuracy of this method in assessing bacterial activity and the distribution of tongue coating in the diagnosis of oral malodor. Since QLF images provide significant accuracy during quantitative analysis in the identification of bacterial activity and the distribution of tongue coating, systematic management of tongue coating and reduced oral malodor can be achieved by actively using QLF images and oral malodor measurement.

Risk of dementia according to the severity of chronic periodontitis in Korea: a nationwide retrospective cohort study.

OBJECTIVES: We investigated the risk of dementia in older adults with chronic periodontitis according to the severity of periodontitis. METHODS: Data on patients with chronic periodontitis were extracted from the National Health Insurance Service-Senior cohort database from 2002 to 2014. Among 52,728 subjects eligible for inclusion, 11,953 subjects had newly diagnosed mild chronic periodontitis (MCP), and 40,775 subjects had newly diagnosed severe chronic periodontitis (SCP). Two 1:1 propensity score matched cohorts were created with 8,624 patients each in the MCP and SCP groups. To analyze the risk of dementia, a Cox proportional-hazard model was used to calculate hazard ratios with 95% confidence intervals (CIs). RESULTS: In the Kaplan-Meier curve, the disease-free probability was significantly lower in the SCP group than in the MCP group (p for log-rank=0.001). In the multivariable-adjusted model, the HR for the occurrence of dementia in the SCP group compared to the MCP group was 1.15 (95% CI, 1.04 to 1.27; p=0.009). A subgroup analysis revealed a significant association between dementia and the severity of periodontitis, especially in subjects who were male, aged ≥70 years, and had comorbidities. CONCLUSIONS: Reducing the severity of chronic periodontitis can help to reduce the risk of dementia. Therefore, it is necessary to aggressively conduct early dementia-prevention programs for males under the age of 70 that include dental health to prevent the progression of periodontitis from mild to severe.

Trend Analysis of Average Frequency Using Toothbrushing per Day in South Korea: An Observational Study of the 2010 to 2018 KNHANES Data.

The aim of this study was to examine the trend of average frequency of toothbrushing per day according to the sociodemographic characteristics using the 5th, 6th, and 7th Korean National Health and Nutrition Examination Survey (KNHANES) data for 9 years; from 2010 to 2018. It intends to understand the state of toothbrushing practices in South Korea, and to provide basic data for promoting toothbrushing practices. Data from the 5th, 6th, and 7th KNHANESs conducted by the Korean Disease Control and Prevention Agency each year was analyzed using IBM SPSS version 26.0 (IBM Co., Armonk, NY, USA). Tableau version 2020.1 was used for the graphs and geographic information system (GIS). The significance level of α was set at 0.05 for testing. In all analyses, the complex sampling analysis method with stratification variables, cluster variables, and weights was applied, and the complex sample linear regression analysis. The average frequency of toothbrushing per day was higher in women for all the years; these women belonged to the age group under 65 and the employed group. The average frequency of toothbrushing per day was lower in the married, elementary school graduate, part-time job, and low-income groups for all years. The demographic and social factors affecting the number of toothbrushing practices per day were gender, education level, income level, and work type. After analyzing the average frequency of toothbrushing per day in each of the cities and provinces, Gangwon-do and Jeonbuk showed the highest increase in the frequency of toothbrushing in 2018 compared to 2010, whereas Incheon showed the lowest increase. From the above results, the average frequency of toothbrushing per day was lower in males, those with a low education level, the unemployed, and those in the rural area for a period of 9 years. Therefore, in-depth oral health promotion projects and national benefit policies should be considered for effective toothbrushing education by identifying individuals who do not brush their teeth.

Association between Dental Treatment, Quality of Life, and Activity Limitation According to Masticatory Discomfort: Evidence from the Korean National Health and Nutrition Examination Survey (2013-2015).

People with masticatory discomfort are unable to consume a balanced diet, which impacts their general health. We studied the relationship between quality of life and dental care associated with masticatory discomfort. Data from Korea's representative 6th Korea National Health and Nutrition Examination Survey (KNHANES) were used. Complex sampling analysis with the stratification variable, clustering variable, and weight was applied. Demographic and dental treatment characteristics and activity limitations were compared through chi-square tests. The comparison of quality of life according to masticatory discomfort was performed using linear regression. The risk of masticatory discomfort was high in people who did not undergo regular oral examinations and preventive and definitive caries treatment and in those who received periodontal, surgical, endodontic, or prosthetic treatments. Generally, people with masticatory discomfort engaged in less activity owing to other disorders like arthritis, rheumatism, and back, neck, and oral disease. People with masticatory discomfort scored low on quality of life. People who received regular oral examinations and preventive care had a low level of masticatory discomfort, and the treated persons had high masticatory discomfort. Therefore, in order to reduce masticatory discomfort, more diverse and active care should be provided for prevention, specifically regular oral examinations.

Serious Choices: A Systematic Environmental Scan of Decision Aids and Their Use for Seriously Ill People Near Death.

Seriously ill people near death face difficult decisions about life-sustaining treatments such as cardiopulmonary resuscitation and mechanical ventilation. Patient decision aids may improve alignment between patients' preferences and the care they receive, but the quantity, quality, and routine use of these tools are unknown. We conducted a systematic environmental scan to identify all decision aids for seriously ill people at high risk of death facing choices about life-sustaining treatments, assess their quality, and explore their use in clinical settings. We searched MEDLINE, Google, and mobile application stores and surveyed experts. We included 27 decision aids in our scan. Concerning content, 14 of 27 decision aids for seriously ill people near death were for people with specific diseases and conditions (ie, advanced cancer or kidney disease); 11 concerned individual life-sustaining treatment decisions (ie, cardiopulmonary resuscitation or mechanical ventilation). Only two focused on more general care pathways (ie, life-sustaining intervention, palliative care, and hospice). Twenty-four of 27 decision aids presented options in a balanced way; 23 identified funding sources, and 19 of 27 reported their publication date. Just 11 used plain language. A minority, 11 of 27, listed evidence sources, five documented rigorous evidence-synthesis methods, six disclosed competing interests, and three offered update policies. Preliminary results suggest that few health systems use decision aids in routine patient care. Although many decision aids exist for life-sustaining treatment decisions during serious illness, the tools are deficient in some key quality areas.

Crosstalk between Fisetin-induced Apoptosis and Autophagy in Human Oral Squamous Cell Carcinoma.

Fisetin (3,3-,4-,7-tetrahydroxyflavone), a naturally occurring flavonoid, has antioxidant, anti-inflammatory, and anticancer effects. Oral squamous cell carcinoma (OSCC) has a 5-year survival rate lower than that of most other carcinomas, and can create functional and aesthetic problems for the patient. New therapies for OSCC are necessary, and treatment using plant-derived natural substances has recently become a trend. It has been suggested that autophagy may play an important role in cancer therapy. Several studies demonstrated that autophagy inhibition enhances apoptotic cell death. Therefore, autophagy inhibition might be a promising therapeutic method against OSCC. Our results showed that fisetin induced apoptotic cell death in human tongue squamous cell line Ca9-22 could be enhanced by inhibition of autophagy. Thus, autophagy process in fisetin treated OSCC might presumed to play a role of pro-survival. The combination of fisetin and an effective autophagy inhibitor could be a potentially adjuvant and useful treatment for oral cancer.

Delphinidin induces apoptosis and inhibits epithelial-to-mesenchymal transition via the ERK/p38 MAPK-signaling pathway in human osteosarcoma cell lines.

Delphinidin is major anthocyanidin that is extracted from many pigmented fruits and vegetables. This substance has anti-oxidant, anti-inflammatory, anti-angiogenic, and anti-cancer properties. In addition, delphinidin strongly suppresses the migration and invasion of various cancer cells during tumorigenesis. Although delphinidin has anti-cancer effects, little is known about its functional roles in osteosarcoma (OS). For these reasons, we have demonstrated the effects of delphinidin on OS cell lines. The effects of delphinidin on cell viability and growth of OS cells were assessed using the MTT assay and colony formation assays. Hoechst staining indicated that the delphinidin-treated OS cells were undergoing apoptosis. Flow cytometry, confocal microscopy, and a western blot analysis also indicated evidence of apoptosis. Inhibition of cell migration and invasion was found to be associated with epithelial-to-mesenchymal transition (EMT), observed by using a wound healing assay, an invasion assay, and a western blot analysis. Furthermore, delphinidin treatment resulted in a profound reduction of phosphorylated forms of ERK and p38. These findings demonstrate that delphinidin treatment suppressed EMT through the mitogen-activated protein kinase (MAPK) signaling pathway in OS cell lines. Taken together, our results suggest that delphinidin strongly inhibits cell proliferation and induces apoptosis. Delphinidin treatment also suppresses cell migration and prevents EMT via the MAPK-signaling pathway in OS cell lines. For these reasons, delphinidin has anti-cancer effects and can suppress metastasis in OS cell lines, and it might be worth using as an OS therapeutic agent.

Development of a New Approach to Determine the Potency of Bacille Calmette-Guérin Vaccines Using Flow Cytometry.

OBJECTIVES: To circumvent the limitations of the current golden standard method, colony-forming unit (CFU) assay, for viability of Bacille Calmette-Guérin (BCG) vaccines, we developed a new method to rapidly and accurately determine the potency of BCG vaccines. METHODS: Based on flow cytometry (FACS) and fluorescein diacetate (FDA) as the most appropriate fluorescent staining reagent, 17 lots of BCG vaccines for percutaneous administration and 5 lots of BCG vaccines for intradermal administration were analyzed in this study. The percentage of viable cells measured by flow cytometry along with the total number of organisms in BCG vaccines, as determined on a cell counter, was used to quantify the number of viable cells. RESULTS: Pearson correlation coefficients of FACS and CFU assays for percutaneous and intradermal BCG vaccines were 0.6962 and 0.7428, respectively, indicating a high correlation. The coefficient of variation value of the FACS assay was less than 7%, which was 11 times lower than that of the CFU assay. CONCLUSION: This study contributes to the evaluation of new potency test method for FACS-based determination of viable cells in BCG vaccines. Accordingly, quality control of BCG vaccines can be significantly improved.

Evaluation of Haemagglutinin Content by RP-HPLC to Generate Pandemic Influenza Vaccine.

The potency of influenza vaccine is determined based on its hemagglutinin (HA) content. In general, single radial immunodiffusion (SRID) assay has been utilized as the standard method to measure HA content. However, preparation of reagents for SRID such as antigen and antibody takes approximately 2~3 months, which causes delays in the development of influenza vaccine. Therefore, quantification of HA content by other alternative methods is required. In this study, we measured HA contents of H1N1 antigen and H1N1 influenza vaccine by reverse phase-high performance liquid chromatography (RP-HPLC) methods. The presence of HA1 and HA2 was investigated by silver staining and Western blot assay. In addition, accuracy and repeatability of HA measurement by RP-HPLC were evaluated. Comparison of HA concentration by SRID and RP-HPLC revealed a precise correlation between the two methods. Our results suggest that RP-HPLC assay can replace SRID in the event of a pandemic flu outbreak for rapid vaccine development.

Detection of Carbapenemases in Clinical Enterobacteriaceae Isolates Using the VITEK AST-N202 Card.

BACKGROUND: The rapid and accurate detection of carbapenemase-producing Enterobacteriaceae (CPE) in clinical microbiology laboratories is essential for the treatment and control of infections caused by these microorganisms. This study was performed to evaluate the ability of the VITEK AST-N202 card to detect CPE isolates. MATERIALS AND METHODS: A total of 43 (Klebsiella pneumoniae, n = 37; Escherichia coli, n = 3; and Enterobacter cloacae, n = 3) CPE isolates and 79 carbapenemase-non-producing Enterobacteriaceae (CNE) isolates were included in this study. The CPE isolates harbored KPC-2 (n = 11), KPC-3 (n = 20), GES-5 (n = 5), VIM-2 (n = 2), IMP-1 (n = 1), NDM-1 (n = 2), or OXA-232 (n = 2). Of the 79 CNE isolates, eight K. pneumoniae isolates were resistant to ertapenem, imipenem, and meropenem, while the remaining 71 isolates were susceptible to the carbapenems. Antimicrobial susceptibilities were tested using the VITEK AST-N202 card, and the results were interpreted as positive when the isolates showed resistant or intermediate results. Modified-Hodge tests (MHTs) were performed using ertapenem or meropenem disks for the screening of carbapenemase production. Polymerase chain reaction (PCR) and direct sequencing were used to identify ß-lactamase genes. RESULTS: Sensitivity of MHT with ertapenem and meropenem disks for the detection of carbapenemase was 81.4% (35/43) and 81.4% (35/43), respectively, and a combination with both antibiotic disks increased the sensitivity to 88.4% (38/43). Specificity of the MHT was 100% (79/79) for the CNE isolates. Sensitivity of ertapenem, imipenem, and meropenem as assessed by the VITEK AST-N202 card was 100% (43/43), 93% (40/43), and 95.3% (41/43), respectively. Specificity (89.8%, 71/79) of the test with each carbapenem was improved to 100% (71/71) when eight carbapenem-resistant CNE isolates were excluded from the testing. CONCLUSION: The VITEK AST-N202 card showed high sensitivity for the detection of carbapenemases in Enterobacteriaceae strains. PCR and sequencing experiments for the detection of carbapenemases are recommended when clinical Enterobacteriaceae isolates show non-susceptibility to carbapenems.

Epidemiology and Characteristics of Metallo-ß-Lactamase-Producing Pseudomonas aeruginosa.

Metallo-ß-lactamase-producing Pseudomonas aeruginosa (MPPA) is an important nosocomial pathogen that shows resistance to all ß-lactam antibiotics except monobactams. There are various types of metallo-ß-lactamases (MBLs) in carbapenem-resistant P. aeruginosa including Imipenemase (IMP), Verona integron-encoded metallo-ß-lactamase (VIM), Sao Paulo metallo-ß-lactamase (SPM), Germany imipenemase (GIM), New Delhi metallo-ß-lactamase (NDM), Florence imipenemase (FIM). Each MBL gene is located on specific genetic elements including integrons, transposons, plasmids, or on the chromosome, in which they carry genes encoding determinants of resistance to carbapenems and other antibiotics, conferring multidrug resistance to P. aeruginosa. In addition, these genetic elements are transferable to other Gram-negative species, increasing the antimicrobial resistance rate and complicating the treatment of infected patients. Therefore, it is essential to understand the epidemiology, resistance mechanism, and molecular characteristics of MPPA for infection control and prevention of a possible global health crisis. Here, we highlight the characteristics of MPPA.

ß-Amino-n-butyric Acid Regulates Seedling Growth and Disease Resistance of Kimchi Cabbage.

Non-protein amino acid, ß-amino-n-butyric acid (BABA), has been involved in diverse physiological processes including seedling growth, stress tolerance and disease resistance of many plant species. In the current study, treatment of kimchi cabbage seedlings with BABA significantly reduced primary root elongation and cotyledon development in a dose-dependent manner, which adverse effects were similar to the plant response to exogenous abscisic acid (ABA) application. BABA was synergistically contributing ABA-induced growth arrest during the early seedling development. Kimchi cabbage leaves were highly damaged and seedling growth was delayed by foliar spraying with high concentrations of BABA (10 to 20 mM). BABA played roles differentially in in vitro fungal conidial germination, mycelial growth and conidation of necrotroph Alternaria brassicicola causing black spot disease and hemibiotroph Colletotrichum higginsianum causing anthracnose. Pretreatment with BABA conferred induced resistance of the kimchi cabbage against challenges by the two different classes of fungal pathogens in a dose-dependent manner. These results suggest that BABA is involved in plant development, fungal development as well as induced fungal disease resistance of kimchi cabbage plant.

Synergistic effects between silibinin and antibiotics on methicillin-resistant Staphylococcus aureus isolated from clinical specimens.

Methicillin-resistant Staphylococcus aureus (MRSA) is a dangerous microorganism, and creates serious medical problems. It causes many types of infections in humans and often acquires multi-drug resistance. In this study, silibinin was evaluated against 20 clinical isolates of MRSA, either alone or in combination with ampicillin or oxacillin, using a checkerboard assay. The silibinin exhibited good activity against isolates of MRSA, and MRSA ATCC33952 and MSSA ATCC25923, with minimum inhibitory concentrations/minimum bactericidal concentrations (MICs/MBCs) ranging between 2-8/4-16 µg/mL, for ampicillin 2-1024/2-2048 µg/mL, and for oxacillin 0.25-32/0.5-64 µg/mL. The range of MIC(50) and MIC(90) were 0.5-4 µg/mL and 2-8 µg/mL, respectively. The MICs/MBCs for the combination of silibinin plus oxacillin or ampicillin were reduced by ≥4-fold against the MRSA isolates tested, demonstrating a synergistic effect, as defined by a fractional inhibitory concentration index (FICI) of ≤0.5. Furthermore, a time-kill study evaluating the growth of the tested bacteria showed that growth was completely attenuated after 2-5 h of treatment with the 1/2 MIC of silibinin, regardless of whether it was administered alone or with oxacillin (1/2 MIC) or ampicillin (1/2 MIC). In conclusion, silibinin exerted synergistic effects when administered with oxacillin or ampicillin and the antibacterial activity and resistant regulation of silibinin against clinical isolates of MRSA might be useful in controlling MRSA infections.