Elevated Cytokine Levels in Gingival Crevicular Fluid of Teeth with Apical Periodontitis.

INTRODUCTION: Biomarkers assayed from gingival crevicular fluid (GCF) are a potential tool for endodontic diagnosis and for monitoring treatment response. This cross-sectional study measured cytokines in GCF from teeth with apical periodontitis and evaluated their relationship with preoperative pain and other clinical findings. METHODS: Participants presenting for root-end resection surgery due to apical periodontitis diagnosis (n = 56) underwent standardized clinical testing and completed preoperative questionnaires. GCF from diseased and control teeth were collected, processed, and analyzed. Mann-Whitney U and Wilcoxon tests were used to examine the cytokine levels in diseased compared to healthy control teeth. We also assessed the relationship of cytokine levels with clinical findings. RESULTS: Interleukins (IL)-1ß, IL-2, IL-4, IL-6, IL-8, IL-10, IL-12p70, IL-13, interferon-γ, and tumor necrosis factor-⍺ (TNF-⍺) were detected in GCF. TNF-⍺ levels were significantly higher in GCF collected from diseased versus control teeth (P = .02) and increased IL-1ß levels in diseased teeth were detected (P = .06). Lower IL-10 levels were observed in teeth with a sinus tract and/or swelling compared to teeth without a sinus tract and/or swelling (P = .08). Cytokine levels did not clearly relate to the presence of pain. CONCLUSIONS: Elevated levels of proinflammatory cytokines, including TNF-⍺ and IL1- ß, were detected in GCF from diseased teeth compared to the healthy controls. Additional studies are needed to further investigate the utility of these biomarkers for objectively evaluating periradicular pathology.

A survey of US early childhood caries programs: findings and recommendations.

OBJECTIVES: To identify and characterize US early childhood caries (ECC) programs. METHODS: A 39 question online survey was fielded to 245 ECC programs identified from the literature and peer programs. The 101 respondents (41 percent response rate) reported their program's geographic reach, type, areas of focus, target populations, approaches, affiliations, providers, goals, costs, and funding. RESULTS: Half of the programs affiliate with formal early childhood social service or nutrition programs. Almost all characterize their work as risk reduction, disease suppression, or arrest. In descending order, programs describe their approaches as educating parents, addressing family-level health behaviors, utilizing pharmacological approaches with fluoride varnish or silver nitrate, delivering education to health professionals, and conducting research. A majority of programs target urban, poor, and low-income populations. Although little more than a third of programs utilize a logic model, most collect evaluation data and believe their program to be "very" or "somewhat" replicable. Programs tend to depend on multiple funding sources and be largely reliant on grants with foundations as the leading source of support followed by federal grants, state/local grants, and governmental programs such as Head Start. CONCLUSIONS: Programs demonstrate attempts at ECC prevention and management through holistic approaches predicated on behavioral theory, cariology science, and public health principles. Partnerships created by these programs provide unique opportunities to promote oral health. Various strategies could potentially leverage systemic changes in the delivery of dental care for young children.