The Oral-Systemic Connection

Transcription

1 THE 1ST INTERNATIONAL QUINTESSENCE SYMPOSIUM ON ORAL HEALTH The Oral-Systemic Connection FEBRUARY 7 8, 2014 SHERATON SAN DIEGO HOTEL & MARINA Presented by In partnership with ADVANCE PROGRAM Speakers Wenche S. Borgnakke Donald M. Brunette Robert J. Genco Barbara L. Greenberg Yiping W. Han Ira B. Lamster Robert E. Marx Panos N. Papapanou Douglas E. Peterson Frank A. Scannapieco Maurizio Tonetti Thomas E. Van Dyke David T. Wong Sook-Bin Woo Michael Glick Program Chair

2 WELCOME INVITATION Dear Colleagues, It is with great pleasure that I invite you to attend the 1st International Quintessence Symposium on Oral Health: The Oral-Systemic Connection in San Diego, February 7 8, 2014, at the Sheraton San Diego Hotel & Marina. This unique gathering will bring together the most prominent clinicians and researchers on the subject of the oral-systemic connection. Over the past several decades, an impressive body of knowledge has accumulated about the impact of oral infections on overall health and well-being. Studies have found important associations that are now being evaluated for causative relationships. New information is being published at a rapid pace, and clinicians must sort through sometimes conflicting published findings. This symposium provides an opportunity for participants to hear the latest scientific information on the associations between oral diseases and health and learn how to interpret claims made by scientists working on this subject. I am confident that this symposium will bring clarity and understanding to a subject of utmost importance to all health care professionals. Not only will you benefit from the knowledge gained from the gathered experts, but you will also be able to apply this knowledge for the benefit of your patients. I look forward to welcoming you to San Diego and the 1st International Quintessence Symposium on Oral Health: The Oral-Systemic Connection. Michael Glick Program Chair

3 GENERAL INFORMATION REGISTRATION Your registration fee includes admission to all symposium sessions and exhibits, daily breakfast, coffee breaks, lunch, and the symposium reception on Friday evening. Take advantage of specially reduced fees by registering in advance. REGISTRATION FEES By December 31, 2013 After December 31, 2013 Regular rate $748 $798 Resident rate* $398 $398 * Please submit verification of resident status with the registration form. HOW TO REGISTER Register online at Complete the registration form and mail with your check (payable to Quintessence Publishing Co Inc) to Quintessence Publishing at the address indicated on the form. Fax your form with credit card information (Visa, Master- Card, American Express, or Discover) to Quintessence at On-site registration will be accepted only on the basis of space availability and therefore cannot be guaranteed. Early advance registration is strongly recommended. The deadline for registering for the symposium is January 21, CANCELLATIONS/REFUNDS Cancellations made in writing and received by Quintessence before January 21, 2014, will be refunded in full. For cancellations received on or after January 21, 2014, but before the start of the meeting, a cancellation fee of US $75 will be charged. No refunds will be made after the symposium begins on February 7, CONTINUING EDUCATION CREDITS One hour of continuing education (CE) credit is offered for each hour of program attendance. CE credit awarded for participation in a course may not apply toward licensing renewal in all states. It is the responsibility of each participant to verify the requirements of his or her state licensing board. Meeting attendees are responsible for ensuring that their education credits are current and on file with their respective state board or other licensing/regulatory agency. Attendees of the symposium may receive up to 14½ hours of CE credit. If you have any questions regarding CE credit, contact Carol Thomas at cthomas@quintbook.com. REGISTRATION DESK Your symposium packet will await you at the symposium registration desk. The desk will be open from 1:00 PM to 5:00 PM on Thursday, February 6, and from 7:00 AM to 5:00 PM on Friday and Saturday. TECHNICAL EXHIBITS Technical exhibits will be held on Friday and Saturday during the symposium in the Nautilus Rooms. Visit the exhibits to observe the latest developments in dental products offered by the leading manufacturers. EXHIBIT HOURS Friday, February 7, 2014 Saturday, February 8, 2014 SYMPOSIUM RECEPTION 7:00 AM 5:30 PM 7:00 AM 5:30 PM A Welcome Reception will be held on Friday, February 7, from 5:30 PM to 7:00 PM in the Lanai Area, located in the beautiful gardens of the hotel. Food and an open bar will be provided. Take this opportunity to renew friendships and meet colleagues from around the world. LOST BADGES Your badge represents your ticket of admittance to all lectures. If you lose or misplace your badge, you will be charged a replacement fee of US $400; there are no exceptions to this policy. You must wear your badge each time you wish to enter the lecture hall. HOTEL RESERVATIONS Hotel rooms have been blocked at the Sheraton San Diego Hotel & Marina. Reservations at the special symposium rate of US $215 will be accepted until the cut-off date of January 13, 2014 or until the room block is sold out, whichever comes first. Call the hotel reservation desk direct at , or you can find a link to the Sheraton San Diego at our website, Make sure to indicate the name of the symposium to receive the special meeting rate of $215 per night plus applicable tax. A deposit equal to one night s room and tax will be required to guarantee the reservation. This deposit is refundable if the hotel receives cancellation notice at least ten (10) days prior to arrival and a cancellation number is obtained. An early departure fee of US $100 will apply if you check out prior to the confirmed checkout date. For any other conditions applicable to your reservation, please contact the hotel directly for explanation.

4 ABSTRACTs Friday, February 7, :15 AM 9:00 AM Causation, Correlation, Complexity, Confusion, and Oral Health Donald M. Brunette, PhD To establish causation, the cause and the effect should be connected through a biologically plausible mechanism. The definitive means of establishing causation is through experimentation, such as randomized controlled clinical trials. But such trials are often not possible, and criteria for judging the strength of the evidence for causation from less rigorous study designs demonstrating associations consequently have evolved. The standard causal inference criteria include strength of the association, dose-response relationship, time sequence, consistency, specificity, biologic plausibility, and independence from confounders. Besides frequentist-based statistical models, other ways of investigating relationships, such as Bayesian networks and complexity theory, have been developed. The output of sophisticated statistical analyses can be confusing even for scientists, so there is a need to consider how best to present such information. This presentation will discuss these concepts using examples from the dental literature and focusing on questions dentists can use in assessing causal relationships, as well as methods of presenting their analysis in understandable terms to their patients. 9:00 AM 9:45 AM The Role of Inflammation in Oral-Systemic Interactions Thomas E. Van Dyke, DDS, PhD Recent studies have suggested a relationship between oral infection, in particular periodontal disease, and systemic diseases that goes beyond simple associations. Epidemiologic studies have implicated periodontal disease as imparting excess risk for the development of cardiovascular disease and stroke and as a risk factor for preterm low birth weight babies in pregnant women. In addition, studies in diabetics have revealed that untreated periodontal disease can lead to diabetic complications and have a direct impact on glycemic control in diabetic patients. The available evidence associating periodontal disease with risk for systemic disease centers on the role of bacteria from the oral cavity and bacteremia but always in the context of initiation or amplification of local and systemic inflammation. The role of inflammation in cardiovascular disease, pregnancy complications, obesity, and diabetes, particularly type 2, is well documented. The role of periodontal inflammation as a local, extravascular source of inflammation that has significant impact on systemic inflammation and inflammatory disease is beginning to be understood. This presentation will provide an overview of current concepts in local infection and inflammation as modifiers of systemic disease. 10:15 AM 11:00 AM The Oral Microbiome and Systemic Health Wenche S. Borgnakke, DDS, MPH, PhD Collectively, the microorganisms in the oral cavity have been referred to as the oral microflora, oral microbiota, or, more recently, the oral microbiome. Our understanding of the human oral microbiome is in a revolutionary phase of development to the point of science having to rethink and rewrite most of what was hitherto known. Highthroughput genetic-based assays and powerful, novel bioinformatics tools recently made it possible to comprehensively survey the human oral microbiome to identify and determine the prevalence of previously unknown or not culturable organisms. The ability to fully describe the microbiome that inhabits the human body, including the oral microbiome, suggests a need to restudy these flora and their relationships with health and disease. With these new methods, the role of the oral microbiome in periodontal disease and in diseases and conditions associated with periodontal disease is currently being studied. Evidence will be presented for systemic diseases and conditions that implicate oral organisms. 11:00 AM 11:45 AM The Cardiovascular System and Oral Infections Maurizio Tonetti, DMD, PhD, MMSc Periodontitis and atherosclerotic cardiovascular disease are highly prevalent, socially relevant chronic diseases. Epidemiologic evidence has linked these two diseases, although the nature of the association remains a matter of debate. Is it due to shared risk factors, or is there a true causal link? Intervention trials provide an initial reading light. Under both scenarios, there are important clinical consequences and reasonable action that needs to be implemented by oral health care professionals. These concepts and their practical implications will be explored. 11:45 AM 12:30 PM Obesity and Oral Health Ira B. Lamster, DDS, MMSc There is an epidemic of obesity in the United States and across the globe. It has been estimated that 1 in 4 adults is overweight and 1 in 10 is obese. Obesity is associated with a variety of significant health problems, including an increased risk of type 2 diabetes, hypertension and cardiovascular diseases, and certain malignancies. Obesity has also been linked to a number of changes in the oral cavity. Obesity has been investigated as a risk factor for periodontitis. Obesity is also a cause of obstructive sleep apnea, a condition associated with abnormal pauses in breathing. In the future, dental professionals can have a role in the general management of obesity by identifying patients who are overweight or obese, referring them to a health care provider for comprehensive care, and then becoming involved in the longer-term management of these individuals.

5 ABSTRACTS Saturday, February 8, :00 PM 2:45 PM The Association of Periodontal Disease and Diabetes Robert J. Genco, DDS, PhD Periodontal disease is an infectious complication of diabetes. People with diabetes, especially those with poor glycemic control, are two to three times more likely than those without diabetes to have periodontal disease. Diabetes likely increases susceptibility to periodontal disease by impairing wound healing. Diabetes also leads to a hyperinflammatory state, which exaggerates periodontal tissue destruction. It is, however, a two-way street in that diabetes is a risk factor for periodontal disease, and periodontal disease makes diabetes glycemic control worse. Patients with diabetes and periodontal disease also suffer from higher mortality and morbidity from heart and kidney disease. Periodontal treatment in patients with diabetes contributes to better glycemic control and helps to preserve a functioning dentition, which allows individuals to maintain a diet higher in fiber and lower in fats and refined carbohydrates. Such a diet is also beneficial to the long-term management of patients with diabetes. 2:45 PM 3:30 PM Pregnancy Outcomes and Oral Infections Panos N. Papapanou, DDS, PhD For the past two decades, the link between periodontal diseases and adverse pregnancy outcomes has been extensively studied in both animal models and observational and experimental intervention trials. Although uncertainties still remain, patients need to be informed and provided with care according to the best available evidence. This presentation will explore the scientific rationale, discuss current epidemiologic data, and address results from intervention studies in order to provide oral health care professionals with an understanding of the association between oral infections and pregnancy outcomes. 8:15 AM 9:00 AM Links between the Oral Microbiota and Pulmonary Disease Frank A. Scannapieco, DDS Associations between poor oral health and pulmonary diseases are possible through a variety of mechanisms. This presentation will provide an overview of the latest information on the problems of aspiration pneumonia and nosocomial-acquired pneumonia, especially ventilatorassociated pneumonia (VAP). Both infections lead to serious consequences for morbidity and mortality in institutional settings. Results from a recent randomized trial that tested the effects of the oral topical antimicrobia chlorhexidine on the oral flora of ventilated patients will be presented. Biologic mechanisms involving the oral microflora and host response that influence pneumonia will be discussed. Practical advice on how to translate this information into everyday practice will be presented. 9:00 AM 9:45 AM Osteoporosis: The Oral-Systemic Connection Robert E. Marx, DDS Osteoporosis is an age- and hormone-related thinning of the cancellous trabeculae and cortex, which structurally weakens bone at varying degrees and thus makes it more prone to fracture. Osteoporosis involving the jaws causes a thinning of their bony trabeculae and cortex, just as it does in other bones; this is often referred to as type III or type IV bone. It is much more difficult to gain primary stability during implant placement, and there is reduced osseointegration potential. However, the greatest impact of osteoporosis on the jaws is a condition now known as drug-induced osteonecrosis of the jaws (DIONJ). All oral and intravenous bisphosphonates marketed for osteoporosis, as well as oral denosumab, have caused DIONJ. Yet, alendronate (Fosamax) because of its potency and a recommended dose that is twice that of other oral bisphosphonates, has been responsible for more than 90% of all reported cases and has even caused femur fractures. It is the osteoporosis drug of greatest oral impact. 10:15 AM 11:00 AM Fusobacterium nucleatum: A Model Organism for Investigating the Mechanisms of Oral Bacteria in Extraoral Infections Yiping W. Han, PhD Fusobacterium nucleatum (Fn), a heterogeneous gram-negative anaerobe, is ubiquitous in the oral cavity and associated with various forms of periodontal diseases. It is infrequently found in the normal floras elsewhere in the body but highly prevalent in the diseased microbiota, having been isolated from infections and abscesses in the liver, spleen, lungs, blood, brain, and intrauterine cavities. Recently, Fn has been recognized as an emerging gut pathogen associated with inflammatory bowel disease and colorectal cancer. Is Fn merely associated with these diseases, or does it play a causative

6 ABSTRACTS role? We have previously demonstrated the mechanisms by which oral Fn cause intrauterine infection leading to adverse pregnancy outcomes. We have recently started to investigate the role of Fn in colorectal carcinoma. Fn promotes carcinogenesis both in vitro and in vivo. A specific virulence determinant and its interaction with the host have been identified. The details of this investigation will be discussed. 11:00 AM 11:45 AM Oral Complications in Immunocompromised Patients: The Oncology Prototype Douglas E. Peterson, DMD, PhD, FDS RCSEd Oral complications in immunocompromised patients can result in clinically impactful sequelae, including compromised quality of life as well as decreased patient survival in select cases. In addition, the oral lesions can be expensive to manage, resulting in increased use of typically limited health care resources. This presentation will address the state-of-the-science of this field, focusing on the myelosuppressed oncology patient as the prototype. Evidence-based strategies for prevention and management of oral disease caused by high-dose as well as emerging molecularly targeted cancer therapies will be discussed. Acute toxicities, including oral mucosal injury, pain, and infection, will be emphasized in relation to the complex interface of the oral cavity with overall systemic status. The presentation will highlight novel basic, translational, and clinical research that could lead to transformational strategies for oncology patient management in the future. The discussion will also compare and contrast the cancer patient prototype with other relevant models of immunocompromised patients, including those with AIDS. 11:45 AM 12:30 PM Oral Manifestations of Systemic Diseases Sook-Bin Woo, DMD, MMSc The general dentist in his or her daily practice encounters a variety of mucosal disorders, most of which are straightforward and easy to diagnose. However, even banal-appearing lesions may be a manifestation of systemic disease or a side effect of treatment for systemic disease. Furthermore, the oral signs may be the first presentation, and the dentist is in a unique position to help render an early diagnosis. This presentation will consider six common oral conditions that are encountered in routine general dental practice. For each, there will be a common default diagnosis, followed by a discussion of other conditions that may look similar but represent the oral presentation of a systemic condition. The differences in history and clinical findings, as well as diagnostic tests that may help distinguish between each of them, will also be presented. The conditions to be discussed include aphthous-like oral ulcers, lichen planus and lichenoid lesions, gingivitis, gingival hyperplasia, pigmented macules, and nonhealing extraction sockets. 2:00 PM 2:45 PM Salivary Biomarkers for Oral and Systemic Diseases David T. Wong, DMD Saliva has long been considered a mirror of the body that reflects the state of overall health. A wide range of systemic diseases, such as diabetes and Sjögren syndrome, have oral manifestations that clinicians (physicians and dentists) encounter in patients at various stages of disease development. Advances in the science of salivary diagnostics have led to identification of disease signatures of candidate biomarkers and/or confirmation of genetic susceptibility for systemic conditions, particularly in molecular oncology. Development of the salivary proteome, transcriptome, micro-rna, metabolome, and microbiome as diagnostic alphabets fully enables saliva to be translated for personalized individual medicine applications. Salivary biomarker panels have been developed for oral cancer, lung cancer, pancreatic cancer, breast cancer, and ovarian cancer. Coupled with the development of point-of-care technologies and the emerging trend of chairside screening for medical conditions, the clinical impact of scientifically credentialed salivary biomarkers for molecular oncology application will improve access to care, reducing health disparities and impacting global health. 2:45 PM 3:30 PM The Role of the Oral Health Care Professional in Overall Health and Well-Being Barbara L. Greenberg, MSc, PhD The role of prevention and the integration of health care providers across disciplines is a critical component of the recent health care reform era. Early identification of individuals at increased risk of developing diseases of increasing significance, such as coronary heart disease and diabetes mellitus, through point-of-care testing in a dental setting could be a significant component of any prevention-oriented health care initiative. Early detection and, consequently, intervention could prevent the onset or control the severity of disease and improve health care delivery. Involving oral health care professionals in strategies to identify individuals at increased risk for coronary heart disease and diabetes can be an effective means of expanding preventive efforts aimed at slowing the development of these diseases and provide a portal into the general health care system for individuals who are not routinely engaged with a primary care provider. This session will provide updated information on the epidemiology of the diseases, recommended and validated available diagnostic screening tests, use of the screening tests, interpretation of the test results, and approaches to discussing test results with patients and making referrals to a physician.

7 PROGRAM SCHEDULE Program Chair: Michael Glick FRIDAY, FEBRUARY 7, 2014 TIME SPEAKER TITLE 7:00 AM 8:00 AM Breakfast with Exhibitors 8:00 AM 8:15 AM Chair: Michael Glick Welcome and Introduction 8:15 AM 9:00 AM Donald M. Brunette Causation, Correlation, Complexity, Confusion, and Oral Health 9:00 AM 9:45 AM Thomas E. Van Dyke The Role of Inflammation in Oral-Systemic Interactions 9:45 AM 10:15 AM Break and Refreshments with Exhibitors 10:15 AM 11:00 AM Wenche S. Borgnakke The Oral Microbiome and Systemic Health 11:00 AM 11:45 AM Maurizio Tonetti The Cardiovascular System and Oral Infections 11:45 AM 12:30 PM Ira B. Lamster Obesity and Oral Health 12:30 PM 2:00 PM Lunch with Exhibitors 2:00 PM 2:45 PM Robert J. Genco The Association of Periodontal Disease and Diabetes 2:45 PM 3:30 PM Panos N. Papapanou Pregnancy Outcomes and Oral Infections 3:30 PM 5:00 PM Panel Discussion and Questions and Answers SATURDAY, FEBRUARY 8, 2014 TIME SPEAKER TITLE 7:00 AM 8:00 AM Breakfast with Exhibitors 8:00 AM 8:15 AM Chair: Michael Glick Welcome 8:15 AM 9:00 AM Frank A. Scannapieco Links Between the Oral Microbiota and Pulmonary Disease 9:00 AM 9:45 AM Robert E. Marx Osteoporosis: The Oral-Systemic Connection 9:45 AM 10:15 AM Break and Refreshments with Exhibitors 10:15 AM 11:00 AM Yiping W. Han Fusobacterium nucleatum: A Model Organism for Investigating the Mechanisms of Oral Bacteria in Extraoral Infections 11:00 AM 11:45 AM Douglas E. Peterson Oral Complications in Immunocompromised Patients: The Oncology Prototype 11:45 AM 12:30 PM Sook-Bin Woo Oral Manifestations of Systemic Diseases 12:30 PM 2:00 PM Lunch with Exhibitors 2:00 PM 2:45 PM David T. Wong Salivary Biomarkers for Oral and Systemic Diseases 2:45 PM 3:30 PM Barbara L. Greenberg The Role of the Oral Health Care Professional in Overall Health and Well-Being 3:30 PM 5:00 PM Panel Discussion and Questions and Answers PROGRAM OBJECTIVES Participants will: Learn how to appraise the literature on the oral-systemic connection Understand the etiology of the oral-systemic connection Learn how to differentiate between associations linking oral health with general health Understand the role of oral health care professionals in improving overall patient health

8 REGISTRATION FORM Mail or fax entire page to: Quintessence Publishing Co Inc Chandler Drive Hanover Park, IL Fax: Please print. To register additional participants, please photocopy this form. Name Address City State Zip Country Fax Please check one: General dentist Other (please specify) By December 31, 2013 After December 31, 2013 Regular rate US $748 (R10) US $798 (R20) Resident rate* US $398 (R30) US $398 (R30) *Please submit verifi cation of resident status with this registration form. Check enclosed (make payable to Quintessence Publishing Co Inc) Charge to: Visa, MasterCard, American Express, or Discover (circle one) Card no. Expires Signature ORAL HEALTH The Oral-Systemic Connection Edited by Michael Glick Oral Health: The Oral-Systemic Connection Edited by Michael Glick Is there a biologic plausibility for an association between oral infections/disorders and systemic health? Can treatment of oral infections and disorders reduce the risk of adverse systemic outcomes? Is it safe to provide dental care for patients with a specific systemic condition? Written with the practicing dentist in mind, this book answers questions about the association between oral infections/disorders and systemic health and provides clinicians with information relevant to daily practice. Available February 2014