Gum Disease - A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References

GUM DISEASE A M EDICAL D ICTIONARY , B IBLIOGRAPHY , AND A NNOTATED R ESEARCH G UIDE TO I NTERNET R E FERENCES

J AMES N. P ARKER , M.D. AND P HILIP M. P ARKER , P H .D., E DITORS

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ICON Health Publications ICON Group International, Inc. 4370 La Jolla Village Drive, 4th Floor San Diego, CA 92122 USA Copyright ©2004 by ICON Group International, Inc. Copyright ©2004 by ICON Group International, Inc. All rights reserved. This book is protected by copyright. No part of it may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without written permission from the publisher. Printed in the United States of America. Last digit indicates print number: 10 9 8 7 6 4 5 3 2 1

Publisher, Health Care: Philip Parker, Ph.D. Editor(s): James Parker, M.D., Philip Parker, Ph.D. Publisher's note: The ideas, procedures, and suggestions contained in this book are not intended for the diagnosis or treatment of a health problem. As new medical or scientific information becomes available from academic and clinical research, recommended treatments and drug therapies may undergo changes. The authors, editors, and publisher have attempted to make the information in this book up to date and accurate in accord with accepted standards at the time of publication. The authors, editors, and publisher are not responsible for errors or omissions or for consequences from application of the book, and make no warranty, expressed or implied, in regard to the contents of this book. Any practice described in this book should be applied by the reader in accordance with professional standards of care used in regard to the unique circumstances that may apply in each situation. The reader is advised to always check product information (package inserts) for changes and new information regarding dosage and contraindications before prescribing any drug or pharmacological product. Caution is especially urged when using new or infrequently ordered drugs, herbal remedies, vitamins and supplements, alternative therapies, complementary therapies and medicines, and integrative medical treatments. Cataloging-in-Publication Data Parker, James N., 1961Parker, Philip M., 1960Gum Disease: A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References / James N. Parker and Philip M. Parker, editors p. cm. Includes bibliographical references, glossary, and index. ISBN: 0-597-83967-0 1. Gum Disease-Popular works. I. Title.

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Disclaimer This publication is not intended to be used for the diagnosis or treatment of a health problem. It is sold with the understanding that the publisher, editors, and authors are not engaging in the rendering of medical, psychological, financial, legal, or other professional services. References to any entity, product, service, or source of information that may be contained in this publication should not be considered an endorsement, either direct or implied, by the publisher, editors, or authors. ICON Group International, Inc., the editors, and the authors are not responsible for the content of any Web pages or publications referenced in this publication.

Copyright Notice If a physician wishes to copy limited passages from this book for patient use, this right is automatically granted without written permission from ICON Group International, Inc. (ICON Group). However, all of ICON Group publications have copyrights. With exception to the above, copying our publications in whole or in part, for whatever reason, is a violation of copyright laws and can lead to penalties and fines. Should you want to copy tables, graphs, or other materials, please contact us to request permission (E-mail: [email protected]). ICON Group often grants permission for very limited reproduction of our publications for internal use, press releases, and academic research. Such reproduction requires confirmed permission from ICON Group International Inc. The disclaimer above must accompany all reproductions, in whole or in part, of this book.

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Acknowledgements The collective knowledge generated from academic and applied research summarized in various references has been critical in the creation of this book which is best viewed as a comprehensive compilation and collection of information prepared by various official agencies which produce publications on gum disease. Books in this series draw from various agencies and institutions associated with the United States Department of Health and Human Services, and in particular, the Office of the Secretary of Health and Human Services (OS), the Administration for Children and Families (ACF), the Administration on Aging (AOA), the Agency for Healthcare Research and Quality (AHRQ), the Agency for Toxic Substances and Disease Registry (ATSDR), the Centers for Disease Control and Prevention (CDC), the Food and Drug Administration (FDA), the Healthcare Financing Administration (HCFA), the Health Resources and Services Administration (HRSA), the Indian Health Service (IHS), the institutions of the National Institutes of Health (NIH), the Program Support Center (PSC), and the Substance Abuse and Mental Health Services Administration (SAMHSA). In addition to these sources, information gathered from the National Library of Medicine, the United States Patent Office, the European Union, and their related organizations has been invaluable in the creation of this book. Some of the work represented was financially supported by the Research and Development Committee at INSEAD. This support is gratefully acknowledged. Finally, special thanks are owed to Tiffany Freeman for her excellent editorial support.

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About the Editors James N. Parker, M.D. Dr. James N. Parker received his Bachelor of Science degree in Psychobiology from the University of California, Riverside and his M.D. from the University of California, San Diego. In addition to authoring numerous research publications, he has lectured at various academic institutions. Dr. Parker is the medical editor for health books by ICON Health Publications. Philip M. Parker, Ph.D. Philip M. Parker is the Eli Lilly Chair Professor of Innovation, Business and Society at INSEAD (Fontainebleau, France and Singapore). Dr. Parker has also been Professor at the University of California, San Diego and has taught courses at Harvard University, the Hong Kong University of Science and Technology, the Massachusetts Institute of Technology, Stanford University, and UCLA. Dr. Parker is the associate editor for ICON Health Publications.

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About ICON Health Publications To discover more about ICON Health Publications, simply check with your preferred online booksellers, including Barnes&Noble.com and Amazon.com which currently carry all of our titles. Or, feel free to contact us directly for bulk purchases or institutional discounts: ICON Group International, Inc. 4370 La Jolla Village Drive, Fourth Floor San Diego, CA 92122 USA Fax: 858-546-4341 Web site: www.icongrouponline.com/health

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Table of Contents FORWARD .......................................................................................................................................... 1 CHAPTER 1. STUDIES ON GUM DISEASE ........................................................................................... 3 Overview........................................................................................................................................ 3 The Combined Health Information Database................................................................................. 3 Federally Funded Research on Gum Disease ................................................................................. 9 E-Journals: PubMed Central ....................................................................................................... 11 The National Library of Medicine: PubMed ................................................................................ 11 CHAPTER 2. ALTERNATIVE MEDICINE AND GUM DISEASE ........................................................... 27 Overview...................................................................................................................................... 27 National Center for Complementary and Alternative Medicine.................................................. 27 Additional Web Resources ........................................................................................................... 28 General References ....................................................................................................................... 33 CHAPTER 3. DISSERTATIONS ON GUM DISEASE ............................................................................. 35 Overview...................................................................................................................................... 35 Dissertations on Gum Disease..................................................................................................... 35 Keeping Current .......................................................................................................................... 36 CHAPTER 4. CLINICAL TRIALS AND GUM DISEASE ........................................................................ 37 Overview...................................................................................................................................... 37 Recent Trials on Gum Disease ..................................................................................................... 37 Keeping Current on Clinical Trials ............................................................................................. 41 CHAPTER 5. PATENTS ON GUM DISEASE ........................................................................................ 43 Overview...................................................................................................................................... 43 Patents on Gum Disease .............................................................................................................. 43 Patent Applications on Gum Disease .......................................................................................... 68 Keeping Current .......................................................................................................................... 81 CHAPTER 6. BOOKS ON GUM DISEASE ............................................................................................ 83 Overview...................................................................................................................................... 83 Book Summaries: Federal Agencies.............................................................................................. 83 Book Summaries: Online Booksellers........................................................................................... 84 The National Library of Medicine Book Index ............................................................................. 85 Chapters on Gum Disease ............................................................................................................ 85 CHAPTER 7. MULTIMEDIA ON GUM DISEASE ................................................................................. 89 Overview...................................................................................................................................... 89 Video Recordings ......................................................................................................................... 89 Bibliography: Multimedia on Gum Disease................................................................................. 90 CHAPTER 8. PERIODICALS AND NEWS ON GUM DISEASE .............................................................. 93 Overview...................................................................................................................................... 93 News Services and Press Releases................................................................................................ 93 Newsletter Articles ...................................................................................................................... 97 Academic Periodicals covering Gum Disease .............................................................................. 97 CHAPTER 9. RESEARCHING MEDICATIONS .................................................................................... 99 Overview...................................................................................................................................... 99 U.S. Pharmacopeia....................................................................................................................... 99 Commercial Databases ............................................................................................................... 100 APPENDIX A. PHYSICIAN RESOURCES .......................................................................................... 105 Overview.................................................................................................................................... 105 NIH Guidelines.......................................................................................................................... 105 NIH Databases........................................................................................................................... 107 Other Commercial Databases..................................................................................................... 110 APPENDIX B. PATIENT RESOURCES ............................................................................................... 111 Overview.................................................................................................................................... 111

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Patient Guideline Sources.......................................................................................................... 111 Finding Associations.................................................................................................................. 125 APPENDIX C. FINDING MEDICAL LIBRARIES ................................................................................ 127 Overview.................................................................................................................................... 127 Preparation................................................................................................................................. 127 Finding a Local Medical Library................................................................................................ 127 Medical Libraries in the U.S. and Canada ................................................................................. 127 ONLINE GLOSSARIES................................................................................................................ 133 Online Dictionary Directories ................................................................................................... 133 GUM DISEASE DICTIONARY .................................................................................................. 135 INDEX .............................................................................................................................................. 183

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FORWARD In March 2001, the National Institutes of Health issued the following warning: "The number of Web sites offering health-related resources grows every day. Many sites provide valuable information, while others may have information that is unreliable or misleading."1 Furthermore, because of the rapid increase in Internet-based information, many hours can be wasted searching, selecting, and printing. Since only the smallest fraction of information dealing with gum disease is indexed in search engines, such as www.google.com or others, a non-systematic approach to Internet research can be not only time consuming, but also incomplete. This book was created for medical professionals, students, and members of the general public who want to know as much as possible about gum disease, using the most advanced research tools available and spending the least amount of time doing so. In addition to offering a structured and comprehensive bibliography, the pages that follow will tell you where and how to find reliable information covering virtually all topics related to gum disease, from the essentials to the most advanced areas of research. Public, academic, government, and peer-reviewed research studies are emphasized. Various abstracts are reproduced to give you some of the latest official information available to date on gum disease. Abundant guidance is given on how to obtain free-of-charge primary research results via the Internet. While this book focuses on the field of medicine, when some sources provide access to non-medical information relating to gum disease, these are noted in the text. E-book and electronic versions of this book are fully interactive with each of the Internet sites mentioned (clicking on a hyperlink automatically opens your browser to the site indicated). If you are using the hard copy version of this book, you can access a cited Web site by typing the provided Web address directly into your Internet browser. You may find it useful to refer to synonyms or related terms when accessing these Internet databases. NOTE: At the time of publication, the Web addresses were functional. However, some links may fail due to URL address changes, which is a common occurrence on the Internet. For readers unfamiliar with the Internet, detailed instructions are offered on how to access electronic resources. For readers unfamiliar with medical terminology, a comprehensive glossary is provided. For readers without access to Internet resources, a directory of medical libraries, that have or can locate references cited here, is given. We hope these resources will prove useful to the widest possible audience seeking information on gum disease. The Editors

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From the NIH, National Cancer Institute (NCI): http://www.cancer.gov/cancerinfo/ten-things-to-know.

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CHAPTER 1. STUDIES ON GUM DISEASE Overview In this chapter, we will show you how to locate peer-reviewed references and studies on gum disease.

The Combined Health Information Database The Combined Health Information Database summarizes studies across numerous federal agencies. To limit your investigation to research studies and gum disease, you will need to use the advanced search options. First, go to http://chid.nih.gov/index.html. From there, select the “Detailed Search” option (or go directly to that page with the following hyperlink: http://chid.nih.gov/detail/detail.html). The trick in extracting studies is found in the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer, and the format option “Journal Article.” At the top of the search form, select the number of records you would like to see (we recommend 100) and check the box to display “whole records.” We recommend that you type “gum disease” (or synonyms) into the “For these words:” box. Consider using the option “anywhere in record” to make your search as broad as possible. If you want to limit the search to only a particular field, such as the title of the journal, then select this option in the “Search in these fields” drop box. The following is what you can expect from this type of search: •

Acupuncture: A Unique Effort to Treat Periodontal Disease: Case Report Source: JADA. Journal of the American Dental Association. 132(12): 1705-1706. December 2001. Contact: Available from American Dental Association. ADA Publishing Co, Inc., 211 East Chicago Avenue, Chicago, IL 60611. Summary: Acupuncture, a technique for conscious sedation, was introduced as a modality for pain control in 1958 in the United States. Acupuncture has been used to treat illnesses in Asia for more than 3,000 years. This case report describes the use of acupuncture as a treatment for periodontal disease as prescribed and administered by a Korean practitioner. The patient was treated in 1991 by the insertion of multiple acupuncture needles in response to a diagnosis of 'gum pain.' Chronic, low grade

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discomfort, diagnosed as a symptom of the disease, disappeared after the acupuncture treatment. The patient had minimal professional care in this country since the acupuncture therapy. The patient had experienced low grade, but persistent, discomfort over the previous two years. The oral diagnosis is moderate to advanced generalized chronic periodontitis with primary occlusal trauma. The present findings tend to implicate parafunction as the etiology for the current pain and perhaps the etiology for the discomfort experienced by the patient 10 years ago. The patient understood the results of a thorough baseline dental examination, and she elected to undergo traditional therapy for advanced generalized chronic periodontitis, through interpretation and advice from her daughter. 3 figures. 14 references. •

Effect of Alcohol Consumption on Periodontal Disease Source: Journal of Periodontology. 72(2): 183-189. February 2001. Contact: Available from American Academy of Periodontology. 737 North Michigan Avenue, Suite 800, Chicago, IL 60611-2690. (312) 573-3220. Fax (312) 573-3225. Summary: Alcohol consumption, like smoking, may be related to periodontal disease independently of oral hygiene status. This article reports on a study that assessed the relationship between alcohol consumption and severity of periodontal disease. The cross sectional study included 1,371 subjects ages 25 to 74, all from Erie County, New York. Alcohol intake was assessed by means of previously validated self reported questionnaires. Outcome variables were gingival (gum) bleeding, clinical attachment loss (a measure of periodontal disease), alveolar bone loss, and presence of subgingival (below the gum) microorganisms. Analyses adjusting for age, gender, race, education, income, smoking, diabetes mellitus, dental plaque, and presence of any of eight subgingival microorganisms showed that those consuming more than five drinks per week had an odds ratio (OR) of 1.65 of having higher gingival bleeding, and OR of 1.36 of having more severe clinical attachment loss, compared to those consuming less than five drinks per week. Those consuming more than 10 drinks per week had an OR of 1.62 of having higher gingival bleeding and OR of 1.44 of having more severe clinical attachment loss, compared to those consuming less than 10 drinks per week. Alcohol consumption was not significantly related to alveolar bone loss nor to any of the subgingival microorganisms. These results suggest that alcohol consumption is associated with moderately increased severity of periodontal disease. Longitudinal studies are needed to determine whether alcohol is a true risk factor for periodontal disease. 2 figures. 4 tables. 27 references.

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Fighting Gum Disease: How to Keep Your Teeth Source: FDA Consumer. 36(3): 16-22. May-June, 2002. Contact: Available from Food and Drug Administration (HFI-40). 5600 Fishers Lane, Rockville, MD 20857. Website: www.fda.gov/fdac/index/conindex.htm. Summary: Attention to every day oral hygiene (tooth brushing and flossing), coupled with professional cleanings twice a year, could be all that is needed to prevent gum disease, to actually reverse the early stage, and to help one keep teeth for a lifetime. This article familiarizes readers with recent research on gum disease and its prevention. The author first defines gum disease (periodontal disease) and its signs and symptoms. Other topics include diagnosis; treatment options, including curettage, flap surgery, bone grafts, soft tissue grafts, guided tissue regeneration, bone (osseous) surgery, and medications; and the use of antibiotics. A final section addresses the interplay between oral health and overall health. One chart summarizes FDA-approved products available

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to control infection and reduce inflammation in gum disease. One sidebar addresses other potential factors that contribute to gum disease, including tobacco use, hormonal changes, stress, medications, poor nutrition, illnesses, and clenching or grinding teeth. Three resource organizations are listed for readers who wish to obtain additional information. 5 figures. 1 table. •

Combined Treatment of Periodontal Disease and Benign Mucous Membrane Pemphigoid. Case Report with 8 Years Maintenance Source: Journal of Periodontology. 71(10): 1620-1629. October 2000. Contact: Available from American Academy of Periodontology. Suite 800, 737 North Michigan Avenue, Chicago, IL 60611-2690. (312) 573-3220. Fax (312) 573-3225. Summary: Desquamative gingivitis (gum inflammation) may be the clinical manifestation (symptom) of one of several systemic (body wide) diseases. The clinical course of this disease can be complicated by plaque associated periodontitis. This paper presents the treatment and 8 year maintenance of a patient with periodontal disease and benign mucous membrane pemphigoid (BMMP). The first phase of treatment included oral hygiene instructions and local corticosteroid administration, followed by scaling and root planing. The patient's compliance and excellent response to therapy allowed for subsequent surgical pocket elimination and augmentation of the zone of keratinized tissue for prosthetic reasons. Over the following 8 years, the patient's periodontal condition remained stable even though periodontal maintenance was erratic. For the control of BMMP, intermittent administration of corticosteroids was necessary, without any significant local or systemic side effects. The authors conclude that combined treatment and long term maintenance of BMMP and periodontitis are feasible under certain conditions. The authors propose a clinical protocol for the treatment of patients with similar conditions. 5 figures. 1 table. 18 references.

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Natural History of Periodontal Disease in Man. Risk Factors for Progression of Attachment Loss in Individuals Receiving No Oral Health Care Source: Journal of Periodontology. 72(8): 1006-1015. August 2001. Contact: Available from American Academy of Periodontology. 737 North Michigan Avenue, Suite 800, Chicago, IL 60611-2690. (312) 573-3220. Fax (312) 573-3225. Summary: Few investigations have reported on the risk factors for periodontal attachment loss (PAL, a measurement of periodontal, or gum, health) over time in subjects with no home or professional dental care. This article identifies these potential risk factors for progression of periodontal attachment loss among male Sri Lankan tea laborers who participated in a 20 year investigation of the natural history of periodontal disease. Data were obtained from the 154 subjects who participated in the 1970 baseline and the final 1990 examinations and included data from their interim examinations, performed in 1971, 1973, 1977, 1982, and 1985. Oral health assessments included: attachment levels of all but third molar teeth; plaque index; gingival (gum) index; calculus index; caries (cavities) index, which was the DMFS or decayed, missing, or filled surfaces; and presence or absence of teeth. Other variables include age, history of smoking, and use of betel nut. The final adjusted model indicated that attachment loss increased significantly with age, gingival inflammation, calculus, and follow up time. Neither plaque index, history of smoking, or history of betel nut use were significantly associated with attachment loss over time. The authors caution that the study parameters, as designed more than 30 years ago, may have a significant impact on the findings. 3 figures. 3 tables. 57 references.

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Periodontal Disease Predicts and Possibly Contributes to Acute Myocardial Infarction Source: Dentistry Today. 20(4): 80-81. April 2001. Contact: Available from Dentistry Today Inc. 26 Park Street, Montclair, NJ 07042. (973) 783-3935. Summary: Patients experiencing an acute myocardial infarction (AMI, heart attack) are more likely to have periodontal disease than those free of coronary artery disease (CAD), according to a report read before the last annual session of the American Heart Association (AHA) in New Orleans (November 2000). This article summarizes that report, outlining the implications for dentists and periodontists. The researchers reported links between the presence of gum disease and coronary thrombosis, noting an amplification of the inflammation of the gums was correlated with the heart condition. The enhanced inflammatory response (as demonstrated by high C reactive protein, or CRP, levels in human blood serum) is predictive of recurrent events in both conditions. Therefore, there is reason to suspect a higher occurrence of CAD among people with periodontal disease compared with those free from periodontal disease. The author notes that treatment of periodontal disease may become a novel strategy for secondary prevention among patients with coronary artery disease or those surviving an AMI. The author also briefly reports on animal studies that support or explore the relationship between infection or inflammation and CAD.

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Prevalence and Severity of Periodontal Disease at Mandibular Molar Teeth in Smokers with Regular Oral Hygiene Habits Source: Journal of Periodontology. 73(7): 735-740. July 2002. Contact: Available from American Academy of Periodontology. Suite 800, 737 North Michigan Avenue, Chicago, IL 60611-2690. (312) 573-3220. Fax (312) 573-3225. Summary: Smoking appears to be detrimental to health because it has been associated with several diseases including cancer and cardiovascular diseases. Smoking also appears to be a major environmental factor associated with periodontal disease progression. This article reports on a study undertaken to evaluate the prevalence and severity of periodontal destruction as influenced by smoking in a Thai population. Gingival (gum) health and periodontal conditions at mandibular (lower jaw) molar furcation (division of the tooth root) sites in 120 Thai dental patients (60 smokers and 60 never smokers, age range 31 to 60 years) with generally high oral hygiene standards and regular dental care habits were evaluated. Smokers exhibited more frequent and severe mandibular molar periodontal destruction than never-smokers. The prevalence and severity of gingival recession, periodontal pocket formation, clinical attachment loss, furcation involvement, and tooth mobility were significantly increased in smokers compared to never-smokers. Seventy-three percent of the smokers exhibited furcation involvement in contrast to only 20 percent of the never-smokers. The authors conclude that smoking appears to be a major environmental factors associated with accelerated periodontal destruction in adult smokers with generally high oral hygiene standards and regular dental care habits in a Thai population. 6 tables. 43 references.

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Periodontal Disease in Pregnancy Complicated by Type 1 Diabetes Mellitus Source: Journal of Periodontology. 72(11): 1485-1490. November 2001. Contact: Available from American Academy of Periodontology. Suite 800, 737 North Michigan Avenue, Chicago, IL 60611-2690. (312) 573-3220. Fax (312) 573-3225.

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Summary: Systemic disease and hormonal changes have been implicated as complicating factors for periodontal disease. Diabetes has been identified as a risk factor for periodontal disease, and people with diabetes can experience periodontal destruction at an earlier age than nondiabetic individuals. Increased hormone levels during pregnancy can contribute to increased gingival inflammation. This article reports on a study undertaken to examine the association of type 1 diabetes mellitus (DM) on the periodontal status of pregnant women. The study included 33 subjects (13 with diabetes, 20 without), at 20 to 39 weeks gestation. The mean age of the subjects with diabetes was 28.5 years (plus or minus 7.1 years) and of the nondiabetics 27.0 years (plus or minus 7.3 years). The authors assessed plaque index (PI), gingival (gum) inflammation (GI), probing depth (PD), gingival margin (GM) location, and clinical attachment level (CAL). Subjects with diabetes had significantly higher PI and GI scores than nondiabetics. Mean PD for diabetics was significantly different from that of nondiabetics. Although mean GM location was coronal to the cemento-enamel junction (CEJ) in both groups, gingival margins were at a more apical position in the subjects with diabetes. Mean CAL values also varied significantly between people with diabetes and nondiabetics. Significant differences were seen for GI, GM location, and CAL when assessing the effect of diabetes and controlling for plaque. When assessing the effect of plaque and controlling for diabetes, the only significant difference was GI. The authors conclude that their results demonstrate that periodontal inflammation and destruction are increased in pregnant women with diabetes as compared to pregnant women who do not have the disease. These findings may have implications for diabetes control and, therefore, maternal and fetal outcomes. 3 tables. 34 references. •

Cigarette Smoking and Periodontal Diseases: The Benefits of Smoking Cessation Source: Northwest Dentistry. 76(5): 25-29. September-October 1997. Contact: Available from Minnesota Dental Association. 2236 Marshall Avenue, St. Paul, MN 55104. (612) 646-7457; Fax (612) 646-8246. Summary: This article discusses smoking as a major risk factor for periodontal diseases. In addition, the author reviews some of the mechanisms for the oral effects of tobacco use and emphasizes the importance of conveying this information to dental patients. The author does not provide an exhaustive review of the literature, but instead highlights the effects of smoking on periodontitis and periodontal therapy. The author also outlines the benefits of instituting smoking cessation and prevention programs in the dental office. Topics include a definition of periodontal disease and its symptoms, how tobacco and its products can damage the gum and bone support around the teeth and lower one's resistance to gum infection, the problems with healing in smokers, the problems with dental implants in smokers, and the benefits of quitting tobacco use. The last page of the article is designed to be photocopied and distributed as a patient handout on the subject of smoking and periodontal diseases. 2 figures. 26 references. (AA-M).

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Brushing up on Gum Disease Source: NCRR Reporter. National Center for Research Resources Reporter. 20(3): 8-10. May-June 1996. Contact: Available from National Center for Research Resources (NCRR). National Institutes of Health (NIH), One Rockledge Centre, 6705 Rockledge Drive, MSC 7965, Bethesda, MD 20892-7965. (301) 435-0888; Fax (301) 480-3558; E-mail: [email protected].

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Summary: This article familiarizes readers with current research on gum disease and the bacterial infections responsible for it. Topics include the prevalence of periodontitis; the feasibility of developing a vaccine against periodontitis; risk factors for periodontitis, including old age, physical or mental limitations, and a variety of medical conditions and drugs; the role of Porphyromonas gingivalis in periodontal disease; and animal research focused on periodontal disease. The author notes that, as researchers learn more about the mechanisms by which bacteria cause disease and the immune system responds, they may also discover ways of ascertaining which patients are at greater risk. 2 figures. 2 references. •

Initial Outcome and Long-Term Effect of Surgical and Non-Surgical Treatment of Advanced Periodontal Disease Source: Journal of Clinical Periodontology. 28(9): 910-916. September 2001. Contact: Available from Munksgaard International Publishers Ltd. Commerce Place, 350 Main Street, Malden, MA 02148-5018. (781) 388-8273. Fax (781) 388-8274. Summary: This article reports on a clinical trial that was performed to determine the initial outcome of nonsurgical and surgical access treatment in subjects with advanced periodontal disease and the incidence of recurrent disease during 12 years of maintenance following active therapy. Each of the 64 subjects included in the trial showed signs of generalized gingival (gum) inflammation, had a minimum of 12 non molar teeth with deep pockets, and with greater than 6 millimeters alveolar bone loss. They were randomly assigned to 2 treatment groups; one surgical (SU) and one non surgical (SRP). Following a baseline examination, all patients were given a detailed case presentation which included oral hygiene instruction. The subjects in SU received surgical access therapy, while in SRP nonsurgical treatment was provided. After this basic therapy, all subjects were enrolled in a maintenance care program and were provided with meticulous supportive periodontal therapy (SPT) three to four times per year. The authors observe that surgical therapy (SU) was more effective than nonsurgical scaling and root planing (SRP) in reducing the overall mean probing pocket depth and in eliminating deep pockets; more SRP treated subjects exhibited signs of advanced disease progression in the 1 to 3 year period following active therapy than SU treated subjects. The authors stress that in subjects with advanced periodontal disease, surgical therapy provides better short and long term periodontal pocket reduction and may lead to fewer subjects requiring additional adjunctive therapy. 1 figure. 7 tables. 27 references.

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Cigar, Pipe, and Cigarette Smoking as Risk Factors for Periodontal Disease and Tooth Loss Source: Journal of Periodontology. 71(12): 1874-1881. December 2000. Contact: Available from American Academy of Periodontology. Suite 800, 737 North Michigan Avenue, Chicago, IL 60611-2690. (312) 573-3220. Fax (312) 573-3225. Summary: This article reports on a study undertaken to test the hypotheses that cigar and pipe smoking have significant associations with periodontal disease and that cigar, pipe, and cigarette smoking is associated with tooth loss. The authors also investigated whether a history of smoking habits cessation may affect the risk of periodontal disease and tooth loss. A group of 705 individuals (aged 21 to 92 years old) were examined clinically to assess their periodontal status and tooth loss. A structured interview was used to assess the participants' smoking behaviors with regard to cigarettes, cigar, and pipe smoking. Cigarette and cigar or pipe smokers had a higher prevalence of moderate

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and severe periodontitis and higher prevalence and extent of attachment loss and gingival (gum) recession than non smokers, suggesting poorer periodontal health in smokers. In addition, smokers had less gingival bleeding and higher number of missing teeth than non smokers. Current cigarette smokers had the highest prevalence of moderate and severe periodontitis (25.7 percent) compared to former cigarette smokers (20.2 percent), and non smokers (13.1 percent). The estimated prevalence of moderate and severe periodontitis in current or former cigar or pipe smokers was 17.6 percent. A similar pattern was seen for other periodontal measures. Analyses showed that current tobacco smokers may have increased risks of having moderate and severe periodontitis than former smokers, however smoking behaviors explained only small percentages of the variances in the multivariate models. The authors conclude that their results suggest that cigar and pipe smoking may have similar adverse effects on periodontal health and tooth loss as cigarette smoking. Smoking cessation efforts should be considered as a means of improving periodontal health and reducing tooth loss in heavy smokers of cigarettes, cigars, and pipes who have periodontal disease. 5 tables. 32 references. •

Update on HIV and Periodontal Disease Source: Journal of Periodontology. 73(9): 1071-1078. September 2002. Contact: Available from American Academy of Periodontology. Suite 800, 737 North Michigan Avenue, Chicago, IL 60611-2690. (312) 573-3220. Fax (312) 573-3225. Summary: With the advent of newer pharmacological approaches to the treatment of human immunodeficiency virus (HIV) infection, the incidence and progression of both atypical and conventional periodontal diseases are changing. This article offers readers an update on HIV and periodontal disease. The incidence of necrotizing periodontitis and gingival diseases of fungal origin appears to be on the decline as a result of these therapies that have led to increased life spans for HIV patients. However, in cases where these therapies lose their effectiveness and HIV patients relapse into an immunosuppressed state, these conditions may recur. Recent evidence has shown that HIV patients with more conventional periodontal diseases such as chronic periodontitis may have increased attachment loss and gingival (gum) recession when compared to their HIV-negative counterparts. This pattern of loss of periodontal support may be due in part to a diffuse invasion of opportunistic bacterial infections, viruses, and fungi into the gingival tissue, leading to a more elevated and more diffuse destructive inflammatory response in the periodontal soft and hard tissues. While the accepted approaches to treating the spectrum of periodontal diseases in HIV patients remain essentially unchanged over the past 15 years, the impact of newer systemic therapies on patient immunocompetence may influence treatment decisions. 83 references.

Federally Funded Research on Gum Disease The U.S. Government supports a variety of research studies relating to gum disease. These studies are tracked by the Office of Extramural Research at the National Institutes of Health.2 CRISP (Computerized Retrieval of Information on Scientific Projects) is a searchable database of federally funded biomedical research projects conducted at universities, hospitals, and other institutions. 2 Healthcare projects are funded by the National Institutes of Health (NIH), Substance Abuse and Mental Health Services (SAMHSA), Health Resources and Services Administration (HRSA), Food and Drug Administration (FDA), Centers for Disease Control and Prevention (CDCP), Agency for Healthcare Research and Quality (AHRQ), and Office of Assistant Secretary of Health (OASH).

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Gum Disease

Search the CRISP Web site at http://crisp.cit.nih.gov/crisp/crisp_query.generate_screen. You will have the option to perform targeted searches by various criteria, including geography, date, and topics related to gum disease. For most of the studies, the agencies reporting into CRISP provide summaries or abstracts. As opposed to clinical trial research using patients, many federally funded studies use animals or simulated models to explore gum disease. The following is typical of the type of information found when searching the CRISP database for gum disease: •

Project Title: GOLDENSEAL (HYDRASTIS CANADENSIS) REMEDY FOR ORAL DISEASES Principal Investigator & Institution: Wu, Christine D.; Associate Professor; Periodontics; University of Illinois at Chicago 1737 West Polk Street Chicago, Il 60612 Timing: Fiscal Year 2001; Project Start 15-APR-2001; Project End 31-MAR-2003 Summary: (APPLICANT'S ABSTRACT): Complementary and alternative medicine (CAM) has recently gained popularity with the American public. Research validating CAM has focused mainly on the treatment and prevention of systemic medical diseases while less attention has been paid to oral diseases. Oral diseases including dental caries and periodontal disease, are a major cause of loss of work and school days. Chemical and mechanical means have been used to control dental plaque bacteria, the etiologic agent of caries and periodontal disease. However, none of the available agents is ideal and frequently cause adverse effects. This justifies further search and development of alternative agents from natural sources that are safe and effective. The North American plant, Hydrastis canadensis L. (Ranunculaceae), known commercially as "Goldenseal," has been used for centuries as an antiseptic to treat skin disorders and as an antidiarrheal, antiseptic, astringent, hemostatic, and vasoconstrictor agent. Goldenseal is one of the major phytomedicines ("herbal remedies") sold in health food stores and pharmacies in the U.S. Several mouthrinses and toothpastes containing Goldenseal are available on the market. Although claims have been made by the manufactures regarding its ability to fight gum diseases and prevent caries, no scientific data is available to substantiate these claims. The goal of the proposed research is to evaluate the potential of Goldenseal as a remedy in prevention and treatment of oral diseases and to maintain oral health. It is hypothesized that antimicrobial compounds that are safe for humans can be identified from H. canadensis. These compounds may have potential as dental prophylactic/therapeutic agents and may also serve as lead compounds for the subsequent design and synthesis of new agents that are even more effective than the existing ones. The Specific Aims of this study are: SA1: To isolate and identify active antimicrobial compounds from H. canadensis by activity-guided fractionation and characterization; SA2: To determine antimicrobial activity of the purified compounds against cariogenic and periodontal pathogens; SA3: To investigate mixtures of purified antimicrobial compounds from H. canadensis for synergistic antimicrobial activities; SA4: To correlate bioactivity of various commercially available Goldenseal-containing oral hygiene products with levels of active alkaloids identified in SA2. The proposed research is innovative in that it represents collaboration between an oral microbiologist and a natural product chemist that will assure the speedy discovery of novel or known active compounds from Goldenseal and will provide scientific explanation as to the remedy's efficacy. It will also serve as a model system for the evaluation of existing herbal remedies for their oral health related claims. This application of CAM research will help to achieve better oral health and oral disease prevention, one of the to priority areas of focus specified b the U.S. Public Health Service in "Health People 2000."

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Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

E-Journals: PubMed Central3 PubMed Central (PMC) is a digital archive of life sciences journal literature developed and managed by the National Center for Biotechnology Information (NCBI) at the U.S. National Library of Medicine (NLM).4 Access to this growing archive of e-journals is free and unrestricted.5 To search, go to http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Pmc, and type “gum disease” (or synonyms) into the search box. This search gives you access to full-text articles. The following is a sample of items found for gum disease in the PubMed Central database: •

Periodontal Disease as a Specific, Albeit Chronic, Infection: Diagnosis and Treatment. by Loesche WJ, Grossman NS.; 2001 Oct; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=89001

The National Library of Medicine: PubMed One of the quickest and most comprehensive ways to find academic studies in both English and other languages is to use PubMed, maintained by the National Library of Medicine.6 The advantage of PubMed over previously mentioned sources is that it covers a greater number of domestic and foreign references. It is also free to use. If the publisher has a Web site that offers full text of its journals, PubMed will provide links to that site, as well as to sites offering other related data. User registration, a subscription fee, or some other type of fee may be required to access the full text of articles in some journals. To generate your own bibliography of studies dealing with gum disease, simply go to the PubMed Web site at http://www.ncbi.nlm.nih.gov/pubmed. Type “gum disease” (or synonyms) into the search box, and click “Go.” The following is the type of output you can expect from PubMed for gum disease (hyperlinks lead to article summaries): •

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A century of progress in understanding periodontal disease. Author(s): Williams RC. Source: Compend Contin Educ Dent. 2002 May; 23(5 Suppl): 3-10. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12789962&dopt=Abstract

Adapted from the National Library of Medicine: http://www.pubmedcentral.nih.gov/about/intro.html.

With PubMed Central, NCBI is taking the lead in preservation and maintenance of open access to electronic literature, just as NLM has done for decades with printed biomedical literature. PubMed Central aims to become a world-class library of the digital age. 5 The value of PubMed Central, in addition to its role as an archive, lies in the availability of data from diverse sources stored in a common format in a single repository. Many journals already have online publishing operations, and there is a growing tendency to publish material online only, to the exclusion of print. 6 PubMed was developed by the National Center for Biotechnology Information (NCBI) at the National Library of Medicine (NLM) at the National Institutes of Health (NIH). The PubMed database was developed in conjunction with publishers of biomedical literature as a search tool for accessing literature citations and linking to full-text journal articles at Web sites of participating publishers. Publishers that participate in PubMed supply NLM with their citations electronically prior to or at the time of publication.

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Gum Disease

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A non-surgical treatment for gum disease: fact or fancy. Author(s): Chasens AI. Source: J Wis Dent Assoc. 1983 April; 59(4): 316-7. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6304358&dopt=Abstract

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A profile of the patient with periodontal disease? Author(s): Rees TD. Source: Periodontology 2000. 2003; 32: 9-10. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12756029&dopt=Abstract

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A retrospective investigation of advanced periodontal disease as a risk factor for septicemia in hematopoietic stem cell and bone marrow transplant recipients. Author(s): Akintoye SO, Brennan MT, Graber CJ, McKinney BE, Rams TE, Barrett AJ, Atkinson JC. Source: Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontics. 2002 November; 94(5): 581-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12424452&dopt=Abstract

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Acquired immune suppression and other risk factors/indicators for periodontal disease progression. Author(s): Stanford TW, Rees TD. Source: Periodontology 2000. 2003; 32: 118-35. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12756038&dopt=Abstract

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Antigen-presenting cells in human periodontal disease tissues. Author(s): Gemmell E, Carter CL, Hart DN, Drysdale KE, Seymour GJ. Source: Oral Microbiology and Immunology. 2002 December; 17(6): 388-93. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12485331&dopt=Abstract

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Are cytokines linked to collagen breakdown during periodontal disease progression? Author(s): Ejeil AL, Gaultier F, Igondjo-Tchen S, Senni K, Pellat B, Godeau G, Gogly B. Source: J Periodontol. 2003 February; 74(2): 196-201. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12666708&dopt=Abstract

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Assessing periodontal disease risk: a comparison of clinicians' assessment versus a computerized tool. Author(s): Persson GR, Mancl LA, Martin J, Page RC. Source: The Journal of the American Dental Association. 2003 May; 134(5): 575-82. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12785492&dopt=Abstract

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Association between interleukin-1 genotype and periodontal disease in a diabetic population. Author(s): Guzman S, Karima M, Wang HY, Van Dyke TE. Source: J Periodontol. 2003 August; 74(8): 1183-90. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14514232&dopt=Abstract

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Association between nanobacteria and periodontal disease. Author(s): Ciftcioglu N, McKay DS, Kajander EO. Source: Circulation. 2003 August 26; 108(8): E58-9; Author Reply E58-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12939248&dopt=Abstract

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Association between periodontal disease and left ventricle mass in essential hypertension. Author(s): Angeli F, Verdecchia P, Pellegrino C, Pellegrino RG, Pellegrino G, Prosciutti L, Giannoni C, Cianetti S, Bentivoglio M. Source: Hypertension. 2003 March; 41(3): 488-92. Epub 2003 February 10. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12623948&dopt=Abstract

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Attacking gum disease. Author(s): Bissada N. Source: Health News. 1998 November 20; 4(14): 4. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9825709&dopt=Abstract

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Change of antibiotic susceptibility following periodontal therapy. A pilot study in aggressive periodontal disease. Author(s): Buchmann R, Muller RF, Van Dyke TE, Lange DE. Source: Journal of Clinical Periodontology. 2003 March; 30(3): 222-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12631180&dopt=Abstract

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Clinical outcome observed in subjects with recurrent periodontal disease following local treatment with 25% metronidazole gel. Author(s): Jansson H, Bratthall G, Soderholm G. Source: J Periodontol. 2003 March; 74(3): 372-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12710758&dopt=Abstract

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Comparison of body composition and periodontal disease using nutritional assessment techniques: Third National Health and Nutrition Examination Survey (NHANES III). Author(s): Wood N, Johnson RB, Streckfus CF. Source: Journal of Clinical Periodontology. 2003 April; 30(4): 321-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12694430&dopt=Abstract

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Gum Disease

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Coping with stress: its influence on periodontal disease. Author(s): Wimmer G, Janda M, Wieselmann-Penkner K, Jakse N, Polansky R, Pertl C. Source: J Periodontol. 2002 November; 73(11): 1343-51. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12479640&dopt=Abstract

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Current concepts and future trends for periodontal disease and periodontal therapy, Part 1: Etiology, risk factors, natural history, and systemic implications. Author(s): Lamster IB. Source: Dent Today. 2001 January; 20(1): 50-5. Review. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12524887&dopt=Abstract

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Current concepts and future trends for periodontal disease and periodontal therapy, Part 2: Classification, diagnosis, and nonsurgical and surgical therapy. Author(s): Lamster IB. Source: Dent Today. 2001 March; 20(3): 86-91. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12524874&dopt=Abstract

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Defensin-induced adaptive immunity in mice and its potential in preventing periodontal disease. Author(s): Brogden KA, Heidari M, Sacco RE, Palmquist D, Guthmiller JM, Johnson GK, Jia HP, Tack BF, McCray PB. Source: Oral Microbiology and Immunology. 2003 April; 18(2): 95-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12654098&dopt=Abstract

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Effects of specific nutrients on periodontal disease onset, progression and treatment. Author(s): Neiva RF, Steigenga J, Al-Shammari KF, Wang HL. Source: Journal of Clinical Periodontology. 2003 July; 30(7): 579-89. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12834494&dopt=Abstract

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Ehlers-Danlos syndrome with severe early-onset periodontal disease (EDS-VIII) is a distinct, heterogeneous disorder with one predisposition gene at chromosome 12p13. Author(s): Rahman N, Dunstan M, Teare MD, Hanks S, Douglas J, Coleman K, Bottomly WE, Campbell ME, Berglund B, Nordenskjold M, Forssell B, Burrows N, Lunt P, Young I, Williams N, Bignell GR, Futreal PA, Pope FM. Source: American Journal of Human Genetics. 2003 July; 73(1): 198-204. Epub 2003 May 29. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12776252&dopt=Abstract

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Elevated levels of collagen cross-link residues in gingival tissues and crevicular fluid of teeth with periodontal disease. Author(s): Jepsen S, Springer IN, Buschmann A, Hedderich J, Acil Y. Source: European Journal of Oral Sciences. 2003 June; 111(3): 198-202. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12786949&dopt=Abstract

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Epidemiology of periodontal disease: a review and clinical perspectives. Author(s): Irfan UM, Dawson DV, Bissada NF. Source: J Int Acad Periodontol. 2001 January; 3(1): 14-21. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12666973&dopt=Abstract

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Estimation of interleukin-1beta levels in the gingival crevicular fluid in health and in inflammatory periodontal disease. Author(s): Faizuddin M, Bharathi SH, Rohini NV. Source: Journal of Periodontal Research. 2003 April; 38(2): 111-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12608903&dopt=Abstract

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Expression of RANKL and OPG mRNA in periodontal disease: possible involvement in bone destruction. Author(s): Liu D, Xu JK, Figliomeni L, Huang L, Pavlos NJ, Rogers M, Tan A, Price P, Zheng MH. Source: International Journal of Molecular Medicine. 2003 January; 11(1): 17-21. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12469211&dopt=Abstract

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Fighting gum disease: how to keep your teeth. Author(s): Lewis C. Source: Fda Consumer. 2002 May-June; 36(3): 16-22. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12085804&dopt=Abstract

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Gene mutation leaves people susceptible to gum disease. Author(s): Scott BL. Source: Journal of Dental Hygiene : Jdh / American Dental Hygienists' Association. 2000 Winter; 74(1): 7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11314121&dopt=Abstract

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Influence of periodontal disease on Th1/Th2-type cytokines in saliva of HIV-positive individuals. Author(s): Vastardis S, Leigh JE, Wozniak K, Yukna R, Fidel PL Jr. Source: Oral Microbiology and Immunology. 2003 April; 18(2): 88-91. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12654096&dopt=Abstract

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Investigation of the association between angiographically defined coronary artery disease and periodontal disease. Author(s): Malthaner SC, Moore S, Mills M, Saad R, Sabatini R, Takacs V, McMahan AC, Oates TW Jr. Source: J Periodontol. 2002 October; 73(10): 1169-76. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12416775&dopt=Abstract

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Gum Disease

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Isotypic antibody response to plaque anaerobes in periodontal disease. Author(s): Plombas M, Gobert B, De March AK, Sarda MN, Sixou M, Bene MC, Miller N, Faure GC. Source: J Periodontol. 2002 December; 73(12): 1507-11. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12546101&dopt=Abstract

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Link between gum disease and heart disease disputed. Author(s): Larkin M. Source: Lancet. 2001 July 28; 358(9278): 303. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11498224&dopt=Abstract

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Managing risk factors in successful nonsurgical treatment of periodontal disease. Author(s): Gottehrer NR. Source: Dent Today. 2003 January; 22(1): 64-9. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12616891&dopt=Abstract

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Maternal periodontal disease is associated with an increased risk for preeclampsia. Author(s): Boggess KA, Lieff S, Murtha AP, Moss K, Beck J, Offenbacher S. Source: Obstetrics and Gynecology. 2003 February; 101(2): 227-31. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12576243&dopt=Abstract

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Matrix molecules and growth factors as indicators of periodontal disease activity. Author(s): Giannobile WV, Al-Shammari KF, Sarment DP. Source: Periodontology 2000. 2003; 31: 125-34. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12656999&dopt=Abstract

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Meta-analysis of periodontal disease and risk of coronary heart disease and stroke. Author(s): Janket SJ, Baird AE, Chuang SK, Jones JA. Source: Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontics. 2003 May; 95(5): 559-69. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12738947&dopt=Abstract

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Microorganisms as risk indicators for periodontal disease. Author(s): Ezzo PJ, Cutler CW. Source: Periodontology 2000. 2003; 32: 24-35. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12756031&dopt=Abstract

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Molecular interaction of Porphyromonas gingivalis with host cells: implication for the microbial pathogenesis of periodontal disease. Author(s): Amano A. Source: J Periodontol. 2003 January; 74(1): 90-6. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12593602&dopt=Abstract

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Monocyte-derived RANTES is intrinsically elevated in periodontal disease while MCP-1 levels are related to inflammation and are inversely correlated with IL-12 levels. Author(s): Fokkema SJ, Loos BG, van der Velden U. Source: Clinical and Experimental Immunology. 2003 March; 131(3): 477-83. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12605701&dopt=Abstract

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Mouthrinses and periodontal disease. Author(s): FDI Commission. Source: Int Dent J. 2002 October; 52(5): 346-52. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12418603&dopt=Abstract

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Negative effects of chronic inflammatory periodontal disease on diabetes mellitus. Author(s): Nishimura F, Kono T, Fujimoto C, Iwamoto Y, Murayama Y. Source: J Int Acad Periodontol. 2000 April; 2(2): 49-55. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12666961&dopt=Abstract

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Neutrophil-mediated tissue injury in periodontal disease pathogenesis: findings from localized aggressive periodontitis. Author(s): Kantarci A, Oyaizu K, Van Dyke TE. Source: J Periodontol. 2003 January; 74(1): 66-75. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12593599&dopt=Abstract

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Nutrition, infection, and periodontal disease. Author(s): Boyd LD, Madden TE. Source: Dent Clin North Am. 2003 April; 47(2): 337-54. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12699235&dopt=Abstract

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Nutrition, inflammation, and periodontal disease. Author(s): Ritchie CS, Kinane DF. Source: Nutrition (Burbank, Los Angeles County, Calif.). 2003 May; 19(5): 475-6. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12714106&dopt=Abstract

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Obesity and periodontal disease in young, middle-aged, and older adults. Author(s): Al-Zahrani MS, Bissada NF, Borawskit EA. Source: J Periodontol. 2003 May; 74(5): 610-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12816292&dopt=Abstract

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Occlusal forces as a risk factor for periodontal disease. Author(s): Harrel SK. Source: Periodontology 2000. 2003; 32: 111-7. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12756037&dopt=Abstract

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Orthodontic movement into infrabony defects in patients with advanced periodontal disease: a clinical and radiological study. Author(s): Corrente G, Abundo R, Re S, Cardaropoli D, Cardaropoli G. Source: J Periodontol. 2003 August; 74(8): 1104-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14514223&dopt=Abstract

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Osteoporosis and periodontal disease progression. Author(s): Geurs NC, Lewis CE, Jeffcoat MK. Source: Periodontology 2000. 2003; 32: 105-10. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12756036&dopt=Abstract

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Partial-mouth assessment of periodontal disease in an adult population of the United States. Author(s): Owens JD, Dowsett SA, Eckert GJ, Zero DT, Kowolik MJ. Source: J Periodontol. 2003 August; 74(8): 1206-13. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14514235&dopt=Abstract

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Patterns of chemokines and chemokine receptors expression in different forms of human periodontal disease. Author(s): Garlet GP, Martins W Jr, Ferreira BR, Milanezi CM, Silva JS. Source: Journal of Periodontal Research. 2003 April; 38(2): 210-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12608917&dopt=Abstract

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Periodontal disease among the middle-aged Vietnamese population. Author(s): Do LG, Spencer JA, Roberts-Thomson K, Ha DH, Tran TV, Trinh HD. Source: J Int Acad Periodontol. 2003 July; 5(3): 77-84. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12887146&dopt=Abstract

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Periodontal disease and diabetes mellitus. Bidirectional relationship. Author(s): Mealey BL, Rethman MP. Source: Dent Today. 2003 April; 22(4): 107-13. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12733412&dopt=Abstract

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Periodontal disease and diabetes mellitus: the role of tumor necrosis factor-alpha in a 2-way relationship. Author(s): Nishimura F, Iwamoto Y, Mineshiba J, Shimizu A, Soga Y, Murayama Y. Source: J Periodontol. 2003 January; 74(1): 97-102. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12593603&dopt=Abstract

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Periodontal disease and preterm birth: results of a pilot intervention study. Author(s): Jeffcoat MK, Hauth JC, Geurs NC, Reddy MS, Cliver SP, Hodgkins PM, Goldenberg RL. Source: J Periodontol. 2003 August; 74(8): 1214-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14514236&dopt=Abstract

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Periodontal disease incidence, progression and rate of tooth loss in a general dental practice: the results of a 12-year retrospective analysis of patient's clinical records. Author(s): Nicholls C. Source: British Dental Journal. 2003 May 10; 194(9): 485-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12835778&dopt=Abstract

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Periodontal disease is associated with lower antioxidant capacity in whole saliva and evidence of increased protein oxidation. Author(s): Sculley DV, Langley-Evans SC. Source: Clinical Science (London, England : 1979). 2003 August; 105(2): 167-72. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12650638&dopt=Abstract

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Periodontal disease predicts and possibly contributes to acute myocardial infarction. Author(s): Wehrmacher WH. Source: Dent Today. 2001 April; 20(4): 80-1. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12528209&dopt=Abstract

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Periodontal disease, tooth loss, and incidence of ischemic stroke. Author(s): Joshipura KJ, Hung HC, Rimm EB, Willett WC, Ascherio A. Source: Stroke; a Journal of Cerebral Circulation. 2003 January; 34(1): 47-52. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12511749&dopt=Abstract

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Periodontal disease: a look at historical, current, and future approaches to therapy. Author(s): Suzuki JB. Source: J Indiana Dent Assoc. 2003 Spring; 82(1): 16-21. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12815935&dopt=Abstract

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Preterm low birth weight and periodontal disease among African Americans. Author(s): Dasanayake AP, Russell S, Boyd D, Madianos PN, Forster T, Hill E. Source: Dent Clin North Am. 2003 January; 47(1): 115-25, X-Xi. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12519009&dopt=Abstract

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Prevalence assessment of periodontal disease in 3-5 year old children through PSR-population study. Author(s): Andrade IT, Rapp GE. Source: J Int Acad Periodontol. 2002 October; 4(4): 126-31. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12670092&dopt=Abstract

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Prevalence assessment of periodontal disease in 3-6 year old children through PSR--a pilot study. Author(s): Rapp GE, Garcia RV, Motta AC, Andrade IT, Biao MA, Carvalho PB. Source: J Int Acad Periodontol. 2001 July; 3(3): 75-80. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12666945&dopt=Abstract

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Prevalence of periodontal disease in endemically flourosed areas of Davangere Taluk, India. Author(s): Anuradha KP, Chadrashekar J, Ramesh N. Source: Indian J Dent Res. 2002 January-March; 13(1): 15-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12420563&dopt=Abstract

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Relationship between periodontal disease and C-reactive protein among adults in the Atherosclerosis Risk in Communities study. Author(s): Slade GD, Ghezzi EM, Heiss G, Beck JD, Riche E, Offenbacher S. Source: Archives of Internal Medicine. 2003 May 26; 163(10): 1172-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12767953&dopt=Abstract

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Relationship between periodontal disease in pregnant women and the nutritional condition of their newborns. Author(s): Romero BC, Chiquito CS, Elejalde LE, Bernardoni CB. Source: J Periodontol. 2002 October; 73(10): 1177-83. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12416776&dopt=Abstract

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Relationship between periodontal disease, tooth loss, and carotid artery plaque: the Oral Infections and Vascular Disease Epidemiology Study (INVEST). Author(s): Desvarieux M, Demmer RT, Rundek T, Boden-Albala B, Jacobs DR Jr, Papapanou PN, Sacco RL; Oral Infections and Vascular Disease Epidemiology Study (INVEST). Source: Stroke; a Journal of Cerebral Circulation. 2003 September; 34(9): 2120-5. Epub 2003 July 31. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12893951&dopt=Abstract

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Relationship between stress factors and periodontal disease. Author(s): Pistorius A, Krahwinkel T, Willershausen B, Boekstegen C. Source: European Journal of Medical Research. 2002 September 30; 7(9): 393-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12435617&dopt=Abstract

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Relationship of destructive periodontal disease to the acute-phase response. Author(s): Craig RG, Yip JK, So MK, Boylan RJ, Socransky SS, Haffajee AD. Source: J Periodontol. 2003 July; 74(7): 1007-16. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12931763&dopt=Abstract

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Salt and periodontal disease. Author(s): Khoury NS. Source: British Dental Journal. 2003 May 10; 194(9): 467. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12835762&dopt=Abstract

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Serum markers of periodontal disease status and inflammation in hemodialysis patients. Author(s): Rahmati MA, Craig RG, Homel P, Kaysen GA, Levin NW. Source: American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation. 2002 November; 40(5): 983-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12407643&dopt=Abstract

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Serum modulation of neutrophil response to Porphyromonas gingivalis LPS in periodontal disease. Author(s): Soolari AS, Champagne C, Punzi JS, Amar S, Van Dyke TE. Source: J Int Acad Periodontol. 1999 October; 1(4): 101-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12666954&dopt=Abstract

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Single-nucleotide polymorphism in the CD14 promoter and periodontal disease expression in a Japanese population. Author(s): Yamazaki K, Ueki-Maruyama K, Oda T, Tabeta K, Shimada Y, Tai H, Nakajima T, Yoshie H, Herawati D, Seymour GJ. Source: Journal of Dental Research. 2003 August; 82(8): 612-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12885845&dopt=Abstract

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Smoking and periodontal disease. Author(s): Rivera-Hidalgo F. Source: Periodontology 2000. 2003; 32: 50-8. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12756033&dopt=Abstract

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Some risk factors for the progression of periodontal disease. Author(s): Skaleric U, Kovac-Kavcic M. Source: J Int Acad Periodontol. 2000 January; 2(1): 19-23. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12666982&dopt=Abstract

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Specific fibronectin fragments as markers of periodontal disease status. Author(s): Huynh QN, Wang S, Tafolla E, Gansky SA, Kapila S, Armitage GC, Kapila YL. Source: J Periodontol. 2002 October; 73(10): 1101-10. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12416766&dopt=Abstract

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Systemic disorders in patients with periodontal disease. Author(s): Lagervall M, Jansson L, Bergstrom J. Source: Journal of Clinical Periodontology. 2003 April; 30(4): 293-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12694426&dopt=Abstract

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The cost-effectiveness of interleukin-1 genetic testing for periodontal disease. Author(s): Higashi MK, Veenstra DL, del Aguila M, Hujoel P. Source: J Periodontol. 2002 December; 73(12): 1474-84. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12546098&dopt=Abstract

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The distribution of periodontal disease and loss of attachment in jaw sextants in different age groups--cross-sectional study. Author(s): Spalj S, Plancak D. Source: Coll Antropol. 2003; 27 Suppl 1: 183-90. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12955908&dopt=Abstract

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The effect of a triclosan-containing dentifrice on the progression of periodontal disease in an adult population. Author(s): Cullinan MP, Westerman B, Hamlet SM, Palmer JE, Faddy MJ, Seymour GJ. Source: Journal of Clinical Periodontology. 2003 May; 30(5): 414-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12716333&dopt=Abstract

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The effect of shared genetic and environmental factors on periodontal disease parameters in untreated adult siblings in Guatemala. Author(s): Dowsett SA, Archila L, Foroud T, Koller D, Eckert GJ, Kowolik MJ. Source: J Periodontol. 2002 October; 73(10): 1160-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12416774&dopt=Abstract

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The genetic relationship to periodontal disease. Author(s): Nares S. Source: Periodontology 2000. 2003; 32: 36-49. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12756032&dopt=Abstract

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The interleukin-1 polymorphism, smoking, and the risk of periodontal disease in the population-based SHIP study. Author(s): Meisel P, Siegemund A, Grimm R, Herrmann FH, John U, Schwahn C, Kocher T. Source: Journal of Dental Research. 2003 March; 82(3): 189-93. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12598547&dopt=Abstract

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The mouth as a mirror of diabetes. Early detection to prevent periodontal disease. Author(s): Satterfield D, Lester AM. Source: Adv Nurse Pract. 2001 February; 9(2): 79-82. Review. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12416059&dopt=Abstract

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The owner-animal-environment triad in the treatment of canine periodontal disease. Author(s): Hale FA. Source: J Vet Dent. 2003 June; 20(2): 118-22. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14528858&dopt=Abstract

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The prevention of dental caries and periodontal disease from the cradle to the grave: what is the best available evidence? Author(s): Davies RM. Source: Dent Update. 2003 May; 30(4): 170-6, 178-9. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12830693&dopt=Abstract

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The relationship between coronary artery disease and periodontal disease. Author(s): Johnson-Leong C, Patel G, Messieha Z. Source: Dent Today. 2003 February; 22(2): 100-5. Review. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12680268&dopt=Abstract

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The relationship of oral malodor in patients with or without periodontal disease. Author(s): Figueiredo LC, Rosetti EP, Marcantonio E Jr, Marcantonio RA, Salvador SL. Source: J Periodontol. 2002 November; 73(11): 1338-42. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12479639&dopt=Abstract

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The role of acquired immunity and periodontal disease progression. Author(s): Teng YT. Source: Critical Reviews in Oral Biology and Medicine : an Official Publication of the American Association of Oral Biologists. 2003; 14(4): 237-52. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12907693&dopt=Abstract

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The role of gingipains in the pathogenesis of periodontal disease. Author(s): Imamura T. Source: J Periodontol. 2003 January; 74(1): 111-8. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12593605&dopt=Abstract

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The role of herpesviruses in periodontal disease. Author(s): Simonian K. Source: J West Soc Periodontol Periodontal Abstr. 2003; 51(1): 5-9. Review. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12830822&dopt=Abstract

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Tobacco smoking and risk for periodontal disease. Author(s): Bergstrom J. Source: Journal of Clinical Periodontology. 2003 February; 30(2): 107-13. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12622851&dopt=Abstract

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Uncovering early gum disease. Author(s): Killoy WJ. Source: Dent Today. 1995 May; 14(5): 82-6. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9540623&dopt=Abstract

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Understanding prevention of dental caries and gum disease in an Asian community. Author(s): Soh G. Source: J Ir Dent Assoc. 1991; 37(1): 6-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1885928&dopt=Abstract

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Understanding prevention of dental caries and gum disease in the singapore population. Author(s): Soh G. Source: Odontostomatol Trop. 1992 March; 15(1): 25-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1287608&dopt=Abstract

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Unification of the “burst” and “linear” theories of periodontal disease progression: a multilevel manifestation of the same phenomenon. Author(s): Gilthorpe MS, Zamzuri AT, Griffiths GS, Maddick IH, Eaton KA, Johnson NW. Source: Journal of Dental Research. 2003 March; 82(3): 200-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12598549&dopt=Abstract

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Untreated periodontal disease: a follow-up on 30 cases. Author(s): Harris RJ. Source: J Periodontol. 2003 May; 74(5): 672-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12816300&dopt=Abstract

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Update on Actinobacillus Actinomycetemcomitans and Porphyromonas gingivalis in human periodontal disease. Author(s): Slots J. Source: J Int Acad Periodontol. 1999 October; 1(4): 121-6. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12666957&dopt=Abstract

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Update on general health risk of periodontal disease. Author(s): Slots J. Source: Int Dent J. 2003; 53 Suppl 3: 200-7. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12875309&dopt=Abstract

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Use of aspartate aminotransferase in diagnosing periodontal disease: a comparative study of clinical and microbiological parameters. Author(s): Barbosa e Silva E, Salvador SL, Fogo JC, Marcantonio RA. Source: J Oral Sci. 2003 March; 45(1): 33-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12816362&dopt=Abstract

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Using host response modifiers in the treatment of periodontal disease. Author(s): Novak MJ, Donley TG. Source: Pract Proced Aesthet Dent. 2002 November-December; 14(9): Suppl 3-10; Quiz 11. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12685424&dopt=Abstract

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Vitamin D receptor alleles, periodontal disease progression, and tooth loss in the VA dental longitudinal study. Author(s): Inagaki K, Krall EA, Fleet JC, Garcia RI. Source: J Periodontol. 2003 February; 74(2): 161-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12666703&dopt=Abstract

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CHAPTER 2. ALTERNATIVE MEDICINE AND GUM DISEASE Overview In this chapter, we will begin by introducing you to official information sources on complementary and alternative medicine (CAM) relating to gum disease. At the conclusion of this chapter, we will provide additional sources.

National Center for Complementary and Alternative Medicine The National Center for Complementary and Alternative Medicine (NCCAM) of the National Institutes of Health (http://nccam.nih.gov/) has created a link to the National Library of Medicine’s databases to facilitate research for articles that specifically relate to gum disease and complementary medicine. To search the database, go to the following Web site: http://www.nlm.nih.gov/nccam/camonpubmed.html. Select “CAM on PubMed.” Enter “gum disease” (or synonyms) into the search box. Click “Go.” The following references provide information on particular aspects of complementary and alternative medicine that are related to gum disease: •

Prevention and control of periodontal diseases in developing and industrialized nations. Author(s): Axelsson P, Albandar JM, Rams TE. Source: Periodontology 2000. 2002; 29: 235-46. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12102711&dopt=Abstract

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Psychosocial factors in inflammatory periodontal diseases. A review. Author(s): da Silva AM, Newman HN, Oakley DA. Source: Journal of Clinical Periodontology. 1995 July; 22(7): 516-26. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7560234&dopt=Abstract

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The natural history of periodontal disease in man. Risk factors for progression of attachment loss in individuals receiving no oral health care. Author(s): Neely AL, Holford TR, Loe H, Anerud A, Boysen H.

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Source: J Periodontol. 2001 August; 72(8): 1006-15. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11525431&dopt=Abstract

Additional Web Resources A number of additional Web sites offer encyclopedic information covering CAM and related topics. The following is a representative sample: •

Alternative Medicine Foundation, Inc.: http://www.herbmed.org/

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AOL: http://search.aol.com/cat.adp?id=169&layer=&from=subcats

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Chinese Medicine: http://www.newcenturynutrition.com/

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drkoop.com®: http://www.drkoop.com/InteractiveMedicine/IndexC.html

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Family Village: http://www.familyvillage.wisc.edu/med_altn.htm

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Google: http://directory.google.com/Top/Health/Alternative/

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Healthnotes: http://www.healthnotes.com/

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MedWebPlus: http://medwebplus.com/subject/Alternative_and_Complementary_Medicine

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Open Directory Project: http://dmoz.org/Health/Alternative/

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HealthGate: http://www.tnp.com/

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WebMD®Health: http://my.webmd.com/drugs_and_herbs

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WholeHealthMD.com: http://www.wholehealthmd.com/reflib/0,1529,00.html

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Yahoo.com: http://dir.yahoo.com/Health/Alternative_Medicine/

The following is a specific Web list relating to gum disease; please note that any particular subject below may indicate either a therapeutic use, or a contraindication (potential danger), and does not reflect an official recommendation: •

General Overview Gingivitis Source: Healthnotes, Inc.; www.healthnotes.com Gum Disease Source: Integrative Medicine Communications; www.drkoop.com Periodontal Disease Alternative names: Gum Disease Source: Prima Communications, Inc.www.personalhealthzone.com Sickle Cell Anemia Source: Healthnotes, Inc.; www.healthnotes.com

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Alternative Therapy Hypnotherapy Source: Integrative Medicine Communications; www.drkoop.com

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Chinese Medicine Bushen Guchi Wan Alternative names: Bushen Guchi Pills Source: Pharmacopoeia Commission of the Ministry of Health, People's Republic of China

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Herbs and Supplements Alpha2-adrenergic Agonists Source: Integrative Medicine Communications; www.drkoop.com Beta-blockers Source: Integrative Medicine Communications; www.drkoop.com Bloodroot Alternative names: Sanguinaria canadensis Source: Healthnotes, Inc.; www.healthnotes.com Bloodroot Source: Prima Communications, Inc.www.personalhealthzone.com Caraway Alternative names: Carum carvi Source: Healthnotes, Inc.; www.healthnotes.com Centella Alternative names: Gotu Kola; Centella asiatica (Linn.) Source: Alternative Medicine Foundation, Inc.; www.amfoundation.org Chamomile Alternative names: Matricaria recutita Source: Healthnotes, Inc.; www.healthnotes.com Chamomile Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,766,00.html Coenzyme Q Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,768,00.html Coenzyme Q10 Source: Healthnotes, Inc.; www.healthnotes.com

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Coenzyme Q10 Source: Integrative Medicine Communications; www.drkoop.com Coenzyme Q10 (coq10) Source: Prima Communications, Inc.www.personalhealthzone.com Coq10 Source: Integrative Medicine Communications; www.drkoop.com Cranberry Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,10019,00.html Echinacea Alternative names: Echinacea purpurea, Echinacea angustifolia, Echinacea pallida Source: Healthnotes, Inc.; www.healthnotes.com Eucalyptus Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,778,00.html Eugenia Clove Alternative names: Cloves; Eugenia sp. Source: Alternative Medicine Foundation, Inc.; www.amfoundation.org Fibric Acid Derivatives Source: Integrative Medicine Communications; www.drkoop.com Flavonoids Source: Healthnotes, Inc.; www.healthnotes.com German Chamomile Alternative names: Matricaria recutita Source: Integrative Medicine Communications; www.drkoop.com Glycyrrhiza1 Alternative names: Licorice; Glycyrrhiza glabra L. Source: Alternative Medicine Foundation, Inc.; www.amfoundation.org Goldenrod Alternative names: Solidago virgaurea Source: Integrative Medicine Communications; www.drkoop.com Gotu Kola Source: Prima Communications, Inc.www.personalhealthzone.com Matricaria Recutita Source: Integrative Medicine Communications; www.drkoop.com

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Melaleuca Alternative names: Tea Tree Oil; Melaleuca alternifolia Source: Alternative Medicine Foundation, Inc.; www.amfoundation.org Myrrh Alternative names: Commiphora molmol Source: Healthnotes, Inc.; www.healthnotes.com Peppermint Alternative names: Mentha piperita Source: Healthnotes, Inc.; www.healthnotes.com Phenothiazine Derivatives Source: Integrative Medicine Communications; www.drkoop.com Sage Alternative names: Salvia officinalis Source: Healthnotes, Inc.; www.healthnotes.com Solidago Virgaurea Source: Integrative Medicine Communications; www.drkoop.com Spirulina and Kelp Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,10058,00.html Sulfonylureas Source: Integrative Medicine Communications; www.drkoop.com Tea Tree Source: Prima Communications, Inc.www.personalhealthzone.com Thiazide Diuretics Source: Integrative Medicine Communications; www.drkoop.com Thioxanthene Derivatives Source: Integrative Medicine Communications; www.drkoop.com Thuja Plicata Alternative names: Western Red Cedar Source: Alternative Medicine Foundation, Inc.; www.amfoundation.org Tricyclic Antidepressants (TCAS) Source: Integrative Medicine Communications; www.drkoop.com Vasodilators Source: Integrative Medicine Communications; www.drkoop.com

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The following is a specific Web list relating to gum disease; please note that any particular subject below may indicate either a therapeutic use, or a contraindication (potential danger), and does not reflect an official recommendation: •

Vitamins Folic Acid Source: Healthnotes, Inc.; www.healthnotes.com Folic Acid Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,887,00.html Vitamin B12 Source: Prima Communications, Inc.www.personalhealthzone.com Vitamin C Source: Healthnotes, Inc.; www.healthnotes.com Vitamin C Source: Prima Communications, Inc.www.personalhealthzone.com Vitamin C Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,904,00.html Vitamin C and Flavonoids Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,935,00.html Vitamin E Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,906,00.html

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Minerals Calcium Source: Healthnotes, Inc.; www.healthnotes.com Calcium Source: Integrative Medicine Communications; www.drkoop.com Calcium Source: Prima Communications, Inc.www.personalhealthzone.com Calcium Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com

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Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,884,00.html Folate Source: Prima Communications, Inc.www.personalhealthzone.com HMG-COA Reductase Inhibitors (Statins) Source: Integrative Medicine Communications; www.drkoop.com Magnesium Source: Prima Communications, Inc.www.personalhealthzone.com Selenium Source: Healthnotes, Inc.; www.healthnotes.com Zinc Source: Prima Communications, Inc.www.personalhealthzone.com •

Food and Diet Cinnamon Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/foods_view/0,1523,271,00.html

General References A good place to find general background information on CAM is the National Library of Medicine. It has prepared within the MEDLINEplus system an information topic page dedicated to complementary and alternative medicine. To access this page, go to the MEDLINEplus site at http://www.nlm.nih.gov/medlineplus/alternativemedicine.html. This Web site provides a general overview of various topics and can lead to a number of general sources.

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CHAPTER 3. DISSERTATIONS ON GUM DISEASE Overview In this chapter, we will give you a bibliography on recent dissertations relating to gum disease. We will also provide you with information on how to use the Internet to stay current on dissertations. IMPORTANT NOTE: When following the search strategy described below, you may discover non-medical dissertations that use the generic term “gum disease” (or a synonym) in their titles. To accurately reflect the results that you might find while conducting research on gum disease, we have not necessarily excluded nonmedical dissertations in this bibliography.

Dissertations on Gum Disease ProQuest Digital Dissertations, the largest archive of academic dissertations available, is located at the following Web address: http://wwwlib.umi.com/dissertations. From this archive, we have compiled the following list covering dissertations devoted to gum disease. You will see that the information provided includes the dissertation’s title, its author, and the institution with which the author is associated. The following covers recent dissertations found when using this search procedure: •

In Vitro Studies of Collagen Catabolism in Progressive Periodontal Disease in Beagle Dogs by Gates, Donald James; PhD from University of Alberta (Canada), 1982 http://wwwlib.umi.com/dissertations/fullcit/NK60302

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Methods for Studying Geochemical - Dental-disease Interrelationships, Including the Assessment of Periodontal Disease by Digital Imaging (Missouri) by Hildebolt, Charles Floyd, PhD from Washington University, 1987, 301 pages http://wwwlib.umi.com/dissertations/fullcit/8722459

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Oral Contraceptive Use and Periodontal Diseases among United States Women: an Analysis of Nhanes Data by Taichman, Linda Susan; PhD from University of Michigan, 2002, 147 pages http://wwwlib.umi.com/dissertations/fullcit/3058058

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Stress-induced Porphyromonas Gingivalis Gene Expression in Periodontal Disease by Shelburne, Charles Edward; PhD from Queen's University of Belfast (Northern Ireland), 2002 http://wwwlib.umi.com/dissertations/fullcit/f336257

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The Role of Mucopolysaccharidase-producing Anaerobic Oral Bacteria in the Pathogenesis of Inflammatory Periodontal Disease by Tam, You-Cheuk; PhD from McGill University (Canada), 1985 http://wwwlib.umi.com/dissertations/fullcit/NL24043

Keeping Current Ask the medical librarian at your library if it has full and unlimited access to the ProQuest Digital Dissertations database. From the library, you should be able to do more complete searches via http://wwwlib.umi.com/dissertations.

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CHAPTER 4. CLINICAL TRIALS AND GUM DISEASE Overview In this chapter, we will show you how to keep informed of the latest clinical trials concerning gum disease.

Recent Trials on Gum Disease The following is a list of recent trials dedicated to gum disease.7 Further information on a trial is available at the Web site indicated. •

Effect of 3 periodontal therapies in current and non-smokers Condition(s): Periodontitis; Periodontal Diseases Study Status: This study is currently recruiting patients. Sponsor(s): National Institute of Dental and Craniofacial Research (NIDCR) Purpose - Excerpt: The purpose of this study is to determine in current and non-smokers the clinical and microbiological effects of 3 therapies: scaling and root planing (SRP) alone; SRP in combination with the orally administered antibiotic metronidazole; and SRP with the orally administered antibiotics metronidazole and amoxicillin along with the locally delivered antibiotic doxycycline at periodontal pockets >= 4 mm. Phase(s): Phase II Study Type: Interventional Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00066066

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Microbial associations in periodontal health and disease Condition(s): Periodontitis; Periodontal Diseases Study Status: This study is currently recruiting patients. Sponsor(s): National Institute of Dental and Craniofacial Research (NIDCR)

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These are listed at www.ClinicalTrials.gov.

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Purpose - Excerpt: The purpose of this study is to determine the clinical and microbiological effects of systemically administered metronidazole alone or in combination with professional plaque removal on periodontally diseased patients. Phase(s): Phase II Study Type: Interventional Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00066001 •

Norplant and Irregular Bleeding/Spotting Condition(s): Endometrial bleeding; Periodontal Disease Study Status: This study is currently recruiting patients. Sponsor(s): National Institute of Child Health and Human Development (NICHD) Purpose - Excerpt: Irregular or prolonged menstrual bleeding and/or spotting are common side effects in patients using progestin-only hormonal contraception such as levonorgestrel implants (Norplant). Doxycyline, a drug approved by the Food and Drug Administration (FDA) to treat gum disease, may reduce the occurrence of uterine bleeding and spotting in women who use Norplant. This study will evaluate the effects of doxycycline on uterine bleeding/spotting in women using Norplant. Phase(s): Phase IV Study Type: Interventional Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00064766

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Study of the Composition of Dental Plaque Condition(s): Dental Caries; Dental Plaque; Periodontal Disease Study Status: This study is currently recruiting patients. Sponsor(s): National Institute of Dental and Craniofacial Research (NIDCR) Purpose - Excerpt: This study will examine the composition of dental plaque-a naturally occurring substance that sticks to the teeth and can cause tooth decay and gum disease. A better understanding of how plaque builds up in the mouth may help in developing improved ways of controlling it. Healthy normal volunteers between the ages of 18 and 65 who work at the National Institutes of Health main campus in Bethesda, Maryland, may participate in this study. Candidates will be screened for eligibility with a medical and dental history. This study involves a maximum of five visits to the dental clinic. At the first visit, participants will have a dental examination, and a mold will be made of the mouth. To make the mold, a small plastic tray containing impression material will be placed in the volunteer's mouth and held in place for about 2 minutes to set. The tray will then be removed and a mold will be made from the impression. The mold will be used to make the mouthpiece used in study 1, described below, and the tooth fittings used in study 2, also described below. Volunteers will participate in one of these two studies. Study 1. Volunteers in study 1 will have their mouthpiece checked at the second visit, have a teeth cleaning, and have the mold put in place. The mouthpiece will be worn for up to 8 hours, during which time soft foods can be eaten. Mouthwash should not be used while the device is in place. At the volunteer's third (last) visit, the mouthpiece will be removed and the volunteer will spit into a tube to collect saliva for

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examination for bacteria. Study 2. Volunteers in study 2 will have their teeth cleaned at the second visit and the tooth fittings placed onto the back teeth with a dental adhesive. The fittings will be worn for up to 72 hours, during which time volunteers can eat a regular diet and brush their teeth. Mouthwash should not be used while the fittings are in place. At the third, fourth and fifth visits, some of the fittings will be removed and, if necessary, the tooth surface will be polished. The last of the fittings will be removed at the fifth visit and the volunteer will spit into a tube to collect saliva for examination for bacteria. Study Type: Observational Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00001726 •

"Clinical Trials to Enhance Elders' Oral Health" ("TEETH") Condition(s): Tooth Loss; Periodontal Disease; Tooth decay Study Status: This study is no longer recruiting patients. Sponsor(s): National Institute of Dental and Craniofacial Research (NIDCR); Colgate Palmolive Purpose - Excerpt: The purpose of this study is to determine if regular rinsing with chlorhexidine is effective as a long-term preventive method for reducing the incidence of tooth loss in low income older adults. The true end-point of the study is tooth loss after five years of regular rinsing with chlorhexidine or a placebo; surrogate endpoints are periodontal disease, root and coronal decay. Phase(s): Phase III Study Type: Interventional Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00004640

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Randomized, Double Blind, Placebo-Controlled, Phase IIB Trial of Ketorolac Mouth Rinse Evaluating the Effect of Cyclooxygenase Inhibition on Oropharyngeal Leukoplakia: Collaborative Study of the NCI, NIDCD and the NIDCR Condition(s): Leukoplakia; Periodontal Disease Study Status: This study is no longer recruiting patients. Sponsor(s): National Cancer Institute (NCI) Purpose - Excerpt: In Phase II trials, treatment with ketorolac tromethamine oral rinse has been shown to block periodontal disease progression even in the absence of standard clinical intervention such as scaling and root planing which is routinely done to reduce the periodontal pathogen load that is driving the local destructive host inflammatory response. Resolution of periodontal disease has a favorable effect on normalizing the cellular and biochemical indices of inflammation as reflected by histological changes as well as the levels of prostaglandin E2 (PGE2) and interleukin I beta (IL-1beta). In this trial, we will prospectively evaluate if eliminating the inflammatory process (via inhibition of PGE2 biosynthesis) in the oral cavity has a favorable impact on reversing oropharyngeal leukoplakia. To test this hypothesis, up to 57 prospectively identified individuals with objective findings of oropharyngeal leukoplakia will be randomized to receive either a mouth rinse containing ketorolac or placebo. Ketorolac is a 7-fold selective inhibitor of cyclooxygenase-2 (Cox-2), which has

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been designed for local delivery to maximize the drug exposure to critical oral target tissues while minimizing gastric and systemic exposure to the drug. All responses will be determined at the three month completion of trial using the response criteria developed at MD Anderson Cancer Center. The drug will be given for three months and then all the patients will be followed for one additional month off all oral treatment to observe for late side effects. Based on the analysis of oral exam and photographically documented change in the pretreatment area of leukoplakia, the response of all patients will be determined. The evaluation of the outcome will include a measurable secondary endpoint consisting of an assessment of histological change as determined by serial punch biopsies of the oral cavity. In addition, a panel of carcinogenesis and inflammatory markers will be serially measured at baseline, at one month follow up or at study conclusion. In the residual tissue, other bioassays will be evaluated to determine their suitability as intermediate endpoint markers. The purpose of this study is a preliminary evaluation of the effectiveness of ketorolac as a potential chemoprevention agent for oropharyngeal cancer. If ketorolac administration in this preliminary Phase IIB trial is associated with reversal of leukoplakia, then a definitive Phase III chemoprevention trial with a cancer reduction endpoint (most likely in a cooperative group-type setting) may be the next validation step. Phase(s): Phase II Study Type: Interventional Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00001698 •

Periodontal Therapy Outcomes Condition(s): Periodontal Disease Study Status: This study is not yet open for patient recruitment. Sponsor(s): National Institute of Dental and Craniofacial Research (NIDCR) Purpose - Excerpt: This trial compares proven surgical methods for treating periodontal infections with newer medical methods using antibiotics. The objective is to determine whether one method or the other provides a better outcome in terms of tooth stability (a clinician's perspective), and tooth function (a patient's perspective). In addition we will determine the relative costs of the two approaches so that one can determine which approach makes most sense financially. Study Type: Interventional Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00016809

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Treating Periodontal Infection Condition(s): Periodontal Disease; Diabetes Mellitus, Non-Insulin-Dependent Study Status: This study is not yet open for patient recruitment. Sponsor(s): National Institute of Dental and Craniofacial Research (NIDCR) Purpose - Excerpt: The purpose of this project is to obtain preliminary data about the effects of treating periodontal infection on blood glucose control in people with type 2 diabetes. This is a pilot study which will provide important information that will help in the design of a full scale clinical trial. 45 subjects with type 2 diabetes and periodontal disease will be treated and evaluated at 3-month intervals for 15 months to obtain

Clinical Trials 41

information regarding the effects of the periodontal treatment procedures on changes in hemoglobin A1c (HbA1c). This project will also provide an opportunity to explore the effects of treating periodontal infection on levels of periodontitis- and glucose metabolism-related inflammatory mediators (TNFa,IL-1B,IL-6) and levels of serum cholesterol, triglyceride and lipids in patients with type 2 diabetes mellitus. The periodontal treatment that will be evaluated will include ultrasonic scaling, local antimicrobial treatment and oral systemic antibiotics. If results provide significant evidence that treating periodontal infection contributes to improved blood glucose control, then diagnosis and treatment of periodontal infection in patients with type 2 diabetes could be an important component in management of type 2 diabetes. Phase(s): Phase II Study Type: Interventional Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00016835

Keeping Current on Clinical Trials The U.S. National Institutes of Health, through the National Library of Medicine, has developed ClinicalTrials.gov to provide current information about clinical research across the broadest number of diseases and conditions. The site was launched in February 2000 and currently contains approximately 5,700 clinical studies in over 59,000 locations worldwide, with most studies being conducted in the United States. ClinicalTrials.gov receives about 2 million hits per month and hosts approximately 5,400 visitors daily. To access this database, simply go to the Web site at http://www.clinicaltrials.gov/ and search by “gum disease” (or synonyms). While ClinicalTrials.gov is the most comprehensive listing of NIH-supported clinical trials available, not all trials are in the database. The database is updated regularly, so clinical trials are continually being added. The following is a list of specialty databases affiliated with the National Institutes of Health that offer additional information on trials: •

For clinical studies at the Warren Grant Magnuson Clinical Center located in Bethesda, Maryland, visit their Web site: http://clinicalstudies.info.nih.gov/

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For clinical studies conducted at the Bayview Campus in Baltimore, Maryland, visit their Web site: http://www.jhbmc.jhu.edu/studies/index.html

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For cancer trials, visit the National Cancer Institute: http://cancertrials.nci.nih.gov/

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For eye-related trials, visit and search the Web page of the National Eye Institute: http://www.nei.nih.gov/neitrials/index.htm

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For heart, lung and blood trials, visit the Web page of the National Heart, Lung and Blood Institute: http://www.nhlbi.nih.gov/studies/index.htm

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For trials on aging, visit and search the Web site of the National Institute on Aging: http://www.grc.nia.nih.gov/studies/index.htm

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For rare diseases, visit and search the Web site sponsored by the Office of Rare Diseases: http://ord.aspensys.com/asp/resources/rsch_trials.asp

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For alcoholism, visit the National Institute on Alcohol Abuse and Alcoholism: http://www.niaaa.nih.gov/intramural/Web_dicbr_hp/particip.htm

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For trials on infectious, immune, and allergic diseases, visit the site of the National Institute of Allergy and Infectious Diseases: http://www.niaid.nih.gov/clintrials/

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For trials on arthritis, musculoskeletal and skin diseases, visit newly revised site of the National Institute of Arthritis and Musculoskeletal and Skin Diseases of the National Institutes of Health: http://www.niams.nih.gov/hi/studies/index.htm

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For hearing-related trials, visit the National Institute on Deafness and Other Communication Disorders: http://www.nidcd.nih.gov/health/clinical/index.htm

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For trials on diseases of the digestive system and kidneys, and diabetes, visit the National Institute of Diabetes and Digestive and Kidney Diseases: http://www.niddk.nih.gov/patient/patient.htm

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For drug abuse trials, visit and search the Web site sponsored by the National Institute on Drug Abuse: http://www.nida.nih.gov/CTN/Index.htm

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For trials on mental disorders, visit and search the Web site of the National Institute of Mental Health: http://www.nimh.nih.gov/studies/index.cfm

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For trials on neurological disorders and stroke, visit and search the Web site sponsored by the National Institute of Neurological Disorders and Stroke of the NIH: http://www.ninds.nih.gov/funding/funding_opportunities.htm#Clinical_Trials

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CHAPTER 5. PATENTS ON GUM DISEASE Overview Patents can be physical innovations (e.g. chemicals, pharmaceuticals, medical equipment) or processes (e.g. treatments or diagnostic procedures). The United States Patent and Trademark Office defines a patent as a grant of a property right to the inventor, issued by the Patent and Trademark Office.8 Patents, therefore, are intellectual property. For the United States, the term of a new patent is 20 years from the date when the patent application was filed. If the inventor wishes to receive economic benefits, it is likely that the invention will become commercially available within 20 years of the initial filing. It is important to understand, therefore, that an inventor’s patent does not indicate that a product or service is or will be commercially available. The patent implies only that the inventor has “the right to exclude others from making, using, offering for sale, or selling” the invention in the United States. While this relates to U.S. patents, similar rules govern foreign patents. In this chapter, we show you how to locate information on patents and their inventors. If you find a patent that is particularly interesting to you, contact the inventor or the assignee for further information. IMPORTANT NOTE: When following the search strategy described below, you may discover non-medical patents that use the generic term “gum disease” (or a synonym) in their titles. To accurately reflect the results that you might find while conducting research on gum disease, we have not necessarily excluded non-medical patents in this bibliography.

Patents on Gum Disease By performing a patent search focusing on gum disease, you can obtain information such as the title of the invention, the names of the inventor(s), the assignee(s) or the company that owns or controls the patent, a short abstract that summarizes the patent, and a few excerpts from the description of the patent. The abstract of a patent tends to be more technical in nature, while the description is often written for the public. Full patent descriptions contain much more information than is presented here (e.g. claims, references, figures, diagrams, etc.). We will tell you how to obtain this information later in the chapter. The following is an 8Adapted

from the United States Patent and Trademark Office: http://www.uspto.gov/web/offices/pac/doc/general/whatis.htm.

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example of the type of information that you can expect to obtain from a patent search on gum disease: •

Anti infective periodontic compositions Inventor(s): Hall; David M. (1784 Lauren La., Auburn, AL 36830), Hunt; James R. (3 Dunwoody Park South, Suite 103, Dunwoody, GA 30338) Assignee(s): none reported Patent Number: 6,579,514 Date filed: May 8, 2002 Abstract: Periodontic compositions in gel or foam form for treating gum diseases or used in the extraction of teeth, which are alcohol free. The composition is a mixture of a tertiary amine oxide and an antimicrobial betaine compound. The composition is useful for treating gum disease and after the extraction of teeth. Excerpt(s): The present invention relates to an improvement in periodontic compositions used in connection with tooth extractions and the treatment of gum diseases by dentists. More particularly, the present invention relates to a foamable or gel anti-microbial composition, which contains a betaine compound and is free of alcohol, for use after tooth extractions and the treatment of gum diseases, especially gingivitis. It is desirable for uses in dentifices that a stable, rigid foam or gel be used in dentifices and in compositions used in tooth extractions and in treating gum diseases. Since P. gingervalis may not be the only microorganism involved in gum diseases, it is advisable to provide a composition having a broad spectrum of microbial kill but also a composition free of alcohols. Alcoholic compositions are considered as being potentially carcinogenic. The use of most gums or gels to improve the stability or foamability of the composition also dilutes the anti-microbial effect. U.S. Pat. No. 4,839,158 to Michaels, which is herein incorporated by reference, discloses a dentifice containing a betaine in an alcoholic composition containing gels, gums, and the like to form a foamable product. However, the addition of such foaming agents dilutes the anti-microbial effect of the composition and the foam produced is not stable for a sufficient length of time. Web site: http://www.delphion.com/details?pn=US06579514__

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Antibody-containing oral composition for suppression of periodontal disease Inventor(s): Harada; Yoshihiro (Odawara, JP) Assignee(s): Lion Corporation (Tokyo, JP) Patent Number: 5,759,544 Date filed: July 5, 1995 Abstract: An oral composition comprises an effective amount of an antibody obtained by immunizing an animal with an antigen comprised of at least one polysaccharide derived from the surface layer of periodontal disease associated bacteria. The at least one polysaccharide may be conjugated with polypeptides to further enhance the efficacy. Excerpt(s): This invention relates to oral compositions which can suppress periodontal disease associated bacteria such as Actinobacillus actinomycetemcomitans, Porphyromonas gingivalis and the like, from colonization to oral surfaces thereby

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preventing or curing the periodontal disease. For the prevention of periodontal diseases, it is effective to inhibit virulence-associated bacteria from colonization on oral surfaces, thereby suppressing their propagation. From this point of view, there have been heretofore proposed oral compositions or anti-periodontal compositions wherein antibodies for the periodontal disease associated bacteria are formulated (Japanese Laid-Open Patent Application Nos. 60-142915 and 1-313438). However, these are antibodies prepared from an immunogen made of entire bodies of bacteria, or mixtures such as extracts of bacteria, so that interaction with other types of strains would not be negated. In addition, such compositions are not satisfactory with respect to the actual efficacy. Accordingly, there is a demand or developing effective ingredients which can conveniently suppress colonization of periodontal disease associated bacteria on oral surfaces thereby effectively preventing the periodontal diseases. Web site: http://www.delphion.com/details?pn=US05759544__ •

Antioxidant gel for gingival conditions Inventor(s): Hersh; Theodore (Atlanta, GA) Assignee(s): Thione International, Inc. (Atlanta, GA) Patent Number: 6,228,347 Date filed: September 29, 1998 Abstract: A gel, paste, gum or lozenge composition for oral application to human gums to prevent and reduce symptoms of gum disease. The composition includes reduced glutathione and a source of selenium. Excerpt(s): The present invention deals with the combination of several synergistic antioxidants, enzymatic co-factors and amino acids in appropriate delivery vehicles forming gels, pastes, gums or lozenges. The gels, pastes, gums or lozenges are intended to be applied or taken orally to prophylactically prevent gum disease and remedially to a patient to reduce reactive oxygen and other free radical species which are causative inflammatory factors in establishing and promoting such gingival diseases. Dentists and other professionals involved with the science of oral hygiene have dealt with a number of symptoms or pathologies of the mouth, gum and teeth. Some of these pathologies are initiated and exacerbated through tobacco consumption, whether smoked or chewed, as smokers often suffer from leukoplakia, a white patch on the buccal mucosa. Although leukoplakia is a benign oral lesion, it has a malignant potential requiring a biopsy of the lesion to rule out cancer. Smokers also have more dental tartar (calculus) than nonsmokers and often suffer from halitosis. It is known that tooth loss can directly result from untreated destructive periodontal (gum) disease. Further, acute necrotizing ulcerative gingivitis is a destructive, painful inflammatory condition which is, again, more acutely observed in cigarette smokers and tobacco users. Web site: http://www.delphion.com/details?pn=US06228347__

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Biological material for treating periodontal diseases Inventor(s): Rigoulet; Franck (760, Chemin des Vignasses, F-06410 Biot, FR) Assignee(s): none reported Patent Number: 6,644,971 Date filed: November 20, 2000 Abstract: A biological material for treating periodontal diseases and all related disorders, the biomaterial comprising biocompatible bioaragonite, added calcium carbonate and optionally a binding agent. The bioaragonite is mother-of-pearl in micronised form. It is obtained by inhibiting the most immunogenic part of the bioaragonite organic substance so as to maintain bioactive only the organic part associated with the mineral capable of having a positive effect. Excerpt(s): The present invention concerns a biomaterial for treatment of periodontopathies and associated diseases, this biomaterial containing biocompatible bioaragonite. Periodontopathies, or diseases affecting the periodontal region, can be of various origins such as genetic, infectious or traumatic. In the present invention the term "bioaragonite" means nacre, preferably in a micronised form. Web site: http://www.delphion.com/details?pn=US06644971__

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Cloned porphyromonas gingivalis genes and probes for the detection of periodontal disease Inventor(s): Han; Naiming (Gainesville, FL), Lantz; Marilyn (Indianapolis, IN), Lepine; Guylaine (Fort Erie, CA), Patti; Joseph M. (Missouri City, TX), Progulske-Fox; Ann (Gainesville, FL), Tumwasorn; Somying (Bangkok, TH) Assignee(s): UAB Research Foundation (Birmingham, AL), University of Florida (Gainesville, FL) Patent Number: 5,824,791 Date filed: December 11, 1995 Abstract: DNA fragments from Porphyromonas gingivalis which express proteins that elicit anti-P. gingivalis immunologic responses are described. Microorganisms, genetically modified to express P. gingivalis antigens, are provided. Also disclosed are probes, vaccines, and monoclonal antibodies for the detection and prevention of periodontal disease. Excerpt(s): Periodontal disease (PD) is a chronic inflammatory disease which results in the destruction of the supporting tissues of teeth. Although the specific microbial etiology of PD is not known, it is widely accepted that bacteria are the contributing agents of the disease. The presence of a complex micro flora in the subgingival crevice has complicated the identification of the specific etiologic agents of PD. However, it appears that a few genera, primarily gram-negative anaerobes, are associated with disease progression. Several lines of evidence strongly implicate the gram-negative anaerobic bacterium Porphyromonas gingivalis, previously known to those skilled in the art as Bacteronides gingivalis, as an etiological agent of adult periodontal disease (White, D., D. Mayrand ›1981! "Association of Oral Bacteroides with Gingivitis and Adult Periodontitis," J. Periodont. Res. 1:1-18; Takazoe, L., T. Nakamura, K. Okuda ›1984! "Colonization of the Subgingival Area by Bacteroides gingivalis," J. Dent. Res. 63:422-426. For example, relatively high proportions of P. gingivalis have been isolated

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from adult periodontitis lesions, patients with adult periodontitis have been found to have higher levels of IgG antibodies to P. gingivalis than do normal adults, and local immunity to P. gingivalis is greater in the more advanced cases than in the early forms of periodontal disease. P. gingivalis also appears to be a causative agent of experimental periodontitis in animals (Slots, J., E. Hausmann ›1979! "Longitudinal Study of Experimentally Induced Periodontal Disease in Macaca arctoides: Relationship Between Microflora and Alveolar Bone Loss," Infect. Immun. 23:260-269). In addition, P. gingivalis possesses a variety of suspected virulence factors such as proteases, collagenases, immunoglobulin degrading enzymes, and adhesins. In order to exert their pathogenic effects, periodontopathic bacteria such as P. gingivalis must possess characteristics which enable them to colonize the host, survive in the periodontal pocket, possibly invade the gingival tissues, and to destroy the collagenous periodontal ligament, the alveolar bone, and other tissue components surrounding the tooth. Components of bacteria which mediate attachment to host tissues include surface structures such as fimbriae, capsular materials, lipopolysaccharides, and membraneassociated extracellular vesicles. Web site: http://www.delphion.com/details?pn=US05824791__ •

Composition for preventing or treating periodontal diseases comprising extract from Achyranthis radix or Ulmus cortex Inventor(s): Choi; Kyung Chul (Daejeon, KR), Kim; Moon Moo (Daejeon, KR), Kim; Sang Nyun (Daejeon, KR), Seok; Jae Kyun (Daejeon, KR) Assignee(s): LG Chemical Ltd. (Seoul, KR) Patent Number: 6,045,800 Date filed: February 26, 1998 Abstract: The present invention provides a composition for preventing or treating periodontal diseases comprising an extract of Achyranthis radix, Ulmus cortex or a mixture thereof which inhibits the productions of superoxide, prostaglandin, and interleukin (IL-1.beta.) which are inducers for periodontal diseases and inhibits the enzyme activity of collagenase which decomposes collagen protein which is a substrate for the periodontal tissues, and at the same time promotes collagen protein synthesis, thereby treating periodontal diseases efficiently. Excerpt(s): The present invention relates to a composition for preventing or treating periodontal diseases comprising an extract from Achyranthis radix or Ulmus cortex. More specifically, the present invention relates to a composition for preventing or treating periodontal diseases comprising at least one of an extract from Achyranthis radixor Ulmus cortex as an active component which has an excellent therapeutic effect against periodontal diseases. The composition according to the present invention includes a dentifrice composition and an ointment composition. Periodontal diseases are referred to as those resulting in gingivitis or periodontitis together with the loss of teeth due to a bleeding, the formation of gingival crevices and the destruction of alveolar bones, etc. These periodontal diseases are progressed by a series of processes comprising colony formation by the periodontal disease-inducing bacteria, the penetration of the bacteria into the gingival tissues and the destruction of the gingival tissues. Briefly, salivary proteins in the saliva within oral cavity are first adsorbed to the surfaces of dentin and cement to form pellicle, and bacteria such as Streptococcus, Actinomyces, etc. are then grown on the surface of the pellicle to form a plaque. As time passes, such a plaque moves to the direction of the periapical root and at the same time

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anaerobic gram-negative bacteria such as Porphyromonas and Actinobacillus are grown by which these bacteria, bacterial components and bacterial metabolites are penetrated into gingival conjunctive tissues via gingival pocket epithelia to form gingival crevices. As a result of the metabolism by these bacteria, toxins such as hydrogen sulfide, ammonia, and amine which are toxic to the periodontal tissues are secreted and the tissues are directly destructed by the endotoxin such as lipopolysaccharide which is a constituting component of cell wall. At the same time, in vivo immune system is stimulated by the endotoxin, and then various kinds of cytokines such as activated oxygens, prostaglandins, leukotrienes, histamine, and interleukins are secreted to the exterior of cells by the various functions of humoral and cell-mediated immune systems to cause gingival inflammation. After collagen which is a substrate for the periodontal tissues is decomposed by the enzyme such as collagenase which is secreted by the bacteria and leukocytes, gums are retracted and periodontal diseases are developed, if these are allowed to lapse without any treatment. As efforts to prevent the occurence of such periodontal diseases, antibacterial agents such as chlorohexidine gluconate, cetylpyridium chloride, sanguinarine and triclosan (e.g., 5-chloro-2-(2,4dichlorophenyl)phenol) and anti-inflamnmatory agents such as triamcinolone acetanide have been developed as the agents which can kill the periodontal diseases-inducing bacteria within a short period of time and applied to the oral cavity products such as gargling solutions, dentifrices, and ointments. The oral cavity products developed hitherto, however, have disadvantages that they could not basically prevent the occurence of the periodontal diseases. Web site: http://www.delphion.com/details?pn=US06045800__ •

Composition for the treatment and prevention of periodontal disease Inventor(s): Bozzacco; Craig (7866 Spring Ave., Elkins Park, PA 19027) Assignee(s): none reported Patent Number: 5,908,613 Date filed: September 8, 1997 Abstract: The present invention is a compound and method for treating and preventing periodontal disease. The compound contains a gum tissue regeneration agent, such as coenzyme Q.sub.10, and a antimicrobial agent, such as melaleuca alternifolia extract oil, mixed into a solution medium. The compound is applied to the bristles of a brush. The brush then is used to introduce the compound into any pockets that may exist between and around the teeth and gums because of periodontal disease. Once introduced into pockets between the teeth and gums, the compound has a dual effect. First, the antimicrobial agent kills any bacteria in the pockets and prevents the growth of new bacteria in the pockets. Second, the gum tissue regeneration agent promotes growth of the gums against the teeth. As a result, the size of the pockets is reduced over time until the pockets are no longer abnormal and the damage from past periodontal disease is at least partially repaired. Excerpt(s): In general, the present invention relates to topical treatments that are used in treating and preventing periodontal disease. More particularly, the present invention relates to compositions that are applied in pockets in between the tooth and gum to heal past damage caused by periodontal disease. Periodontal disease accounts for more lost teeth in adults than any other cause. Periodontal disease begins with plaque bacteria in the mouth. As plaque bacteria digest food, the by-products given off by the bacteria irritate the gums. As a result, the gums often become red, tender, swollen and exhibit a

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tendency to bleed. If left untreated, the tissue that attaches the gums to the teeth is eventually destroyed by the irritants produced by the plaque bacteria. This causes the gums to begin to pull away from the teeth. As the gums pull away from the teeth, pockets are created that harbor yet more bacteria. The pockets therefore become ever larger as the cycle repeats. Eventually, the amount of gum loss is so large that the tooth is lost. In treating gum disease, two approaches can be taken. The most common approach is to kill the plaque bacteria by practicing good dental hygiene. The prior art is replete with different toothpastes and mouth rinses that are designed to kill plaque bacteria during a dental hygiene regimen. Good dental hygiene using such prior art preparations will retard the spread of periodontal disease but will not actively repair the damage to the gums that has already occurred. Web site: http://www.delphion.com/details?pn=US05908613__ •

Compositions and methods for diagnosing periodontal disease Inventor(s): Diehl; Scott R. (Gaithersburg, MD), Schenkein; Harvey A. (Richmond, VA), Wang; Yue-Fen (North Potomac, MD) Assignee(s): The United States of America as represented by the Department of Health (Washington, DC) Patent Number: 6,130,042 Date filed: March 5, 1998 Abstract: Compositions and methods are described for diagnosing periodontal disease, and in particular, early-onset periodontal disease. Nucleic acid-based testing is described which permits the detection of a high risk haplotype. Excerpt(s): The present invention relates to compositions and methods for diagnosing periodontal disease, and in particular, early-onset periodontal disease. The early-onset periodontal diseases (EOP), including clinical syndromes designated localized juvenile periodontitis (LJP), generalized juvenile periodontitis (GJP), and rapidly progressive periodontitis (RPP), are characterized by their age of onset, which is usually after puberty, and the unusually rapid progression of periodontal attachment loss in affected individuals. EOP is also sometime manifested before puberty, and it is then called prepubertal periodontitis (PPP). The localized (LJP) and generalized (GJP, RPP) forms of EOP aid are distinguished by the pattern of teeth affected by such attachment loss. Classically, LJP has been defined by attachment loss at first molar and incisor teeth, while GJP affects a large number of teeth not limited to first molars and incisors. Recent studies have underscored the association of periodontal infections with certain medically important conditions. There are increasing data accumulating that implicate periodontal disease as a risk factor for cardiovascular diseases such as heart attack and stroke. See e.g. J. Beck et al., "Periodontal Disease and Cardiovascular Disease," J. Periodontol. 67:1123 (1996). Epidemiologic studies indicate that, even after accounting for other known risk factors for cardiovascular disease, the relative risk attributable to periodontal infections is significant. Secondly, recent studies have shown that mothers with periodontitis are at greater risk for having low weight babies than those without periodontitis. See Offenbacher et al., "Periodontal Infection as a Possible Risk Factor for Preterm Low Birth Weight," J. Periodontol. 67:1103 (1996). Web site: http://www.delphion.com/details?pn=US06130042__

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Compounds with chelation affinity and selectivity for first transition elements and their use in cosmetics and personal care products, inhibition of metalloenzymes, and inhibition of reperfusion injury Inventor(s): Cyjon; Rosa L. (Haifa, IL), Klein; Joseph Y. (Haifa, IL), Klein; Ofer (Haifa, IL), Simhon; Elliot D. (Haifa, IL), Winchell; Harry S. (Lafayette, CA), Zaklad; Haim (Haifa, IL) Assignee(s): Concat, Ltd. (Concord, CA) Patent Number: 6,264,966 Date filed: February 22, 2000 Abstract: This invention involves the use of a class of compounds with chelation affinity and selectivity for first transition series elements. Application or administration of the free or conjugated compound, or physiological salts of the free or conjugated compound, results in decrease of the bioavailability and/or chemical action of first transition series elements. These characteristics make such compounds useful in cosmetics and personal care products to decrease odor arising from microbial growth on body surfaces and in body cavities, decrease microbial growth on teeth, plaque, and gums that cause tooth decay and gum disease, inhibition of oxidative damage to the skin, inhibition of enzymatic action of metalloenzymes dependent on first transition series elements, and inhibition of reperfusion injury. Excerpt(s): All literature and patent citations appearing in this specification are hereby incorporated herein by reference. First transition series elements are essential to the replication and growth of all cells and viruses. They are essential co-enzymes required in a variety of metabolic processes. Iron and copper can catalyze free radical formation leading to oxidative damage to tissues. Consequently, alterations of the bioavailability and function of first transition series elements can affect cell systems, metabolic processes, and complex phenomena that are affected by such processes. It is generally appreciated that most body odors arise from chemical byproducts of microbial growth. Thus, antimicrobial agents such as triclosan are commonly added to personal care products and cosmetics to inhibit development of body odors (such as underarm odor) through inhibition of microbial growth. See, Antiperspirants and Deodorants, 2d Ed., K. Laden, Ed., 1999, Marcel Dekker, Inc., New York, N.Y. Web site: http://www.delphion.com/details?pn=US06264966__

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Dental products to treat and prevent periodontal disease Inventor(s): Cutler; Edward T. (Merion, PA) Assignee(s): Squigle, Inc. (Narberth, PA) Patent Number: 5,900,230 Date filed: August 18, 1997 Abstract: The dental products of this invention can be used to treat and prevent periodontal disease. They contain a synergistic mixture of poloxamers, and/or poloxamer congeners, plus xylitol. These active ingredients are present in specific amounts. It is also necessary to eliminate all irritants from the dental products of this invention. The dental products of this invention include a dentifrice paste or gel, powder, granules, disintegrable tablet, and a mouthwash, lozenge, and chewing gum.

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Excerpt(s): The dental products of this invention can be used to treat and prevent periodontal disease. These dental products contain a synergistic mixture of poloxamers, and/or poloxamer congeners, plus xylitol. These active ingredients are present in specific amounts. It is also necessary to eliminate all irritants from the dental products of this invention. 75% of the US population suffer from periodontal disease, also known as pyorrhea or gum disease. This epidemic costs billions of dollars a year and causes much pain, whether or not the disease is treated. And many of the people diagnosed with periodontal disease must endure draconian "maintenance therapy" three to four times a year for the rest of their lives. According to the Merck Manual ›14.sup.th ed., page 2104, R. Berkow, ed., Merck & Co., Rahway, N.J., 1982!, the most common types of periodontal disease are gingivitis and periodontitis. Gingivitis (early stage gum disease) is an inflammation of the gingivae (gums), characterized by swelling, redness, change of normal contours, and bleeding. If gingivitis is allowed to progress, periodontitis (late stage gum disease), characterized by loss of tooth-supporting bone, will follow. Web site: http://www.delphion.com/details?pn=US05900230__ •

Detecting genetic predisposition to periodontal disease Inventor(s): Duff; Gordon W. (18 Ashgate Road, Broomhill, Sheffield, GB2), Kornman; Kenneth S. (3007 Orchard Hill, San Antonio, TX 78230) Assignee(s): none reported Patent Number: 5,686,246 Date filed: August 3, 1995 Abstract: A method and kit for the identification of a patient's genetic polymorphism pattern associated with increased periodontal disease severity is disclosed. The kit includes DNA sample collecting means and means for determining a genetic polymorphism pattern which is then compared to control samples to determine a patient's susceptibility to severe periodontal disease. Excerpt(s): This invention relates to a method of detecting a predisposition for severity of periodontal disease. Periodontal disease is a disease of the hard and soft tissues that support the teeth and is initiated by oral bacteria. Gingivitis is an early stage of the periodontal disease where the gums may become red, swollen and bleed easily. Gingivitis is usually painless and, if not treated, can advance to periodontitis, which may be classified by the magnitude of tissue destruction as mild, moderate, or severe. Periodontitis is primarily a disease of adults and is usually not detectable until after the age of 35. Bacteria that are present in dental plaque initiate periodontal disease. Toxins produced by the bacteria in the plaque activate the body's inflammatory and other immune mechanisms which ultimately leads to the destruction of the bone and gum tissue that support the teeth. As the disease progresses, the gums pull away from the teeth and periodontal pockets are formed which provide a protected environment for the bacteria, thereby causing the cycle to continue. However, some sites do not continue to be active. U.S. Pat. No. 5,328,829 discloses a method for determination of active periodontal disease sites within the oral cavity by measuring interleukin IL-1.beta. at the site. Smoking has been associated with an increased prevalence and severity of periodontitis. However, a significant number of individuals with periodontitis have never smoked. Web site: http://www.delphion.com/details?pn=US05686246__

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Folic acid dentifrice Inventor(s): Takhtalian; Robert (7141 S. Valley View, Las Vegas, NV 89118), Takhtalian; Yvonne M. (7141 S. Valley View, Las Vegas, NV 89118) Assignee(s): none reported Patent Number: 6,231,836 Date filed: January 4, 2000 Abstract: A non-alcoholic dentifrice for controlling gum disease and bad breath includes natural constituents such as nutrients which aid in cell reproduction, immunity, and wound healing and herbal supplements having anti-bacterial and anti-inflammatory properties. An optional embodiment of the solution includes approximately 10% by mass folic acid, 10% by mass zinc, 25% by mass myrrh oil, 25% by mass clove oil, and 30% by mass water. A single dose of five milliliters includes approximately 0.5 milligrams folic acid, 0.5 milligrams zinc, 1.25 milligrams myrrh oil, 1.25 milligrams clove oil, and 1.5 milligrams water. Excerpt(s): The present invention relates to solutions for cleaning the teeth and gums. Specifically, the present invention is a non-alcoholic dentifrice for controlling inflammation and infection of the gums, inhibiting bacterial growth, controlling bad breath, and encouraging wound healing, immunity, and tissue growth of the teeth and gums. Medical studies estimate that as many as 75% of adults in the United States suffer from some form of gum disease. This is a significant medical problem because, in its advance stages, gum disease can cause teeth to loosen and, eventually, fall out. Thus, gum disease is believed to be a leading cause of tooth loss. Among gum diseases, gingivitis is the most common. Gingivitis is caused by a buildup of bacteria on the teeth and gums. In its early stages, gingivitis causes minor symptoms such as bad breath, bleeding, and sensitivity of the gums. However, in its advanced stages, the gingivitiscausing bacteria cause swelling and irritation of the gums and can lead to more severe forms of periodontal disease. Web site: http://www.delphion.com/details?pn=US06231836__

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Intragingival delivery systems for treatment of periodontal disease Inventor(s): Dunn; Richard L. (Fort Collins, CO), Harkrader; Ronald J. (Louisville, CO), Rogers; Jack A. (Fort Collins, CO), Tipton; Arthur J. (Fort Collins, CO) Assignee(s): Vipont Pharmaceutical, Inc. (New York, NY) Patent Number: 5,324,520 Date filed: April 13, 1993 Abstract: A polymeric controlled delivery system is provided for use in treating periodontal disease. The delivery system in a variety of forms is placed directly in the infected gingival tissue where the chemotherapeutic agent is slowly released into the tissue and into the infected periodontal pocket by means of the gingival crevicular fluid originating in the gingival tissue. Excerpt(s): Periodontal disease or gum disease as it is often called can be defined as an infection and inflammation of the gingiva or gums and loss of underlying alveolar bone support. There are varying levels of severity of the disease. The mildest cases are clinically termed gingivitis (inflamed and bleeding gums). More severe cases are clinically known as periodontitis and can involve loss of bone support. Gingivitis is

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reversible and can often be eliminated with a thorough dental prophylaxis followed by improved personal oral hygiene procedures. If gingivitis is not controlled, the disease often progresses into periodontitis. Periodontitis is not only characterized by bacterial infection and inflammation, it is also accompanied by the formation of periodontal pockets (spaces between the teeth and gums) and bone deterioration which can lead to tooth loss. Periodontitis is recurring, progressive, and episodic. There is no cure at this time. Effective treatment is to apply professional intervention to halt disease progression. Professional intervention may involve surgical or nonsurgical procedures. Nonsurgical treatment consists of periodic professional scaling, root planing, and soft tissue curettage, in combination with conscientious home care by brushing and flossing on the part of the patient. Surgical treatment involves gingivectomy and flap surgery to recontour the soft and hard tissue around the diseased areas. Web site: http://www.delphion.com/details?pn=US05324520__ •

Ionic tooth polishing agent Inventor(s): Kaizuka; Kazutoshi (Fukuoka, JP) Assignee(s): Create Co., Ltd. (Fukuoka, JP) Patent Number: 6,432,387 Date filed: March 23, 2000 Abstract: A tooth polishing agent for effectively removing stains such as tobacco tar and tartar with the use of a toothbrush and gentle brushing, using only a small amount of the tooth polishing agent. The improved tooth polishing agent of the present invention generates negative ions in the mouth, effectively cleaning the teeth without the use of large amounts of abrasives or aggressive brushing. The negative ions also act to improve circulation of the blood in the gums and prevent gum disease. The tooth polishing agent of the present invention is constituted with the powdered form of a multi-element mineral, which negatively ionizes water. This multi-element mineral contains a balance of elements, including silica-like perlite, pitchstone and tourmaline. Excerpt(s): The present invention relates generally to dental hygienic products, and more particularly to an improved tooth polishing agent. Tooth polishing agents, including toothpastes and gels, are well known in the art. Most such agents containing blended ingredients such as an abrasive, a lubricant, a foaming agent, a caking additive, a flavor additive, medicine and water are generally known. The main ingredient in many tooth polishing agents is an abrasive, which is used to remove tartar and other stains caused by food, tobacco, coffee, etc. By removing these staining items from the teeth, the abrasive ingredient generally imparts brilliance to the teeth. However, the use of abrasive does not come without a cost. Many times, when the removal of particularly stubborn stains is difficult, large amounts of a tooth polishing agent combined with aggressive brushing is necessary. This action on a regular basis causes the surface of the teeth, and in some cases the enamel, to be removed, creating various problems with the teeth and gums. Thus, there exists a need to provide a tooth polishing agent that can be used in small amounts, requiring only light brushing, which will just as effectively remove the stubborn stains caused by tobacco tar and the like, without removing the surface of the tooth. Web site: http://www.delphion.com/details?pn=US06432387__

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Materials for treatment of periodontal disease Inventor(s): Kitamura; Hiroyuki (Moriguchi, JP), Nishigaki; Mitsuru (Kyoto, JP), Nishimura; Kazuaki (Sakai, JP), Yamaoka; Akira (Osaka, JP), Yoshikawa; Etsuo (Kitakatsuragi-gun, JP) Assignee(s): Kanebo Ltd. (Tokyo, JP) Patent Number: 5,792,508 Date filed: March 15, 1996 Abstract: A material for treatment of periodontal disease which is comprised of cementum of a human or other animals combined with a bioabsorbable material. Excerpt(s): The present invention relates to materials for treatment of periodontal disease, and more specifically to materials for treatment of periodontal disease suitable for use for the treatment of severe periodontal disease which require periodontal surgery for regeneration of periodontal tissues and restoration of occlusive function. Periodontal disease is an inflammatory disease in which dental supporting apparatus (gingiva, periodontal membrane, alveolar bone) is destroyed by dental plaque (a lump of bacteria), and it, along with dental caries, are said to constitute the two major diseases in the field of dentistry. In this disease, the connecting tissue (periodontal fibers) between the tooth and gingiva is destroyed, resulting in pocket formation. As the disease progresses, this pocket becomes deeper and the alveolar bone is destroyed and absorbed. If this condition is left untreated, the tooth may in some cases fall out spontaneously. Web site: http://www.delphion.com/details?pn=US05792508__

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Method for detection of dental caries and periodontal disease using optical imaging Inventor(s): Kinney; John H. (Danville, CA), Nathel; Howard (Albany, CA), Otis; Linda L. (San Francisco, CA) Assignee(s): Regents of the University of California (Oakland, CA) Patent Number: 5,570,182 Date filed: May 27, 1994 Abstract: A method for detecting the presence of active and inactive caries in teeth and diagnosing periodontal disease uses non-ionizing radiation with techniques for reducing interference from scattered light. A beam of non-ionizing radiation is divided into sample and reference beams. The region to be examined is illuminated by the sample beam, and reflected or transmitted radiation from the sample is recombined with the reference beam to form an interference pattern on a detector. The length of the reference beam path is adjustable, allowing the operator to select the reflected or transmitted sample photons that recombine with the reference photons. Thus radiation scattered by the dental or periodontal tissue can be prevented from obscuring the interference pattern. A series of interference patterns may be generated and interpreted to locate dental caries and periodontal tissue interfaces. Excerpt(s): The invention relates to imaging of dental and periodontal tissue. More particularly, the invention relates to a method for detection of caries and periodontal disease by an optical imaging technique that is non-invasive and uses non-ionizing radiation. Dental caries, caused primarily by bacterial action on sugars, are a common disease that can be easily treated if detected early. If undetected and untreated, caries

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may progress through the outer enamel layer of a tooth into the softer dentin so far as to require extraction of the tooth or to cause inflammation of periodontal tissue surrounding the tooth. The standard methods for detecting caries in teeth are by visual inspection or by the use dental x-rays. Both methods are unreliable for the detection of small caries (<1 mm) or caries between teeth. In addition, dental x-rays subject the patient to ionizing radiation, a known mutagen. Non-ionizing radiation has long been used for imaging the internal structures of soft tissue, and has shown promise in such applications as mammography, neonatal brain scanning and imaging of some tumors. Generally, however, it is unsatisfactory for tissue imaging because scattering of the lower-energy non-ionizing radiation by the tissue severely compromises the resolution of the image. Although resolution of optical images may be improved by the use of polarizing filters or phase conjugated mirrors, or by collimation of the incident and transmitted beams to reduce interference from scattered radiation, x-ray images still produce superior resolution. Optical imaging with non-ionizing radiation requires sophisticated techniques such as photon time-of-flight range gating to achieve image resolution comparable to x-ray techniques. Web site: http://www.delphion.com/details?pn=US05570182__ •

Method for predicting refractory periodontal disease Inventor(s): Levine; Martin (505 Kensington Rd., Norman, OK 73072) Assignee(s): none reported Patent Number: 6,576,435 Date filed: August 24, 2000 Abstract: A kit and method of predicting a refractory response in a subject diagnosed as having periodontal disease by measuring serum concentrations of actinomyces antibodies, streptococcal antibodies and lysine decarboxylase antibodies and using the measurement along with other subject information in a set of derived equations. Excerpt(s): Inflammatory adult periodontitis is a major cause of tooth loss in the middle aged and elderly. The gingival sulci of teeth become infected with a complex mixture of bacteria that impair tooth attachment. Mechanical debridement of the teeth-surfaces (scaling and root planing, SRP) is the current basis of prevention. Many patients preserve tooth attachment with regular SRP and home care, but some,.defined as refractory, continue to lose attachment, even after additional therapy, tetracycline and surgery, to supplement SRP efficacy [1,2]. The severity of prior attachment loss increases the likelihood that a patient will be refractory to therapy [3,4], as also does attachment loss in response to initial SRP [5]. The ability to identify refractory subjects at initial examination would provide several functions that are currently lacking in periodontics. It would indicate how patients should be divided to determine differences in host response or bacterial flora a priori, what patients would benefit most from new and experimental therapies and provide an objective criterion for periodontists to warn patients of failure before treatment is begun. Although patients develop antibody responses to various bacterial antigens, responses to specific bacteria have not been related to disease severity or progression except in a general way. The odds ratio of being refractory increased from 3-fold to 19-fold as the number of bacterial taxa with an antibody concentration >50.mu.g/ml increased from 3 to 17, out of a total of 85 bacterial taxa examined [6]. Measuring antibody levels to 85 taxa is difficult. A more specific response was the antibody to Hemophilus aphrophilus being >50.mu.g/ml, but the rationale for measuring antibodies to this organism is not clear and a second, more

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complex laboratory procedure, measuring bacterial DNA to Streptococcus constellatus, is also required [6]. The proposed procedure requires only antibody levels, and clinical measurements that all periodontists obtain prior to therapy. Recent findings suggest that, of 40 bacterial species detected in the sulci pre-therapy, 37% of the variance in attachment level change after initial SRP was predicted by only the amount of Actinomyces naeslundii serotype 2 and Treponema denticola [5]. A. naeslundii extrudes an ornithine-rich antigen that contains an epitope to which an IgG antibody is directed in human serum [7,8]. An antibody response to this Actinomyces antigen is increased in subjects with less plaque, gingivitis and caries [9]. The sulci of refractory patients contain increased numbers of constellatus/anginosus streptococci [2] that possess a streptococcal antigen (e.g., D-alanyl lipoteichoic acid (D-alanyl-LTA)), whereas mitis/oralis streptococci do not possess D-alanyl LTA and increase in healthy sulci [10,11]. Web site: http://www.delphion.com/details?pn=US06576435__ •

Method for the prevention of gum disease Inventor(s): Creeth; Jonathan Edward (Bebington, GB), Stead; William John (Bebington, GB), Williams; David Michael (London, GB) Assignee(s): Unilever Home & Personal Care USA, division of Conopco, Inc. (Greenwich, CT) Patent Number: 6,290,975 Date filed: May 14, 1999 Abstract: A method is provided which treats or prevents gum disease involving applying to the gums an agent for maintaining or improving the permeability barrier of the gum. Excerpt(s): The present invention relates to the use of an agent which maintains or improves the permeability barrier of the gum in the manufacture of an oral composition for the treatment or prevention of gum disease. Efficient dental hygiene is a primary requirement in maintaining good oral health. Poor oral health manifests itself in many forms, for example tooth decay, gum disease, mouth ulcers etc. In addition, stained teeth and diseased gums are a cosmetically undesirable consequence of poor oral hygiene. Web site: http://www.delphion.com/details?pn=US06290975__

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Method for treating periodontal disease Inventor(s): Kurtz; Seymour J. (211 E. Ontario St., Suite 1195, Chicago, IL 60611) Assignee(s): none reported Patent Number: 6,261,597 Date filed: December 3, 1999 Abstract: A method of improving the periodontal condition of a person is disclosed. A suspension of small, unilamellar vesicles composed primarily of phospholipids, similar in nature to those of egg phosphatidylcholine, is administered parenterally to a person suffering from periodontal disease. In the method, liposomes are infused over an

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extended period of time of at least several weeks, until a desired improvement in gum condition is achieved. Excerpt(s): The present invention relates to methods for improving the periodontal health of a subject by intravenous administration of a suspension of liposomes. The invention also relates to methods for improving hair regrowth of a subject by intravenous administration of a suspension of liposomes. Amselem, S., et al., LIPOSOME TECHNOLOGY (Gregoriadis, G., Ed.), pp. 501-524, CRC Press, Boca Raton, Fla. (1993). Barenholz, Y., et al., Biochemistry 16:2806 (1977). Web site: http://www.delphion.com/details?pn=US06261597__ •

Method of detecting periodontal disease by detecting the natural frequency of a tooth. Inventor(s): Huang; Haw Ming (2F.,-1, No. 186-1, Hsin An St., Taipei, TW), Lee; Sheng Yang (3F., No. 28-1, Lane 97, Sec. 1, Hsin Sheng S. Rd., Taipei, TW), Lin; Ching Yi (No. 134, Fu Hsing Rd., 14 Hu, Chin Hu Chen, Chin Men Hsien, TW) Assignee(s): none reported Patent Number: 5,951,292 Date filed: September 18, 1998 Abstract: A method of detecting periodontal disease involves attaching a vibration detector to the tooth, causing the tooth to vibrate by means of striking the tooth with a hammer, and then picking up signals corresponding to of the vibration of the tooth for processing by a dynamic signal analyzer and a microprocessor using Fourier analysis. The location of the natural frequency of the tooth is determined based on the lowest point in the image mode and the point of contraflexure in the real mode. Excerpt(s): The invention provides a method of detecting of a periodontal disease through determination of the natural frequency of a tooth. When inspecting for periodontal disease, a dentist usually measures the depth of the periodontal pocket or the height of the surrounding area of the tooth in question. It is important to obtain the relevant data accurately. A probe is mostly commonly used for inspecting for periodontal disease. However, it is inconvenient to operate a probe in inspecting for periodontal disease, and likewise inconvenient to check the scales of the probe visually. The accuracy of using a probe to inspect for periodontal disease may be affected by various factors including the diameter of the probe used, the positioning of the probe in the periodontal tissues, or the force applied by the dentist. There is another method of inspecting for periodontal disease, referred to as a Periotest. However, a Periotest cannot accurately detect the depth of the periodontal pocket, and the intensity of force applied to the Periotest may affect the result of the inspection. Therefore, this method cannot eliminate human error. X-ray films may also be used for inspecting the depth of the tooth sac. However, an X-ray film cannot show a three-dimensional image. Further, because X-rays maybe harmful to one's health, it is not recommended to receive X-rays for a long term exposure. The present invention has been developed in order to eliminate the aforesaid problems. Using this new method, a vibration detector is attached to the tooth. A hammer strikes the tooth, causing vibrations, which are picked up by the vibration detector, then processed through a dynamic signal analyzer and a microprocessor using Fourier analysis. The location of the natural frequency of the tooth can then be determined from the frequency domain using to the lowest point in the image mode and the point of contraflexure in the real mode.

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Method of determining sites of active periodontal disease Inventor(s): Stashenko; Philip (Norfolk, MA) Assignee(s): Forsyth Dental Infirmary for Children (Boston, MA) Patent Number: 5,328,829 Date filed: July 5, 1990 Abstract: The present invention comprises a method for the determination of periodontal disease active sites within the human oral cavity by a measurement of the level of interleukin 1 beta (IL-1b) in oral tissues and gingival crevicular fluid at a particular site. Excerpt(s): Interleukin 1 beta (IL-1b) is a highly potent bone resorptive cytokine which is responsible for most of the activity formerly referred to as osteoclast activating factor, or `OAF` (Dewhirst et al. 1985). IL-1b is produced in large amounts by macrophagemonocytes in response to a variety of stimuli, including bacterial components such as LPS (Burchett et al. 1988). IL-1b exerts other biological activities consistent with its potential role as a local mediator of tissue destruction in human periodontitis. These include inhibition of bone formation (Stashenko et al. 1987, Nguyen et al. 1990), stimulation of prostaglandin and thromboxane synthesis (Tatakis 1988), stimulation of collagenase and protease production (Mizel et al. 1981, Saklatvala et al. 1985), potentiation of neutrophil degranulation and superoxide production (Dinarello 1989), enhancement of endothelial cell-leukocyte adhesion (Bevilacqua et al. 1987), and stimulation of fibroblast and keratinocyte proliferation (Schmidt et al. 1982). IL-1-like activity is present in elevated amounts in crevicular fluid adjacent to sites of gingival inflammation (Charon et al. 1982). Recently IL-1 b-containing cells were shown to be present in greater numbers in diseased as compared to clinically-healthy periodontal tissues (Jandinski et al. 1990). Substantial evidence indicates that periodontal destruction is not continuous, but rather occurs episodically in bursts of disease activity (Goodson et al. 1982). At any given point in time the majority of sites with periodontal disease involvement are in fact quiescent. An important consequence of this finding is that putative host or bacterial indicators of periodontal disease must be evaluated in the temporal context of these relatively infrequent events (Caton 1990). It is therefore desirable to provide an effective method of determining periodontal disease active sites in the oral cavity of a patient. The invention relates to a method for the determination and detection of active periodontal disease sites by a measurement of the level of (IL1b). Web site: http://www.delphion.com/details?pn=US05328829__

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Method of diagnosing periodontal disease Inventor(s): Lamster; Ira B. (Wycoff, NJ) Assignee(s): The Trustees of Columbia University in the City of New York (New York, NY) Patent Number: 6,063,588 Date filed: November 14, 1996

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Abstract: This invention provides a method of diagnosing periodontal disease in a subject by detecting elevated concentrations of.beta.-glucuronidase in saliva from the subject. The concentration of.beta.-glucuronidase in the subject's saliva may be determined by adding to a sample of the saliva a substrate for.beta.-glucuronidase and measuring the amount of a product produced by the reaction of.beta.-glucuronidase on the substrate. Also, the concentration of.beta.-glucuronidase in the subject's saliva may be determined by adding to a sample of saliva a labeled antibody specific for.beta.glucuronidase and measuring the amount of labeled antibody which complexes with.beta.-glucuronidase present in the saliva. Excerpt(s): Throughout this application, various publications are referenced by author and date. Full citations for these publications may be found listed alphabetically at the end of the specification immediately before the claims. The disclosures of these publications in their entireties are hereby incorporated by reference into this application in order to more fully describe the state of the art as known to those skilled therein. Conventional diagnostic evaluation of periodontal disease has relied on measuring clinical parameters, such as probing depth, attachment level, and plaque accumulation, and on measuring the height of the alveolar bone using radiographs. One shortcoming of these conventional tests is that they only define the status of the periodontium at the time of examination. In the past 10 to 15 years, studies have shown that clinical parameters of periodontal disease are poor predictors of when and at which sites patients that would experience active disease (Haffajee, A. D., et al., 1993). In addition, measurement of alveolar bone loss using intraoral radiographs is of limited value because it provides only a historical record of past disease and cannot be used to determine when the loss of crestal bone occurred. Due to these limitations, researchers have investigated alternative methods for evaluating patients with periodontal disease (Lamster, I. B., et al., 1993). Web site: http://www.delphion.com/details?pn=US06063588__ •

Method of making molecular chlorine dioxide Inventor(s): Madray; George (4 Carteret Rd., Brunswick, GA 31525) Assignee(s): none reported Patent Number: 6,231,830 Date filed: March 4, 1999 Abstract: A method for manufacturing molecular chlorine dioxide, by the addition of potassium iodide to a solution of alkali metal chlorite. The metal chlorite and the potassium iodide are kept separate, until the need for the generation of chlorine dioxide arises--to ensure long-shelf life. After initiation or activation of the chlorite anion to form chlorine dioxide, the beneficial properties of chlorine dioxide can be used, for different health and cosmetic purposes. Such uses include the treatment of herpes, dandruff, acne, skin rashes (e.g. poison ivy), ulcers, bed sores, warts, nail fungus, athletes foot, sun burn and gum disease; and as an antiseptic, disinfectant, and general deodorant form refrigerator sprays to oral mouthrinses. Excerpt(s): The invention relates to a broad field, being as broad as are the properties of chlorine dioxide. For example, in the field of dentistry alone, it can be used as a biofilm control to prevent the buildup of plaque which is responsible for tooth decay, as a whitener maintenance, as an oral/periodontal irrigant and as a breath freshener. Chlorine dioxide (ClO2) has many beneficial properties. Chlorine dioxide is an efficient

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oxidant. Because it readily reacts with substances (phenolics and sulfides) known to cause taste and odor problems, chlorine dioxide is a widely used treatment for drinking water. Chlorine dioxide has other beneficial properties resulting from its ability to maintain its oxidizing power and antimicrobial properties over a wide pH range. For example, chlorine dioxide is effective against viruses, bacteria, and protozoan cysts. Chlorine dioxide has been shown to be effective in controlling cryptosporidium (Peters, J.; Mazas, E.; Masschelein, W.; 1989, "Effect of Disinfection of Drinking water with Ozone or Chlorine Dioxide on Survival of Cryptosporidium parvum Oocyst". Appl. Environ. Microbiol., 55(6):1519-1522);(Korich, D.; Mead, J.; Madore, M.; Sinclair, N.; Sterling. C. 1990, "Effects of Ozone, Chlorine Dixoide, Chlorine and Monochloramine of Cryptosporidium parvum Oocyst Viability". Appl. Environ. Microbiol., 56:14231428.);(Finch, G.; Liyanage, L.; Belosivic, M. 1995, "Effect of Chlorine Dioxide on Cryptosporidium and Giardia. In InProc. 3rd International Symposium on Chlorine Dioxide Use in Drinking Water, Wastewater and Industrial Applications. CMA, USEPA, and AWWARF.) which causes severe gastrointestinal problems (and even death) in AIDS and immunocompromised individuals. In contrast, chlorine is not effective in treating water sources containing cryptosporidium. Other applications include its use as a bleaching agent, disinfectant, deodorant, and biofilm control. Even though it is not well understood, microbial cell walls and microbial membranes, being different from human cells, rupture when ClO2penetrates them at concentrations even below one part per million (PPM) whick is equivalent to one milligram per liter (mg/L). Alteration of electrolytic permeability, and metabolic processes quickly follow, destroying the microbes of which no immunity results. Web site: http://www.delphion.com/details?pn=US06231830__ •

Methods and compositions for treating periodontal disease with an inhibitor of secretory phospholipase A2 Inventor(s): Draheim; Susan E. (6125 Burlington Ave., Indianapolis, IN 46220) Assignee(s): none reported Patent Number: 6,325,991 Date filed: August 24, 1999 Abstract: The present invention relates to methods of treating periodontal disease in a mammal. The methods include administering to an animal an s effective amount of an inhibitor of sPLA.sub.2. The inhibitors may be advantageously delivered as a composition that includes various carriers. In certain aspects of the invention, inhibitors used in the method include substituted indole or substituted pyrrole sPLA.sub.2 inhibitors. Also provided are compositions that include the sPLA.sub.2 carriers for oral delivery of the inhibitors. Excerpt(s): Periodontal disease is an oral inflammatory disease that begins when inflammation of gingival tissues (gingivitis) progresses to an inflammation of the periodontal attachment tissues. This inflammation may eventually lead to breakdown of the periodontal attachment, periodontal pocket formation and bone loss-periodontitis. The disease may progress to the extent of causing tooth loss due to destruction of the tooth supporting bone. A similar course of events can take place in the tissues surrounding dental implants (peri-implantitis), and can result in gradual loosening and eventual loss of the implant. The rate of progression of periodontal disease is extremely variable. It is believed to be modulated by a complex interaction between subgingival bacterial, the host defense system (including immune and inflammatory responses), and

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other local tissue factors. Methods of treatment, however, have traditionally focused on the bacterial component of the disease. The conventional approach to the treatment of periodontal disease involves initially removing subgingival bacterial plaque and calculus deposits with scaling and root planing procedures and following-up with improved oral hygiene procedures. If this treatment does not halt progression of the disease, surgical reduction of periodontal tissues is often performed, with the intention of decreasing the depth of the periodontal pocket, thus decreasing the area available for bacterial colonization and aiding mechanical removal of the microorganisms. Concurrent treatment with an antibacterial agent may also be used to further reduce bacterial numbers. Web site: http://www.delphion.com/details?pn=US06325991__ •

Methods and test kits for specific and sensitive diagnosing of periodontal diseases Inventor(s): Lundqvist; Leila Christina (Espoo, FI), Sorsa; Timo Arto (Helsinki, FI), Tikanoja; Sari Hannele (Helsinki, FI) Assignee(s): Oy Medix Biochemica AB (Kauniainen, FI) Patent Number: 5,736,341 Date filed: June 7, 1995 Abstract: Methods and test kits are described which provide a reliable, sensitive and selective assessment of periodontal disease activity, peri-implantitis or HIV(+)infection/AIDS-disease related periodontal diseases. The preferred methods and test kits are constructed to be easy and rapid chair-side tests. The method is based on the preparation and use of monoclonal antibodies which recognize the active mammalian matrix metalloproteinase-S (MMP-8) and is capable of differentiating between said active matrix metalloproteinase-8 and its inactive proform. Excerpt(s): The present invention relates to methods and test kits for diagnosis of periodontal disease activity in mammals, especially in human beings. The methods of the invention provide for rapid chair-side diagnosis of periodontitis, peri-implantitis and HIV(+)-infection/AIDS-disease related periodontal diseases. Periodontal diseases are a major problem in the human dentition. In fact, more teeth are lost from periodontal disease than from dental caries. Thus, there is a great need for reliable diagnostic tests for periodontal disease. Periodontal disease comprises a group of inflammatory disorders originating from infections affecting the gingiva (gum) and the alveolar (jaw) bone structures supporting the teeth. The primary cause of periodontal diseases is bacterial plaque attached to the teeth. This causes inflammation of the gum which may result in destruction of the actual tooth-supporting structure and bone. In periodontal disease, there is usually a large accumulation of bacteria in plaque, both above (supragingival) and below (subgingival) the gum line. The plaque can calcify and form calculus deposits. The calculus deposit and associated plaque can create a "pocket" between the teeth and the gingiva which is characteristic of the periodontal disease. Web site: http://www.delphion.com/details?pn=US05736341__

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Methods for diagnosis of periodontal diseases Inventor(s): Lundqvist; Leila Christina (Espoo, FI), Sorsa; Timo Arto (Helsinki, FI), Tikanoja; Sari Hannele (Helsinki, FI) Assignee(s): Oy Medix Biochemica AB (Kauiainen, FI) Patent Number: 5,866,432 Date filed: December 11, 1996 Abstract: The present invention is related to a rapid and reliable method for making chair-side diagnoses of periodontal diseases and especially for predicting the risk of progressing of the periodontal diseases. The diagnosis and prognosis are performed using an immunological test kit by which increased levels of neutrophil gelatinaserelated lipocalin (NGAL) derived from polymorphonuclear neutrophilic leucocytes PMNs) is measured. Excerpt(s): The present invention relates to methods for rapid, reliable, specific and sensitive chair-side diagnosis of different forms of periodontal diseases as well as periimplantitis and HIV(+)-associated periodontal diseases and especially for predicting the risks for progression of said diseases by using test kits with which neutrophil gelatinaseassociated lipocalin (NGAL) can be measured. The traditional method for determining the progression of periodontitis is to assess the degree of damage which has occurred to the periodontal tissues over a given period of time by probing. Unfortunately, as a measurement technique, periodontal probing has several sources of error which make it inexact. Radiographs have long been used to assess the level and loss of alveolar bone around teeth. However, it is impossible to visually detect minor changes in bone. Hence, the amount of bone destruction/loss tends to be underestimated when radiographs are read in a routine fashion. Web site: http://www.delphion.com/details?pn=US05866432__

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Oral cleaning apparatus Inventor(s): Rimkus; Ronald J. (Flossmoor, IL) Assignee(s): AMTEC Products, Inc. (Flossmoor, IL) Patent Number: 6,015,293 Date filed: December 31, 1997 Abstract: A disposable oral cleaning apparatus for cleaning and removing particles and bacteria from the upper surface of the tongue and between the teeth, including an elongated handle, a head component and a flexible connector connecting the elongated handle and the head component. The head component has a pre-cleaning portion, a cleaning portion and an absorbent portion to provide an initial cleaning of the coating of the tongue, a secondary deep cleansing of the pores of the tongue, and a final absorption and removal of all debris. The oral cleaning apparatus is adapted to promote proper cleansing of the tongue and teeth so as to eliminate oral bacteria and bad breath, to reduce tooth decay, gum disease and plaque buildup, and promote proper oral hygiene with no deleterious changes to the tongue. Excerpt(s): The present invention relates generally to an oral cleaning apparatus for cleaning and medicating the surface of the tongue. Generally, brushing, flossing and rinsing with mouthwash have been standard methods utilized to eliminate oral bacteria and bad breath. According to studies, however, bacteria on the surface of the tongue can

Patents 63

cause up to 75% of bad breath odor. As such, numerous devices have been conceived to try to remove bacterial growth on the surface of the tongue. Prior attempts to provide a means for cleaning the tongue generally fall into two categories: scraper-style cleaners and brush-style cleaners. Scraper-style tongue cleaners are disclosed in U.S. Utility Pat. Nos. 5,438,726, 5,282,814, 5,005,246 and 2,218,072. Scraper-style tongue cleaners are also disclosed in U.S. Design Pat. Nos. Des. 367,707 and Des. 285,342. Web site: http://www.delphion.com/details?pn=US06015293__ •

Periodontal disease preventive and ameliorative agent Inventor(s): Aoe; Seiichirou (Sayama, JP), Dousako; Shunichi (Urawa, JP), Serizawa; Atsusi (Kawagoe, JP), Suguri; Toshiaki (Tokyo, JP), Takada; Yukihiro (Kawagoe, JP) Assignee(s): Snow Brand Milk Products Co., Ltd. (Hokkai-do, JP) Patent Number: 6,544,498 Date filed: March 20, 2000 Abstract: A periodontal disease preventive and ameliorative agent with milk-derived basic protein as its effective ingredient, which protein is obtained by contacting a milk or milk-derived ingredient with cation-exchange resin, and then eluting a fraction adsorbed by the resin using an elution solution and which protein has an isoelectric point within a range of 7.5.about.11, and food/drink and a medicament such as toothpaste and gargling agents, which contain this periodontal disease preventive and ameliorative agent. Excerpt(s): The application claims the priority of PCT International Application No. PCT/JP99/02223, filed Apr. 27, 1999 and Japanese patent document No. 10-134243, filed Apr. 30, 1998, the disclosure of which is expressly incorporated by reference herein. This invention relates to a periodontal disease preventive and ameliorative agent with a milk-derived basic protein as an effective ingredient. This invention also relates to the utilization of the periodontal disease preventive and ameliorative agent with a milkderived basic protein as an effective ingredient for a food/drink and medicament. In recent years, periodontal disease has become an object of public concern. Unlike dental caries, periodontal disease is a disease wherein the foundation of the teeth becomes weak and the use of teeth other than a decayed tooth is eventually lost. In addition, it is said that there are a large number of people who show symptoms of periodontal disease. In this sense, periodontal disease is a more serious disease than dental caries. Web site: http://www.delphion.com/details?pn=US06544498__

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Periodontal probe tip for diagnosing periodontitis and dental decay Inventor(s): Yeh; Richard T. (13572 Montague St., Arleta, CA 91331) Assignee(s): none reported Patent Number: 5,725,373 Date filed: July 17, 1996 Abstract: A periodontal probe tip 14 is made of strong flexible plastic with thermochromatic plastic ingredient and litmus test paper band, Probe tip 14 is an indicator for measuring the depth of periodontal pocket and for sensing gum temperature increasing and sensing acidity around tooth, Probe tip 14 will show color

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change to indicate gum disease and tooth decay initiating the disease process, People will have time to interrupt the disease process and on to better oral health. Excerpt(s): The present invention relates to a periodontal probe and is particularly directed to a periodontal probe tip which is diagnosing periodontitis and tooth decay in the very early stages by color change. Gum disease and tooth decay are caused by bacterial invasion which result in decompostion of bone around tooth and tooth infection, if left untreated. Gum disease and tooth decay can be prevented by good oral hygiene and be treated. The treatment will mainly be directed to interrupt the progress of the disease. Web site: http://www.delphion.com/details?pn=US05725373__ •

Pharmaceutical composition, containing medium-chain fatty acids as active ingredients, for dental caries and periodontal disease Inventor(s): Min; Byung-Moo (#13-501 Rex Apt., 300-3 Ichon-dong, Yongsan-ku, Seoul 140-030, KR) Assignee(s): none reported Patent Number: 6,180,599 Date filed: September 27, 1999 Abstract: The present invention relates to a new use of medium-chain fatty acids in prevention and treatment of dental caries and a pharmaceutical composition containing medium-chain fatty acids as active ingredients.Particularly, the present invention relates to the use of the salt form of medium-chain fatty acids; nonanoic acid, capric acid, undecanoic acid, lauric acid, tridecanoic acid or myristic acid, for prevention and treatment of dental caries and periodontal disease. The pharmaceutical composition containing medium-chain fatty acids as active ingredients may include lectins and/or fluoride in addition to medium-chain fatty acids. Excerpt(s): The present invention relates to a new use of medium-chain fatty acids as a prophylactic against dental caries and as a therapeutic treatment of the disease, and a pharmaceutical composition containing these medium-chain fatty acids as active ingredients. Particularly, the present invention relates to the use of the salt form of specific medium-chain (C.sub.9 -C.sub.14) fatty acids; nonanoic acid (C.sub.9) capric acid (C.sub.10), undecanoic acid (C.sub.11), lauric acid (C.sub.12), tridecanoic acid (C.sub.13) or myristic acids (C.sub.14), as a prophylactic against dental caries and therapeutic treatment of the same disease and periodontal disease. The pharmaceutical composition of these medium-chain fatty acids may include lectins and/or fluoride as well. Dental caries, one of the most prevalent and significant forms of oral disease, can lead to loss of teeth in spite of development of therapeutics. Caused by dental plaque formed on the surface of teeth, dental caries results in tooth loss as a result of organic acids, the natural metabolite of plaque bacteria contained in dental plaque, which decalcify dental hard tissue locally and gradually. Web site: http://www.delphion.com/details?pn=US06180599__

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Screening method for periodontal disease Inventor(s): Eggert; F. Michael (Edmonton, CA), Gomez; Baltazar (Fremont, CA), Kung; Viola T. (Menlo Park, CA), Winterbottom; Neil (San Mateo, CA) Assignee(s): Metra Biosystems, Inc. (Mountain View, CA) Patent Number: 5,756,361 Date filed: September 8, 1994 Abstract: A method of screening for the presence of a periodontal disease condition is disclosed. The method involves obtaining an oral fluid sample from a human subject being tested, and determining the level of native free pyridinium crosslinks (free pyridinoline and/or free deoxypyridinoline) from the subject. An above-normal level of crosslinks, when compared with a predetermined level characteristic of normal subjects, is an indication of the presence of a periodontal disease condition. Excerpt(s): The present invention relates to methods for detecting and monitoring the presence of periodontal disease in mammals. Black, D., et al., Anal. Biochem. 169:197203 (1988). Campbell, A., Monoclonal Antibody and Immunosensor Technology, Elsevier (1991). Web site: http://www.delphion.com/details?pn=US05756361__

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System and method for applying oral fluid absorbing material to dental arches, with application in treatment of periodontal gum disease Inventor(s): Wehrli; Janet M. (6737 S. 153 Cir., Omaha, NE 68137) Assignee(s): none reported Patent Number: 6,475,471 Date filed: November 3, 2001 Abstract: Disclosed is a method which provides for positioning materials which absorb oral fluids in into controlled, direct contact with at least one dental arch of a subject. The method is particularly applicable to treatment of periodontal gum disease where the material is made from a mixture of bicarbonate of soda, psyllium husk fiber and optionally at least one antimicrobial agent, in combination with a moistening agent and optional flavoring. Excerpt(s): The present invention relates to application of materials in mouths of subjects, and more specifically to a method of applying material(s) which absorb oral fluids to dental arches, which method finds particularly relevant application in the context of the of treatment periodontal gum disease. Utility patent application Ser. No. 09/549,301 filed Apr. 13, 2000, and Provisional Patent Application Ser. No. 60/145,028 filed Jul. 22, 1999 are included hereinto by reference. Typical approaches to applying dentifrice in liquid, powder, gel or paste form include toothbrush, flossing, rinsing and by use of pressure driven sprays. Less common, but known methods include use of selfsticking strips and impregnated finger cots. Web site: http://www.delphion.com/details?pn=US06475471__

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Therapy with coenzyme Q10 to reduce subgingival microorganisms in patients with periodontal disease Inventor(s): Folkers; Karl (Austin, TX), Hanioka; Takashi (Suita-Osaka, JP), McRee; Judson T. (Lockhart, TX) Assignee(s): Biomedical and Clinical Research (Austin, TX) Patent Number: 6,461,593 Date filed: February 19, 1992 Abstract: The presence of diverse microorganisms in the gingiva of patients having periodontal disease is very well known to be deleterious to gingival health, and particularly to facilitate the appearance and development of dental cavities. Such microorganisms are always associated with periodontal disease, and if such microorganisms remain unchecked or uncontrolled, extraction of teeth are likely to occur.In the past, the presence of microorganisms in the gingiva of patients with periodontal disease has been periodically and erratically treated with anti-microbial agents, including antibiotics. For anti-microbial agents and antibiotics to be effective in the gingiva, such agents and antibiotics must come into direct contact with microorganisms, and such contact is known to be incomplete, partly because there may be barriers of fluid and tissue which prevent direct contact between the agents and antibiotics with the microorganisms. Also, such agents can be inactive for certain microorganisms and even when there is activity, such microorganisms can become metabolically resistant to the agents and antibiotics.A more effective way to reduce and to control microorganisms in the gingiva of patients with periodontal disease is to increase the efficacy of the immune system of the host. Coenzyme Q.sub.10 (CoQ.sub.10) has been known to increase the immune system, but previously it was unknown that CoQ.sub.10 could be a very effective mechanism to reduce and to eliminate microorganisms in the gingiva of patients with periodontal disease. Excerpt(s): This invention relates to a new and very safe therapy which involves treatment with coenzyme Q.sub.10 (CoQ.sub.10) of patients in the normal practice of dentistry who have periodontal disease. The gingiva of these patients with periodontal disease are afflicted with diverse microorganisms which are the primary cause of the initiation and development of dental caries and loss of bone support. There has never been a completely effective and safe therapy to diminish or eradicate microorganisms in periodontal disease. Anti-microbial agents and antibiotics have been used but have never been totally effective, although they have been widely and commonly used in dental practice across the country. Many periodontal patients do not respond to treatment with such agents and antibiotics. Many or most patients with periodontal disease have depressed immune systems which allow the growth and presence of microorganisms in the diseased gingiva. A new and far better approach to reduce subgingival microorganisms of patients with periodontal disease is to rejuvenate the depleted immune system of patients. Web site: http://www.delphion.com/details?pn=US06461593__

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Use of locally delivered metal ions for treatment of periodontal disease Inventor(s): Friden; Phillip M. (Bedford, MA), Nelson; Eric (Waltham, MA), Roberts; F. Donald (Dover, MA), Spacciapoli; Peter (Newbury, MA) Assignee(s): Periodontix, Inc. (Watertown, MA) Patent Number: 6,153,210 Date filed: August 14, 1997 Abstract: Periodontal disease can be treated by the administration of metal ions, preferably silver ions, to the site where the microorganisms that cause this disease reside. Administration can be to periodontal pockets or adjacent to exposed tooth roots or alveolar bone during periodontal surgical procedures. The metal ions can be administered in polymeric microparticles, deformable films or microparticles embedded within deformable films. The metal ions are particularly microbiocidal to the bacterial pathogens that are the causative agents of periodontal disease. Excerpt(s): Continuing maladies that afflict man and other animals are tooth decay and tooth loss. Both of these afflictions have been subjected to much study and application of dental therapeutic measures with marginal success to date. One aspect of dental therapy that has received attention is the understanding of and attempts at overcoming periodontal disease. Periodontal disease is a general term that encompasses diseases that affect the gingiva and diseases that affect the supporting connective tissue and alveolar bone which anchors the teeth in the jaws. A particular periodontal disease that can occur in individuals is periodontitis where connective tissue such as periodontal ligament tissue is lost, alveolar bone is resorbed and periodontal pockets are formed. In more advanced stages of such a periodontal disease, teeth become loosened and may eventually be lost. Periodontal diseases including periodontitis are caused by an accumulation of bacteria on the surface of the tooth and under the gingiva. Elimination of bacterial infection is key to the successful treatment of periodontal disease. It has been known for some time that silver compounds exhibit antimicrobial activity. Currently, this knowledge is most often exploited in the treatment of burn wounds. There appear to have been limited attempts to use silver compounds in the treatment of periodontal disease. Silver sulfadiazine, when applied topically to the supragingival tooth surface in a gel base, has been shown both to prevent and to reduce gingival inflammation and plaque formation in beagle dogs (T. H. Howell et al., J. Periodontal Res. 25:197-200 (1990) and T. H. Howell et al., J. Clin. Periodontal. 17: 734-737 (1990)). However, these findings apparently have not been further pursued. Potential drawbacks to using silver compounds supragingivally in the treatment of periodontal disease are the staining of teeth and oral mucosa and the unpleasant taste that such treatment engenders. Thus, a potent, microbiocidally effective formulation that is locally applied subgingivally would provide a significant improvement in the treatment of periodontal disease. Web site: http://www.delphion.com/details?pn=US06153210__

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Wash composition, test kit and method for determination of microorganisms associated with periodontal diseases Inventor(s): Boyer; Bradley P. (Rochester, NY), Contestable; Paul B. (Rochester, NY), Snyder; Brian A. (Rochester, NY) Assignee(s): Eastman Kodak Company (Rochester, NY) Patent Number: 5,248,595 Date filed: October 8, 1991 Abstract: An aqueous wash composition has been found useful in methods for determination of specific binding ligands. The composition is buffered to a pH of less than or equal to 6 or greater than or equal to 9. It also includes as its essential component at least about 0.1 weight percent of an anionic surfactant which is represented by the formula:[A-SO.sub.3+y ].sup.-(1+y) [X.sup.+m ].sub.nwherein A is a hydrocarbon having a molecular weight of at least about 180, X.sup.+m is hydrogen or a monovalent or divalent cation, m is 1 or 2, y is 0 or 1, and n is 1 or 2 provided that m and n are not both 2. Optionally and preferably, the wash composition also includes a nonimmunoreactive protein. This wash composition is particularly useful in methods for determination of microorganisms associated with periodontal diseases. Such methods can be of a variety of formats, but immunometric assays are particularly useful. The wash composition can be included as part of a diagnostic test kit. Excerpt(s): The present invention relates to an aqueous wash composition, a diagnostic test kit and a method for using the wash composition to determine microorganisms associated with periodontal diseases. In particular, the method is useful for the determination of any of the microorganisms Actinobacillus actinomycetemcomitans, Prevotella intermedia (formerly known as Bacteroides intermedius) or Prophyromonas gingavalis (formerly known as Bacteroides gingivalis). There is a continuous need in medical practice, research and diagnostic procedures for rapid, accurate and qualitative or quantitative determinations of biological substances which are present in biological fluids at low concentrations. For example, the presence of drugs, narcotics, hormones, steroids, polypeptides, prostaglandins or infectious organisms in blood, urine, saliva, vaginal secretions, dental plaque, gingival crevicular fluid and other biological specimens has to be determined in an accurate and rapid fashion for suitable diagnosis or treatment. To provide such determinations, various methods have been devised for isolating and identifying biological substances employing specific binding reactions between the substance to be detected (sometimes identified as a "ligand") and a compound specifically reactive with that substance (sometimes identified as a "receptor"). Web site: http://www.delphion.com/details?pn=US05248595__

Patent Applications on Gum Disease As of December 2000, U.S. patent applications are open to public viewing.9 Applications are patent requests which have yet to be granted. (The process to achieve a patent can take several years.) The following patent applications have been filed since December 2000 relating to gum disease: 9

This has been a common practice outside the United States prior to December 2000.

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Apparatus and method for treating atherosclerotic vascular disease through light sterilization Inventor(s): Ganz, Robert A.; (Minnetonka, MN), Zelickson, Brian D.; (Minneapolis, MN) Correspondence: James V. Harmon; 1000 Northstar Center East; 608 Second Avenue South; Minneapolis; MN; 55402; US Patent Application Number: 20030097122 Date filed: November 18, 2002 Abstract: A method and apparatus for treating gum disease includes a light producing dental appliance that is accessible exteriorly of the body for placement within the mouth of the patient to expose the mouth to light radiation of a selected wavelength and in an amount that is effective for killing or debilitating pathogenic microorganisms and especially Porphyromona gingivalis within the mouth of the patient such that the bacterial load carried to the heart is diminished thereby reducing or eliminating the symptoms of coronary artery disease, atherosclerosis vascular inflammation and plaque formation. Excerpt(s): The present application is a continuation in part of application Ser. No. 10/119,855 filed Apr. 9, 2002. This invention relates to an apparatus and method for treating atherosclerotic vascular disease and periodontal disease by means of light radiation. Atherosclerotic vascular disease represents one of the major health problems in the world. It is the number one cause of death in the United States, being responsible for one third of all reported mortality on an annual basis. The magnitude of the problem is staggering; in the United States alone over 60 million people have some form of atherosclerotic vascular disease. In 1995, approximately 1,000,000 people died from this problem. Atherosclerotic vascular disease ranks as the leading reason for social security disability, limitation in physical activity, and hospital bed use accounting for 46 million bed days in 1994. The direct and indirect costs of treating this scourge is in the hundreds of billions of dollars on an annual basis. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

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Bacteriophage-encoded enzymes for the treatment and prevention of dental caries and periodontal diseases Inventor(s): Delisle, Allan L.; (Sykesville, MD) Correspondence: Long Aldridge & Norman Llp; 701 Pennsylvania Avenue, N.W., Suite 600; Washington; DC; 20004; US Patent Application Number: 20020044911 Date filed: September 14, 2001 Abstract: A method for the treatment and prevention of dental caries and periodontal diseases using bacteriophages and phage-encoded anti-bacterial enzymes to inhibit establishment of bacteria in the oral cavity is provided. Also provided are methods for studying the cell wall of an oral bacterium, a method for preventing spoilage of perishable items and a method for removing dextrans from surfaces utilized in sugar manufacture. Purified enzymes and the isolated DNA fragments encoding them are also provided.

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Excerpt(s): This invention relates to bacteriophage-encoded enzymes useful in preventing dental caries and periodontal diseases. More specifically, this invention relates to lysozyme-like enzymes isolated from bacteriophages which are capable of killing cariogenic bacteria and other periodontal disease-causing organisms. The invention also relates to dextranase-like enzymes suitable for dental treatments (i.e., loosening plaque) and other applications where it is desired to remove dextran and other bacterial polysaccharides (i.e., mutan) synthesized from sucrose. With regard to their function in dental plaque, phages are likely to influence the plaque flora in several potentially significant ways. Prophages, for example, provide immunity to superinfection by homoimmune phages and would presumably assist lysogens which carry them in competing with other bacteria in plaque by killing phage-sensitive competitors in a manner analogous to bacteriocinogenic cells. The semi-solid nature of dental plaque provides an especially favorable environment for this type of competition. Alternatively, lytic phage would be expected to select for phage-resistant mutants of sensitive strains and for mucoid mutants (phenotypically phage-resistant), which could well have altered colonizing and pathogenic properties. Actinophage-resistant mutants have in fact already been used to study cell surface structures that appear to be involved in specific, intergeneric oral bacterial coagreggation reactions (Delisle, A. L. et al (1988) Infect. Immun. 56:54-59; Tylenda, C. A. et al (1985) Infect. Immun. 48:228-233), which are believed to play an important role in colonization of dental plaque (Kolenbrander, P. E. et al (1985) In, S. E. Murgenhagen and B. Rosan (eds) pp. 164-171, American Society for Microbiology, Washington, D.C.). The literature on S. mutans phages dates back to 1970, when Greer first claimed to be able to induce phages, by treatment with mitomycin C, from oral streptococcal strains AHT, BHT and HHT (Greer, S. W., et al (1970) IADR Abstr. 160; J. Dent. Res, 48A:88) and subsequently claimed that the same virus was present in all of eight cariogenic streptococci he examined, but not in non-cariogenic strains (Greer, S. W., et al (1971) J. Dent. Res. 50:1594-1604). He then reported that lysogens could be cured of their prophages by treatment with acridine orange (Greer, S. W., et al (1971) IADR Abstr. 57: J. Dent. Res. 49:67) and nitrosoguanidine (Greer, S. W., et al (1972) IADR Abstr. 68: J. Dent. Res. 50:65). The latter was used to isolate temperaturesensitive mutants, one of which was heat-inducible and could be used to obtain cured cells by brief heating. Greer also proposed a curing procedure based on radiosensitization of DNA by incorporating 5-bromodeoxyuridine lysogens (Ramberg, E. et al (1973) IADR Abstr. 113: J. Dent. Res. 52a), but its application to S. mutans was never subsequently reported. Greer never reported the successful isolation of an infectious phage which could be grown in S. mutans. Difficulties in repeating Greer's induction experiments led many microbiologists to assume that he was really working with enterococci, which were common contaminants in the oral streptococcal cultures being exchanged among various laboratories during this time. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

Biofilm therapy process and elements Inventor(s): Brown, Dale; (Wharton, TX), White, Robert D.; (Chadds Ford, PA) Correspondence: Banner & Witcoff, LTD.; 28 State Street; 28th Floor; Boston; MA; 02109; US Patent Application Number: 20030035779 Date filed: December 4, 2001

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Abstract: Disclosed is a self-treatment process and system for periodontal patients with gingival detachment of about 3 mm and greater comprising regularly removing biofilms from various supragingival, interproximal and subgingival surfaces, wherein "soft abrasives" are physically worked into the biofilms using toothbrushing, proxy brushing and flossing. The process is also used to help control those inflammation related substances resulting from gum disease that are associated with heart disease. Excerpt(s): This application claims domestic priority from copending U.S. Provisional Application Serial No. 60/254,457, filed Dec. 8, 2000, the disclosure of which is hereby incorporated herein by reference. Current "at-home" oral care practice in the U.S. is at least partly responsible for 13 million adults being treated annually for gum disease, as well as for the 67 million adults indicating some periodontal disease, i.e., gingival detachment of at least 3 mm. Emphasis on toothbrushing with fluoride, whitening toothpastes and rinsing with germ fighting rinses fails to address the fundamental oral care problem of those patients suffering from gum disease, i.e., the need to physically remove supragingival, interproximal and subgingival plaque from critical tooth surfaces. daily. Aged plaque is now described as a biofilm. Biofilms below the gumline and between teeth are recognized as the host for those pathogens responsible for gum disease, as well as C-reactive protein which is identified with heart disease. Throughout nature, biofilms have a reputation for being notoriously difficult to remove. Biofilms are unique ecosystems that are most pervasive; they extend from "slimes" common to various industrial processes to inflammation in humans and animals. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

Compounds with chelation affinity and selectivity for first transition series elements and their use in cosmetics and personal care products, inhibition of metalloenzymes, and inhibition of reperfusion injury Inventor(s): Cyjon, Rosa L.; (Haifa, IL), Klein, Joseph Y.; (Haifa, IL), Klein, Ofer; (Haifa, IL), Simhon, Elliot D.; (Haifa, IL), Winchell, Harry S.; (Lafayette, CA), Zaklad, Haim; (Haifa, IL) Correspondence: Townsend And Townsend And Crew; Two Embarcadero Center; Eighth Floor; San Francisco; CA; 94111-3834; US Patent Application Number: 20010041170 Date filed: April 20, 2001 Abstract: This invention involves the use of a class of compounds with chelation affinity and selectivity for first transition series elements. Application or administration of the free or conjugated compound, or physiological salts of the free or conjugated compound, results in decrease of the bioavailability and/or chemical action of first transition series elements. These characteristics make such compounds useful in cosmetics and personal care products to decrease odor arising from microbial growth on body surfaces and in body cavities, decrease microbial growth on teeth, plaque, and gums that cause tooth decay and gum disease, inhibition of oxidative damage to the skin, inhibition of enzymatic action of metalloenzymes dependent on first transition series elements, and inhibition of reperfusion injury. Excerpt(s): All literature and patent citations appearing in this specification are hereby incorporated herein by reference. First transition series elements are essential to the replication and growth of all cells and viruses. They are essential co-enzymes required in a variety of metabolic processes. Iron and copper can catalyze free radical formation

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leading to oxidative damage to tissues. Consequently, alterations of the bioavailability and function of first transition series elements can affect cell systems, metabolic processes, and complex phenomena that are affected by such processes. It is generally appreciated that most body odors arise from chemical byproducts of microbial growth. Thus, antimicrobial agents such as triclosan are commonly added to personal care products and cosmetics to inhibit development of body odors (such as underarm odor) through inhibition of microbial growth. See, Antiperspirants and Deodorants, 2d Ed., K. Laden, Ed., 1999, Marcel Dekker, Inc., New York, N.Y. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

Dentifrice compositions Inventor(s): Dana, Frederic; (Deauville Cedex, FR) Correspondence: Coleman Sudol Sapone, P.C.; 714 Colorado Avenue; Bridgeport; CT; 06605-1601; US Patent Application Number: 20030003059 Date filed: November 15, 2001 Abstract: The present invention relates to oral care compositions which provide a means to deliver actives which are useful in the prevention, treatment and/or management of dental and related tissue conditions, including dental caries, dental cavities, microbial flora, tartar, periodontal and related gum disease. In addition, the present invention may be used in the healthy maintenance of teeth and gums. Further aspects of the present invention are related to the present compositions being useful to whiten teeth and otherwise favorably impact the cosmetic appeal of the teeth and gums of a subject or patient. A further aspect of the present invention is directed to the inclusion of effective amounts of colostrum in dental care compositions for the unexpectedly high efficacy such formulations provide in inhibiting, reducing or otherwise preventing microbial growth, dental caries, plaque, cavities and gum disease, including periodontal disease. The use of colustrum with other enzymes as otherwise described herein represents a particularly preferred embodiment for use in the present invention because of the unexpected antimicrobial activity exhibited by the enzyme combination. Excerpt(s): This application is a continuation-in-part application of Ser. No. 09/872,829 of same title, filed Jun. 1, 2001. A further aspect of the present invention is directed to the inclusion of effective amounts of colostrum in dental care compositions for the unexpectedly high efficacy such formulations provide in inhibiting, reducing or otherwise preventing microbial growth, dental caries, plaque, cavities and gum disease. The use of colustrum with other enzymes as otherwise described herein represent particularly preferred additives for use in because of the unexpected and synergistic (i.e., more than additive) antimicrobial activity exhibited by the enzyme combination. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

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Diagnostics and treatments of periodontal disease Inventor(s): Bhogal, Peter Singh; (Victoria, AU), Reynolds, Eric Charles; (Victoria, AU), Slakeski, Nada; (Victoria, AU) Correspondence: Nixon & Vanderhye P.C.; 1100 North Glebe Road, 8th Floor; Arlington; VA; 22201-4714; US Patent Application Number: 20030157637 Date filed: August 28, 2002 Abstract: This invention relates to the PrtR-PrtK cell surface protein of Porphyromonas gingivalis and in particular a multimeric cell associated protein complex comprising the PrtR and PrtK proteins. Accordingly the invention provides a substantially purified antigenic complex for use in raising an antibody response directed against Porphyromonas gingivalis. The complex comprises at least one multimeric protein complex of arginine-specific and lysine-specific thiol endopeptidases each containing at least one adhesin domain, the complex having a molecular weight of greater than about 200 kDa. The invention also relates to pharmaceutical compositions and associated agents based on said complex for the detection, prevention and treatment of Periodontal disease associated with P. gingivalis. Excerpt(s): This invention relates to the PrtR-PrtK cell surface protein of Porphyromonas gingivalis and in particular a multimeric cell associated protein complex comprising the PrtR and PrtK proteins. The invention also relates to pharmaceutical compositions and associated agents based on said complex for the detection, prevention and treatment of Periodontal disease associated with P. gingivalis. Periodontal diseases are bacterialassociated inflammatory diseases of the supporting tissues of the teeth and range from the relatively mild form of gingivitis, the non-specific, reversible inflammation of gingival tissue to the more aggressive forms of periodontitis which are characterised by the destruction of the tooth's supporting structures. Periodontitis is associated with a subgingival infection of a consortium of specific Gram-negative bacteria that leads to the destruction of the periodontium and is a major public health problem. One bacterium that has attracted considerable interest is P. gingivalis as the recovery of this microorganism from adult periodontitis lesions can be up to 50% of the subgingival anaerobically cultivable flora, whereas P. gingivalis is rarely recovered, and then in low numbers, from healthy sites. A proportional increase in the level of P. gingivalis in subgingival plaque has been associated with an increased severity of periodontitis and eradication of the microorganism from the cultivable subgingival microbial population is accompanied by resolution of the disease. The progression of periodontitis lesions in non-human primates has been demonstrated with the subgingival implantation of P. gingivalis. These findings in both animals and humans suggest a major role for P. gingivalis in the development of adult periodontitis. P. gingivalis is a black-pigmented, anaerobic, asaccharolytic, proteolytic Gram-negative rod that obtains energy from the metabolism of specific amino acids. The microorganism has an absolute growth requirement for iron, preferentially in the form of haeme or its Fe(III) oxidation product haemin and when grown under conditions of excess haemin is highly virulent in experimental animals. A number of virulence factors have been implicated in the pathogenicity of P. gingivalis including the capsule, adhesins, cytotoxins and extracellular hydrolytic enzymes. In particular, proteases have received a great deal of attention for their ability to degrade a broad range of host proteins including structural proteins and others involved in defence. The proteins that have been shown to be substrates for P. gingivalis proteolytic activity include collagen types I and IV, fibronectin, fibrinogen, laminin, complement and plasma clotting cascade

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proteins,.alpha.sub.1-antitrypsin,.alpha.sub.2-macroglobulin antichymotrypsin, antithrombin III, antiplasmin, cystatin C, IgG and IgA. The major proteolytic activities associated with this organism have been defined by substrate specificity and are "trypsin-like", that is cleavage on the carboxyl side of arginyl and lysyl residues and collagenolytic although other minor activities have been reported. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

Local delivery of agents for disruption and inhibition of bacterial biofilm for treatment of periodontal disease Inventor(s): Jernberg, Gary R.; (Mankato, MN) Correspondence: Merchant & Gould PC; P.O. Box 2903; Minneapolis; MN; 55402-0903; US Patent Application Number: 20030219387 Date filed: June 6, 2003 Abstract: The present invention relates to compositions and methods of treating periodontal disease and related disorders utilizing a sustained, controlled release targeted delivery method to effectively disrupt and inhibit bacterial biofilms at periodontal treatment sites. Excerpt(s): The present application is a continuation in part of U.S. patent application Ser. No. 09/715,514, filed Nov. 17, 2000, and issued Jun. 10, 2003 as U.S. Pat. No. 6,576,226, which application and patent are incorporated herein by reference. Periodontal diseases are a major affliction to mankind. Gingivitis, inflammation of gingival (gum) tissue, and periodontitis, inflammation and progressive loss of ligament and alveolar (socket) bone support to teeth, are caused by bacteria which colonize tooth surfaces and occupy the gingival crevice area. These are major periodontal disease afflictions worldwide. Bacterial plaque is the principal causative agent of these periodontal diseases. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

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Method for the treatment of periodontal disease Inventor(s): Crooks, Stephen L.; (St. Paul, MN), Merrill, Bryon A.; (St. Paul, MN) Correspondence: Ted K. Ringsred; Office OF Intellectual Property Counsel; 3M Innovative Properties Company; P.O. Box 33427; ST. Paul; MN; 55133-3427; US Patent Application Number: 20030130299 Date filed: June 15, 2001 Abstract: The disclosure provides methods for the treatment and prevention of periodontal disease. In preferred embodiments, the invention provides for local treatment of periodontal tissues with a pharmaceutical composition including an immune response modifier (IRM) selected from the group of immune response modifiers comprising imidazoquinoline amines, imidazopyridine amines, 6,7-fused cycloalkylimidazopyridine amines, imidazonaphthyridine amines, oxazoloquinoline amines, thiazoloquinoline amines and 1,2-bridged imidazoquinoline amines.

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Excerpt(s): The invention is directed to methods for the treatment or prevention of periodontal conditions. Specifically the invention includes the novel use of immune response modifier compounds to treat or prevent periodontal disease. Preferred immune response modifiers are selected from the group of immune response modifiers comprising imidazoquinoline amines, imidazopyridine amines, 6,7-fused cycloalkylimidazopyridine amines, imidazonaphthyridine amines, oxazoloquinoline amines, thiazoloquinoline amines and 1,2-bridged imidazoquinoline amines. Periodontal disease or periodontitis is an inflammatory disease that results in the destruction of both the hard and soft tissues supporting the teeth and has recently been hypothesized as a risk factor for cardiovascular disease. Beck et al. "Dental Infections and atherosclerosis, "American Heart Journal, 13:S528-533 (1999). It is estimated that over 10 million people in the United States are currently being treated for the more serious forms of this disease, with approximately 8 billion dollars spent for treatment each year. Clinically, periodontitis is an inflammation of the periodontium that results in inflammation of the gingiva and may result in resorption of alveolar bone and recession of the gingiva. Recession of the gingiva can lead to exposure of the periodontal ligament allowing microorganisms to invade and destroy the ligament. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

Method of collecting data for estimation of susceptibility to periodontal disease Inventor(s): Abiko, Yoshihiro; (Sapporo-shi, JP), Arakawa, Toshiya; (Sapporo-shi, JP), Kaku, Tohru; (Sapporo-shi, JP), Kusano, Kaoru; (Sapporo-shi, JP), Nishimura, Michiko; (Ebetsu-shi, JP), Takuma, Taishin; (Sapporo-shi, JP) Correspondence: Sherman & Shalloway; 413 N. Washington Street; Alexandria; VA; 22314; US Patent Application Number: 20030175755 Date filed: November 21, 2002 Abstract: A method is provided, which comprises examining the regulating activity of a defensin gene promoter closely associated with the expression activity of defensin, an antibacterial peptide, on the basis of the detection of a gene mutation, and estimating future susceptibility to periodontal disease. The sequence homology between DNA derived from a defensin gene promoter existing in a sample obtained from the gingival tissues of a subject and a nucleotide sequence comprising a mutation site in the promoter region, and/or compatibility in PCR amplification, are determined. Thereby a gene mutation is detected and then the site of the gene mutation is determined, so that data for the estimation can be collected. Excerpt(s): The present invention relates to a method of collecting data for estimating susceptibility to periodontal disease and nucleotide sequences used in the data collection. Specifically, the present invention relates to nucleotide sequences comprising mutant sequence portions in a defensin gene promoter region that regulates the expression of defensin, an antibacterial peptide; and a method of collecting data for estimating susceptibility to periodontal disease wherein the variations of the promoter activity of regulating the expression activity of the defensin gene are examined using the above nucleotide sequences so as to obtain the above data. Periodontal disease is a chronic inflammatory disease of periodontal tissues caused by dental plaque bacteria. A number of periodontal disease-related bacteria have been specified, which are directly or indirectly associated with that disease. When periodontitis is developed, factors 2 associated with the innate immunity of gingival epithelial cells exerting a protective

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function such as cytokines, adhesive factors and antibacterial substances, intervene in the activity of the periodontal disease-related bacteria. Defensin is a microbicidal peptide known as such an antimicrobial substance. Defensins are peptides having an antimicrobial activity against Gram-positive bacteria, Gram-negative bacteria, fungi and envelope viruses, and these are classified into.alpha. type and.beta. type. Examples of.alpha. type defensins, which have been reported, include a total 6 types such as HNP1 to -4 localized in azurophilic granules of human neutrophil and human defensin-5 and -6 localized in Paneth cells in human small intestine. Examples of.beta. type include LAP (lingual antimicrobial peptide) and TAP (trancheal antimicrobial peptide), which are localized in bovine tongue and trachea, and these act as epithelium-derived protective factors against infection. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

Method of treating periodontal disease Inventor(s): Basara, Michael; (Hugo, MN) Correspondence: Schwegman, Lundberg, Woessner & Kluth, P.A.; P.O. Box 2938; Minneapolis; MN; 55402; US Patent Application Number: 20030185768 Date filed: April 2, 2003 Abstract: The present invention includes a method for treating periodontal disease. The method comprises delivering to a pocket of a tooth with periodontal disease, a viscous, reddish-brown solution comprising sulfuric acid and sulphonated phenolic compounds. The method also comprises retaining the reddish-brown solution in the pocket for t time ranging from about 5 seconds to about 60 seconds. Excerpt(s): This application is a continuation application of Ser. No.: 09/575,297, filed May 19, 2000, entitled: METHOD OF TREATING PERIODONTAL DISEASE. The present invention relates to a method for treating periodontal disease. Periodontal disease is characterized by a loss of supporting tissues of the teeth. In particular, periodontitis includes a loss of the periodontal ligament and a disruption of the ligament attachments to cementum, as well as reabsorption of alveola and bone. Along with a loss of tissue attachments, periodontal disease produces a migration of the epithelial attachments along the root surface and reabsorption of bone. It is widely accepted that an initiation and progression of periodontal disease is dependent upon the presence of micro-organisms which are capable of causing the disease. At least three characteristics of periodontal micro-organisms have been identified which contribute to the ability of microbes to act as pathogens. A first characteristic is a capacity of the microbes to colonize. A second characteristic is an ability of the microbes to evade antibacterial host defense mechanisms. A third characteristic is an ability of the microbes to produce substances which directly initiate tissue destruction. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

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Method of treating periodontal disease using periodontal regeneration composition Inventor(s): Szymaitis, Dennis W.; (Pittsburgh, PA) Correspondence: Buchanan Ingersoll, P.C.; One Oxford Centre, 301 Grant Street; 20th Floor; Pittsburgh; PA; 15219; US Patent Application Number: 20030202947 Date filed: April 3, 2003 Abstract: A periodontal structure regeneration composition for treatment of periodontal disease is a mixture of particles of a bone growth material and free collagen. The periodontal regeneration composition is injected into the periodontal pocket through a needle. The composition may contain a thickener that increases the viscosity of the composition after the material has been injected into the periodontal pocket. The composition is available in pre-filled syringes offered in a kit that may also contain strips of surgical sponge or gauze that are sized to fit within a periodontal pocket, a tube of adhesive, a dental bur, a probe, a gauze placement tool, gauze counter and a brush for cleaning the dental bur. Excerpt(s): This is a continuation-in-part of U.S. patent application Ser. No. 09/912,930 filed Jul. 25, 2001. The invention relates to a bone growth and periodontal structure regeneration material, and method for treating periodontal disease. Periodontal disease occurs when bacteria colonize the sulcus space between the teeth and gingiva. The bacteria cause inflammation. The inflammation destroys the gingival epithelial lining and epithelial attachment to the tooth. The inflammation then progresses down the tooth root toward the apex of the root and destroys periodontal structure and bone. As periodontal disease progresses open pockets develop between the tooth and the gingiva. A dentist can determine the presence and extent of periodontal disease using a probe to measure the depth of pockets between each tooth and gingiva. X-rays can reveal the extent of any bone loss. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

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METHODS FOR TREATING PERIODONTAL DISEASE Inventor(s): Andersen, Scot N.; (Draper, UT), Wilson, Jimmy B.; (Draper, UT) Correspondence: Rick D. Nydegger; Workman, Nydegger & Seeley; 1000 Eagle Gate Tower; 60 East South Temple; Salt Lake City; UT; 84111; US Patent Application Number: 20030059379 Date filed: September 19, 2001 Abstract: Methods for treating periodontal disease and other diseased tissues that utilize a dye composition and laser energy. The laser energy (typically about 450 nm to about 600 nm) heats and destroys the diseased tissue and bacteria, while the dye composition causes the laser energy to be selectively absorbed by the targeted tissue. An argon gas laser that emits blue-green light may be used in conjunction with a red-orange dye that strongly absorbs light energy emitted by the argon gas laser. An 810 diode laser may be used in conjunction with the argon laser in order to provide additional heating properties. Excerpt(s): The present invention relates generally to methods for treating periodontal disease, particularly to methods that utilize laser energy to destroy necrotic tissue and bacteria that have been stained with an appropriate dye. It is well known that

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periodontal disease is caused by bacteria that grows and festers within the periodontal pocket. Porphyromonas gingivalis and other bacteria host not only in the soft tissue around the periodontal pocket, but also in plaque that is formed on the surface of the tooth. If left untreated, such bacteria can cause swelling of the gingiva, pain and possible loss of the tooth. Surrounding gums and teeth can also become infected. In the conventional treatment of periodontal disease, instruments are inserted into the periodontal pocket to mechanically debride the plaque from the tooth and also to remove the necrotic soft tissue by curettage. Antibiotics may also be conventionally placed in the periodontal pocket following such conventional treatment to ensure complete eradication of the infection and to combat reinfection. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

Novel transcription factor regulating TNF-alpha Inventor(s): Amar, Salomon; (Brookline, MA) Correspondence: Kevin M. Farrell; Pierce Atwood; Suite 350; One New Hampshire Avenue; Portsmouth; NH; 03801; US Patent Application Number: 20030166159 Date filed: April 2, 2003 Abstract: Disclosed herein is an isolated polypeptide which binds to the DNA binding domain located from -550 to -487 in the promoter of the human TNF-.alpha. gene. This isolated polypeptide is referred to herein as the LITAF protein. Polypeptides of human origin are specifically provided. Also disclosed is a nucleic acid sequence which encodes the LITAF protein. Such nucleic acids may be incorporated into an expression vector, which may be inserted into a cell. LITAF dependent induction of TNF-.alpha. gene expression in a cell can be inhibited by delivering an inhibitor of expression of the LITAF gene to the cell. Such an inhibitor is for example an antisense construct which encodes an antisense RNA molecule which is complementary to a portion of the LITAF mRNA which is greater than 200 nucleotides in length. Preferably, the antisense RNA molecule is complementary to the start site of translation, upstream adjacent 5' untranslated sequence, and downstream adjacent coding sequence of the LITAF mRNA. Optimal lengths and specific nucleotides for complementary are discussed. Inhibition of LITAF dependent induction of TNF-.alpha. gene expression in a cell can also be achieved by contacting an inhibitor of LITAF protein function to the LITAF protein within a cell. Such an inhibitor may be an antibody which binds the LITAF protein, or alternatively a small molecule which inhibits the function of the LITAF protein. One example of such an inhibitor is a recombinant mutant LITAF protein. Administration of a LITAF inhibitor can be performed as a therapeutic method for treating a patient with a disease associated with chronic inflammation. Such diseases include rheumatoid arthritis, gum disease Crohn's disease, and graft-versus-host disease. Therapeutic methods for treating a patient with a disease in which TNF-.alpha. plays a role in pathology are also provided. Examples of such diseases are diabetes mellitus, cancer, cachexia, breast cancer, HIV, sepsis, malaria, trypanomiasis and asthma. Other methods provided include a method for identifying genes which are regulated by the LITAF protein, a method for identifying a molecule which inhibits LITAF binding to the TNF.alpha. promoter, and a method for identifying molecules which bind LITAF from a protein array. Excerpt(s): The innate host response to bacterial pathogens is characterized by an immediate release of biologically active compounds, including monokines and

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cytokines. These proinflammatory molecules, which are intended to enable the host to eliminate the pathogen, may also adversely affect the host. In acute situations, the pathogen is often eliminated, with resolution of inflammation and minimal tissue damage. However, failure to control the pathogen often leads to a state of metabolic anarchy in which the inflammatory response is not controlled and significant tissue damage results. Endotoxins, produced from the outer membrane of Gram-negative bacteria, and exotoxins, released from the cell wall of Gram-positive bacteria, are known to be potent inducers of the inflammatory response. Lipopolysaccharide (LPS), extracted from the outer membrane of Gram-negative bacteria, has been identified as a principal endotoxic component. Although the inflammatory response is mediated by a variety of secreted factors, the cytotoxic effects of LPS have been ascribed to TNF-.alpha. activity (Beutler et al., Science 229: 869-871 (1985); Tracey et al., Science 234: 470-474 (1986); Miethke et al., J. Exp. Med. 175: 91-98 (1992)). TNF-.alpha. is a pleiotropic cytokine which serves to either benefit the host or in some situations exert detrimental effects on the host (Beutler and Cerami, Nature 320: 584-588 (1986); Beutler et al., Science 232: 977980 (1986); Beutler and Cerami, N. Engl. J. Med. 316: 379-385 (1987)). TNF-.alpha. benefits the host by helping to prevent cancer, protecting against infection, promoting tissue remodeling, and activating inflammatory responses. Conversely, in host responses which have gone awry, TNF-.alpha. mediates septic shock in chronic infections, is responsible for cachexia in cancer patients, causes inflammation in rheumatoid arthritis patients, and activates the human immunodeficiency virus. The pleiotropic effects of TNF-.alpha. are dose-dependent. Hence, the perceived need to control TNF-.alpha. production has raised interest into the understanding of the mechanisms that modulate TNF-.alpha. gene expression. It is well known that gene transcription is controlled by DNA-binding proteins. Recently, several groups have examined the transcriptional regulation of TNF-.alpha. by various inducers, such as virus, LPS, and PMA. The human TNF-.alpha. promoter contains motifs that resemble nuclear factor kappa B (NF-.kappa.B) binding sites; however, controversy exists as to the involvement of NF-.kappa.B in TNF-.alpha. gene regulation. The nature of the nuclear factor(s) involved in the regulation of LPS-induced TNF-.alpha. gene expression in humans remains unknown. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

Oral therapeutic delivery appliance Inventor(s): Zegarelli, Peter J.; (Sleepy Hollow, NY) Correspondence: Fish & Neave; 1251 Avenue OF The Americas; 50th Floor; New York; NY; 10020-1105; US Patent Application Number: 20020110780 Date filed: April 15, 2002 Abstract: This invention relates to an oral therapeutic delivery appliance. Using this oral therapeutic delivery appliance medicaments may be delivered to oral soft tissues, where medicaments are easily absorbed. To aide the delivery of medicaments to oral soft tissues the oral therapeutic delivery appliance contains a therapeutic pooling reservoir where the medicaments may be placed. The oral therapeutic delivery appliance may be used to treat or aide in the treatment of various oral maladies such as periodontal disease (i.e., gum disease) as well as treating or aiding the treatment of other physical ailments and systemic diseases (e.g., diabetes and other chronic diseases which require either single, intermittent or constant dosing of medicament).

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Excerpt(s): This invention relates to a dental medical oral appliance, and more specifically a drug delivery device for the administration of medicaments orally by means of this appliance. This invention also relates to the methods for treating various oral maladies such as periodontal disease (i.e., gum disease) as well as treating other physical ailments and systemic diseases (e.g., diabetes and other chronic diseases which require either single, intermittent or constant dosing of medicament). Dental appliances or dental trays have been used in various dental procedures for many years. For example, dental appliances have been used to whiten teeth (See U.S. Pat. No. Re. 34,196 to Munro). Or, dental appliances (referred to as night guards)have been used to prevent patients from grinding their teeth while asleep. They have also been used in conjunction with fluoride as a caries (cavity) preventative. And, dental appliances in conjunction with medication have been used to treat oral pain. (See M. Padilla, C. T. Glenn and M. L. Robert, Topical medications for orofacial neuropathic pain: a review, 131 Journal of the American Dental Association 185 (February 2000). A general process for preparing these dental appliances is by forming an alginate impression which registers all teeth surfaces in a jaw. Next, a stone cast model is made using the alginate impression of the mouth. In the case of tooth whitening agents, the reservoirs for holding whitening agents are formed by building a layer of rigid material on the teeth surface(s) to be treated of the stone cast (See U.S. Pat. No. 5,985,249). Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

PAI-2 AND T-PA AS DIAGNOSTIC MARKERS OF PERIODONTAL DISEASE Inventor(s): BARTOLD, PETER M.; (ROSEVILLE, AU), BUNN, CLIVE L.; (ROSEVILLE, AU), XIAO, YIN; (ROSEVILLE, AU) Correspondence: Foley & Lardner; 3000 K Street NW; Suite 500 P O Box 25696; Washington; DC; 200078696 Patent Application Number: 20020012944 Date filed: January 26, 1999 Abstract: The existence and the extent of periodontal disease can be diagnosed by measuring plasminogen activator inhibitor 2 (PAI-2) and/or tissue plasminogen activator (t-PA) levels in gingival crevicular fluid (GCF). Levels of PAI-2 and t-PA in GCF rise sharply in the context of periodontal disease, and they also correlate with the severity of disease at different sites in the same patient. Excerpt(s): Periodontal disease is possibly the most common disease known to man, and is said to affect three-quarters of the adult population. Loss of periodontal tissue due to periodontal disease is the principal cause of tooth loss in adulthood. Periodontal tissue loss may result from infectious disease (e.g., bacterially-induced gingivitis), nutritional disease, (e.g., scurvy), or neoplastic conditions. Typically, tissue loss is accompanied by inflammation, bleeding and ulceration. Without treatment, periodontal tissue loss loosens the tooth and ultimately may cause loss of the tooth and the alveolar bone tissue (periodontitis). Gingivitis and periodontal disease cause enlargement of the periodontal pocket (gingival sulcus) of the affected tooth. The pocket observed in diseased gingiva is much deeper than the normal sulcus. This enlarged pocket is difficult to clean with either a tooth brush or floss and, consequently, bacteria and plaque accumulate within the pocket, causing further enlargement of the pocket. Eventually, the periodontal ligament and supporting alveolar bone are destroyed, leading to loss of the tooth. To permit effective treatment of periodontitis, it is essential to identify the presence and severity of active periodontal disease within a periodontal pocket. Even deep

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periodontal pockets do not necessarily correlate with the presence of active periodontal disease and, accordingly, traditional methods of measuring pocket depth may not provide an accurate indicator of the progression of the disease. Clearly, a more accurate means of determining the presence and extent of active periodontal disease is greatly to be desired. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

Use of ozone for the treatment of dental and oral conditions Inventor(s): Lynch, Edward; (Belfast, GB), Schemmer, Jurgen; (King City, CA) Correspondence: Walter A. Hackler, PH.D.; Attorney OF Record; Suite B; 2372 S.E. Bristol; Newport Beach; CA; 92660-0755; US Patent Application Number: 20030104342 Date filed: March 13, 2002 Abstract: A method of treating gum disease provides for directing a stream comprising an oxidizing gas onto inflamed human gingiva for a period of time sufficient to kill microorganisms within said inflamed human tissue. Excerpt(s): This invention relates to the use of ozone in he treatment of dental and oral conditions. The great destructive disease of teeth is dental caries which may be defined as the acid dissolution of enamel, dentine or cementum as a consequence of the metabolism of micro-organisms living within deposits on the teeth known as plaque. Dental caries is believed to be associated with specific micro-organisms, the principal ones being Streptococcus Mutans, Lactobacilli, Actinomyces Visosus Serovar 2, Actinomyces Naesludii and "Intermediate" Actinomyces, other Streptococci and yeasts. These are acid producing micro-organisms which produce acids such as acetic and lactic acids from the dietary carbohydrates. The micro-organisms associated with dental caries are unique and are ecologically very different from those associated with, for example, infected root canals. (iii) the protection of any newly exposed non-carious dentine with restorative material. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

Keeping Current In order to stay informed about patents and patent applications dealing with gum disease, you can access the U.S. Patent Office archive via the Internet at the following Web address: http://www.uspto.gov/patft/index.html. You will see two broad options: (1) Issued Patent, and (2) Published Applications. To see a list of issued patents, perform the following steps: Under “Issued Patents,” click “Quick Search.” Then, type “gum disease” (or synonyms) into the “Term 1” box. After clicking on the search button, scroll down to see the various patents which have been granted to date on gum disease. You can also use this procedure to view pending patent applications concerning gum disease. Simply go back to http://www.uspto.gov/patft/index.html. Select “Quick Search” under “Published Applications.” Then proceed with the steps listed above.

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CHAPTER 6. BOOKS ON GUM DISEASE Overview This chapter provides bibliographic book references relating to gum disease. In addition to online booksellers such as www.amazon.com and www.bn.com, excellent sources for book titles on gum disease include the Combined Health Information Database and the National Library of Medicine. Your local medical library also may have these titles available for loan.

Book Summaries: Federal Agencies The Combined Health Information Database collects various book abstracts from a variety of healthcare institutions and federal agencies. To access these summaries, go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. You will need to use the “Detailed Search” option. To find book summaries, use the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer. For the format option, select “Monograph/Book.” Now type “gum disease” (or synonyms) into the “For these words:” box. You should check back periodically with this database which is updated every three months. The following is a typical result when searching for books on gum disease: •

Periodontal Diseases Source: Torrance, CA: Homestead Schools, Inc. 2001. 68 p. Contact: Available from Homestead Schools, Inc. 23844 Hawthorne Boulevard, Suite 200, Torrance, CA 90505. (310) 791-9975. Fax (310) 791-0135. E-mail: [email protected]. Website: www.homesteadschools.com. PRICE: $48.00 plus shipping and handling. Course No. 6600. Summary: Periodontal disease is characterized by infection and inflammation of the gums and surrounding tissue resulting in the formation of periodontal pockets (spaces between the gum and tooth) and loss of supporting bone structure. Periodontal disease is recurring, progressive and episodic and, if not controlled, may lead to loss of teeth. This continuing education program for dentists focuses on periodontal diseases. Topics include the importance of identifying the specific genetic marker responsible for producing excess amount of the chemical that regulates the body's inflammatory

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response to bacteria; the two most common forms of periodontal diseases, gingivitis and periodontitis; the pathophysiology of periodontal disease; the symptoms of periodontal disease; the progression of periodontal disease; risk factors for periodontitis; prevention strategies; the link between periodontitis and other serious systemic disorders, such as heart disease, chronic pulmonary disease, and premature low birth weight babies; the effectiveness of antibiotics against bacteria that cause most gum disease; new approaches in the etiology, treatment and monitoring of periodontal disease; the body's host immune response system in initiating the destructive periodontal disease process; pharmaceutical and nonsurgical treatment options for periodontal disease; the application and benefits of PerioChip in the treatment of periodontal disease, particularly as it compares with scaling and root planing; the application of Atridox in the nonsurgical treatment of chronic periodontitis; the application of Periostat in fighting adult periodontitis; patient education concerns, including assessment, prevention, causes of periodontal diseases, and treatment; the various stages of periodontal disease; and the necessity and benefits of various treatments of periodontal disease, including pocket reduction, regeneration, crown lengthening, soft tissue grafts, and dental implants. The document includes a posttest with which readers can qualify for continuing education. 31 figures. 4 tables. 4 references.

Book Summaries: Online Booksellers Commercial Internet-based booksellers, such as Amazon.com and Barnes&Noble.com, offer summaries which have been supplied by each title’s publisher. Some summaries also include customer reviews. Your local bookseller may have access to in-house and commercial databases that index all published books (e.g. Books in Print®). IMPORTANT NOTE: Online booksellers typically produce search results for medical and non-medical books. When searching for “gum disease” at online booksellers’ Web sites, you may discover non-medical books that use the generic term “gum disease” (or a synonym) in their titles. The following is indicative of the results you might find when searching for “gum disease” (sorted alphabetically by title; follow the hyperlink to view more details at Amazon.com): •

Brushing up on gum disease (SuDoc HE 20.4010/a:G 95) by Steven Shepherd; ISBN: B000106YHM; http://www.amazon.com/exec/obidos/ASIN/B000106YHM/icongroupinterna

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Diabetes & periodontal disease : a guide for patients (SuDoc HE 20.3408:D 54/997) by U.S. Dept of Health and Human Services; ISBN: B00010STG6; http://www.amazon.com/exec/obidos/ASIN/B00010STG6/icongroupinterna

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Diabetes, periodontal disease : a guide for patients (SuDoc HE 20.3408:D 54) by U.S. Dept of Health and Human Services; ISBN: B00010LCD8; http://www.amazon.com/exec/obidos/ASIN/B00010LCD8/icongroupinterna

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Freedom from Tooth Decay and Gum Disease by Leonard Horowitz; ISBN: 0960938664; http://www.amazon.com/exec/obidos/ASIN/0960938664/icongroupinterna

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Ignore Your Teeth and They'll Go Away: The Complete Guide to Gum Disease by Sheldon D. Sydney; ISBN: 0960749829; http://www.amazon.com/exec/obidos/ASIN/0960749829/icongroupinterna

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Reversing Gum Disease Naturally : A Holistic Home Care Program by Sandra Senzon (Author); ISBN: 0471222305; http://www.amazon.com/exec/obidos/ASIN/0471222305/icongroupinterna

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Taking care of your teeth : diabetes and gum disease (SuDoc HE 20.302:T 22) by U.S. Dept of Health and Human Services; ISBN: B00010U2PC; http://www.amazon.com/exec/obidos/ASIN/B00010U2PC/icongroupinterna

The National Library of Medicine Book Index The National Library of Medicine at the National Institutes of Health has a massive database of books published on healthcare and biomedicine. Go to the following Internet site, http://locatorplus.gov/, and then select “Search LOCATORplus.” Once you are in the search area, simply type “gum disease” (or synonyms) into the search box, and select “books only.” From there, results can be sorted by publication date, author, or relevance. The following was recently catalogued by the National Library of Medicine:10 •

Dental care and oral health sourcebook: basic consumer health information about dental care, including oral hygiene, dental visits, pain management, cavities, crowns, bridges, dental implants, and fillings, and other oral health concerns, such as gum disease, bad breath, dry mouth, genetic and developmemtal abnormalities, oral cancers, orthodontics, and temporomandibular disorders; along with updates on current research in oral health, a glossary, a directory of dental and oral health organizations, and resources for people with dental and oral health disorders Author: Sutton, Amy L.; Year: 2003; Detroit, MI: Omnigraphics, c2003; ISBN: 0780806344 http://www.amazon.com/exec/obidos/ASIN/0780806344/icongroupinterna

Chapters on Gum Disease In order to find chapters that specifically relate to gum disease, an excellent source of abstracts is the Combined Health Information Database. You will need to limit your search to book chapters and gum disease using the “Detailed Search” option. Go to the following hyperlink: http://chid.nih.gov/detail/detail.html. To find book chapters, use the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer, and the format option “Book Chapter.” Type “gum disease” (or synonyms) into the “For these words:” box. The following is a typical result when searching for book chapters on gum disease: •

Gingivitis and Periodontal Disease Source: in McDonald, R.E. and Avery, D.A., eds. Dentistry for the Child and Adolescent. 7th ed. St. Louis, MO: Mosby, Inc. 2000. p. 440-484.

10

In addition to LOCATORPlus, in collaboration with authors and publishers, the National Center for Biotechnology Information (NCBI) is currently adapting biomedical books for the Web. The books may be accessed in two ways: (1) by searching directly using any search term or phrase (in the same way as the bibliographic database PubMed), or (2) by following the links to PubMed abstracts. Each PubMed abstract has a "Books" button that displays a facsimile of the abstract in which some phrases are hypertext links. These phrases are also found in the books available at NCBI. Click on hyperlinked results in the list of books in which the phrase is found. Currently, the majority of the links are between the books and PubMed. In the future, more links will be created between the books and other types of information, such as gene and protein sequences and macromolecular structures. See http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Books.

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Contact: Available from Harcourt Health Sciences. 11830 Westline Industrial Drive, St. Louis, MO 63146. (800) 325-4177. Fax (800) 874-6418. Website: www.harcourthealth.com. PRICE: $72.00 plus shipping and handling. ISBN: 0815190174. Summary: Gingivitis, a type of periodontal disease, is an inflammation involving only the gingival (gum) tissues next to the tooth. This chapter on gingivitis and periodontal disease is from a textbook on dentistry for the child and adolescent that is designed to help undergraduate dental students and postdoctoral pediatric dentistry students provide comprehensive oral health care for infants, children, teenagers, and individuals with various disabilities. The authors cover simple gingivitis, including eruption gingivitis, gingivitis associated with poor oral hygiene, and allergy and gingival inflammation; acute gingival disease, including that due to herpes simplex virus infection, recurrent aphthous ulcer (canker sore), acute necrotizing ulcerative gingivitis (ANUG), acute candidiasis (thrush, a fungal infection), and acute bacterial infections; chronic nonspecific gingivitis; chlorhexidine as a therapeutic plaque control agent; conditioned gingival enlargement, including puberty gingivitis, fibromatosis, and phenytoin (Dilantin) induced gingival overgrowth; scorbutic gingivitis (associated with vitamin C deficiency); periodontal diseases in children, including periodontitis, premature bone loss in primary dentition, Papillon Lefevre syndrome (precocious periodontosis), gingival recession, the differential diagnosis of self mutilation, abnormal frenum attachment, and frenectomy; the clinical assessment of oral cleanliness and periodontal disease; extrinsic stains and deposits on teeth; and dental calculus (seen with low frequency in children). 44 figures. 93 references. •

Classification and Pathogenesis of Periodontal Diseases Source: in Axelsson, P. Diagnosis and Risk Prediction of Periodontal Diseases. Chicago, IL: Quintessence Publishing Co, Inc. 2002. p. 237-315. Contact: Available from Quintessence Publishing Co, Inc. 551 Kimberly Drive, Carol Stream, IL 60188-9981. (800) 621-0387 or (630) 682-3223. Fax (630) 682-3288. E-mail: [email protected]. Website: www.quintpub.com. PRICE: $156.00 plus shipping and handling. ISBN: 0867153636. Summary: Periodontal diseases range in severity from early inflammation of the gingival (gum) margin to advanced loss of periodontal support and tooth loss. The chapter on the classification and pathogenesis of periodontal diseases is from a textbook that gives the reader updated knowledge about the etiology, modifying factors, risk evaluation, pathogenesis, diagnosis, and epidemiology of periodontal diseases, as well as the relationship between periodontal diseases and other diseases. This chapter begins by defining classification categories, then discusses the pathogenesis of periodontal diseases at the clinical and cellular levels, and at the cellular and molecular levels; factors affecting rates of periodontal disease progression; and the arrest and control of periodontal diseases. The authors offer a section of concluding thoughts on each of these topics. Black-and-white and full-color photographs and graphics illustrate the text. 108 figures. 9 tables.

•

Acquired Gingival and Periodontal Disease Source: in Scully, C., et al. Color Atlas of Orofacial Health and Disease in Children and Adolescents. London, England: Martin Dunitz Ltd. 2002. p.105-121. Contact: Available from Martin Dunitz Ltd, The Livery House. 7-9 Pratt Street, London, England NW1 0AE. 4404074822202. Website: www.dunitz.co.uk. Email:

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[email protected]. PRICE: $125.00 plus shipping and handling. ISBN: 1841841021. Summary: This chapter on acquired gingival (gum) and periodontal disease is from a full-color atlas that covers the presentation of the common orofacial disorders and a wide range of less common and some rare disorders. The chapter begins with an overview of inflammatory gingival and periodontal disease, including common complaints, then covers acute necrotizing ulcerative gingivitis (ANUG, Vincent's disease), acute pericoronitis, Cancrum oris (noma), chronic hyperplastic gingivitis, chronic marginal gingivitis, drug-induced gingival overgrowth (hyperplasia), pyogenic granuloma, fibroepithelial polyps, giant cell granuloma, lateral periodontal abscess, early onset periodontitis, and trauma. Full-color photographs are accompanied by brief text entries describing each condition and noting diagnostic and management considerations for each. 33 figures. 4 tables.

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CHAPTER 7. MULTIMEDIA ON GUM DISEASE Overview In this chapter, we show you how to keep current on multimedia sources of information on gum disease. We start with sources that have been summarized by federal agencies, and then show you how to find bibliographic information catalogued by the National Library of Medicine.

Video Recordings An excellent source of multimedia information on gum disease is the Combined Health Information Database. You will need to limit your search to “Videorecording” and “gum disease” using the “Detailed Search” option. Go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. To find video productions, use the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer, and the format option “Videorecording (videotape, videocassette, etc.).” Type “gum disease” (or synonyms) into the “For these words:” box. The following is a typical result when searching for video recordings on gum disease: •

Smokeless Tobacco: Breaking Free Source: Princeton, NJ: Films for the Humanities and Sciences. 1997. (videocassette). Contact: Available from Films for the Humanities and Sciences. P.O. Box 2053, Princeton, NJ 08543-2053. (800) 257-5126 or (609) 275-1400. Fax (609) 275-3767. E-mail: [email protected]. Website: www.films.com. PRICE: $129.00 plus shipping and handling. Item number VCS 6934. Summary: This health promotion videotape emphasizes that the best advice concerning smokeless tobacco is 'Don't start.' The program encourages children and teenagers who chew tobacco to stop immediately. Using graphic illustrations of cancerous lesions, mouth cankers, and gum disease, a medical expert sternly discusses the health hazards, while offering step by step advice on how to quit. Baseball star Rod Carew talks about his own addiction to the substance and advises young ballplayers against using it. Interviews with teenage users provide the basis for a classroom discussion of the issues. (AA-M).

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•

Oral Care for the Alzheimer's Patient Source: Seattle, WA: Washington State Dental Association. 1999. Contact: Washington State Dental Association. 2033 Sixth Avenue, Suite 333, Seattle, WA 98121. (800) 448-3368; FAX: (206) 443-9266. PRICE: $35.00. Summary: This videotape is intended to assist the caregiver in meeting the oral hygiene needs of the Alzheimer's disease (AD) patient. Because people suffering from AD often are unable or unwilling to maintain their own oral hygiene, it is important for the caregiver to learn to manage the patient's dental care. Instruction begins with a visual assessment of oral health, followed by suggestions on brushing and flossing. The instructor displays a variety of oral hygiene products that may be useful in caring for an AD patient, such as an easy-grip, foam-handled toothbrush and an automatic flossthreader. Practiced in combination with regular visits to the dentist, good dental hygiene can prevent cavities, gum disease, oral cancer, and other painful dental problems for the patient.

•

Dental Care in the 20th Century: How Your Teeth Affect Your Health Source: Calhoun, KY: NIMCO. 1994. (videocassette). Contact: Available from National Center for Health Care Advances. NIMCO, Inc., P.O. Box 9, 117 Highway 815, Calhoun, KY 42327-0009. (800) 962-6662 or (502) 273-5050; Fax (502) 273-5844; http://nimcoinc.com. PRICE: $89.95 plus shipping and handling. Number NIM-SM-DC20-V52. Summary: This videotape program presents an overview of dental health concerns and how the teeth and their problems affect general health. Topics include taking better care of one's teeth, recognizing gum disease, different types of dentistry and dental specialties (including orthodontics, restorative dentistry, pediatrics, and oral surgery), anatomy and physiology of the teeth, role of nutrition, recommended dental care for infants and children, dietary concerns for children, preventing baby bottle tooth decay, toothbrushing and flossing, fluoride, dental caries (four types of cavities: pit and fissure, smooth surface, gum line, and root), problems of the temporomandibular joint (TMJ), problems and sequelae of tooth loss, and types of periodontal disease. The program features interviews with a variety of dentists and patients who have undergone different types of dental procedures. The program also includes some graphics, including diagrams of the dentition and anatomy of a tooth.

Bibliography: Multimedia on Gum Disease The National Library of Medicine is a rich source of information on healthcare-related multimedia productions including slides, computer software, and databases. To access the multimedia database, go to the following Web site: http://locatorplus.gov/. Select “Search LOCATORplus.” Once in the search area, simply type in gum disease (or synonyms). Then, in the option box provided below the search box, select “Audiovisuals and Computer Files.” From there, you can choose to sort results by publication date, author, or relevance. The following multimedia has been indexed on gum disease: •

Gum disease [videorecording] Source: a presentation of Films for the Humanities & Sciences; ITV, Information Television Network; Year: 2001; Format: Videorecording; Princeton, N.J.: Films for the Humanities & Sciences, c2001

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•

Periodontal gum disease [videorecording] Source: presented by the Warren Magnuson Clinical Center, National Institutes of Health, Office of Clinical Reports & Inquiries; a production of AVP Inc; Year: 1985; Format: Videorecording; [Los Angeles, Calif.]: Hospital Satellite Network, c1985

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CHAPTER 8. PERIODICALS AND NEWS ON GUM DISEASE Overview In this chapter, we suggest a number of news sources and present various periodicals that cover gum disease.

News Services and Press Releases One of the simplest ways of tracking press releases on gum disease is to search the news wires. In the following sample of sources, we will briefly describe how to access each service. These services only post recent news intended for public viewing. PR Newswire To access the PR Newswire archive, simply go to http://www.prnewswire.com/. Select your country. Type “gum disease” (or synonyms) into the search box. You will automatically receive information on relevant news releases posted within the last 30 days. The search results are shown by order of relevance. Reuters Health The Reuters’ Medical News and Health eLine databases can be very useful in exploring news archives relating to gum disease. While some of the listed articles are free to view, others are available for purchase for a nominal fee. To access this archive, go to http://www.reutershealth.com/en/index.html and search by “gum disease” (or synonyms). The following was recently listed in this archive for gum disease: •

Gum disease raises death risk in diabetics: study Source: Reuters Health eLine Date: July 04, 2003

•

Obese young adults more likely to have gum disease Source: Reuters Health eLine Date: June 05, 2003

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Findings tie gum disease to mouth cancer Source: Reuters Health eLine Date: March 20, 2003

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Gum disease tied to pregnancy complication Source: Reuters Health eLine Date: February 03, 2003

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Another danger of drug abuse: cavities, gum disease Source: Reuters Health eLine Date: January 30, 2003

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Maternal periodontal disease may impair fetal growth Source: Reuters Industry Breifing Date: March 11, 2002

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Mom's gum disease may impair fetal growth: study Source: Reuters Health eLine Date: March 08, 2002

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Gold teeth can worsen gum disease, dentists warn Source: Reuters Health eLine Date: March 07, 2002

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Scientists map genome of gum disease bacteria Source: Reuters Industry Breifing Date: June 13, 2001

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Teen smokers end up with gum disease in their 20s Source: Reuters Health eLine Date: March 20, 2001

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Gum disease can raise risk for premature birth Source: Reuters Health eLine Date: March 12, 2001

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Blood-clotting gene linked to gum disease Source: Reuters Health eLine Date: March 12, 2001

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FDA approves OraPharma's periodontal disease treatment Source: Reuters Industry Breifing Date: February 16, 2001

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Periodontal disease may not be a risk factor for cardiovascular disease Source: Reuters Medical News Date: February 07, 2001

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Gum disease may not boost heart disease risk Source: Reuters Health eLine Date: January 31, 2001

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Gum disease linked to heart attack risk Source: Reuters Health eLine Date: November 13, 2000

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Smoking may cause half of US gum disease cases Source: Reuters Health eLine Date: May 30, 2000

Periodicals and News

•

New toothpaste cures gum disease Source: Reuters Health eLine Date: May 23, 2000

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Gum disease linked to premature delivery risk Source: Reuters Health eLine Date: May 08, 2000

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Gum disease linked to blood clotting factors Source: Reuters Health eLine Date: February 23, 2000

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Abnormal gene linked to severe gum disease Source: Reuters Health eLine Date: February 18, 2000

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Enzyme deficiency linked to gum disease Source: Reuters Health eLine Date: December 01, 1999

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Uncontrolled diabetes linked to gum disease Source: Reuters Health eLine Date: November 23, 1999

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Financial strain may raise gum disease risk Source: Reuters Health eLine Date: July 19, 1999

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Gum disease may boost stroke risk Source: Reuters Health eLine Date: April 22, 1999

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Periodontal disease linked to coronary heart disease Source: Reuters Medical News Date: January 27, 1999

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Gum disease linked to heart disease Source: Reuters Health eLine Date: January 26, 1999

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FDA approves low-dose doxycycline for gum disease Source: Reuters Medical News Date: October 02, 1998

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Birth control pills may up gum disease risk Source: Reuters Health eLine Date: September 10, 1998

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Obesity may increase gum disease risk Source: Reuters Health eLine Date: August 12, 1998

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Gum Disease Begins at Home Source: Reuters Health eLine Date: September 17, 1997

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FDA Approves New Toothpaste Shown To Reduce Gum Disease Source: Reuters Medical News Date: July 16, 1997

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•

Gel Fights Gum Disease Source: Reuters Health eLine Date: May 12, 1997

•

Americans Winning Gum Disease Battle Source: Reuters Health eLine Date: October 22, 1996

•

Antibiotics May Obviate Surgery For Periodontal Disease Source: Reuters Medical News Date: May 15, 1996 The NIH

Within MEDLINEplus, the NIH has made an agreement with the New York Times Syndicate, the AP News Service, and Reuters to deliver news that can be browsed by the public. Search news releases at http://www.nlm.nih.gov/medlineplus/alphanews_a.html. MEDLINEplus allows you to browse across an alphabetical index. Or you can search by date at the following Web page: http://www.nlm.nih.gov/medlineplus/newsbydate.html. Often, news items are indexed by MEDLINEplus within its search engine. Business Wire Business Wire is similar to PR Newswire. To access this archive, simply go to http://www.businesswire.com/. You can scan the news by industry category or company name. Market Wire Market Wire is more focused on technology than the other wires. To browse the latest press releases by topic, such as alternative medicine, biotechnology, fitness, healthcare, legal, nutrition, and pharmaceuticals, access Market Wire’s Medical/Health channel at http://www.marketwire.com/mw/release_index?channel=MedicalHealth. Or simply go to Market Wire’s home page at http://www.marketwire.com/mw/home, type “gum disease” (or synonyms) into the search box, and click on “Search News.” As this service is technology oriented, you may wish to use it when searching for press releases covering diagnostic procedures or tests. Search Engines Medical news is also available in the news sections of commercial Internet search engines. See the health news page at Yahoo (http://dir.yahoo.com/Health/News_and_Media/), or you can use this Web site’s general news search page at http://news.yahoo.com/. Type in “gum disease” (or synonyms). If you know the name of a company that is relevant to gum disease, you can go to any stock trading Web site (such as http://www.etrade.com/) and search for the company name there. News items across various news sources are reported on indicated hyperlinks. Google offers a similar service at http://news.google.com/.

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BBC Covering news from a more European perspective, the British Broadcasting Corporation (BBC) allows the public free access to their news archive located at http://www.bbc.co.uk/. Search by “gum disease” (or synonyms).

Newsletter Articles Use the Combined Health Information Database, and limit your search criteria to “newsletter articles.” Again, you will need to use the “Detailed Search” option. Go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. Go to the bottom of the search page where “You may refine your search by.” Select the dates and language that you prefer. For the format option, select “Newsletter Article.” Type “gum disease” (or synonyms) into the “For these words:” box. You should check back periodically with this database as it is updated every three months. The following is a typical result when searching for newsletter articles on gum disease: •

Gum Disease: You Can Often Prevent This Cause of Tooth Loss Source: Mayo Clinic Health Letter. 10(12): 4-6. December 1992. Contact: Available from Mayo Clinic Health Letter. Subscription Services, P.O. Box 53889, Boulder, CO 80322-3889. (800) 333-9037. Summary: This newsletter article reminds readers of the steps to take in preventing gum disease, including gingivitis and periodontitis. Topics covered include the symptoms of these types of gum disease; how the dentist screens for gum disease; risk factors, including genetics, medications, smoking, pregnancy, and decreased immunity; and treatment options, such as scaling and root planing, antibiotic therapy, and surgery. The article concludes with a brief discussion on research and development of new treatment strategies. One sidebar summarizes daily tooth care recommendations. 6 figures.

Academic Periodicals covering Gum Disease Numerous periodicals are currently indexed within the National Library of Medicine’s PubMed database that are known to publish articles relating to gum disease. In addition to these sources, you can search for articles covering gum disease that have been published by any of the periodicals listed in previous chapters. To find the latest studies published, go to http://www.ncbi.nlm.nih.gov/pubmed, type the name of the periodical into the search box, and click “Go.” If you want complete details about the historical contents of a journal, you can also visit the following Web site: http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi. Here, type in the name of the journal or its abbreviation, and you will receive an index of published articles. At http://locatorplus.gov/, you can retrieve more indexing information on medical periodicals (e.g. the name of the publisher). Select the button “Search LOCATORplus.” Then type in the name of the journal and select the advanced search option “Journal Title Search.”

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CHAPTER 9. RESEARCHING MEDICATIONS Overview While a number of hard copy or CD-ROM resources are available for researching medications, a more flexible method is to use Internet-based databases. Broadly speaking, there are two sources of information on approved medications: public sources and private sources. We will emphasize free-to-use public sources.

U.S. Pharmacopeia Because of historical investments by various organizations and the emergence of the Internet, it has become rather simple to learn about the medications recommended for gum disease. One such source is the United States Pharmacopeia. In 1820, eleven physicians met in Washington, D.C. to establish the first compendium of standard drugs for the United States. They called this compendium the U.S. Pharmacopeia (USP). Today, the USP is a nonprofit organization consisting of 800 volunteer scientists, eleven elected officials, and 400 representatives of state associations and colleges of medicine and pharmacy. The USP is located in Rockville, Maryland, and its home page is located at http://www.usp.org/. The USP currently provides standards for over 3,700 medications. The resulting USP DI® Advice for the Patient® can be accessed through the National Library of Medicine of the National Institutes of Health. The database is partially derived from lists of federally approved medications in the Food and Drug Administration’s (FDA) Drug Approvals database, located at http://www.fda.gov/cder/da/da.htm. While the FDA database is rather large and difficult to navigate, the Phamacopeia is both user-friendly and free to use. It covers more than 9,000 prescription and over-the-counter medications. To access this database, simply type the following hyperlink into your Web browser: http://www.nlm.nih.gov/medlineplus/druginformation.html. To view examples of a given medication (brand names, category, description, preparation, proper use, precautions, side effects, etc.), simply follow the hyperlinks indicated within the United States Pharmacopeia (USP). Below, we have compiled a list of medications associated with gum disease. If you would like more information on a particular medication, the provided hyperlinks will direct you to ample documentation (e.g. typical dosage, side effects, drug-interaction risks, etc.). The

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following drugs have been mentioned in the Pharmacopeia and other sources as being potentially applicable to gum disease: Ascorbic Acid (Vitamin C) •

Systemic - U.S. Brands: Ascorbicap; Cecon; Cee-500; Cemill; Cenolate; Cetane; Cevi-Bid; Flavorcee; Ortho/CS; Sunkist http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202071.html

Chlorhexidine •

Implantation-Dental - U.S. Brands: PerioChip http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/203651.html

Doxycycline •

Dental - U.S. Brands: Atridox http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/203716.html

Doxycycline for Dental Use •

Systemic - U.S. Brands: Periostat http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/203724.html

Tetracycline Periodontal Fibers •

Dental - U.S. Brands: Actisite http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202729.html

Commercial Databases In addition to the medications listed in the USP above, a number of commercial sites are available by subscription to physicians and their institutions. Or, you may be able to access these sources from your local medical library.

Mosby’s Drug Consult™ Mosby’s Drug Consult™ database (also available on CD-ROM and book format) covers 45,000 drug products including generics and international brands. It provides prescribing information, drug interactions, and patient information. Subscription information is available at the following hyperlink: http://www.mosbysdrugconsult.com/.

PDRhealth The PDRhealth database is a free-to-use, drug information search engine that has been written for the public in layman’s terms. It contains FDA-approved drug information adapted from the Physicians’ Desk Reference (PDR) database. PDRhealth can be searched by brand name, generic name, or indication. It features multiple drug interactions reports. Search PDRhealth at http://www.pdrhealth.com/drug_info/index.html.

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Other Web Sites Drugs.com (www.drugs.com) reproduces the information in the Pharmacopeia as well as commercial information. You may also want to consider the Web site of the Medical Letter, Inc. (http://www.medletter.com/) which allows users to download articles on various drugs and therapeutics for a nominal fee. If you have any questions about a medical treatment, the FDA may have an office near you. Look for their number in the blue pages of the phone book. You can also contact the FDA through its toll-free number, 1-888-INFO-FDA (1-888-463-6332), or on the World Wide Web at www.fda.gov.

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APPENDICES

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APPENDIX A. PHYSICIAN RESOURCES Overview In this chapter, we focus on databases and Internet-based guidelines and information resources created or written for a professional audience.

NIH Guidelines Commonly referred to as “clinical” or “professional” guidelines, the National Institutes of Health publish physician guidelines for the most common diseases. Publications are available at the following by relevant Institute11: •

Office of the Director (OD); guidelines consolidated across agencies available at http://www.nih.gov/health/consumer/conkey.htm

•

National Institute of General Medical Sciences (NIGMS); fact sheets available at http://www.nigms.nih.gov/news/facts/

•

National Library of Medicine (NLM); extensive encyclopedia (A.D.A.M., Inc.) with guidelines: http://www.nlm.nih.gov/medlineplus/healthtopics.html

•

National Cancer Institute (NCI); guidelines available at http://www.cancer.gov/cancerinfo/list.aspx?viewid=5f35036e-5497-4d86-8c2c714a9f7c8d25

•

National Eye Institute (NEI); guidelines available at http://www.nei.nih.gov/order/index.htm

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National Heart, Lung, and Blood Institute (NHLBI); guidelines available at http://www.nhlbi.nih.gov/guidelines/index.htm

•

National Human Genome Research Institute (NHGRI); research available at http://www.genome.gov/page.cfm?pageID=10000375

•

National Institute on Aging (NIA); guidelines available at http://www.nia.nih.gov/health/

11

These publications are typically written by one or more of the various NIH Institutes.

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•

National Institute on Alcohol Abuse and Alcoholism (NIAAA); guidelines available at http://www.niaaa.nih.gov/publications/publications.htm

•

National Institute of Allergy and Infectious Diseases (NIAID); guidelines available at http://www.niaid.nih.gov/publications/

•

National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS); fact sheets and guidelines available at http://www.niams.nih.gov/hi/index.htm

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National Institute of Child Health and Human Development (NICHD); guidelines available at http://www.nichd.nih.gov/publications/pubskey.cfm

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National Institute on Deafness and Other Communication Disorders (NIDCD); fact sheets and guidelines at http://www.nidcd.nih.gov/health/

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National Institute of Dental and Craniofacial Research (NIDCR); guidelines available at http://www.nidr.nih.gov/health/

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National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK); guidelines available at http://www.niddk.nih.gov/health/health.htm

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National Institute on Drug Abuse (NIDA); guidelines available at http://www.nida.nih.gov/DrugAbuse.html

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National Institute of Environmental Health Sciences (NIEHS); environmental health information available at http://www.niehs.nih.gov/external/facts.htm

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National Institute of Mental Health (NIMH); guidelines available at http://www.nimh.nih.gov/practitioners/index.cfm

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National Institute of Neurological Disorders and Stroke (NINDS); neurological disorder information pages available at http://www.ninds.nih.gov/health_and_medical/disorder_index.htm

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National Institute of Nursing Research (NINR); publications on selected illnesses at http://www.nih.gov/ninr/news-info/publications.html

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National Institute of Biomedical Imaging and Bioengineering; general information at http://grants.nih.gov/grants/becon/becon_info.htm

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Center for Information Technology (CIT); referrals to other agencies based on keyword searches available at http://kb.nih.gov/www_query_main.asp

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National Center for Complementary and Alternative Medicine (NCCAM); health information available at http://nccam.nih.gov/health/

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National Center for Research Resources (NCRR); various information directories available at http://www.ncrr.nih.gov/publications.asp

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Office of Rare Diseases; various fact sheets available at http://rarediseases.info.nih.gov/html/resources/rep_pubs.html

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Centers for Disease Control and Prevention; various fact sheets on infectious diseases available at http://www.cdc.gov/publications.htm

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NIH Databases In addition to the various Institutes of Health that publish professional guidelines, the NIH has designed a number of databases for professionals.12 Physician-oriented resources provide a wide variety of information related to the biomedical and health sciences, both past and present. The format of these resources varies. Searchable databases, bibliographic citations, full-text articles (when available), archival collections, and images are all available. The following are referenced by the National Library of Medicine:13 •

Bioethics: Access to published literature on the ethical, legal, and public policy issues surrounding healthcare and biomedical research. This information is provided in conjunction with the Kennedy Institute of Ethics located at Georgetown University, Washington, D.C.: http://www.nlm.nih.gov/databases/databases_bioethics.html

•

HIV/AIDS Resources: Describes various links and databases dedicated to HIV/AIDS research: http://www.nlm.nih.gov/pubs/factsheets/aidsinfs.html

•

NLM Online Exhibitions: Describes “Exhibitions in the History of Medicine”: http://www.nlm.nih.gov/exhibition/exhibition.html. Additional resources for historical scholarship in medicine: http://www.nlm.nih.gov/hmd/hmd.html

•

Biotechnology Information: Access to public databases. The National Center for Biotechnology Information conducts research in computational biology, develops software tools for analyzing genome data, and disseminates biomedical information for the better understanding of molecular processes affecting human health and disease: http://www.ncbi.nlm.nih.gov/

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Population Information: The National Library of Medicine provides access to worldwide coverage of population, family planning, and related health issues, including family planning technology and programs, fertility, and population law and policy: http://www.nlm.nih.gov/databases/databases_population.html

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Cancer Information: Access to cancer-oriented databases: http://www.nlm.nih.gov/databases/databases_cancer.html

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Profiles in Science: Offering the archival collections of prominent twentieth-century biomedical scientists to the public through modern digital technology: http://www.profiles.nlm.nih.gov/

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Chemical Information: Provides links to various chemical databases and references: http://sis.nlm.nih.gov/Chem/ChemMain.html

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Clinical Alerts: Reports the release of findings from the NIH-funded clinical trials where such release could significantly affect morbidity and mortality: http://www.nlm.nih.gov/databases/alerts/clinical_alerts.html

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Space Life Sciences: Provides links and information to space-based research (including NASA): http://www.nlm.nih.gov/databases/databases_space.html

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MEDLINE: Bibliographic database covering the fields of medicine, nursing, dentistry, veterinary medicine, the healthcare system, and the pre-clinical sciences: http://www.nlm.nih.gov/databases/databases_medline.html

12

Remember, for the general public, the National Library of Medicine recommends the databases referenced in MEDLINEplus (http://medlineplus.gov/ or http://www.nlm.nih.gov/medlineplus/databases.html). 13 See http://www.nlm.nih.gov/databases/databases.html.

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Toxicology and Environmental Health Information (TOXNET): Databases covering toxicology and environmental health: http://sis.nlm.nih.gov/Tox/ToxMain.html

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Visible Human Interface: Anatomically detailed, three-dimensional representations of normal male and female human bodies: http://www.nlm.nih.gov/research/visible/visible_human.html The Combined Health Information Database

A comprehensive source of information on clinical guidelines written for professionals is the Combined Health Information Database. You will need to limit your search to one of the following: Brochure/Pamphlet, Fact Sheet, or Information Package, and “gum disease” using the “Detailed Search” option. Go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. To find associations, use the drop boxes at the bottom of the search page where “You may refine your search by.” For the publication date, select “All Years.” Select your preferred language and the format option “Fact Sheet.” Type “gum disease” (or synonyms) into the “For these words:” box. The following is a sample result: •

Special Report: American Council on Science and Health Presents Dubious Dental Care Source: New York, NY: American Council on Science and Health (ACSH). 1991. 17 p. Contact: Available from American Council on Science and Health. 1995 Broadway, 16th Floor, New York, NY 10023-5860. (212) 362-7044. PRICE: $3.85; bulk prices available. Summary: The American Council on Science and Health (ACSH) believes that deleterious or fraudulent dental care poses a substantial risk for the American public. This ACSH report identifies the main problem areas and suggests what can be done about them. Topics covered include genuine versus dubious dental credentials; controversial care, including Sargenti root canal therapy, Keyes gum disease treatment, and inappropriate temporomandibular joint disorder therapy; and other problem areas, including improper implants, dubious claims for bonding, do-it-yourself bleaching, silver-amalgam toxicity, holistic dentistry, nutrition quackery, applied kinesiology, cranial osteopathy, auriculotherapy, and reflexology. An additional section discusses the promotion of dubious dentistry, including the role of the media. The booklet concludes with a list of ACSH recommendations regarding dubious dentistry. 30 references.

The NLM Gateway14 The NLM (National Library of Medicine) Gateway is a Web-based system that lets users search simultaneously in multiple retrieval systems at the U.S. National Library of Medicine (NLM). It allows users of NLM services to initiate searches from one Web interface, providing one-stop searching for many of NLM’s information resources or databases.15 To use the NLM Gateway, simply go to the search site at http://gateway.nlm.nih.gov/gw/Cmd. Type “gum disease” (or synonyms) into the search box and click “Search.” The results will be presented in a tabular form, indicating the number of references in each database category. 14 15

Adapted from NLM: http://gateway.nlm.nih.gov/gw/Cmd?Overview.x.

The NLM Gateway is currently being developed by the Lister Hill National Center for Biomedical Communications (LHNCBC) at the National Library of Medicine (NLM) of the National Institutes of Health (NIH).

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Results Summary Category Journal Articles Books / Periodicals / Audio Visual Consumer Health Meeting Abstracts Other Collections Total

Items Found 15592 42 938 3 0 16575

HSTAT16 HSTAT is a free, Web-based resource that provides access to full-text documents used in healthcare decision-making.17 These documents include clinical practice guidelines, quickreference guides for clinicians, consumer health brochures, evidence reports and technology assessments from the Agency for Healthcare Research and Quality (AHRQ), as well as AHRQ’s Put Prevention Into Practice.18 Simply search by “gum disease” (or synonyms) at the following Web site: http://text.nlm.nih.gov.

Coffee Break: Tutorials for Biologists19 Coffee Break is a general healthcare site that takes a scientific view of the news and covers recent breakthroughs in biology that may one day assist physicians in developing treatments. Here you will find a collection of short reports on recent biological discoveries. Each report incorporates interactive tutorials that demonstrate how bioinformatics tools are used as a part of the research process. Currently, all Coffee Breaks are written by NCBI staff.20 Each report is about 400 words and is usually based on a discovery reported in one or more articles from recently published, peer-reviewed literature.21 This site has new articles every few weeks, so it can be considered an online magazine of sorts. It is intended for general background information. You can access the Coffee Break Web site at the following hyperlink: http://www.ncbi.nlm.nih.gov/Coffeebreak/.

16

Adapted from HSTAT: http://www.nlm.nih.gov/pubs/factsheets/hstat.html.

17

The HSTAT URL is http://hstat.nlm.nih.gov/.

18

Other important documents in HSTAT include: the National Institutes of Health (NIH) Consensus Conference Reports and Technology Assessment Reports; the HIV/AIDS Treatment Information Service (ATIS) resource documents; the Substance Abuse and Mental Health Services Administration's Center for Substance Abuse Treatment (SAMHSA/CSAT) Treatment Improvement Protocols (TIP) and Center for Substance Abuse Prevention (SAMHSA/CSAP) Prevention Enhancement Protocols System (PEPS); the Public Health Service (PHS) Preventive Services Task Force's Guide to Clinical Preventive Services; the independent, nonfederal Task Force on Community Services’ Guide to Community Preventive Services; and the Health Technology Advisory Committee (HTAC) of the Minnesota Health Care Commission (MHCC) health technology evaluations. 19 Adapted from http://www.ncbi.nlm.nih.gov/Coffeebreak/Archive/FAQ.html. 20 The figure that accompanies each article is frequently supplied by an expert external to NCBI, in which case the source of the figure is cited. The result is an interactive tutorial that tells a biological story. 21 After a brief introduction that sets the work described into a broader context, the report focuses on how a molecular understanding can provide explanations of observed biology and lead to therapies for diseases. Each vignette is accompanied by a figure and hypertext links that lead to a series of pages that interactively show how NCBI tools and resources are used in the research process.

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Other Commercial Databases In addition to resources maintained by official agencies, other databases exist that are commercial ventures addressing medical professionals. Here are some examples that may interest you: •

CliniWeb International: Index and table of contents to selected clinical information on the Internet; see http://www.ohsu.edu/cliniweb/.

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Medical World Search: Searches full text from thousands of selected medical sites on the Internet; see http://www.mwsearch.com/.

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APPENDIX B. PATIENT RESOURCES Overview Official agencies, as well as federally funded institutions supported by national grants, frequently publish a variety of guidelines written with the patient in mind. These are typically called “Fact Sheets” or “Guidelines.” They can take the form of a brochure, information kit, pamphlet, or flyer. Often they are only a few pages in length. Since new guidelines on gum disease can appear at any moment and be published by a number of sources, the best approach to finding guidelines is to systematically scan the Internet-based services that post them.

Patient Guideline Sources The remainder of this chapter directs you to sources which either publish or can help you find additional guidelines on topics related to gum disease. Due to space limitations, these sources are listed in a concise manner. Do not hesitate to consult the following sources by either using the Internet hyperlink provided, or, in cases where the contact information is provided, contacting the publisher or author directly. The National Institutes of Health The NIH gateway to patients is located at http://health.nih.gov/. From this site, you can search across various sources and institutes, a number of which are summarized below. Topic Pages: MEDLINEplus The National Library of Medicine has created a vast and patient-oriented healthcare information portal called MEDLINEplus. Within this Internet-based system are “health topic pages” which list links to available materials relevant to gum disease. To access this system, log on to http://www.nlm.nih.gov/medlineplus/healthtopics.html. From there you can either search using the alphabetical index or browse by broad topic areas. Recently, MEDLINEplus listed the following when searched for “gum disease”:

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Guides on gum disease Gum Disease http://www.nlm.nih.gov/medlineplus/gumdisease.html

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Other guides Child Dental Health http://www.nlm.nih.gov/medlineplus/childdentalhealth.html Cosmetic Dentistry http://www.nlm.nih.gov/medlineplus/cosmeticdentistry.html Dental Health http://www.nlm.nih.gov/medlineplus/dentalhealth.html Heart Diseases http://www.nlm.nih.gov/medlineplus/heartdiseases.html Tooth Disorders http://www.nlm.nih.gov/medlineplus/toothdisorders.html

Within the health topic page dedicated to gum disease, the following was listed: •

General/Overviews Fighting Gum Disease: How to Keep Your Teeth Source: Food and Drug Administration http://www.fda.gov/fdac/features/2002/302_gums.html General Periodontal Questions Source: American Academy of Periodontology http://www.perio.org/consumer/faq.htm What Are Periodontal Diseases? Source: American Academy of Periodontology http://www.perio.org/consumer/2a.html

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Diagnosis/Symptoms Tooth Problems: Self-Care Flowcharts Source: American Academy of Family Physicians http://familydoctor.org/flowcharts/511.html

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Treatment Blade-Free Radiosurgery Offers New Cosmetic and Surgery Source: Academy of General Dentistry http://www.agd.org/consumer/topics/technology/radiosurgery.html Periodontal Procedures Source: American Academy of Periodontology http://www.perio.org/consumer/procedures.htm

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Specific Conditions/Aspects Endocarditis Prophylaxis Information Source: American Heart Association http://www.americanheart.org/presenter.jhtml?identifier=11086 Facts and Fallacies About Periodontal Disease Source: American Academy of Periodontology http://www.perio.org/consumer/f1.html Mouth-Body Connection Source: American Academy of Periodontology http://www.perio.org/consumer/mbc.top2.htm Pericoronitis Source: InteliHealth, University of Pennsylvania, School of Dental Medicine http://www.simplestepsdental.com/SS/ihtSS/r.WSIHW000/st.32219/t.29748/pr.3 .html Periodontitis Source: Mayo Foundation for Medical Education and Research http://www.mayoclinic.com/invoke.cfm?id=DS00369 Prevent Diabetes Problems: Keep Your Teeth and Gums Healthy Source: National Diabetes Information Clearinghouse http://diabetes.niddk.nih.gov/dm/pubs/complications_teeth/index.htm Tobacco Use and Periodontal Disease Source: American Academy of Periodontology http://www.perio.org/consumer/smoking.htm Trench Mouth Source: Mayo Foundation for Medical Education and Research http://www.mayoclinic.com/invoke.cfm?id=DS00457 What is Gingivitis? Source: Mayo Foundation for Medical Education and Research http://www.mayoclinic.com/invoke.cfm?id=DS00363

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Children Protecting Children's Oral Health Source: American Academy of Periodontology http://www.perio.org/consumer/children.htm

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From the National Institutes of Health Periodontal (Gum) Diseases Source: National Institute of Dental and Craniofacial Research http://www.nidcr.nih.gov/health/newsandhealth/gumDiseasesPub.asp Special Care in Oral Health Source: National Institute of Dental and Craniofacial Research http://www.nohic.nidcr.nih.gov/special_care.html

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Men Women and Periodontal Disease: Protecting Oral Health Throughout Your Life Source: American Academy of Periodontology http://www.perio.org/consumer/women.htm

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Organizations American Academy of Periodontology http://www.perio.org/ American Dental Association http://www.ada.org/ National Institute of Dental and Craniofacial Research http://www.nidcr.nih.gov/

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Prevention/Screening Oral Health: Preventing Cavities, Gum Disease, and Mouth and Throat Cancer Source: Centers for Disease Control and Prevention http://www.cdc.gov/nccdphp/aag/aag_oh.htm Preventing Periodontal Disease Source: American Dental Association http://www.ada.org/prof/resources/pubs/jada/patient/patient_08.pdf

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Research Periodontal Disease Increases Risk of Preeclampsia Source: American College of Obstetricians and Gynecologists http://www.medem.com/medlb/article_detaillb.cfm?article_ID=ZZZCKHVGSBD &sub_cat=2 Scientists Report Important Lead in Studying Possible Association Between Periodontal and Cardiovascular Disease Source: National Institute of Dental and Craniofacial Research http://www.nidcr.nih.gov/news/08042003.asp

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Statistics FASTATS: Oral Health Source: National Center for Health Statistics http://www.cdc.gov/nchs/fastats/dental.htm National Oral Health Surveillance System Source: Centers for Disease Control and Prevention http://www.cdc.gov/nohss/

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Teenagers Gum Disease Source: Nemours Foundation http://kidshealth.org/teen/diseases_conditions/mouth/gum_disease.html

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Women Women and Periodontal Disease: Protecting Oral Health Throughout Your Life Source: American Academy of Periodontology http://www.perio.org/consumer/women.htm

You may also choose to use the search utility provided by MEDLINEplus at the following Web address: http://www.nlm.nih.gov/medlineplus/. Simply type a keyword into the search box and click “Search.” This utility is similar to the NIH search utility, with the exception that it only includes materials that are linked within the MEDLINEplus system (mostly patient-oriented information). It also has the disadvantage of generating unstructured results. We recommend, therefore, that you use this method only if you have a very targeted search. The Combined Health Information Database (CHID) CHID Online is a reference tool that maintains a database directory of thousands of journal articles and patient education guidelines on gum disease. CHID offers summaries that describe the guidelines available, including contact information and pricing. CHID’s general Web site is http://chid.nih.gov/. To search this database, go to http://chid.nih.gov/detail/detail.html. In particular, you can use the advanced search options to look up pamphlets, reports, brochures, and information kits. The following was recently posted in this archive: •

What You Need to Know About Gum Disease and Your Health Source: Phoenix, AZ: SmartPractice. 199x. [4 p.]. Contact: Available from SmartPractice. 3400 East McDowell, Phoenix, AZ 85008. (800) 522-0800. Fax (800) 522-8329. Website: www.smartpractice.com. PRICE: $34.00 for 100 brochures, plus shipping and handling. Summary: Good oral hygiene and regular professional care are the keys to preventing periodontal disease. This patient education brochure outlines facts about gum disease and general health. The brochure first describes gum disease and how it develops, then summarizes the impact of gum disease on general health, on the cardiovascular (heart) system, on patients with diabetes, on respiratory diseases, and specific concerns for women. Gum disease is caused by plaque, a colorless film of bacteria that forms on the teeth. Without daily removal, plaque hardens to form calculus (tartar) around the teeth. This process caused the gums to pull away from the teeth, creating pockets that become filled with plaque. These pockets may become deeper over time, destroying the bone structure that supports the teeth, thus resulting in tooth loss. The brochure notes that up to 90 percent of all systemic diseases including kidney disease, diabetes, and heart disease have links to oral health. For women, hormonal changes throughout life can affect many tissues in the body, including gum tissue; these changes call for special care of one's oral health. The brochure concludes by encouraging patients to work closely with their dentists to diagnose gum disease in its early stages or to prevent it altogether. A list of recommended oral hygiene strategies, including regular dental care, toothbrushing and flossing, and use of fluoride, is also provided. The brochure includes space for personalization by the dental office. The brochure is illustrated with full color graphics and photographs of smiling patients. 4 figures.

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Dealing with Gum Disease: A Life-Threatening Health Risk Source: Chicago, IL: American Dental Hygienists' Association. 2001. [2 p.]. Contact: American Dental Hygienists' Association. 444 North Michigan Avenue, Suite 3400, Chicago, IL 60611. (312) 440-8900. E-mail: [email protected]. Website: www.adha.org. PRICE: $.75 for 24 fact sheets; $.50 for 25 plus fact sheets; $.25 for 100 plus fact sheets; plus shipping and handling. Summary: Nearly 75 percent of American adults have various forms of undiagnosed periodontal (gum) disease. Though reversible in its initial stages, mounting evidence of the relationship between oral bacteria and life threatening diseases makes it critical that the condition be prevented or treated aggressively. This consumer fact sheet from the American Dental Hygienists' Association (ADHA) explains the role of oral health in heart disease, diabetes, respiratory ailments, low birthweight, and other serious conditions. For each condition, the fact sheet offers statistics about incidence and complications, and briefly summarizes research on the relationship between that condition and oral health. The contact information for reaching the ADHA is provided (www.adha.org; 800-847-6718). The full color fact sheet is made possible by an educational grant from Procter and Gamble; the fact sheet uses the Crest logo. 3 figures.

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Preventing and Treating Periodontal Diseases Source: Chicago, IL: American Dental Association (ADA). 1998. [4 p.]. Contact: Available from American Dental Association (ADA). Catalog Sales, P.O. Box 776, St. Charles, IL 60174. (800) 947-4746. Fax (888) 476-1880 or (630) 443-9970. Website: www.ada.org. PRICE: $19.00 for 50; nonmembers add 50 percent; bulk rates available. Item number W646. Summary: Periodontal (gum) disease is a condition in which bacteria attack the tissues that surround and support teeth. This brochure describes the use of scaling and root planing to prevent or treat the early stages of periodontal diseases. The brochure begins with a list of the common warning signs of periodontal diseases. The brochure then discusses the causes of periodontal diseases, how periodontal diseases are diagnosed, and prevention and treatment options. Scaling is used to remove plaque and tartar beneath the gumline with a small scaler or ultrasonic cleaner. The tooth's root surfaces are then smoothed or planed to allow the gum tissue to heal and reattach to the tooth. Once the scaling and root planing treatment is complete, another appointment will be made so the dentist can check how the gums have healed and how the periodontal pockets have decreased. When pockets greater than 3 mm persist after root planing and scaling, additional treatment may be needed. The brochure is illustrated with line drawings and full color photographs of gingivitis and of healthy gums. 10 figures.

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Ask Your Periodontist About Periodontal Disease and Heart Disease Source: Chicago, IL: American Academy of Periodontology. 1999. [5 p.]. Contact: Available from American Academy of Periodontology. Suite 800, 737 North Michigan Avenue, Chicago, IL 60611-2690. Website: www.perio.org. PRICE: Single copy free. Summary: Periodontal disease (also known as gum disease) is a bacterial infection of the gums, bone and periodontal ligament (attachment fibers that support the teeth and hold them in the jaw). Recent research is showing a link between heart diseases and periodontal disease. This patient education brochure informs patients about these risks

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and encourages them to take precautions before dental treatment. The brochure emphasizes that taking care of one's periodontal health may be an important step toward prevention of heart disease, along with controlling the other well known risk factors for cardiovascular disease. The brochure describes the precautions that should be taken before dental treatment, to help limit the entry of bacteria into the blood stream during dental procedures. The brochure includes an insert that requests patients to list specific drugs that they are taking; the insert can then be given to the dentist or periodontist, who will work with the patient to minimize any potentially negative effects of the dental treatment. 1 figure. •

Orally Balanced Enzyme System For Reduction of Cavities, Plaque and Gum Disease Due to Xerostomia Source: Gardena, CA: Laclede Research Laboratories. 199x. 6 p. Contact: Available from Laclede Research Laboratories. 15011 Staff Court, Gardena, CA 90248. (800) 922-5856 or (310) 515-1430; Fax (310) 515-1154; E-mail: [email protected]; http://www.laclede.com. PRICE: Single copy free. Summary: This brochure describes the Biotene system of oral care for reduction of cavities, plaque, and gum disease related to xerostomia (dry mouth). The Biotene products described include dry mouth toothpaste, a supersoft toothbrush, alcohol-free mouthwash, dental chewing gum, and a moisturizing gel. Each product (except the toothbrush) contains anti-bacterial enzymes to help prevent oral infections and gum disease. The products are sweetened with xylitol. The brochure describes each product and illustrates each with a full-color photograph. One figure shows the basic anatomy of the glands and another set of photographs shows the gum line of a patient before and after using Biotene toothpaste for two weeks. The brochure describes how the Biotene enzyme system enhances the mouth's natural defense mechanisms by supplementing the supply of key enzymes and substrates. A final section reminds readers of the importance of saliva in protecting the mouth and dentition. 5 figures. 1 table.

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Women and Gum Disease Source: Chicago, IL: American Dental Association (ADA). 1998. [4 p.]. Contact: Available from American Dental Association (ADA). Catalog Sales, P.O. Box 776, St. Charles, IL 60174. (800) 947-4746. Fax (888) 476-1880 or (630) 443-9970. Website: www.ada.org. PRICE: $18.00 for 50; nonmembers add 50 percent; bulk rates available. Item number P081. Summary: This brochure discusses some of the special dental needs that women may face at different stages of life. Puberty, menstruation, pregnancy, and menopause can each influence oral health and the need for dental treatment. During these times, the body experiences hormonal changes that can make the gums sensitive and increase the risk for gum disease. The brochure describes gum disease (periodontal disease) and its causes, prevention, and treatment. The brochure then briefly reviews specific concerns for each of the stages of life noted above. The brochure concludes by reminding readers that it is dental plaque (not changing hormone levels) that is the major cause of periodontal disease. The brochure offers a list of strategies to prevent periodontal disease, noting that these techniques may be even more important during a woman's higher risk times. Understanding these unique dental needs can help promote good dental habits. 5 figures.

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Women and Gum Disease: Your Unique Oral Health Needs Source: Chicago, IL: American Academy of Periodontology. 1996. [4 p.]. Contact: Available from American Academy of Periodontology. Sales and Marketing Department, 737 North Michigan Avenue, Suite 800, Chicago, IL 60611-2690. (312) 5733253; Fax (312) 787-3670; E-mail: [email protected]; http://www.perio.org. PRICE: $20.00 per 50 copies; bulk rates available. Summary: This brochure discusses the unique dental health needs and concerns of women, focusing on the prevention of gum disease. Topics include a definition of periodontal (gum) disease; the role of home oral care, including toothbrushing and flossing; and the physiological changes of each stage of a woman's life, including puberty, menstruation, pregnancy, and menopause. The brochure discusses the symptoms and changes of gums and gum disease during each stage. Specific topics covered include hormonal changes; gingivitis during menstruation; gingivitis, dental care, and tumors during pregnancy; oral contraceptives; and menopausal gingivostomatitis.

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Women and Periodontal Disease Source: Chicago, IL: American Academy of Periodontology. 1998. [4 p.]. Contact: Available from American Academy of Periodontology. 737 North Michigan Avenue, Suite 800, Chicago, IL 60611-2690. Website: www.perio.org. PRICE: $39.00 for 100, plus shipping and handling. Summary: This brochure offers information for women about periodontal diseases (gum disease), chronic bacterial infections that can damage the gums and bone supporting the teeth. Left untreated, periodontal diseases can lead to tooth loss. The brochure describes how periodontal disease develops from plaque buildup, then notes that other factors can affect the health of the gums and the bone supporting the teeth. Smoking and tobacco use, stress, medications, diabetes and other systemic diseases, poor nutrition, clenching or grinding the teeth, and hormonal fluctuations are some of these factors. The brochure then outlines specific concerns for women during different times of life: puberty and menstruation, during pregnancy and during the use of oral contraceptives, and during menopause. The symptoms that a woman might experience during each of these times are outlined. The brochure focuses on the ongoing healthy mouth habits of good oral hygiene, brushing, and flossing, as well as the need for overall good health. Simple graphics illustrate the brochure.

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Periodontal Disease in Children: Healthy Gums Source: Chicago, IL: American Society of Dentistry for Children. 1990. [2 p.]. Contact: Available from American Society of Dentistry for Children. 875 North Michigan Avenue, Suite 4040, Chicago, IL 60611-1901. Voice (800) 637-ASDC; Fax (312) 943-5341. PRICE: $40.00 per 100 copies (nonmembers); $28.00 per 100 copies (members); shipping and handling additional. Item Number B1090. Summary: This brochure on gum disease in children is published by the American Society of Dentistry for Children as part of a series of 12 brochures on dental health for children. Topics covered include a description and definition of gum disease, signs of gum disease, the cause of gum disease, common conditions that can cause plaque to form, and the role of proper nutrition. The brochure includes a list of the other items in the series.

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Gum Disease: Are You At Risk? Source: Chicago, IL: American Dental Association (ADA). 1991. [4 p.]. Contact: Available from American Dental Association (ADA). Catalog Sales, P.O. Box 776, St. Charles, IL 60174. (800) 947-4746; Fax (630) 443-9970; http://www.ada.org. PRICE: $19.00 for 50 copies; nonmembers add 50 percent; bulk orders available. Order Number W172. Summary: This brochure provides answers to some commonly asked questions about gum disease (periodontal disease). Topics include a description of periodontal disease, including gingivitis and periodontitis; the causes of gum disease; the symptoms of gum disease; times when gum disease is more likely to occur, such as puberty or pregnancy, and when certain lifestyle risks are present; how the dentist diagnoses gum disease; what patients can do to prevent gum disease; and how and by whom gum disease is treated. The brochure is illustrated with small photographs of patients representing various ethnic groups.

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Diabetes and Gum Disease Source: Chicago, IL: American Academy of Periodontology. 1995. 6 p. Contact: Available from American Academy of Periodontology. Sales and Marketing Department, Suite 800, 737 North Michigan Avenue, Chicago, IL 60611. (312) 573-3253. Fax (312) 787-3670. PRICE: $34 per 100 brochures, plus shipping and handling. Summary: This brochure provides readers with information about diabetes and gum disease. Topics include why oral health is so important to people who have diabetes; a definition of periodontal disease; oral conditions for which people with diabetes are at higher risk, including delayed wound healing, decreased or diminished flow of saliva, burning sensation in the mouth or on the tongue, and increased sugars in the gingival fluid; steps to take to prevent gum disease; managing periodontal disease; and monitoring oral health. The brochure concludes that, with careful attention to at-home oral hygiene and regular dental visits, periodontal infection should never play a major role in diabetes.

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Keep Your Teeth for Life: Prevent Gum Disease Source: Augusta, ME: Maine Department of Human Services, Bureau of Health, Division of Dental Health. 1992. 2 p. Contact: Available from Maine Department of Human Services, Bureau of Health, Division of Dental Health. State House Station 11, Augusta, ME 04333. (207) 287-2361 or (207) 287-3121. PRICE: Single copy free. Summary: This brochure reviews basic facts about gum disease and its prevention. The brochure describes the symptoms of gum disease; the causes of gum disease; and tips for preventing gum disease, including daily oral hygiene, toothbrushing, the use of dental floss, the use of fluoride toothpastes, and the role of regular dental care. The brochure is written in clear, easy-to-understand language and concludes with a summary of the concepts discussed.

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Periodontal Diseases: What You Need to Know Source: Chicago, IL: American Academy of Periodontology. 1996. 10 p.

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Contact: Available from American Academy of Periodontology. 737 North Michigan Avenue, Suite 800, Chicago, IL 60611-2690. (312) 787-5518. Fax (312) 787-3670. Website: www.perio.org. PRICE: Single copy free; bulk orders available. Summary: This brochure uses a question and answer format to provide information on periodontal diseases, which are bacterial gum infections that destroy the attachment fibers and supporting bone that hold the teeth in the mouth. The most common forms of periodontal disease are gingivitis, mild periodontitis, and moderate-advanced periodontitis. Although plaque is the main cause of periodontal disease, other factors such as smoking or tobacco use, pregnancy and puberty, stress, medications, clenching or grinding the teeth, diabetes, poor nutrition, and systemic diseases, can affect gum health. The brochure lists the symptoms of periodontal disease and discusses their prevention and treatment. It also includes four inserts that explain the relationship between periodontal disease and respiratory disease, pregnancy outcomes, diabetes, and heart disease. 6 figures. •

What Do these Words Have in Common?: Gum Disease, Nicotine, Stained Teeth, Cancer, Bad Breath Source: Timonium, MD: American Lung Association of Maryland. 1993. 2 p. Contact: Available from American Lung Association of Maryland. 1840 York Road, Timonium, MD 21093. (800) 492-7527 (in Maryland) or (410) 560-2120. Also available from local American Lung Association chapters. PRICE: Single copy free. Stock Number 0606 8/93. Summary: This brochure, aimed at young adolescents, provides facts that encourage readers to avoid the use of smokeless tobacco. The brochure notes the different names used for smokeless tobacco and stresses that tobacco in any form is still tobacco, with the accompanying risks. Topics discussed include nicotine addiction, cancer, problems with bad breath, the impact of tobacco on the taste buds, and cost factors. The brochure includes a section of questions and answers on topics including: why some sports stars chew tobacco; the myth that smokeless tobacco is safer than smoking cigarettes; tobacco company ads; and legislation and warning labels on smokeless tobacco. The brochure concludes with a section of replies that young readers can use when someone offers them a chaw of tobacco. The brochure is illustrated with line drawings of young male adolescents and smokeless tobacco products.

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Periodontal Disease: Be Tested to See if You Have It Source: Chicago, IL: American Academy of Periodontology (AAP). 1996. [4 p.]. Contact: Available from American Academy of Periodontology. 737 North Michigan Avenue, Suite 737, Chicago, IL 60611-2690. (312) 573-3253; Fax (312) 787-3670; E-mail: [email protected]; http://www.perio.org. PRICE: $37.00 per 100 copies; bulk rates available. Summary: This brochure, from a series of patient education brochures produced by the American Academy of Periodontology, provides an introduction to periodontal disease and its detection. Written in question and answer format, the brochure covers the importance of testing for gum disease, the technique of periodontal probing, checking oneself for gum disease, the warning signs of gum disease, the causes of gum disease, and the prevention of gum disease. The brochure includes simple line drawings illustrating the concepts discussed.

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Xerostomia: Dry Mouth, The Hidden Cause of Gum Disease and Tooth Loss in 3 of Every 10 Adults Source: Gardena, CA: Laclede Research Laboratories. 199x. 1 p. Contact: Available from Laclede Research Laboratories. 15011 Staff Court, Gardena, CA 90248. (800) 922-5856 or (310) 515-1430; Fax (310) 515-1154; E-mail: [email protected]; http://www.laclede.com. PRICE: Single copy free. Summary: This fact sheet lists examples of some drugs that can contribute to xerostomia (dry mouth). The brand names and generic names are listed for drugs in the following categories: anorexiant, anti-acne, anti-anxiety, anti-cholinergic (and anti-spasmodic), anti-convulsant, anti-depressant, anti-diarrheal, antihistamine, anti-hypertensive, antiinflammatory analgesic, anti-nauseant, anti-Parkinsonian, anti-psychotic, bronchodilator, decongestant, diuretic, muscle relaxant, narcotic analgesic, and sedative. The fact sheet also lists common causes of dry mouth: medications, radiation therapy, diabetes, stress and depression, and autoimmune disorders. The fact sheet features three small color photographs of some products designed to manage xerostomia, including dry mouth toothpaste, dental chewing gum, antibacterial mouthwash, and moisturizing gel. These products are manufactured by Laclede Research Laboratories, the company that printed this fact sheet. 3 figures.

•

Preventing Periodontal Disease Source: JADA. Journal of the American Dental Association. 132(9): 1339. September 2001. Contact: Available from American Dental Association. ADA Publishing Co, Inc., 211 East Chicago Avenue, Chicago, IL 60611. (312) 440-2867. Website: www.ada.org. Summary: This fact sheet on preventing periodontal disease is designed to be photocopied and distributed by dentists and dental care providers. The fact sheet notes that many adults develop some type of periodontal (the gums and other structures that hold the teeth) disease. There is some evidence that links periodontal diseases with other health concerns such as cardiovascular problems, stroke, bacterial pneumonia, and increased risk during pregnancy. The fact sheet reviews the known causes of gum disease, emphasizing the importance of daily removal of plaque (the sticky film of bacteria that constantly forms on teeth). If plaque is not removed with thorough daily brushing and cleaning between teeth, gums become irritated and inflamed (gingivitis). The irritated gum tissue can separate from the teeth and form spaces called pockets. Bacteria move into the pockets, where they continue to promote irritation. Left untreated, the process can continue until the bone and other tooth supporting tissues are destroyed. The early stage of periodontal disease is called gingivitis; this stage is usually reversible. The fact sheet emphasizes the importance of prevention through regular check ups and daily dental care. The fact sheet concludes with a list of the warning signs of gum disease, which include gums that bleed during brushing, red or swollen gums, gums that have pulled away from the teeth, persistent bad breath, pus between the teeth and gums, loose or separating teeth, a change in the way the teeth fit together when they are closed, a change in the fit of partial dentures.

•

Oral health: Preventing cavities, gum disease, and mouth and throat cancer Source: Atlanta, GA: Centers for Disease Control and Prevention. 2003. 4 pp. Contact: Available from Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Division of Oral Health, 4770 Buford

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Highway, N.E., Mailstop F-10, Atlanta, GA 30341- 3724. Telephone: (770) 488-6054 / email: [email protected] / Web site: http://www.cdc.gov/OralHealth. Available from the Web site at no charge. Summary: This fact sheet provides an overview of oral health problems, focusing on the pain, cost, and preventability of such problems for children and adults. Information about the leadership role of the Centers for Disease Control and Prevention (CDC) in encouraging effective use of fluoride, promoting the use of dental sealants, targeting mouth and throat cancers, and guiding infection control in dentistry is presented. In addition, the fact sheet presents information on CDC's role in helping states reach vulnerable populations, provide fluoridation training, support a national research network, and monitor the oral health of America. •

Know How to Detect and Prevent Gum Disease Source: Chicago, IL: American Dental Hygienists' Association (ADHA). 1995. 1 p. Contact: Available from American Dental Hygienists' Association (ADHA). 444 North Michigan Avenue, Chicago, IL 60611. (800) 243-2342 or (312) 440-8900; Fax (312) 4408929; E-mail: [email protected]; http://www.adha.org. PRICE: $0.75 each for 1-24 copies; bulk orders available. Order Number 3506. Summary: This fact sheet provides patients with information about how to detect and prevent gum disease. Topics covered include a definition of periodontal disease, complications that can arise from gingivitis, the role of proper dental hygiene in preventing periodontal diseases, the warning signs of periodontal disease and what to do about them, conservative or nonsurgical periodontal therapy options, and surgical therapy options. The fact sheet includes a chart that lists ten warning signs of periodontal disease. The fact sheet is also available as a journal article in Access, a periodical published by the American Dental Hygienists' Association.

•

Mouth: Owner's Manual: Preventing and Controlling Gum Disease Source: San Bruno, CA: Staywell Company. 1998. 16 p. Contact: Available from Staywell Company. Order Department, 1100 Grundy Lane, San Bruno, CA 94066-3030. (800) 333-3032. PRICE: $1.35 plus shipping and handling; quantity discounts available. Order Number 1315. Summary: This full-color, illustrated patient education brochure presents a guide to preventing and controlling periodontal (gum) disease. Topics covered include a guide to diagnosing gum disease, including a patient checklist of symptoms; the anatomy of the mouth and the physiology of bacteria, plaque, and periodontal disease; the three stages of gum disease: gingivitis, periodontitis, and advanced periodontitis; the full dental evaluation, including dental history, exam, and pocket charting; a how-to guide to selfcare, especially flossing and toothbrushing; and professional treatment options for periodontal disease. The brochure concludes with an overview of proper dental hygiene and a blank space for the dentist to record recommendations for the patient.

•

Tobacco and Gum Disease Source: Chicago, IL: American Academy of Periodontology. 1996. [4 p.]. Contact: Available from American Academy of Periodontology. Sales and Marketing Department, Suite 800, 737 North Michigan Avenue, Chicago, IL 60611. (312) 573-3253;

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Fax (312) 787-3670; E-mail: [email protected]; http://www.perio.org. PRICE: $20.00 per 50 plus shipping and handling; bulk rates available. Summary: This health education brochure familiarizes readers with the interplay between tobacco and gum disease, stressing that tobacco use may be one of the most significant risk factors in the development and progression of periodontal disease. Topics covered include a definition of periodontal disease, how tobacco use affects oral health, smokeless tobacco users, and why quitting makes sense. Researchers have shown that people use tobacco are more likely to have oral cancer, bad breath, stained teeth, tooth loss, bone loss, loss of taste and smell, less success with periodontal treatment, less success with dental implants, gum recession and mouth sores. The brochure encourages readers to talk with their dentists, periodontists, or physicians about a tobacco-cessation program. •

Gum Disease: The Warning Signs Source: Chicago, IL: American Dental Association (ADA). 1996. [2 p.]. Contact: Available from American Dental Association (ADA). Catalog Sales, P.O. Box 776, St. Charles, IL 60174. (800) 947-4746; Fax (630) 443-9970; http://www.ada.org. PRICE: Single copy free; bulk orders available. Order Number W105. Summary: This mini-brochure, from the American Dental Association, provides basic information about the warning signs of gum disease. Illustrated with colorful line drawings, the brochure discusses the forms of gum disease, including gingivitis, and periodontitis; the causes of gum disease; what happens during a dental care examination and how the dentist determines if gum disease is present; and the role of good oral hygiene in preventing gum disease.

•

Mouth Care and Diabetes: Managing Periodontal Disease Source: San Bruno, CA: StayWell Company. 2000. [2 p.]. Contact: Available from StayWell Company. Order Department, 1100 Grundy Lane, San Bruno, CA 94066-9821. (800) 333-3032. Fax (650) 244-4512. E-mail: [email protected]. Website: www.staywell.com. PRICE: $17.95 for a pack of 50; plus shipping and handling. Summary: This pamphlet provides people who have diabetes with tips for preventing and treating periodontal disease. People who have diabetes are at increased risk for periodontal disease. Periodontal disease occurs in three stages: gingivitis, periodontitis, and advanced periodontitis. Steps that people can take to prevent periodontal disease include using good oral hygiene, visiting the dentist every 3 to 4 months for examinations and cleanings, and keeping blood glucose at a healthy level. Treatment of periodontal disease involves scaling and root planing, taking antibiotics, and undergoing gum surgery. 13 figures.

•

Taking Care of Your Teeth: Diabetes and Gum Disease Source: Albuquerque, NM: Indian Health Service Diabetes Program. 1992. 6 p. Contact: Available from IHS HQW Diabetes Program. 5300 Homestead Road, NE, Albuquerque, NM 78110. (505) 837-4182. Fax (505) 837-4188. PRICE: Materials are available only to health care professionals serving American Indian populations; contact the IHS Diabetes Program for list of currently available materials.

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Summary: This patient education booklet, written for the Native American population, describes the problem of diabetes and gum disease. Topics covered include the causes of gum disease, the problem of plaque build-up, the signs and symptoms of gum disease, and how to prevent gum disease. The brochure emphasizes the importance of the reader taking an active role in his or her own health care. Culturally-sensitive line drawings illustrate each of the concepts presented. •

Periodontal Disease: More Than Bleeding Gums Source: Journal of Practical Hygiene. 12(2): 18. March-April 2003. Contact: Available from Montage Media Corporation. 1000 Wyckoff Avenue, Mahwah, NJ 07430-3164. (201) 891-3200. Summary: This patient education fact sheet reviews the problem of periodontal disease, an infection of the gums and bone supporting the teeth. Periodontal disease is caused by bacteria in plaque which makes the gums irritated. Untreated periodontal disease can lead to gum recession surrounding the teeth, exposing the roots of the teeth, and can even lead to tooth loss. The fact sheet reviews the epidemiology of periodontal disease (who gets it), the different types of periodontal disease, and how periodontal disease is treated and prevented. 4 figures. 2 references. The National Guideline Clearinghouse™

The National Guideline Clearinghouse™ offers hundreds of evidence-based clinical practice guidelines published in the United States and other countries. You can search this site located at http://www.guideline.gov/ by using the keyword “gum disease” (or synonyms). The following was recently posted: •

Parameter on acute periodontal diseases Source: American Academy of Periodontology - Professional Association; 1996 October (revised 2000 May); 4 pages http://www.guideline.gov/summary/summary.aspx?doc_id=2329&nbr=1555&a mp;string=periodontal+AND+disease

•

Parameter on systemic conditions affected by periodontal diseases Source: American Academy of Periodontology - Professional Association; 2000 May; 4 pages http://www.guideline.gov/summary/summary.aspx?doc_id=2334&nbr=1560&a mp;string=periodontal+AND+disease The NIH Search Utility

The NIH search utility allows you to search for documents on over 100 selected Web sites that comprise the NIH-WEB-SPACE. Each of these servers is “crawled” and indexed on an ongoing basis. Your search will produce a list of various documents, all of which will relate in some way to gum disease. The drawbacks of this approach are that the information is not organized by theme and that the references are often a mix of information for professionals and patients. Nevertheless, a large number of the listed Web sites provide useful

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background information. We can only recommend this route, therefore, for relatively rare or specific disorders, or when using highly targeted searches. To use the NIH search utility, visit the following Web page: http://search.nih.gov/index.html. Additional Web Sources A number of Web sites are available to the public that often link to government sites. These can also point you in the direction of essential information. The following is a representative sample: •

AOL: http://search.aol.com/cat.adp?id=168&layer=&from=subcats

•

Family Village: http://www.familyvillage.wisc.edu/specific.htm

•

Google: http://directory.google.com/Top/Health/Conditions_and_Diseases/

•

Med Help International: http://www.medhelp.org/HealthTopics/A.html

•

Open Directory Project: http://dmoz.org/Health/Conditions_and_Diseases/

•

Yahoo.com: http://dir.yahoo.com/Health/Diseases_and_Conditions/

•

WebMD®Health: http://my.webmd.com/health_topics

Finding Associations There are several Internet directories that provide lists of medical associations with information on or resources relating to gum disease. By consulting all of associations listed in this chapter, you will have nearly exhausted all sources for patient associations concerned with gum disease. The National Health Information Center (NHIC) The National Health Information Center (NHIC) offers a free referral service to help people find organizations that provide information about gum disease. For more information, see the NHIC’s Web site at http://www.health.gov/NHIC/ or contact an information specialist by calling 1-800-336-4797. Directory of Health Organizations The Directory of Health Organizations, provided by the National Library of Medicine Specialized Information Services, is a comprehensive source of information on associations. The Directory of Health Organizations database can be accessed via the Internet at http://www.sis.nlm.nih.gov/Dir/DirMain.html. It is composed of two parts: DIRLINE and Health Hotlines. The DIRLINE database comprises some 10,000 records of organizations, research centers, and government institutes and associations that primarily focus on health and biomedicine. To access DIRLINE directly, go to the following Web site: http://dirline.nlm.nih.gov/. Simply type in “gum disease” (or a synonym), and you will receive information on all relevant organizations listed in the database.

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Health Hotlines directs you to toll-free numbers to over 300 organizations. You can access this database directly at http://www.sis.nlm.nih.gov/hotlines/. On this page, you are given the option to search by keyword or by browsing the subject list. When you have received your search results, click on the name of the organization for its description and contact information. The Combined Health Information Database Another comprehensive source of information on healthcare associations is the Combined Health Information Database. Using the “Detailed Search” option, you will need to limit your search to “Organizations” and “gum disease”. Type the following hyperlink into your Web browser: http://chid.nih.gov/detail/detail.html. To find associations, use the drop boxes at the bottom of the search page where “You may refine your search by.” For publication date, select “All Years.” Then, select your preferred language and the format option “Organization Resource Sheet.” Type “gum disease” (or synonyms) into the “For these words:” box. You should check back periodically with this database since it is updated every three months. The National Organization for Rare Disorders, Inc. The National Organization for Rare Disorders, Inc. has prepared a Web site that provides, at no charge, lists of associations organized by health topic. You can access this database at the following Web site: http://www.rarediseases.org/search/orgsearch.html. Type “gum disease” (or a synonym) into the search box, and click “Submit Query.”

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APPENDIX C. FINDING MEDICAL LIBRARIES Overview In this Appendix, we show you how to quickly find a medical library in your area.

Preparation Your local public library and medical libraries have interlibrary loan programs with the National Library of Medicine (NLM), one of the largest medical collections in the world. According to the NLM, most of the literature in the general and historical collections of the National Library of Medicine is available on interlibrary loan to any library. If you would like to access NLM medical literature, then visit a library in your area that can request the publications for you.22

Finding a Local Medical Library The quickest method to locate medical libraries is to use the Internet-based directory published by the National Network of Libraries of Medicine (NN/LM). This network includes 4626 members and affiliates that provide many services to librarians, health professionals, and the public. To find a library in your area, simply visit http://nnlm.gov/members/adv.html or call 1-800-338-7657.

Medical Libraries in the U.S. and Canada In addition to the NN/LM, the National Library of Medicine (NLM) lists a number of libraries with reference facilities that are open to the public. The following is the NLM’s list and includes hyperlinks to each library’s Web site. These Web pages can provide information on hours of operation and other restrictions. The list below is a small sample of

22

Adapted from the NLM: http://www.nlm.nih.gov/psd/cas/interlibrary.html.

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libraries recommended by the National Library of Medicine (sorted alphabetically by name of the U.S. state or Canadian province where the library is located)23: •

Alabama: Health InfoNet of Jefferson County (Jefferson County Library Cooperative, Lister Hill Library of the Health Sciences), http://www.uab.edu/infonet/

•

Alabama: Richard M. Scrushy Library (American Sports Medicine Institute)

•

Arizona: Samaritan Regional Medical Center: The Learning Center (Samaritan Health System, Phoenix, Arizona), http://www.samaritan.edu/library/bannerlibs.htm

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California: Kris Kelly Health Information Center (St. Joseph Health System, Humboldt), http://www.humboldt1.com/~kkhic/index.html

•

California: Community Health Library of Los Gatos, http://www.healthlib.org/orgresources.html

•

California: Consumer Health Program and Services (CHIPS) (County of Los Angeles Public Library, Los Angeles County Harbor-UCLA Medical Center Library) - Carson, CA, http://www.colapublib.org/services/chips.html

•

California: Gateway Health Library (Sutter Gould Medical Foundation)

•

California: Health Library (Stanford University Medical Center), http://wwwmed.stanford.edu/healthlibrary/

•

California: Patient Education Resource Center - Health Information and Resources (University of California, San Francisco), http://sfghdean.ucsf.edu/barnett/PERC/default.asp

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California: Redwood Health Library (Petaluma Health Care District), http://www.phcd.org/rdwdlib.html

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California: Los Gatos PlaneTree Health Library, http://planetreesanjose.org/

•

California: Sutter Resource Library (Sutter Hospitals Foundation, Sacramento), http://suttermedicalcenter.org/library/

•

California: Health Sciences Libraries (University of California, Davis), http://www.lib.ucdavis.edu/healthsci/

•

California: ValleyCare Health Library & Ryan Comer Cancer Resource Center (ValleyCare Health System, Pleasanton), http://gaelnet.stmarysca.edu/other.libs/gbal/east/vchl.html

•

California: Washington Community Health Resource Library (Fremont), http://www.healthlibrary.org/

•

Colorado: William V. Gervasini Memorial Library (Exempla Healthcare), http://www.saintjosephdenver.org/yourhealth/libraries/

•

Connecticut: Hartford Hospital Health Science Libraries (Hartford Hospital), http://www.harthosp.org/library/

•

Connecticut: Healthnet: Connecticut Consumer Health Information Center (University of Connecticut Health Center, Lyman Maynard Stowe Library), http://library.uchc.edu/departm/hnet/

23

Abstracted from http://www.nlm.nih.gov/medlineplus/libraries.html.

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•

Connecticut: Waterbury Hospital Health Center Library (Waterbury Hospital, Waterbury), http://www.waterburyhospital.com/library/consumer.shtml

•

Delaware: Consumer Health Library (Christiana Care Health System, Eugene du Pont Preventive Medicine & Rehabilitation Institute, Wilmington), http://www.christianacare.org/health_guide/health_guide_pmri_health_info.cfm

•

Delaware: Lewis B. Flinn Library (Delaware Academy of Medicine, Wilmington), http://www.delamed.org/chls.html

•

Georgia: Family Resource Library (Medical College of Georgia, Augusta), http://cmc.mcg.edu/kids_families/fam_resources/fam_res_lib/frl.htm

•

Georgia: Health Resource Center (Medical Center of Central Georgia, Macon), http://www.mccg.org/hrc/hrchome.asp

•

Hawaii: Hawaii Medical Library: Consumer Health Information Service (Hawaii Medical Library, Honolulu), http://hml.org/CHIS/

•

Idaho: DeArmond Consumer Health Library (Kootenai Medical Center, Coeur d’Alene), http://www.nicon.org/DeArmond/index.htm

•

Illinois: Health Learning Center of Northwestern Memorial Hospital (Chicago), http://www.nmh.org/health_info/hlc.html

•

Illinois: Medical Library (OSF Saint Francis Medical Center, Peoria), http://www.osfsaintfrancis.org/general/library/

•

Kentucky: Medical Library - Services for Patients, Families, Students & the Public (Central Baptist Hospital, Lexington), http://www.centralbap.com/education/community/library.cfm

•

Kentucky: University of Kentucky - Health Information Library (Chandler Medical Center, Lexington), http://www.mc.uky.edu/PatientEd/

•

Louisiana: Alton Ochsner Medical Foundation Library (Alton Ochsner Medical Foundation, New Orleans), http://www.ochsner.org/library/

•

Louisiana: Louisiana State University Health Sciences Center Medical LibraryShreveport, http://lib-sh.lsuhsc.edu/

•

Maine: Franklin Memorial Hospital Medical Library (Franklin Memorial Hospital, Farmington), http://www.fchn.org/fmh/lib.htm

•

Maine: Gerrish-True Health Sciences Library (Central Maine Medical Center, Lewiston), http://www.cmmc.org/library/library.html

•

Maine: Hadley Parrot Health Science Library (Eastern Maine Healthcare, Bangor), http://www.emh.org/hll/hpl/guide.htm

•

Maine: Maine Medical Center Library (Maine Medical Center, Portland), http://www.mmc.org/library/

•

Maine: Parkview Hospital (Brunswick), http://www.parkviewhospital.org/

•

Maine: Southern Maine Medical Center Health Sciences Library (Southern Maine Medical Center, Biddeford), http://www.smmc.org/services/service.php3?choice=10

•

Maine: Stephens Memorial Hospital’s Health Information Library (Western Maine Health, Norway), http://www.wmhcc.org/Library/

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•

Manitoba, Canada: Consumer & Patient Health Information Service (University of Manitoba Libraries), http://www.umanitoba.ca/libraries/units/health/reference/chis.html

•

Manitoba, Canada: J.W. Crane Memorial Library (Deer Lodge Centre, Winnipeg), http://www.deerlodge.mb.ca/crane_library/about.asp

•

Maryland: Health Information Center at the Wheaton Regional Library (Montgomery County, Dept. of Public Libraries, Wheaton Regional Library), http://www.mont.lib.md.us/healthinfo/hic.asp

•

Massachusetts: Baystate Medical Center Library (Baystate Health System), http://www.baystatehealth.com/1024/

•

Massachusetts: Boston University Medical Center Alumni Medical Library (Boston University Medical Center), http://med-libwww.bu.edu/library/lib.html

•

Massachusetts: Lowell General Hospital Health Sciences Library (Lowell General Hospital, Lowell), http://www.lowellgeneral.org/library/HomePageLinks/WWW.htm

•

Massachusetts: Paul E. Woodard Health Sciences Library (New England Baptist Hospital, Boston), http://www.nebh.org/health_lib.asp

•

Massachusetts: St. Luke’s Hospital Health Sciences Library (St. Luke’s Hospital, Southcoast Health System, New Bedford), http://www.southcoast.org/library/

•

Massachusetts: Treadwell Library Consumer Health Reference Center (Massachusetts General Hospital), http://www.mgh.harvard.edu/library/chrcindex.html

•

Massachusetts: UMass HealthNet (University of Massachusetts Medical School, Worchester), http://healthnet.umassmed.edu/

•

Michigan: Botsford General Hospital Library - Consumer Health (Botsford General Hospital, Library & Internet Services), http://www.botsfordlibrary.org/consumer.htm

•

Michigan: Helen DeRoy Medical Library (Providence Hospital and Medical Centers), http://www.providence-hospital.org/library/

•

Michigan: Marquette General Hospital - Consumer Health Library (Marquette General Hospital, Health Information Center), http://www.mgh.org/center.html

•

Michigan: Patient Education Resouce Center - University of Michigan Cancer Center (University of Michigan Comprehensive Cancer Center, Ann Arbor), http://www.cancer.med.umich.edu/learn/leares.htm

•

Michigan: Sladen Library & Center for Health Information Resources - Consumer Health Information (Detroit), http://www.henryford.com/body.cfm?id=39330

•

Montana: Center for Health Information (St. Patrick Hospital and Health Sciences Center, Missoula)

•

National: Consumer Health Library Directory (Medical Library Association, Consumer and Patient Health Information Section), http://caphis.mlanet.org/directory/index.html

•

National: National Network of Libraries of Medicine (National Library of Medicine) provides library services for health professionals in the United States who do not have access to a medical library, http://nnlm.gov/

•

National: NN/LM List of Libraries Serving the Public (National Network of Libraries of Medicine), http://nnlm.gov/members/

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•

Nevada: Health Science Library, West Charleston Library (Las Vegas-Clark County Library District, Las Vegas), http://www.lvccld.org/special_collections/medical/index.htm

•

New Hampshire: Dartmouth Biomedical Libraries (Dartmouth College Library, Hanover), http://www.dartmouth.edu/~biomed/resources.htmld/conshealth.htmld/

•

New Jersey: Consumer Health Library (Rahway Hospital, Rahway), http://www.rahwayhospital.com/library.htm

•

New Jersey: Dr. Walter Phillips Health Sciences Library (Englewood Hospital and Medical Center, Englewood), http://www.englewoodhospital.com/links/index.htm

•

New Jersey: Meland Foundation (Englewood Hospital and Medical Center, Englewood), http://www.geocities.com/ResearchTriangle/9360/

•

New York: Choices in Health Information (New York Public Library) - NLM Consumer Pilot Project participant, http://www.nypl.org/branch/health/links.html

•

New York: Health Information Center (Upstate Medical University, State University of New York, Syracuse), http://www.upstate.edu/library/hic/

•

New York: Health Sciences Library (Long Island Jewish Medical Center, New Hyde Park), http://www.lij.edu/library/library.html

•

New York: ViaHealth Medical Library (Rochester General Hospital), http://www.nyam.org/library/

•

Ohio: Consumer Health Library (Akron General Medical Center, Medical & Consumer Health Library), http://www.akrongeneral.org/hwlibrary.htm

•

Oklahoma: The Health Information Center at Saint Francis Hospital (Saint Francis Health System, Tulsa), http://www.sfh-tulsa.com/services/healthinfo.asp

•

Oregon: Planetree Health Resource Center (Mid-Columbia Medical Center, The Dalles), http://www.mcmc.net/phrc/

•

Pennsylvania: Community Health Information Library (Milton S. Hershey Medical Center, Hershey), http://www.hmc.psu.edu/commhealth/

•

Pennsylvania: Community Health Resource Library (Geisinger Medical Center, Danville), http://www.geisinger.edu/education/commlib.shtml

•

Pennsylvania: HealthInfo Library (Moses Taylor Hospital, Scranton), http://www.mth.org/healthwellness.html

•

Pennsylvania: Hopwood Library (University of Pittsburgh, Health Sciences Library System, Pittsburgh), http://www.hsls.pitt.edu/guides/chi/hopwood/index_html

•

Pennsylvania: Koop Community Health Information Center (College of Physicians of Philadelphia), http://www.collphyphil.org/kooppg1.shtml

•

Pennsylvania: Learning Resources Center - Medical Library (Susquehanna Health System, Williamsport), http://www.shscares.org/services/lrc/index.asp

•

Pennsylvania: Medical Library (UPMC Health System, Pittsburgh), http://www.upmc.edu/passavant/library.htm

•

Quebec, Canada: Medical Library (Montreal General Hospital), http://www.mghlib.mcgill.ca/

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•

South Dakota: Rapid City Regional Hospital Medical Library (Rapid City Regional Hospital), http://www.rcrh.org/Services/Library/Default.asp

•

Texas: Houston HealthWays (Houston Academy of Medicine-Texas Medical Center Library), http://hhw.library.tmc.edu/

•

Washington: Community Health Library (Kittitas Valley Community Hospital), http://www.kvch.com/

•

Washington: Southwest Washington Medical Center Library (Southwest Washington Medical Center, Vancouver), http://www.swmedicalcenter.com/body.cfm?id=72

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ONLINE GLOSSARIES The Internet provides access to a number of free-to-use medical dictionaries. The National Library of Medicine has compiled the following list of online dictionaries: •

ADAM Medical Encyclopedia (A.D.A.M., Inc.), comprehensive medical reference: http://www.nlm.nih.gov/medlineplus/encyclopedia.html

•

MedicineNet.com Medical Dictionary (MedicineNet, Inc.): http://www.medterms.com/Script/Main/hp.asp

•

Merriam-Webster Medical Dictionary (Inteli-Health, Inc.): http://www.intelihealth.com/IH/

•

Multilingual Glossary of Technical and Popular Medical Terms in Eight European Languages (European Commission) - Danish, Dutch, English, French, German, Italian, Portuguese, and Spanish: http://allserv.rug.ac.be/~rvdstich/eugloss/welcome.html

•

On-line Medical Dictionary (CancerWEB): http://cancerweb.ncl.ac.uk/omd/

•

Rare Diseases Terms (Office of Rare Diseases): http://ord.aspensys.com/asp/diseases/diseases.asp

•

Technology Glossary (National Library of Medicine) - Health Care Technology: http://www.nlm.nih.gov/nichsr/ta101/ta10108.htm

Beyond these, MEDLINEplus contains a very patient-friendly encyclopedia covering every aspect of medicine (licensed from A.D.A.M., Inc.). The ADAM Medical Encyclopedia can be accessed at http://www.nlm.nih.gov/medlineplus/encyclopedia.html. ADAM is also available on commercial Web sites such as drkoop.com (http://www.drkoop.com/) and Web MD (http://my.webmd.com/adam/asset/adam_disease_articles/a_to_z/a).

Online Dictionary Directories The following are additional online directories compiled by the National Library of Medicine, including a number of specialized medical dictionaries: •

Medical Dictionaries: Medical & Biological (World Health Organization): http://www.who.int/hlt/virtuallibrary/English/diction.htm#Medical

•

MEL-Michigan Electronic Library List of Online Health and Medical Dictionaries (Michigan Electronic Library): http://mel.lib.mi.us/health/health-dictionaries.html

•

Patient Education: Glossaries (DMOZ Open Directory Project): http://dmoz.org/Health/Education/Patient_Education/Glossaries/

•

Web of Online Dictionaries (Bucknell University): http://www.yourdictionary.com/diction5.html#medicine

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GUM DISEASE DICTIONARY The definitions below are derived from official public sources, including the National Institutes of Health [NIH] and the European Union [EU]. Abscess: Accumulation of purulent material in tissues, organs, or circumscribed spaces, usually associated with signs of infection. [NIH] Acceptor: A substance which, while normally not oxidized by oxygen or reduced by hydrogen, can be oxidized or reduced in presence of a substance which is itself undergoing oxidation or reduction. [NIH] Acetylcholine: A neurotransmitter. Acetylcholine in vertebrates is the major transmitter at neuromuscular junctions, autonomic ganglia, parasympathetic effector junctions, a subset of sympathetic effector junctions, and at many sites in the central nervous system. It is generally not used as an administered drug because it is broken down very rapidly by cholinesterases, but it is useful in some ophthalmological applications. [NIH] Acne: A disorder of the skin marked by inflammation of oil glands and hair glands. [NIH] Acridine Orange: Cationic cytochemical stain specific for cell nuclei, especially DNA. It is used as a supravital stain and in fluorescence cytochemistry. It may cause mutations in microorganisms. [NIH] Actinomyces: A genus of gram-positive, rod-shaped bacteria whose organisms are nonmotile. Filaments that may be present in certain species are either straight or wavy and may have swollen or clubbed heads. [NIH] Acupuncture Therapy: Treatment of disease by inserting needles along specific pathways or meridians. The placement varies with the disease being treated. Heat or moxibustion and acupressure may be used in conjunction. [NIH] Adjunctive Therapy: Another treatment used together with the primary treatment. Its purpose is to assist the primary treatment. [NIH] Adolescence: The period of life beginning with the appearance of secondary sex characteristics and terminating with the cessation of somatic growth. The years usually referred to as adolescence lie between 13 and 18 years of age. [NIH] Adrenal Cortex: The outer layer of the adrenal gland. It secretes mineralocorticoids, androgens, and glucocorticoids. [NIH] Adrenergic: Activated by, characteristic of, or secreting epinephrine or substances with similar activity; the term is applied to those nerve fibres that liberate norepinephrine at a synapse when a nerve impulse passes, i.e., the sympathetic fibres. [EU] Adverse Effect: An unwanted side effect of treatment. [NIH] Affinity: 1. Inherent likeness or relationship. 2. A special attraction for a specific element, organ, or structure. 3. Chemical affinity; the force that binds atoms in molecules; the tendency of substances to combine by chemical reaction. 4. The strength of noncovalent chemical binding between two substances as measured by the dissociation constant of the complex. 5. In immunology, a thermodynamic expression of the strength of interaction between a single antigen-binding site and a single antigenic determinant (and thus of the stereochemical compatibility between them), most accurately applied to interactions among simple, uniform antigenic determinants such as haptens. Expressed as the association constant (K litres mole -1), which, owing to the heterogeneity of affinities in a population of antibody molecules of a given specificity, actually represents an average value (mean

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intrinsic association constant). 6. The reciprocal of the dissociation constant. [EU] Agar: A complex sulfated polymer of galactose units, extracted from Gelidium cartilagineum, Gracilaria confervoides, and related red algae. It is used as a gel in the preparation of solid culture media for microorganisms, as a bulk laxative, in making emulsions, and as a supporting medium for immunodiffusion and immunoelectrophoresis. [NIH]

Age Groups: Persons classified by age from birth (infant, newborn) to octogenarians and older (aged, 80 and over). [NIH] Age of Onset: The age or period of life at which a disease or the initial symptoms or manifestations of a disease appear in an individual. [NIH] Aged, 80 and Over: A person 80 years of age and older. [NIH] Agonist: In anatomy, a prime mover. In pharmacology, a drug that has affinity for and stimulates physiologic activity at cell receptors normally stimulated by naturally occurring substances. [EU] Airway: A device for securing unobstructed passage of air into and out of the lungs during general anesthesia. [NIH] Algorithms: A procedure consisting of a sequence of algebraic formulas and/or logical steps to calculate or determine a given task. [NIH] Alkaline: Having the reactions of an alkali. [EU] Alkaloid: A member of a large group of chemicals that are made by plants and have nitrogen in them. Some alkaloids have been shown to work against cancer. [NIH] Alleles: Mutually exclusive forms of the same gene, occupying the same locus on homologous chromosomes, and governing the same biochemical and developmental process. [NIH] Allylamine: Possesses an unusual and selective cytotoxicity for vascular smooth muscle cells in dogs and rats. Useful for experiments dealing with arterial injury, myocardial fibrosis or cardiac decompensation. [NIH] Alpha Particles: Positively charged particles composed of two protons and two neutrons, i.e., helium nuclei, emitted during disintegration of very heavy isotopes; a beam of alpha particles or an alpha ray has very strong ionizing power, but weak penetrability. [NIH] Alpha-Defensins: Defensins found in azurophilic granules of neutrophils and in the secretory granules of intestinal paneth cells. [NIH] Alternative medicine: Practices not generally recognized by the medical community as standard or conventional medical approaches and used instead of standard treatments. Alternative medicine includes the taking of dietary supplements, megadose vitamins, and herbal preparations; the drinking of special teas; and practices such as massage therapy, magnet therapy, spiritual healing, and meditation. [NIH] Alveolar Bone Loss: The resorption of bone in the supporting structures of the maxilla or mandible as a result of periodontal disease. [NIH] Alveolar Process: The thickest and spongiest part of the maxilla and mandible hollowed out into deep cavities for the teeth. [NIH] Alveoli: Tiny air sacs at the end of the bronchioles in the lungs. [NIH] Amebiasis: Infection with any of various amebae. It is an asymptomatic carrier state in most individuals, but diseases ranging from chronic, mild diarrhea to fulminant dysentery may occur. [NIH] Amine: An organic compound containing nitrogen; any member of a group of chemical

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compounds formed from ammonia by replacement of one or more of the hydrogen atoms by organic (hydrocarbon) radicals. The amines are distinguished as primary, secondary, and tertiary, according to whether one, two, or three hydrogen atoms are replaced. The amines include allylamine, amylamine, ethylamine, methylamine, phenylamine, propylamine, and many other compounds. [EU] Amino Acid Sequence: The order of amino acids as they occur in a polypeptide chain. This is referred to as the primary structure of proteins. It is of fundamental importance in determining protein conformation. [NIH] Amino Acids: Organic compounds that generally contain an amino (-NH2) and a carboxyl (COOH) group. Twenty alpha-amino acids are the subunits which are polymerized to form proteins. [NIH] Amino Acids: Organic compounds that generally contain an amino (-NH2) and a carboxyl (COOH) group. Twenty alpha-amino acids are the subunits which are polymerized to form proteins. [NIH] Ammonia: A colorless alkaline gas. It is formed in the body during decomposition of organic materials during a large number of metabolically important reactions. [NIH] Amoxicillin: A broad-spectrum semisynthetic antibiotic similar to ampicillin except that its resistance to gastric acid permits higher serum levels with oral administration. [NIH] Ampicillin: Semi-synthetic derivative of penicillin that functions as an orally active broadspectrum antibiotic. [NIH] Amplification: The production of additional copies of a chromosomal DNA sequence, found as either intrachromosomal or extrachromosomal DNA. [NIH] Anaerobic: 1. Lacking molecular oxygen. 2. Growing, living, or occurring in the absence of molecular oxygen; pertaining to an anaerobe. [EU] Anaesthesia: Loss of feeling or sensation. Although the term is used for loss of tactile sensibility, or of any of the other senses, it is applied especially to loss of the sensation of pain, as it is induced to permit performance of surgery or other painful procedures. [EU] Anal: Having to do with the anus, which is the posterior opening of the large bowel. [NIH] Analgesic: An agent that alleviates pain without causing loss of consciousness. [EU] Analogous: Resembling or similar in some respects, as in function or appearance, but not in origin or development;. [EU] Anaphylatoxins: The family of peptides C3a, C4a, C5a, and C5a des-arginine produced in the serum during complement activation. They produce smooth muscle contraction, mast cell histamine release, affect platelet aggregation, and act as mediators of the local inflammatory process. The order of anaphylatoxin activity from strongest to weakest is C5a, C3a, C4a, and C5a des-arginine. The latter is the so-called "classical" anaphylatoxin but shows no spasmogenic activity though it contains some chemotactic ability. [NIH] Anatomical: Pertaining to anatomy, or to the structure of the organism. [EU] Androgens: A class of sex hormones associated with the development and maintenance of the secondary male sex characteristics, sperm induction, and sexual differentiation. In addition to increasing virility and libido, they also increase nitrogen and water retention and stimulate skeletal growth. [NIH] Anemia: A reduction in the number of circulating erythrocytes or in the quantity of hemoglobin. [NIH] Anesthesia: A state characterized by loss of feeling or sensation. This depression of nerve function is usually the result of pharmacologic action and is induced to allow performance

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of surgery or other painful procedures. [NIH] Angiogenesis: Blood vessel formation. Tumor angiogenesis is the growth of blood vessels from surrounding tissue to a solid tumor. This is caused by the release of chemicals by the tumor. [NIH] Anionic: Pertaining to or containing an anion. [EU] Anions: Negatively charged atoms, radicals or groups of atoms which travel to the anode or positive pole during electrolysis. [NIH] Anomalies: Birth defects; abnormalities. [NIH] Anorexia: Lack or loss of appetite for food. Appetite is psychologic, dependent on memory and associations. Anorexia can be brought about by unattractive food, surroundings, or company. [NIH] Anorexiant: A drug, process, or event that leads to anorexia. [NIH] Antiallergic: Counteracting allergy or allergic conditions. [EU] Antibacterial: A substance that destroys bacteria or suppresses their growth or reproduction. [EU] Antibiotic: A drug used to treat infections caused by bacteria and other microorganisms. [NIH]

Antibodies: Immunoglobulin molecules having a specific amino acid sequence by virtue of which they interact only with the antigen that induced their synthesis in cells of the lymphoid series (especially plasma cells), or with an antigen closely related to it. [NIH] Antibody: A type of protein made by certain white blood cells in response to a foreign substance (antigen). Each antibody can bind to only a specific antigen. The purpose of this binding is to help destroy the antigen. Antibodies can work in several ways, depending on the nature of the antigen. Some antibodies destroy antigens directly. Others make it easier for white blood cells to destroy the antigen. [NIH] Anticoagulant: A drug that helps prevent blood clots from forming. Also called a blood thinner. [NIH] Antigen: Any substance which is capable, under appropriate conditions, of inducing a specific immune response and of reacting with the products of that response, that is, with specific antibody or specifically sensitized T-lymphocytes, or both. Antigens may be soluble substances, such as toxins and foreign proteins, or particulate, such as bacteria and tissue cells; however, only the portion of the protein or polysaccharide molecule known as the antigenic determinant (q.v.) combines with antibody or a specific receptor on a lymphocyte. Abbreviated Ag. [EU] Antigen-Antibody Complex: The complex formed by the binding of antigen and antibody molecules. The deposition of large antigen-antibody complexes leading to tissue damage causes immune complex diseases. [NIH] Antihistamine: A drug that counteracts the action of histamine. The antihistamines are of two types. The conventional ones, as those used in allergies, block the H1 histamine receptors, whereas the others block the H2 receptors. Called also antihistaminic. [EU] Anti-infective: An agent that so acts. [EU] Anti-inflammatory: Having to do with reducing inflammation. [NIH] Anti-Inflammatory Agents: Substances that reduce or suppress inflammation. [NIH] Antimetabolite: A chemical that is very similar to one required in a normal biochemical reaction in cells. Antimetabolites can stop or slow down the reaction. [NIH]

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Antimicrobial: Killing microorganisms, or suppressing their multiplication or growth. [EU] Antineoplastic: Inhibiting or preventing the development of neoplasms, checking the maturation and proliferation of malignant cells. [EU] Antioxidant: A substance that prevents damage caused by free radicals. Free radicals are highly reactive chemicals that often contain oxygen. They are produced when molecules are split to give products that have unpaired electrons. This process is called oxidation. [NIH] Antiplasmin: A member of the serpin superfamily found in human plasma that inhibits the lysis of fibrin clots which are induced by plasminogen activator. It is a glycoprotein, molecular weight approximately 70,000 that migrates in the alpha 2 region in immunoelectrophoresis. It is the principal plasmin inactivator in blood, rapidly forming a very stable complex with plasmin. [NIH] Antiseptic: A substance that inhibits the growth and development of microorganisms without necessarily killing them. [EU] Antiviral: Destroying viruses or suppressing their replication. [EU] Anxiety: Persistent feeling of dread, apprehension, and impending disaster. [NIH] Aorta: The main trunk of the systemic arteries. [NIH] Aqueous: Having to do with water. [NIH] Arachidonic Acid: An unsaturated, essential fatty acid. It is found in animal and human fat as well as in the liver, brain, and glandular organs, and is a constituent of animal phosphatides. It is formed by the synthesis from dietary linoleic acid and is a precursor in the biosynthesis of prostaglandins, thromboxanes, and leukotrienes. [NIH] Arginine: An essential amino acid that is physiologically active in the L-form. [NIH] Argon: A noble gas with the atomic symbol Ar, atomic number 18, and atomic weight 39.948. It is used in fluorescent tubes and wherever an inert atmosphere is desired and nitrogen cannot be used. [NIH] Arterial: Pertaining to an artery or to the arteries. [EU] Arteries: The vessels carrying blood away from the heart. [NIH] Aspartate: A synthetic amino acid. [NIH] Aspartic: The naturally occurring substance is L-aspartic acid. One of the acidic-amino-acids is obtained by the hydrolysis of proteins. [NIH] Aspartic Endopeptidases: A sub-subclass of endopeptidases that depend on an aspartic acid residue for their activity. EC 3.4.23. [NIH] Astringent: Causing contraction, usually locally after topical application. [EU] Atrium: A chamber; used in anatomical nomenclature to designate a chamber affording entrance to another structure or organ. Usually used alone to designate an atrium of the heart. [EU] Atypical: Irregular; not conformable to the type; in microbiology, applied specifically to strains of unusual type. [EU] Bacteria: Unicellular prokaryotic microorganisms which generally possess rigid cell walls, multiply by cell division, and exhibit three principal forms: round or coccal, rodlike or bacillary, and spiral or spirochetal. [NIH] Bacterial Infections: Infections by bacteria, general or unspecified. [NIH] Bacteriophage: A virus whose host is a bacterial cell; A virus that exclusively infects bacteria. It generally has a protein coat surrounding the genome (DNA or RNA). One of the coliphages most extensively studied is the lambda phage, which is also one of the most

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important. [NIH] Bacteriostatic: 1. Inhibiting the growth or multiplication of bacteria. 2. An agent that inhibits the growth or multiplication of bacteria. [EU] Bacterium: Microscopic organism which may have a spherical, rod-like, or spiral unicellular or non-cellular body. Bacteria usually reproduce through asexual processes. [NIH] Basal cells: Small, round cells found in the lower part (or base) of the epidermis, the outer layer of the skin. [NIH] Base: In chemistry, the nonacid part of a salt; a substance that combines with acids to form salts; a substance that dissociates to give hydroxide ions in aqueous solutions; a substance whose molecule or ion can combine with a proton (hydrogen ion); a substance capable of donating a pair of electrons (to an acid) for the formation of a coordinate covalent bond. [EU] Basement Membrane: Ubiquitous supportive tissue adjacent to epithelium and around smooth and striated muscle cells. This tissue contains intrinsic macromolecular components such as collagen, laminin, and sulfated proteoglycans. As seen by light microscopy one of its subdivisions is the basal (basement) lamina. [NIH] Basophils: Granular leukocytes characterized by a relatively pale-staining, lobate nucleus and cytoplasm containing coarse dark-staining granules of variable size and stainable by basic dyes. [NIH] Benign: Not cancerous; does not invade nearby tissue or spread to other parts of the body. [NIH]

Beta-Defensins: Defensins found mainly in epithelial cells. [NIH] Binding agent: A substance that makes a loose mixture stick together. For example, binding agents can be used to make solid pills from loose powders. [NIH] Binding Sites: The reactive parts of a macromolecule that directly participate in its specific combination with another molecule. [NIH] Bioassays: Determination of the relative effective strength of a substance (as a vitamin, hormone, or drug) by comparing its effect on a test organism with that of a standard preparation. [NIH] Bioavailability: The degree to which a drug or other substance becomes available to the target tissue after administration. [EU] Biochemical: Relating to biochemistry; characterized by, produced by, or involving chemical reactions in living organisms. [EU] Biofilms: Films of bacteria or other microbial organisms, usually embedded in extracellular polymers such as implanted medical devices, which adhere to surfaces submerged in, or subjected to, aquatic environments (From Singleton & Sainsbury, Dictionary of Microbiology and Molecular Biology, 2d ed). Biofilms consist of multilayers of microbial cells glued together to form microbial communities which are highly resistant to both phagocytes and antibiotics. [NIH] Biological therapy: Treatment to stimulate or restore the ability of the immune system to fight infection and disease. Also used to lessen side effects that may be caused by some cancer treatments. Also known as immunotherapy, biotherapy, or biological response modifier (BRM) therapy. [NIH] Biopsy: Removal and pathologic examination of specimens in the form of small pieces of tissue from the living body. [NIH] Biosynthesis: The building up of a chemical compound in the physiologic processes of a living organism. [EU]

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Biotechnology: Body of knowledge related to the use of organisms, cells or cell-derived constituents for the purpose of developing products which are technically, scientifically and clinically useful. Alteration of biologic function at the molecular level (i.e., genetic engineering) is a central focus; laboratory methods used include transfection and cloning technologies, sequence and structure analysis algorithms, computer databases, and gene and protein structure function analysis and prediction. [NIH] Bladder: The organ that stores urine. [NIH] Blood Coagulation: The process of the interaction of blood coagulation factors that results in an insoluble fibrin clot. [NIH] Blood Glucose: Glucose in blood. [NIH] Blood pressure: The pressure of blood against the walls of a blood vessel or heart chamber. Unless there is reference to another location, such as the pulmonary artery or one of the heart chambers, it refers to the pressure in the systemic arteries, as measured, for example, in the forearm. [NIH] Blood vessel: A tube in the body through which blood circulates. Blood vessels include a network of arteries, arterioles, capillaries, venules, and veins. [NIH] Body Composition: The relative amounts of various components in the body, such as percent body fat. [NIH] Bone Marrow: The soft tissue filling the cavities of bones. Bone marrow exists in two types, yellow and red. Yellow marrow is found in the large cavities of large bones and consists mostly of fat cells and a few primitive blood cells. Red marrow is a hematopoietic tissue and is the site of production of erythrocytes and granular leukocytes. Bone marrow is made up of a framework of connective tissue containing branching fibers with the frame being filled with marrow cells. [NIH] Bowel: The long tube-shaped organ in the abdomen that completes the process of digestion. There is both a small and a large bowel. Also called the intestine. [NIH] Bowel Movement: Body wastes passed through the rectum and anus. [NIH] Brachytherapy: A collective term for interstitial, intracavity, and surface radiotherapy. It uses small sealed or partly-sealed sources that may be placed on or near the body surface or within a natural body cavity or implanted directly into the tissues. [NIH] Branch: Most commonly used for branches of nerves, but applied also to other structures. [NIH]

Breakdown: A physical, metal, or nervous collapse. [NIH] Broad-spectrum: Effective against a wide range of microorganisms; said of an antibiotic. [EU] Bromodeoxyuridine: A nucleoside that substitutes for thymidine in DNA and thus acts as an antimetabolite. It causes breaks in chromosomes and has been proposed as an antiviral and antineoplastic agent. It has been given orphan drug status for use in the treatment of primary brain tumors. [NIH] Bronchi: The larger air passages of the lungs arising from the terminal bifurcation of the trachea. [NIH] Bronchial: Pertaining to one or more bronchi. [EU] Bronchodilator: A drug that relaxes the smooth muscles in the constricted airway. [NIH] Buccal: Pertaining to or directed toward the cheek. In dental anatomy, used to refer to the buccal surface of a tooth. [EU] Buccal mucosa: The inner lining of the cheeks and lips. [NIH]

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Cachexia: General ill health, malnutrition, and weight loss, usually associated with chronic disease. [NIH] Calcium: A basic element found in nearly all organized tissues. It is a member of the alkaline earth family of metals with the atomic symbol Ca, atomic number 20, and atomic weight 40. Calcium is the most abundant mineral in the body and combines with phosphorus to form calcium phosphate in the bones and teeth. It is essential for the normal functioning of nerves and muscles and plays a role in blood coagulation (as factor IV) and in many enzymatic processes. [NIH] Calcium Carbonate: Carbonic acid calcium salt (CaCO3). An odorless, tasteless powder or crystal that occurs in nature. It is used therapeutically as a phosphate buffer in hemodialysis patients and as a calcium supplement. [NIH] Calculus I: An abnormal concretion occurring within the animal body and usually composed of mineral salts. [EU] Candidiasis: Infection with a fungus of the genus Candida. It is usually a superficial infection of the moist cutaneous areas of the body, and is generally caused by C. albicans; it most commonly involves the skin (dermatocandidiasis), oral mucous membranes (thrush, def. 1), respiratory tract (bronchocandidiasis), and vagina (vaginitis). Rarely there is a systemic infection or endocarditis. Called also moniliasis, candidosis, oidiomycosis, and formerly blastodendriosis. [EU] Candidosis: An infection caused by an opportunistic yeasts that tends to proliferate and become pathologic when the environment is favorable and the host resistance is weakened. [NIH]

Capsular: Cataract which is initiated by an opacification at the surface of the lens. [NIH] Carbohydrate: An aldehyde or ketone derivative of a polyhydric alcohol, particularly of the pentahydric and hexahydric alcohols. They are so named because the hydrogen and oxygen are usually in the proportion to form water, (CH2O)n. The most important carbohydrates are the starches, sugars, celluloses, and gums. They are classified into mono-, di-, tri-, polyand heterosaccharides. [EU] Carcinogen: Any substance that causes cancer. [NIH] Carcinogenesis: The process by which normal cells are transformed into cancer cells. [NIH] Carcinogenic: Producing carcinoma. [EU] Carcinoma: Cancer that begins in the skin or in tissues that line or cover internal organs. [NIH]

Cardiovascular: Having to do with the heart and blood vessels. [NIH] Cardiovascular disease: Any abnormal condition characterized by dysfunction of the heart and blood vessels. CVD includes atherosclerosis (especially coronary heart disease, which can lead to heart attacks), cerebrovascular disease (e.g., stroke), and hypertension (high blood pressure). [NIH] Case report: A detailed report of the diagnosis, treatment, and follow-up of an individual patient. Case reports also contain some demographic information about the patient (for example, age, gender, ethnic origin). [NIH] Cations: Postively charged atoms, radicals or groups of atoms which travel to the cathode or negative pole during electrolysis. [NIH] Cause of Death: Factors which produce cessation of all vital bodily functions. They can be analyzed from an epidemiologic viewpoint. [NIH] Cell: The individual unit that makes up all of the tissues of the body. All living things are made up of one or more cells. [NIH]

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Cell Division: The fission of a cell. [NIH] Cell membrane: Cell membrane = plasma membrane. The structure enveloping a cell, enclosing the cytoplasm, and forming a selective permeability barrier; it consists of lipids, proteins, and some carbohydrates, the lipids thought to form a bilayer in which integral proteins are embedded to varying degrees. [EU] Cell Survival: The span of viability of a cell characterized by the capacity to perform certain functions such as metabolism, growth, reproduction, some form of responsiveness, and adaptability. [NIH] Cellulose: A polysaccharide with glucose units linked as in cellobiose. It is the chief constituent of plant fibers, cotton being the purest natural form of the substance. As a raw material, it forms the basis for many derivatives used in chromatography, ion exchange materials, explosives manufacturing, and pharmaceutical preparations. [NIH] Central Nervous System: The main information-processing organs of the nervous system, consisting of the brain, spinal cord, and meninges. [NIH] Cerebral: Of or pertaining of the cerebrum or the brain. [EU] Cerebrovascular: Pertaining to the blood vessels of the cerebrum, or brain. [EU] Chelation: Combination with a metal in complexes in which the metal is part of a ring. [EU] Chemokines: Class of pro-inflammatory cytokines that have the ability to attract and activate leukocytes. They can be divided into at least three structural branches: C (chemokines, C), CC (chemokines, CC), and CXC (chemokines, CXC), according to variations in a shared cysteine motif. [NIH] Chemoprevention: The use of drugs, vitamins, or other agents to try to reduce the risk of, or delay the development or recurrence of, cancer. [NIH] Chemotactic Factors: Chemical substances that attract or repel cells or organisms. The concept denotes especially those factors released as a result of tissue injury, invasion, or immunologic activity, that attract leukocytes, macrophages, or other cells to the site of infection or insult. [NIH] Chlorhexidine: Disinfectant and topical anti-infective agent used also as mouthwash to prevent oral plaque. [NIH] Chlorine: A greenish-yellow, diatomic gas that is a member of the halogen family of elements. It has the atomic symbol Cl, atomic number 17, and atomic weight 70.906. It is a powerful irritant that can cause fatal pulmonary edema. Chlorine is used in manufacturing, as a reagent in synthetic chemistry, for water purification, and in the production of chlorinated lime, which is used in fabric bleaching. [NIH] Chlorophyll: Porphyrin derivatives containing magnesium that act to convert light energy in photosynthetic organisms. [NIH] Cholesterol: The principal sterol of all higher animals, distributed in body tissues, especially the brain and spinal cord, and in animal fats and oils. [NIH] Cholinergic: Resembling acetylcholine in pharmacological action; stimulated by or releasing acetylcholine or a related compound. [EU] Chorda Tympani Nerve: A branch of the facial (7th cranial) nerve which passes through the middle ear and continues through the petrotympanic fissure. The chorda tympani nerve carries taste sensation from the anterior two-thirds of the tongue and conveys parasympathetic efferents to the salivary glands. [NIH] Chromosomal: Pertaining to chromosomes. [EU] Chromosome: Part of a cell that contains genetic information. Except for sperm and eggs, all

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human cells contain 46 chromosomes. [NIH] Chronic: A disease or condition that persists or progresses over a long period of time. [NIH] Chronic Disease: Disease or ailment of long duration. [NIH] Clear cell carcinoma: A rare type of tumor of the female genital tract in which the inside of the cells looks clear when viewed under a microscope. [NIH] Clinical trial: A research study that tests how well new medical treatments or other interventions work in people. Each study is designed to test new methods of screening, prevention, diagnosis, or treatment of a disease. [NIH] Cloning: The production of a number of genetically identical individuals; in genetic engineering, a process for the efficient replication of a great number of identical DNA molecules. [NIH] Coenzyme: An organic nonprotein molecule, frequently a phosphorylated derivative of a water-soluble vitamin, that binds with the protein molecule (apoenzyme) to form the active enzyme (holoenzyme). [EU] Cofactor: A substance, microorganism or environmental factor that activates or enhances the action of another entity such as a disease-causing agent. [NIH] Coliphages: Viruses whose host is Escherichia coli. [NIH] Collagen: A polypeptide substance comprising about one third of the total protein in mammalian organisms. It is the main constituent of skin, connective tissue, and the organic substance of bones and teeth. Different forms of collagen are produced in the body but all consist of three alpha-polypeptide chains arranged in a triple helix. Collagen is differentiated from other fibrous proteins, such as elastin, by the content of proline, hydroxyproline, and hydroxylysine; by the absence of tryptophan; and particularly by the high content of polar groups which are responsible for its swelling properties. [NIH] Collagenases: Enzymes that catalyze the degradation of collagen by acting on the peptide bonds. EC 3.4.24.-. [NIH] Collapse: 1. A state of extreme prostration and depression, with failure of circulation. 2. Abnormal falling in of the walls of any part of organ. [EU] Colostrum: The thin, yellow, serous fluid secreted by the mammary glands during pregnancy and immediately postpartum before lactation begins. It consists of immunologically active substances, white blood cells, water, protein, fat, and carbohydrates. [NIH]

Complement: A term originally used to refer to the heat-labile factor in serum that causes immune cytolysis, the lysis of antibody-coated cells, and now referring to the entire functionally related system comprising at least 20 distinct serum proteins that is the effector not only of immune cytolysis but also of other biologic functions. Complement activation occurs by two different sequences, the classic and alternative pathways. The proteins of the classic pathway are termed 'components of complement' and are designated by the symbols C1 through C9. C1 is a calcium-dependent complex of three distinct proteins C1q, C1r and C1s. The proteins of the alternative pathway (collectively referred to as the properdin system) and complement regulatory proteins are known by semisystematic or trivial names. Fragments resulting from proteolytic cleavage of complement proteins are designated with lower-case letter suffixes, e.g., C3a. Inactivated fragments may be designated with the suffix 'i', e.g. C3bi. Activated components or complexes with biological activity are designated by a bar over the symbol e.g. C1 or C4b,2a. The classic pathway is activated by the binding of C1 to classic pathway activators, primarily antigen-antibody complexes containing IgM, IgG1, IgG3; C1q binds to a single IgM molecule or two adjacent IgG molecules. The alternative pathway can be activated by IgA immune complexes and also by nonimmunologic materials

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including bacterial endotoxins, microbial polysaccharides, and cell walls. Activation of the classic pathway triggers an enzymatic cascade involving C1, C4, C2 and C3; activation of the alternative pathway triggers a cascade involving C3 and factors B, D and P. Both result in the cleavage of C5 and the formation of the membrane attack complex. Complement activation also results in the formation of many biologically active complement fragments that act as anaphylatoxins, opsonins, or chemotactic factors. [EU] Complementary and alternative medicine: CAM. Forms of treatment that are used in addition to (complementary) or instead of (alternative) standard treatments. These practices are not considered standard medical approaches. CAM includes dietary supplements, megadose vitamins, herbal preparations, special teas, massage therapy, magnet therapy, spiritual healing, and meditation. [NIH] Complementary medicine: Practices not generally recognized by the medical community as standard or conventional medical approaches and used to enhance or complement the standard treatments. Complementary medicine includes the taking of dietary supplements, megadose vitamins, and herbal preparations; the drinking of special teas; and practices such as massage therapy, magnet therapy, spiritual healing, and meditation. [NIH] Computational Biology: A field of biology concerned with the development of techniques for the collection and manipulation of biological data, and the use of such data to make biological discoveries or predictions. This field encompasses all computational methods and theories applicable to molecular biology and areas of computer-based techniques for solving biological problems including manipulation of models and datasets. [NIH] Conception: The onset of pregnancy, marked by implantation of the blastocyst; the formation of a viable zygote. [EU] Concretion: Minute, hard, yellow masses found in the palpebral conjunctivae of elderly people or following chronic conjunctivitis, composed of the products of cellular degeneration retained in the depressions and tubular recesses in the conjunctiva. [NIH] Congestion: Excessive or abnormal accumulation of blood in a part. [EU] Conjugated: Acting or operating as if joined; simultaneous. [EU] Connective Tissue: Tissue that supports and binds other tissues. It consists of connective tissue cells embedded in a large amount of extracellular matrix. [NIH] Connective Tissue: Tissue that supports and binds other tissues. It consists of connective tissue cells embedded in a large amount of extracellular matrix. [NIH] Connective Tissue Cells: A group of cells that includes fibroblasts, cartilage cells, adipocytes, smooth muscle cells, and bone cells. [NIH] Conscious Sedation: An alternative to general anesthesia in patients for whom general anesthesia is refused or considered inadvisable. It involves the administering of an antianxiety drug (minor tranquilizer) and an analgesic or local anesthetic. This renders the patient free of anxiety and pain while allowing the patient to remain in verbal contact with the physician or dentist. [NIH] Consciousness: Sense of awareness of self and of the environment. [NIH] Consumption: Pulmonary tuberculosis. [NIH] Contraception: Use of agents, devices, methods, or procedures which diminish the likelihood of or prevent conception. [NIH] Contraindications: Any factor or sign that it is unwise to pursue a certain kind of action or treatment, e. g. giving a general anesthetic to a person with pneumonia. [NIH] Conventional therapy: A currently accepted and widely used treatment for a certain type of

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disease, based on the results of past research. Also called conventional treatment. [NIH] Conventional treatment: A currently accepted and widely used treatment for a certain type of disease, based on the results of past research. Also called conventional therapy. [NIH] Convulsions: A general term referring to sudden and often violent motor activity of cerebral or brainstem origin. Convulsions may also occur in the absence of an electrical cerebral discharge (e.g., in response to hypotension). [NIH] Cooperative group: A group of physicians, hospitals, or both formed to treat a large number of persons in the same way so that new treatment can be evaluated quickly. Clinical trials of new cancer treatments often require many more people than a single physician or hospital can care for. [NIH] Coronary: Encircling in the manner of a crown; a term applied to vessels; nerves, ligaments, etc. The term usually denotes the arteries that supply the heart muscle and, by extension, a pathologic involvement of them. [EU] Coronary heart disease: A type of heart disease caused by narrowing of the coronary arteries that feed the heart, which needs a constant supply of oxygen and nutrients carried by the blood in the coronary arteries. When the coronary arteries become narrowed or clogged by fat and cholesterol deposits and cannot supply enough blood to the heart, CHD results. [NIH] Coronary Thrombosis: Presence of a thrombus in a coronary artery, often causing a myocardial infarction. [NIH] Cortex: The outer layer of an organ or other body structure, as distinguished from the internal substance. [EU] Corticosteroid: Any of the steroids elaborated by the adrenal cortex (excluding the sex hormones of adrenal origin) in response to the release of corticotrophin (adrenocorticotropic hormone) by the pituitary gland, to any of the synthetic equivalents of these steroids, or to angiotensin II. They are divided, according to their predominant biological activity, into three major groups: glucocorticoids, chiefly influencing carbohydrate, fat, and protein metabolism; mineralocorticoids, affecting the regulation of electrolyte and water balance; and C19 androgens. Some corticosteroids exhibit both types of activity in varying degrees, and others exert only one type of effect. The corticosteroids are used clinically for hormonal replacement therapy, for suppression of ACTH secretion by the anterior pituitary, as antineoplastic, antiallergic, and anti-inflammatory agents, and to suppress the immune response. Called also adrenocortical hormone and corticoid. [EU] Cranial: Pertaining to the cranium, or to the anterior (in animals) or superior (in humans) end of the body. [EU] Criterion: A standard by which something may be judged. [EU] Crown Lengthening: Technique combining controlled eruptive tooth movement and incision of the supracrestal gingival attachment to allow for proper restoration of a destroyed or damaged crown of a tooth. Controlled eruption of the tooth is obtained using orthodontic appliances. During this eruptive phase, repeated incisions are made at the junctional epithelium of the sulcus and the supracrestal connective tissue to prevent coronal displacement of the gingiva and of the attachment apparatus. [NIH] Crowns: A prosthetic restoration that reproduces the entire surface anatomy of the visible natural crown of a tooth. It may be partial (covering three or more surfaces of a tooth) or complete (covering all surfaces). It is made of gold or other metal, porcelain, or resin. [NIH] Cryptosporidium: A genus of coccidian parasites of the family Cryptosporidiidae, found in the intestinal epithelium of many vertebrates including humans. [NIH]

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Curare: Plant extracts from several species, including Strychnos toxifera, S. castelnaei, S. crevauxii, and Chondodendron tomentosum, that produce paralysis of skeletal muscle and are used adjunctively with general anesthesia. These extracts are toxic and must be used with the administration of artificial respiration. [NIH] Curative: Tending to overcome disease and promote recovery. [EU] Curettage: Removal of tissue with a curette, a spoon-shaped instrument with a sharp edge. [NIH]

Curette: A spoon-shaped instrument with a sharp edge. [NIH] Cutaneous: Having to do with the skin. [NIH] Cyclic: Pertaining to or occurring in a cycle or cycles; the term is applied to chemical compounds that contain a ring of atoms in the nucleus. [EU] Cysteine: A thiol-containing non-essential amino acid that is oxidized to form cystine. [NIH] Cysteine Endopeptidases: Endopeptidases which have a cysteine involved in the catalytic process. This group of enzymes is inactivated by sulfhydryl reagents. EC 3.4.22. [NIH] Cytokine: Small but highly potent protein that modulates the activity of many cell types, including T and B cells. [NIH] Cytoplasm: The protoplasm of a cell exclusive of that of the nucleus; it consists of a continuous aqueous solution (cytosol) and the organelles and inclusions suspended in it (phaneroplasm), and is the site of most of the chemical activities of the cell. [EU] Cytotoxic: Cell-killing. [NIH] Cytotoxins: Substances elaborated by microorganisms, plants or animals that are specifically toxic to individual cells; they may be involved in immunity or may be contained in venoms. [NIH]

Data Collection: Systematic gathering of data for a particular purpose from various sources, including questionnaires, interviews, observation, existing records, and electronic devices. The process is usually preliminary to statistical analysis of the data. [NIH] Databases, Bibliographic: Extensive collections, reputedly complete, of references and citations to books, articles, publications, etc., generally on a single subject or specialized subject area. Databases can operate through automated files, libraries, or computer disks. The concept should be differentiated from factual databases which is used for collections of data and facts apart from bibliographic references to them. [NIH] Decarboxylation: The removal of a carboxyl group, usually in the form of carbon dioxide, from a chemical compound. [NIH] Decongestant: An agent that reduces congestion or swelling. [EU] Defense Mechanisms: Unconscious process used by an individual or a group of individuals in order to cope with impulses, feelings or ideas which are not acceptable at their conscious level; various types include reaction formation, projection and self reversal. [NIH] Defensins: Family of antimicrobial peptides that have been identified in humans, animals, and plants. They are thought to play a role in host defenses against infections, inflammation, wound repair, and acquired immunity. Based on the disulfide pairing of their characteristic six cysteine residues, they are divided into alpha-defensins and beta-defensins. [NIH] Dental Abutments: Natural teeth or teeth roots used as anchorage for a fixed or removable denture or other prosthesis (such as an implant) serving the same purpose. [NIH] Dental Calculus: Abnormal concretion or calcified deposit that forms around the teeth or dental prostheses. [NIH] Dental Care: The total of dental diagnostic, preventive, and restorative services provided to

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meet the needs of a patient (from Illustrated Dictionary of Dentistry, 1982). [NIH] Dental Caries: Localized destruction of the tooth surface initiated by decalcification of the enamel followed by enzymatic lysis of organic structures and leading to cavity formation. If left unchecked, the cavity may penetrate the enamel and dentin and reach the pulp. The three most prominent theories used to explain the etiology of the disase are that acids produced by bacteria lead to decalcification; that micro-organisms destroy the enamel protein; or that keratolytic micro-organisms produce chelates that lead to decalcification. [NIH]

Dental implant: A small metal pin placed inside the jawbone to mimic the root of a tooth. Dental implants can be used to help anchor a false tooth or teeth, or a crown or bridge. [NIH] Dental Plaque: A film that attaches to teeth, often causing dental caries and gingivitis. It is composed of mucins, secreted from salivary glands, and microorganisms. [NIH] Dental Polishing: Creation of a smooth and glossy surface finish on a denture or amalgam. [NIH]

Dental Prophylaxis: Treatment for the prevention of periodontal diseases or other dental diseases by the cleaning of the teeth in the dental office using the procedures of dental scaling and dental polishing. The treatment may include plaque detection, removal of supraand subgingival plaque and calculus, application of caries-preventing agents, checking of restorations and prostheses and correcting overhanging margins and proximal contours of restorations, and checking for signs of food impaction. [NIH] Dental Scaling: Removal of dental plaque and dental calculus from the surface of a tooth, from the surface of a tooth apical to the gingival margin accumulated in periodontal pockets, or from the surface coronal to the gingival margin. [NIH] Dentifrices: Any preparations used for cleansing teeth; they usually contain an abrasive, detergent, binder and flavoring agent and may exist in the form of liquid, paste or powder; may also contain medicaments and caries preventives. [NIH] Dentists: Individuals licensed to practice dentistry. [NIH] Dentition: The teeth in the dental arch; ordinarily used to designate the natural teeth in position in their alveoli. [EU] Dentures: An appliance used as an artificial or prosthetic replacement for missing teeth and adjacent tissues. It does not include crowns, dental abutments, nor artificial teeth. [NIH] DES: Diethylstilbestrol. A synthetic hormone that was prescribed from the early 1940s until 1971 to help women with complications of pregnancy. DES has been linked to an increased risk of clear cell carcinoma of the vagina in daughters of women who used DES. DES may also increase the risk of breast cancer in women who used DES. [NIH] Deuterium: Deuterium. The stable isotope of hydrogen. It has one neutron and one proton in the nucleus. [NIH] Dextrans: A group of glucose polymers made by certain bacteria. Dextrans are used therapeutically as plasma volume expanders and anticoagulants. They are also commonly used in biological experimentation and in industry for a wide variety of purposes. [NIH] Diabetes Mellitus: A heterogeneous group of disorders that share glucose intolerance in common. [NIH] Diagnostic procedure: A method used to identify a disease. [NIH] Dialyzer: A part of the hemodialysis machine. (See hemodialysis under dialysis.) The dialyzer has two sections separated by a membrane. One section holds dialysate. The other holds the patient's blood. [NIH] Diastolic: Of or pertaining to the diastole. [EU]

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Digestive system: The organs that take in food and turn it into products that the body can use to stay healthy. Waste products the body cannot use leave the body through bowel movements. The digestive system includes the salivary glands, mouth, esophagus, stomach, liver, pancreas, gallbladder, small and large intestines, and rectum. [NIH] Digestive tract: The organs through which food passes when food is eaten. These organs are the mouth, esophagus, stomach, small and large intestines, and rectum. [NIH] Dilatation: The act of dilating. [NIH] Direct: 1. Straight; in a straight line. 2. Performed immediately and without the intervention of subsidiary means. [EU] Disease Progression: The worsening of a disease over time. This concept is most often used for chronic and incurable diseases where the stage of the disease is an important determinant of therapy and prognosis. [NIH] Disinfectant: An agent that disinfects; applied particularly to agents used on inanimate objects. [EU] Dissociation: 1. The act of separating or state of being separated. 2. The separation of a molecule into two or more fragments (atoms, molecules, ions, or free radicals) produced by the absorption of light or thermal energy or by solvation. 3. In psychology, a defense mechanism in which a group of mental processes are segregated from the rest of a person's mental activity in order to avoid emotional distress, as in the dissociative disorders (q.v.), or in which an idea or object is segregated from its emotional significance; in the first sense it is roughly equivalent to splitting, in the second, to isolation. 4. A defect of mental integration in which one or more groups of mental processes become separated off from normal consciousness and, thus separated, function as a unitary whole. [EU] Diuretic: A drug that increases the production of urine. [NIH] Dose-dependent: Refers to the effects of treatment with a drug. If the effects change when the dose of the drug is changed, the effects are said to be dose dependent. [NIH] Doxycycline: A synthetic tetracycline derivative with a range of antimicrobial activity and mode of action similar to that of tetracycline, but more effective against many species. Animal studies suggest that it may cause less tooth staining than other tetracyclines. [NIH] Drug Interactions: The action of a drug that may affect the activity, metabolism, or toxicity of another drug. [NIH] Duct: A tube through which body fluids pass. [NIH] Dyes: Chemical substances that are used to stain and color other materials. The coloring may or may not be permanent. Dyes can also be used as therapeutic agents and test reagents in medicine and scientific research. [NIH] Eclampsia: Onset of convulsions or coma in a previously diagnosed pre-eclamptic patient. [NIH]

Edema: Excessive amount of watery fluid accumulated in the intercellular spaces, most commonly present in subcutaneous tissue. [NIH] Effector: It is often an enzyme that converts an inactive precursor molecule into an active second messenger. [NIH] Efficacy: The extent to which a specific intervention, procedure, regimen, or service produces a beneficial result under ideal conditions. Ideally, the determination of efficacy is based on the results of a randomized control trial. [NIH] Elastin: The protein that gives flexibility to tissues. [NIH] Electrolyte: A substance that dissociates into ions when fused or in solution, and thus

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becomes capable of conducting electricity; an ionic solute. [EU] Electrons: Stable elementary particles having the smallest known negative charge, present in all elements; also called negatrons. Positively charged electrons are called positrons. The numbers, energies and arrangement of electrons around atomic nuclei determine the chemical identities of elements. Beams of electrons are called cathode rays or beta rays, the latter being a high-energy biproduct of nuclear decay. [NIH] Electroplating: Coating with a metal or alloy by electrolysis. [NIH] Embryo: The prenatal stage of mammalian development characterized by rapid morphological changes and the differentiation of basic structures. [NIH] Embryo Transfer: Removal of a mammalian embryo from one environment and replacement in the same or a new environment. The embryo is usually in the pre-nidation phase, i.e., a blastocyst. The process includes embryo or blastocyst transplantation or transfer after in vitro fertilization and transfer of the inner cell mass of the blastocyst. It is not used for transfer of differentiated embryonic tissue, e.g., germ layer cells. [NIH] Emollient: Softening or soothing; called also malactic. [EU] Enamel: A very hard whitish substance which covers the dentine of the anatomical crown of a tooth. [NIH] Endemic: Present or usually prevalent in a population or geographical area at all times; said of a disease or agent. Called also endemial. [EU] Endocarditis: Exudative and proliferative inflammatory alterations of the endocardium, characterized by the presence of vegetations on the surface of the endocardium or in the endocardium itself, and most commonly involving a heart valve, but sometimes affecting the inner lining of the cardiac chambers or the endocardium elsewhere. It may occur as a primary disorder or as a complication of or in association with another disease. [EU] Endodontics: A dental specialty concerned with the maintenance of the dental pulp in a state of health and the treatment of the pulp cavity (pulp chamber and pulp canal). [NIH] Endometriosis: A condition in which tissue more or less perfectly resembling the uterine mucous membrane (the endometrium) and containing typical endometrial granular and stromal elements occurs aberrantly in various locations in the pelvic cavity. [NIH] Endopeptidases: A subclass of peptide hydrolases. They are classified primarily by their catalytic mechanism. Specificity is used only for identification of individual enzymes. They comprise the serine endopeptidases, EC 3.4.21; cysteine endopeptidases, EC 3.4.22; aspartic endopeptidases, EC 3.4.23, metalloendopeptidases, EC 3.4.24; and a group of enzymes yet to be assigned to any of the above sub-classes, EC 3.4.99. EC 3.4.-. [NIH] Endothelial cell: The main type of cell found in the inside lining of blood vessels, lymph vessels, and the heart. [NIH] Endotoxic: Of, relating to, or acting as an endotoxin (= a heat-stable toxin, associated with the outer membranes of certain gram-negative bacteria. Endotoxins are not secreted and are released only when the cells are disrupted). [EU] Endotoxin: Toxin from cell walls of bacteria. [NIH] Enteropeptidase: A specialized proteolytic enzyme secreted by intestinal cells. It converts trypsinogen into its active form trypsin by removing the N-terminal peptide. EC 3.4.21.9. [NIH]

Environmental Health: The science of controlling or modifying those conditions, influences, or forces surrounding man which relate to promoting, establishing, and maintaining health. [NIH]

Enzymatic: Phase where enzyme cuts the precursor protein. [NIH]

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Enzyme: A protein that speeds up chemical reactions in the body. [NIH] Eosinophils: Granular leukocytes with a nucleus that usually has two lobes connected by a slender thread of chromatin, and cytoplasm containing coarse, round granules that are uniform in size and stainable by eosin. [NIH] Epidemic: Occurring suddenly in numbers clearly in excess of normal expectancy; said especially of infectious diseases but applied also to any disease, injury, or other healthrelated event occurring in such outbreaks. [EU] Epidermal: Pertaining to or resembling epidermis. Called also epidermic or epidermoid. [EU] Epinephrine: The active sympathomimetic hormone from the adrenal medulla in most species. It stimulates both the alpha- and beta- adrenergic systems, causes systemic vasoconstriction and gastrointestinal relaxation, stimulates the heart, and dilates bronchi and cerebral vessels. It is used in asthma and cardiac failure and to delay absorption of local anesthetics. [NIH] Epithelial: Refers to the cells that line the internal and external surfaces of the body. [NIH] Epithelial Cells: Cells that line the inner and outer surfaces of the body. [NIH] Epithelium: One or more layers of epithelial cells, supported by the basal lamina, which covers the inner or outer surfaces of the body. [NIH] Epitope: A molecule or portion of a molecule capable of binding to the combining site of an antibody. For every given antigenic determinant, the body can construct a variety of antibody-combining sites, some of which fit almost perfectly, and others which barely fit. [NIH]

Erythrocytes: Red blood cells. Mature erythrocytes are non-nucleated, biconcave disks containing hemoglobin whose function is to transport oxygen. [NIH] Esophagus: The muscular tube through which food passes from the throat to the stomach. [NIH]

Ether: One of a class of organic compounds in which any two organic radicals are attached directly to a single oxygen atom. [NIH] Ethnic Groups: A group of people with a common cultural heritage that sets them apart from others in a variety of social relationships. [NIH] Exhaustion: The feeling of weariness of mind and body. [NIH] Exogenous: Developed or originating outside the organism, as exogenous disease. [EU] Exotoxins: Toxins produced, especially by bacterial or fungal cells, and released into the culture medium or environment. [NIH] External-beam radiation: Radiation therapy that uses a machine to aim high-energy rays at the cancer. Also called external radiation. [NIH] Extracellular: Outside a cell or cells. [EU] Extracellular Matrix: A meshwork-like substance found within the extracellular space and in association with the basement membrane of the cell surface. It promotes cellular proliferation and provides a supporting structure to which cells or cell lysates in culture dishes adhere. [NIH] Extracellular Matrix Proteins: Macromolecular organic compounds that contain carbon, hydrogen, oxygen, nitrogen, and usually, sulfur. These macromolecules (proteins) form an intricate meshwork in which cells are embedded to construct tissues. Variations in the relative types of macromolecules and their organization determine the type of extracellular matrix, each adapted to the functional requirements of the tissue. The two main classes of macromolecules that form the extracellular matrix are: glycosaminoglycans, usually linked

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to proteins (proteoglycans), and fibrous proteins (e.g., collagen, elastin, fibronectins and laminin). [NIH] Extraction: The process or act of pulling or drawing out. [EU] Facial: Of or pertaining to the face. [EU] Facial Nerve: The 7th cranial nerve. The facial nerve has two parts, the larger motor root which may be called the facial nerve proper, and the smaller intermediate or sensory root. Together they provide efferent innervation to the muscles of facial expression and to the lacrimal and salivary glands, and convey afferent information for taste from the anterior two-thirds of the tongue and for touch from the external ear. [NIH] Family Planning: Programs or services designed to assist the family in controlling reproduction by either improving or diminishing fertility. [NIH] Fat: Total lipids including phospholipids. [NIH] Fatty acids: A major component of fats that are used by the body for energy and tissue development. [NIH] Fertilization in Vitro: Fertilization of an egg outside the body when the egg is normally fertilized in the body. [NIH] Fertilizers: Substances or mixtures that are added to the soil to supply nutrients or to make available nutrients already present in the soil, in order to increase plant growth and productivity. [NIH] Fibrin: A protein derived from fibrinogen in the presence of thrombin, which forms part of the blood clot. [NIH] Fibrinogen: Plasma glycoprotein clotted by thrombin, composed of a dimer of three nonidentical pairs of polypeptide chains (alpha, beta, gamma) held together by disulfide bonds. Fibrinogen clotting is a sol-gel change involving complex molecular arrangements: whereas fibrinogen is cleaved by thrombin to form polypeptides A and B, the proteolytic action of other enzymes yields different fibrinogen degradation products. [NIH] Fibronectin: An adhesive glycoprotein. One form circulates in plasma, acting as an opsonin; another is a cell-surface protein which mediates cellular adhesive interactions. [NIH] Fissure: Any cleft or groove, normal or otherwise; especially a deep fold in the cerebral cortex which involves the entire thickness of the brain wall. [EU] Flatus: Gas passed through the rectum. [NIH] Fluorescence: The property of emitting radiation while being irradiated. The radiation emitted is usually of longer wavelength than that incident or absorbed, e.g., a substance can be irradiated with invisible radiation and emit visible light. X-ray fluorescence is used in diagnosis. [NIH] Fluoridation: The addition of fluorine usually as a fluoride to something, as the adding of a fluoride to drinking water or public water supplies for prevention of tooth decay in children. [NIH] Fluorine: A nonmetallic, diatomic gas that is a trace element and member of the halogen family. It is used in dentistry as flouride to prevent dental caries. [NIH] Folate: A B-complex vitamin that is being studied as a cancer prevention agent. Also called folic acid. [NIH] Fold: A plication or doubling of various parts of the body. [NIH] Folic Acid: N-(4-(((2-Amino-1,4-dihydro-4-oxo-6-pteridinyl)methyl)amino)benzoyl)-Lglutamic acid. A member of the vitamin B family that stimulates the hematopoietic system. It is present in the liver and kidney and is found in mushrooms, spinach, yeast, green leaves,

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and grasses. Folic acid is used in the treatment and prevention of folate deficiencies and megaloblastic anemia. [NIH] Fractionation: Dividing the total dose of radiation therapy into several smaller, equal doses delivered over a period of several days. [NIH] Fungi: A kingdom of eukaryotic, heterotrophic organisms that live as saprobes or parasites, including mushrooms, yeasts, smuts, molds, etc. They reproduce either sexually or asexually, and have life cycles that range from simple to complex. Filamentous fungi refer to those that grow as multicelluar colonies (mushrooms and molds). [NIH] Fungistatic: Inhibiting the growth of fungi. [EU] Fungus: A general term used to denote a group of eukaryotic protists, including mushrooms, yeasts, rusts, moulds, smuts, etc., which are characterized by the absence of chlorophyll and by the presence of a rigid cell wall composed of chitin, mannans, and sometimes cellulose. They are usually of simple morphological form or show some reversible cellular specialization, such as the formation of pseudoparenchymatous tissue in the fruiting body of a mushroom. The dimorphic fungi grow, according to environmental conditions, as moulds or yeasts. [EU] Gallbladder: The pear-shaped organ that sits below the liver. Bile is concentrated and stored in the gallbladder. [NIH] Gamma Rays: Very powerful and penetrating, high-energy electromagnetic radiation of shorter wavelength than that of x-rays. They are emitted by a decaying nucleus, usually between 0.01 and 10 MeV. They are also called nuclear x-rays. [NIH] Gas: Air that comes from normal breakdown of food. The gases are passed out of the body through the rectum (flatus) or the mouth (burp). [NIH] Gastric: Having to do with the stomach. [NIH] Gastric Acid: Hydrochloric acid present in gastric juice. [NIH] Gastrin: A hormone released after eating. Gastrin causes the stomach to produce more acid. [NIH]

Gastrointestinal: Refers to the stomach and intestines. [NIH] Gastrointestinal tract: The stomach and intestines. [NIH] Gels: Colloids with a solid continuous phase and liquid as the dispersed phase; gels may be unstable when, due to temperature or other cause, the solid phase liquifies; the resulting colloid is called a sol. [NIH] Gene: The functional and physical unit of heredity passed from parent to offspring. Genes are pieces of DNA, and most genes contain the information for making a specific protein. [NIH]

Gene Expression: The phenotypic manifestation of a gene or genes by the processes of gene action. [NIH] Genetic Code: The specifications for how information, stored in nucleic acid sequence (base sequence), is translated into protein sequence (amino acid sequence). The start, stop, and order of amino acids of a protein is specified by consecutive triplets of nucleotides called codons (codon). [NIH] Genetic testing: Analyzing DNA to look for a genetic alteration that may indicate an increased risk for developing a specific disease or disorder. [NIH] Genetics: The biological science that deals with the phenomena and mechanisms of heredity. [NIH] Genotype: The genetic constitution of the individual; the characterization of the genes. [NIH]

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Gestation: The period of development of the young in viviparous animals, from the time of fertilization of the ovum until birth. [EU] Giardiasis: An infection of the small intestine caused by the flagellated protozoan Giardia lamblia. It is spread via contaminated food and water and by direct person-to-person contact. [NIH] Gingival Pocket: An abnormal extension of a gingival sulcus not accompanied by the apical migration of the epithelial attachment. [NIH] Gingival Recession: The exposure of root surface by an apical shift in the position of the gingiva. [NIH] Glossopharyngeal Nerve: The 9th cranial nerve. The glossopharyngeal nerve is a mixed motor and sensory nerve; it conveys somatic and autonomic efferents as well as general, special, and visceral afferents. Among the connections are motor fibers to the stylopharyngeus muscle, parasympathetic fibers to the parotid glands, general and taste afferents from the posterior third of the tongue, the nasopharynx, and the palate, and afferents from baroreceptors and chemoreceptors of the carotid sinus. [NIH] Glucocorticoids: A group of corticosteroids that affect carbohydrate metabolism (gluconeogenesis, liver glycogen deposition, elevation of blood sugar), inhibit corticotropin secretion, and possess pronounced anti-inflammatory activity. They also play a role in fat and protein metabolism, maintenance of arterial blood pressure, alteration of the connective tissue response to injury, reduction in the number of circulating lymphocytes, and functioning of the central nervous system. [NIH] Glucose: D-Glucose. A primary source of energy for living organisms. It is naturally occurring and is found in fruits and other parts of plants in its free state. It is used therapeutically in fluid and nutrient replacement. [NIH] Glucose Intolerance: A pathological state in which the fasting plasma glucose level is less than 140 mg per deciliter and the 30-, 60-, or 90-minute plasma glucose concentration following a glucose tolerance test exceeds 200 mg per deciliter. This condition is seen frequently in diabetes mellitus but also occurs with other diseases. [NIH] Glutamic Acid: A non-essential amino acid naturally occurring in the L-form. Glutamic acid (glutamate) is the most common excitatory neurotransmitter in the central nervous system. [NIH]

Glutathione Peroxidase: An enzyme catalyzing the oxidation of 2 moles of glutathione in the presence of hydrogen peroxide to yield oxidized glutathione and water. EC 1.11.1.9. [NIH]

Glycerol: A trihydroxy sugar alcohol that is an intermediate in carbohydrate and lipid metabolism. It is used as a solvent, emollient, pharmaceutical agent, and sweetening agent. [NIH]

Glycerophospholipids: Derivatives of phosphatidic acid in which the hydrophobic regions are composed of two fatty acids and a polar alcohol is joined to the C-3 position of glycerol through a phosphodiester bond. They are named according to their polar head groups, such as phosphatidylcholine and phosphatidylethanolamine. [NIH] Glycoprotein: A protein that has sugar molecules attached to it. [NIH] Governing Board: The group in which legal authority is vested for the control of healthrelated institutions and organizations. [NIH] Grade: The grade of a tumor depends on how abnormal the cancer cells look under a microscope and how quickly the tumor is likely to grow and spread. Grading systems are different for each type of cancer. [NIH]

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Graft: Healthy skin, bone, or other tissue taken from one part of the body and used to replace diseased or injured tissue removed from another part of the body. [NIH] Grafting: The operation of transfer of tissue from one site to another. [NIH] Graft-versus-host disease: GVHD. A reaction of donated bone marrow or peripheral stem cells against a person's tissue. [NIH] Gram-negative: Losing the stain or decolorized by alcohol in Gram's method of staining, a primary characteristic of bacteria having a cell wall composed of a thin layer of peptidoglycan covered by an outer membrane of lipoprotein and lipopolysaccharide. [EU] Gram-Negative Bacteria: Bacteria which lose crystal violet stain but are stained pink when treated by Gram's method. [NIH] Gram-positive: Retaining the stain or resisting decolorization by alcohol in Gram's method of staining, a primary characteristic of bacteria whose cell wall is composed of a thick layer of peptidologlycan with attached teichoic acids. [EU] Granuloma: A relatively small nodular inflammatory lesion containing grouped mononuclear phagocytes, caused by infectious and noninfectious agents. [NIH] Grasses: A large family, Gramineae, of narrow-leaved herbaceous monocots. Many grasses produce highly allergenic pollens and are hosts to cattle parasites and toxic fungi. [NIH] Growth: The progressive development of a living being or part of an organism from its earliest stage to maturity. [NIH] Growth factors: Substances made by the body that function to regulate cell division and cell survival. Some growth factors are also produced in the laboratory and used in biological therapy. [NIH] Guided Tissue Regeneration: The repopulating of the periodontium, after treatment for periodontal disease. Repopulation is achieved by guiding the periodontal ligament progenitor cells to reproduce in the desired location by blocking contact of epithelial and gingival connective tissues with the root during healing. This blocking is accomplished by using synthetic membranes or collagen membranes. [NIH] Halitosis: An offensive, foul breath odor resulting from a variety of causes such as poor oral hygiene, dental or oral infections, or the ingestion of certain foods. [NIH] Hammer: The largest of the three ossicles of the ear. [NIH] Haptens: Small antigenic determinants capable of eliciting an immune response only when coupled to a carrier. Haptens bind to antibodies but by themselves cannot elicit an antibody response. [NIH] Health Education: Education that increases the awareness and favorably influences the attitudes and knowledge relating to the improvement of health on a personal or community basis. [NIH] Health Promotion: Encouraging consumer behaviors most likely to optimize health potentials (physical and psychosocial) through health information, preventive programs, and access to medical care. [NIH] Heart attack: A seizure of weak or abnormal functioning of the heart. [NIH] Hemodialysis: The use of a machine to clean wastes from the blood after the kidneys have failed. The blood travels through tubes to a dialyzer, which removes wastes and extra fluid. The cleaned blood then flows through another set of tubes back into the body. [NIH] Hemoglobin: One of the fractions of glycosylated hemoglobin A1c. Glycosylated hemoglobin is formed when linkages of glucose and related monosaccharides bind to hemoglobin A and its concentration represents the average blood glucose level over the

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previous several weeks. HbA1c levels are used as a measure of long-term control of plasma glucose (normal, 4 to 6 percent). In controlled diabetes mellitus, the concentration of glycosylated hemoglobin A is within the normal range, but in uncontrolled cases the level may be 3 to 4 times the normal conentration. Generally, complications are substantially lower among patients with Hb levels of 7 percent or less than in patients with HbA1c levels of 9 percent or more. [NIH] Hemorrhage: Bleeding or escape of blood from a vessel. [NIH] Heredity: 1. The genetic transmission of a particular quality or trait from parent to offspring. 2. The genetic constitution of an individual. [EU] Herpes: Any inflammatory skin disease caused by a herpesvirus and characterized by the formation of clusters of small vesicles. When used alone, the term may refer to herpes simplex or to herpes zoster. [EU] Herpes Zoster: Acute vesicular inflammation. [NIH] Heterogeneity: The property of one or more samples or populations which implies that they are not identical in respect of some or all of their parameters, e. g. heterogeneity of variance. [NIH]

Heterotrophic: Pertaining to organisms that are consumers and dependent on other organisms for their source of energy (food). [NIH] Histamine: 1H-Imidazole-4-ethanamine. A depressor amine derived by enzymatic decarboxylation of histidine. It is a powerful stimulant of gastric secretion, a constrictor of bronchial smooth muscle, a vasodilator, and also a centrally acting neurotransmitter. [NIH] Histidine: An essential amino acid important in a number of metabolic processes. It is required for the production of histamine. [NIH] Histology: The study of tissues and cells under a microscope. [NIH] Homologous: Corresponding in structure, position, origin, etc., as (a) the feathers of a bird and the scales of a fish, (b) antigen and its specific antibody, (c) allelic chromosomes. [EU] Hormonal: Pertaining to or of the nature of a hormone. [EU] Hormone: A substance in the body that regulates certain organs. Hormones such as gastrin help in breaking down food. Some hormones come from cells in the stomach and small intestine. [NIH] Host: Any animal that receives a transplanted graft. [NIH] Humoral: Of, relating to, proceeding from, or involving a bodily humour - now often used of endocrine factors as opposed to neural or somatic. [EU] Humour: 1. A normal functioning fluid or semifluid of the body (as the blood, lymph or bile) especially of vertebrates. 2. A secretion that is itself an excitant of activity (as certain hormones). [EU] Hydrogen: The first chemical element in the periodic table. It has the atomic symbol H, atomic number 1, and atomic weight 1. It exists, under normal conditions, as a colorless, odorless, tasteless, diatomic gas. Hydrogen ions are protons. Besides the common H1 isotope, hydrogen exists as the stable isotope deuterium and the unstable, radioactive isotope tritium. [NIH] Hydrolysis: The process of cleaving a chemical compound by the addition of a molecule of water. [NIH] Hydroxylysine: A hydroxylated derivative of the amino acid lysine that is present in certain collagens. [NIH] Hydroxyproline: A hydroxylated form of the imino acid proline. A deficiency in ascorbic

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acid can result in impaired hydroxyproline formation. [NIH] Hygienic: Pertaining to hygiene, or conducive to health. [EU] Hyperplasia: An increase in the number of cells in a tissue or organ, not due to tumor formation. It differs from hypertrophy, which is an increase in bulk without an increase in the number of cells. [NIH] Hypersensitivity: Altered reactivity to an antigen, which can result in pathologic reactions upon subsequent exposure to that particular antigen. [NIH] Hypertension: Persistently high arterial blood pressure. Currently accepted threshold levels are 140 mm Hg systolic and 90 mm Hg diastolic pressure. [NIH] Hypertrophy: General increase in bulk of a part or organ, not due to tumor formation, nor to an increase in the number of cells. [NIH] Id: The part of the personality structure which harbors the unconscious instinctive desires and strivings of the individual. [NIH] Immune response: The activity of the immune system against foreign substances (antigens). [NIH]

Immune system: The organs, cells, and molecules responsible for the recognition and disposal of foreign ("non-self") material which enters the body. [NIH] Immunity: Nonsusceptibility to the invasive or pathogenic microorganisms or to the toxic effect of antigenic substances. [NIH]

effects

of

foreign

Immunocompetence: The ability of lymphoid cells to mount a humoral or cellular immune response when challenged by antigen. [NIH] Immunocompromised: Having a weakened immune system caused by certain diseases or treatments. [NIH] Immunodeficiency: The decreased ability of the body to fight infection and disease. [NIH] Immunodeficiency syndrome: The inability of the body to produce an immune response. [NIH]

Immunoelectrophoresis: A technique that combines protein electrophoresis and double immunodiffusion. In this procedure proteins are first separated by gel electrophoresis (usually agarose), then made visible by immunodiffusion of specific antibodies. A distinct elliptical precipitin arc results for each protein detectable by the antisera. [NIH] Immunogen: A substance that is capable of causing antibody formation. [NIH] Immunogenic: Producing immunity; evoking an immune response. [EU] Immunoglobulin: A protein that acts as an antibody. [NIH] Immunologic: The ability of the antibody-forming system to recall a previous experience with an antigen and to respond to a second exposure with the prompt production of large amounts of antibody. [NIH] Immunology: The study of the body's immune system. [NIH] Impaction: The trapping of an object in a body passage. Examples are stones in the bile duct or hardened stool in the colon. [NIH] Impairment: In the context of health experience, an impairment is any loss or abnormality of psychological, physiological, or anatomical structure or function. [NIH] Implant radiation: A procedure in which radioactive material sealed in needles, seeds, wires, or catheters is placed directly into or near the tumor. Also called [NIH] Implantation: The insertion or grafting into the body of biological, living, inert, or radioactive material. [EU]

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In vitro: In the laboratory (outside the body). The opposite of in vivo (in the body). [NIH] In vivo: In the body. The opposite of in vitro (outside the body or in the laboratory). [NIH] Incision: A cut made in the body during surgery. [NIH] Incisor: Anything adapted for cutting; any one of the four front teeth in each jaw. [NIH] Indicative: That indicates; that points out more or less exactly; that reveals fairly clearly. [EU] Indomethacin: A non-steroidal anti-inflammatory agent (NSAID) that inhibits the enzyme cyclooxygenase necessary for the formation of prostaglandins and other autacoids. It also inhibits the motility of polymorphonuclear leukocytes. [NIH] Induction: The act or process of inducing or causing to occur, especially the production of a specific morphogenetic effect in the developing embryo through the influence of evocators or organizers, or the production of anaesthesia or unconsciousness by use of appropriate agents. [EU] Infant, Newborn: An infant during the first month after birth. [NIH] Infarction: A pathological process consisting of a sudden insufficient blood supply to an area, which results in necrosis of that area. It is usually caused by a thrombus, an embolus, or a vascular torsion. [NIH] Infection: 1. Invasion and multiplication of microorganisms in body tissues, which may be clinically unapparent or result in local cellular injury due to competitive metabolism, toxins, intracellular replication, or antigen-antibody response. The infection may remain localized, subclinical, and temporary if the body's defensive mechanisms are effective. A local infection may persist and spread by extension to become an acute, subacute, or chronic clinical infection or disease state. A local infection may also become systemic when the microorganisms gain access to the lymphatic or vascular system. 2. An infectious disease. [EU]

Infection Control: Programs of disease surveillance, generally within health care facilities, designed to investigate, prevent, and control the spread of infections and their causative microorganisms. [NIH] Inflammation: A pathological process characterized by injury or destruction of tissues caused by a variety of cytologic and chemical reactions. It is usually manifested by typical signs of pain, heat, redness, swelling, and loss of function. [NIH] Ingestion: Taking into the body by mouth [NIH] Initiation: Mutation induced by a chemical reactive substance causing cell changes; being a step in a carcinogenic process. [NIH] Inlay: In dentistry, a filling first made to correspond with the form of a dental cavity and then cemented into the cavity. [NIH] Inorganic: Pertaining to substances not of organic origin. [EU] Insulin: A protein hormone secreted by beta cells of the pancreas. Insulin plays a major role in the regulation of glucose metabolism, generally promoting the cellular utilization of glucose. It is also an important regulator of protein and lipid metabolism. Insulin is used as a drug to control insulin-dependent diabetes mellitus. [NIH] Interleukin-1: A soluble factor produced by monocytes, macrophages, and other cells which activates T-lymphocytes and potentiates their response to mitogens or antigens. IL-1 consists of two distinct forms, IL-1 alpha and IL-1 beta which perform the same functions but are distinct proteins. The biological effects of IL-1 include the ability to replace macrophage requirements for T-cell activation. The factor is distinct from interleukin-2. [NIH] Interleukin-2: Chemical mediator produced by activated T lymphocytes and which

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regulates the proliferation of T cells, as well as playing a role in the regulation of NK cell activity. [NIH] Interleukins: Soluble factors which stimulate growth-related activities of leukocytes as well as other cell types. They enhance cell proliferation and differentiation, DNA synthesis, secretion of other biologically active molecules and responses to immune and inflammatory stimuli. [NIH] Intermittent: Occurring at separated intervals; having periods of cessation of activity. [EU] Internal radiation: A procedure in which radioactive material sealed in needles, seeds, wires, or catheters is placed directly into or near the tumor. Also called brachytherapy, implant radiation, or interstitial radiation therapy. [NIH] Intestinal: Having to do with the intestines. [NIH] Intestine: A long, tube-shaped organ in the abdomen that completes the process of digestion. There is both a large intestine and a small intestine. Also called the bowel. [NIH] Intracellular: Inside a cell. [NIH] Intravenous: IV. Into a vein. [NIH] Intrinsic: Situated entirely within or pertaining exclusively to a part. [EU] Invasive: 1. Having the quality of invasiveness. 2. Involving puncture or incision of the skin or insertion of an instrument or foreign material into the body; said of diagnostic techniques. [EU]

Involuntary: Reaction occurring without intention or volition. [NIH] Ionization: 1. Any process by which a neutral atom gains or loses electrons, thus acquiring a net charge, as the dissociation of a substance in solution into ions or ion production by the passage of radioactive particles. 2. Iontophoresis. [EU] Ionizing: Radiation comprising charged particles, e. g. electrons, protons, alpha-particles, etc., having sufficient kinetic energy to produce ionization by collision. [NIH] Ions: An atom or group of atoms that have a positive or negative electric charge due to a gain (negative charge) or loss (positive charge) of one or more electrons. Atoms with a positive charge are known as cations; those with a negative charge are anions. [NIH] Irritants: Drugs that act locally on cutaneous or mucosal surfaces to produce inflammation; those that cause redness due to hyperemia are rubefacients; those that raise blisters are vesicants and those that penetrate sebaceous glands and cause abscesses are pustulants; tear gases and mustard gases are also irritants. [NIH] Ischemia: Deficiency of blood in a part, due to functional constriction or actual obstruction of a blood vessel. [EU] Ischemic stroke: A condition in which the blood supply to part of the brain is cut off. Also called "plug-type" strokes. Blocked arteries starve areas of the brain controlling sight, speech, sensation, and movement so that these functions are partially or completely lost. Ischemic stroke is the most common type of stroke, accounting for 80 percent of all strokes. Most ischemic strokes are caused by a blood clot called a thrombus, which blocks blood flow in the arteries feeding the brain, usually the carotid artery in the neck, the major vessel bringing blood to the brain. When it becomes blocked, the risk of stroke is very high. [NIH] Isoelectric: Separation of amphoteric substances, dissolved in water, based on their isoelectric behavior. The amphoteric substances are a mixture of proteins to be separated and of auxiliary "carrier ampholytes". [NIH] Isoelectric Point: The pH in solutions of proteins and related compounds at which the dipolar ions are at a maximum. [NIH]

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Joint: The point of contact between elements of an animal skeleton with the parts that surround and support it. [NIH] Kb: A measure of the length of DNA fragments, 1 Kb = 1000 base pairs. The largest DNA fragments are up to 50 kilobases long. [NIH] Keratolytic: An agent that promotes keratolysis. [EU] Ketorolac: A drug that belongs to a family of drugs called nonsteroidal anti-inflammatory agents. It is being studied in cancer prevention. [NIH] Ketorolac Tromethamine: A pyrrolizine carboxylic acid derivative structurally related to indomethacin. It is a non-steroidal anti-inflammatory agent used for analgesia for postoperative pain and inhibits cyclooxygenase activity. [NIH] Kidney Disease: Any one of several chronic conditions that are caused by damage to the cells of the kidney. People who have had diabetes for a long time may have kidney damage. Also called nephropathy. [NIH] Kinetic: Pertaining to or producing motion. [EU] Labile: 1. Gliding; moving from point to point over the surface; unstable; fluctuating. 2. Chemically unstable. [EU] Lactation: The period of the secretion of milk. [EU] Laminin: Large, noncollagenous glycoprotein with antigenic properties. It is localized in the basement membrane lamina lucida and functions to bind epithelial cells to the basement membrane. Evidence suggests that the protein plays a role in tumor invasion. [NIH] Large Intestine: The part of the intestine that goes from the cecum to the rectum. The large intestine absorbs water from stool and changes it from a liquid to a solid form. The large intestine is 5 feet long and includes the appendix, cecum, colon, and rectum. Also called colon. [NIH] Larynx: An irregularly shaped, musculocartilaginous tubular structure, lined with mucous membrane, located at the top of the trachea and below the root of the tongue and the hyoid bone. It is the essential sphincter guarding the entrance into the trachea and functioning secondarily as the organ of voice. [NIH] Latent: Phoria which occurs at one distance or another and which usually has no troublesome effect. [NIH] Lectins: Protein or glycoprotein substances, usually of plant origin, that bind to sugar moieties in cell walls or membranes and thereby change the physiology of the membrane to cause agglutination, mitosis, or other biochemical changes in the cell. [NIH] Lens: The transparent, double convex (outward curve on both sides) structure suspended between the aqueous and vitreous; helps to focus light on the retina. [NIH] Lesion: An area of abnormal tissue change. [NIH] Leukocytes: White blood cells. These include granular leukocytes (basophils, eosinophils, and neutrophils) as well as non-granular leukocytes (lymphocytes and monocytes). [NIH] Leukoplakia: A white patch that may develop on mucous membranes such as the cheek, gums, or tongue and may become cancerous. [NIH] Leukotrienes: A family of biologically active compounds derived from arachidonic acid by oxidative metabolism through the 5-lipoxygenase pathway. They participate in host defense reactions and pathophysiological conditions such as immediate hypersensitivity and inflammation. They have potent actions on many essential organs and systems, including the cardiovascular, pulmonary, and central nervous system as well as the gastrointestinal tract and the immune system. [NIH]

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Levonorgestrel: A progestational hormone with actions similar to those of progesterone and about twice as potent as its racemic or (+-)-isomer (norgestrel). It is used for contraception, control of menstrual disorders, and treatment of endometriosis. [NIH] Library Services: Services offered to the library user. They include reference and circulation. [NIH]

Life cycle: The successive stages through which an organism passes from fertilized ovum or spore to the fertilized ovum or spore of the next generation. [NIH] Ligament: A band of fibrous tissue that connects bones or cartilages, serving to support and strengthen joints. [EU] Ligands: A RNA simulation method developed by the MIT. [NIH] Linkages: The tendency of two or more genes in the same chromosome to remain together from one generation to the next more frequently than expected according to the law of independent assortment. [NIH] Lipid: Fat. [NIH] Lipopolysaccharide: Substance consisting of polysaccaride and lipid. [NIH] Lipoprotein: Any of the lipid-protein complexes in which lipids are transported in the blood; lipoprotein particles consist of a spherical hydrophobic core of triglycerides or cholesterol esters surrounded by an amphipathic monolayer of phospholipids, cholesterol, and apolipoproteins; the four principal classes are high-density, low-density, and very-lowdensity lipoproteins and chylomicrons. [EU] Liposomes: Artificial, single or multilaminar vesicles (made from lecithins or other lipids) that are used for the delivery of a variety of biological molecules or molecular complexes to cells, for example, drug delivery and gene transfer. They are also used to study membranes and membrane proteins. [NIH] Lipoxygenase: An enzyme of the oxidoreductase class that catalyzes reactions between linoleate and other fatty acids and oxygen to form hydroperoxy-fatty acid derivatives. Related enzymes in this class include the arachidonate lipoxygenases, arachidonate 5lipoxygenase, arachidonate 12-lipoxygenase, and arachidonate 15-lipoxygenase. EC 1.13.11.12. [NIH] Liquor: 1. A liquid, especially an aqueous solution containing a medicinal substance. 2. A general term used in anatomical nomenclature for certain fluids of the body. [EU] Liver: A large, glandular organ located in the upper abdomen. The liver cleanses the blood and aids in digestion by secreting bile. [NIH] Localized: Cancer which has not metastasized yet. [NIH] Longitudinal study: Also referred to as a "cohort study" or "prospective study"; the analytic method of epidemiologic study in which subsets of a defined population can be identified who are, have been, or in the future may be exposed or not exposed, or exposed in different degrees, to a factor or factors hypothesized to influence the probability of occurrence of a given disease or other outcome. The main feature of this type of study is to observe large numbers of subjects over an extended time, with comparisons of incidence rates in groups that differ in exposure levels. [NIH] Lucida: An instrument, invented by Wollaton, consisting essentially of a prism or a mirror through which an object can be viewed so as to appear on a plane surface seen in direct view and on which the outline of the object may be traced. [NIH] Lymph: The almost colorless fluid that travels through the lymphatic system and carries cells that help fight infection and disease. [NIH]

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Lymphatic: The tissues and organs, including the bone marrow, spleen, thymus, and lymph nodes, that produce and store cells that fight infection and disease. [NIH] Lymphocyte: A white blood cell. Lymphocytes have a number of roles in the immune system, including the production of antibodies and other substances that fight infection and diseases. [NIH] Lymphoid: Referring to lymphocytes, a type of white blood cell. Also refers to tissue in which lymphocytes develop. [NIH] Lysine: An essential amino acid. It is often added to animal feed. [NIH] Lytic: 1. Pertaining to lysis or to a lysin. 2. Producing lysis. [EU] Macrophage: A type of white blood cell that surrounds and kills microorganisms, removes dead cells, and stimulates the action of other immune system cells. [NIH] Maintenance therapy: Treatment that is given to help a primary (original) treatment keep working. Maintenance therapy is often given to help keep cancer in remission. [NIH] Malaria: A protozoan disease caused in humans by four species of the genus Plasmodium (P. falciparum (malaria, falciparum), P. vivax (malaria, vivax), P. ovale, and P. malariae) and transmitted by the bite of an infected female mosquito of the genus Anopheles. Malaria is endemic in parts of Asia, Africa, Central and South America, Oceania, and certain Caribbean islands. It is characterized by extreme exhaustion associated with paroxysms of high fever, sweating, shaking chills, and anemia. Malaria in animals is caused by other species of plasmodia. [NIH] Malaria, Falciparum: Malaria caused by Plasmodium falciparum. This is the severest form of malaria and is associated with the highest levels of parasites in the blood. This disease is characterized by irregularly recurring febrile paroxysms that in extreme cases occur with acute cerebral, renal, or gastrointestinal manifestations. [NIH] Malaria, Vivax: Malaria caused by Plasmodium vivax. This form of malaria is less severe than malaria, falciparum, but there is a higher probability for relapses to occur. Febrile paroxysms often occur every other day. [NIH] Malignant: Cancerous; a growth with a tendency to invade and destroy nearby tissue and spread to other parts of the body. [NIH] Malnutrition: A condition caused by not eating enough food or not eating a balanced diet. [NIH]

Mammary: Pertaining to the mamma, or breast. [EU] Mammography: Radiographic examination of the breast. [NIH] Mandible: The largest and strongest bone of the face constituting the lower jaw. It supports the lower teeth. [NIH] Mannans: Polysaccharides consisting of mannose units. [NIH] Matrix metalloproteinase: A member of a group of enzymes that can break down proteins, such as collagen, that are normally found in the spaces between cells in tissues (i.e., extracellular matrix proteins). Because these enzymes need zinc or calcium atoms to work properly, they are called metalloproteinases. Matrix metalloproteinases are involved in wound healing, angiogenesis, and tumor cell metastasis. [NIH] Mediate: Indirect; accomplished by the aid of an intervening medium. [EU] Mediator: An object or substance by which something is mediated, such as (1) a structure of the nervous system that transmits impulses eliciting a specific response; (2) a chemical substance (transmitter substance) that induces activity in an excitable tissue, such as nerve or muscle; or (3) a substance released from cells as the result of the interaction of antigen

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with antibody or by the action of antigen with a sensitized lymphocyte. [EU] Medicament: A medicinal substance or agent. [EU] MEDLINE: An online database of MEDLARS, the computerized bibliographic Medical Literature Analysis and Retrieval System of the National Library of Medicine. [NIH] Megaloblastic: A large abnormal red blood cell appearing in the blood in pernicious anaemia. [EU] Membrane: A very thin layer of tissue that covers a surface. [NIH] Membrane Proteins: Proteins which are found in membranes including cellular and intracellular membranes. They consist of two types, peripheral and integral proteins. They include most membrane-associated enzymes, antigenic proteins, transport proteins, and drug, hormone, and lectin receptors. [NIH] Menopause: Permanent cessation of menstruation. [NIH] Menstruation: The normal physiologic discharge through the vagina of blood and mucosal tissues from the nonpregnant uterus. [NIH] Mental Disorders: Psychiatric illness or diseases manifested by breakdowns in the adaptational process expressed primarily as abnormalities of thought, feeling, and behavior producing either distress or impairment of function. [NIH] Mental Health: The state wherein the person is well adjusted. [NIH] Metabolite: Any substance produced by metabolism or by a metabolic process. [EU] Metalloendopeptidases: Endopeptidases which use a metal, normally zinc, in the catalytic mechanism. This group of enzymes is inactivated by metal chelators. EC 3.4.24. [NIH] Metastasis: The spread of cancer from one part of the body to another. Tumors formed from cells that have spread are called "secondary tumors" and contain cells that are like those in the original (primary) tumor. The plural is metastases. [NIH] Metronidazole: Antiprotozoal used in amebiasis, trichomoniasis, giardiasis, and as treponemacide in livestock. It has also been proposed as a radiation sensitizer for hypoxic cells. According to the Fourth Annual Report on Carcinogens (NTP 85-002, 1985, p133), this substance may reasonably be anticipated to be a carcinogen (Merck, 11th ed). [NIH] MI: Myocardial infarction. Gross necrosis of the myocardium as a result of interruption of the blood supply to the area; it is almost always caused by atherosclerosis of the coronary arteries, upon which coronary thrombosis is usually superimposed. [NIH] Microbe: An organism which cannot be observed with the naked eye; e. g. unicellular animals, lower algae, lower fungi, bacteria. [NIH] Microbiological: Pertaining to microbiology : the science that deals with microorganisms, including algae, bacteria, fungi, protozoa and viruses. [EU] Microbiology: The study of microorganisms such as fungi, bacteria, algae, archaea, and viruses. [NIH] Microorganism: An organism that can be seen only through a microscope. Microorganisms include bacteria, protozoa, algae, and fungi. Although viruses are not considered living organisms, they are sometimes classified as microorganisms. [NIH] Micro-organism: An organism which cannot be observed with the naked eye; e. g. unicellular animals, lower algae, lower fungi, bacteria. [NIH] Migration: The systematic movement of genes between populations of the same species, geographic race, or variety. [NIH] Milligram: A measure of weight. A milligram is approximately 450,000-times smaller than a

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pound and 28,000-times smaller than an ounce. [NIH] Mineralocorticoids: A group of corticosteroids primarily associated with the regulation of water and electrolyte balance. This is accomplished through the effect on ion transport in renal tubules, resulting in retention of sodium and loss of potassium. Mineralocorticoid secretion is itself regulated by plasma volume, serum potassium, and angiotensin II. [NIH] Mitomycin: An antineoplastic antibiotic produced by Streptomyces caespitosus. It acts as a bi- or trifunctional alkylating agent causing cross-linking of DNA and inhibition of DNA synthesis. [NIH] Mitosis: A method of indirect cell division by means of which the two daughter nuclei normally receive identical complements of the number of chromosomes of the somatic cells of the species. [NIH] Mobility: Capability of movement, of being moved, or of flowing freely. [EU] Molecular: Of, pertaining to, or composed of molecules : a very small mass of matter. [EU] Molecule: A chemical made up of two or more atoms. The atoms in a molecule can be the same (an oxygen molecule has two oxygen atoms) or different (a water molecule has two hydrogen atoms and one oxygen atom). Biological molecules, such as proteins and DNA, can be made up of many thousands of atoms. [NIH] Monitor: An apparatus which automatically records such physiological signs as respiration, pulse, and blood pressure in an anesthetized patient or one undergoing surgical or other procedures. [NIH] Monoclonal: An antibody produced by culturing a single type of cell. It therefore consists of a single species of immunoglobulin molecules. [NIH] Monoclonal antibodies: Laboratory-produced substances that can locate and bind to cancer cells wherever they are in the body. Many monoclonal antibodies are used in cancer detection or therapy; each one recognizes a different protein on certain cancer cells. Monoclonal antibodies can be used alone, or they can be used to deliver drugs, toxins, or radioactive material directly to a tumor. [NIH] Monocytes: Large, phagocytic mononuclear leukocytes produced in the vertebrate bone marrow and released into the blood; contain a large, oval or somewhat indented nucleus surrounded by voluminous cytoplasm and numerous organelles. [NIH] Monokines: Soluble mediators of the immune response that are neither antibodies nor complement. They are produced largely, but not exclusively, by monocytes and macrophages. [NIH] Mononuclear: A cell with one nucleus. [NIH] Morphine: The principal alkaloid in opium and the prototype opiate analgesic and narcotic. Morphine has widespread effects in the central nervous system and on smooth muscle. [NIH] Morphological: Relating to the configuration or the structure of live organs. [NIH] Motor nerve: An efferent nerve conveying an impulse that excites muscular contraction. [NIH]

Mouth Ulcer: A localized necrotic lesion of the skin or a mucous surface. [NIH] Mucins: A secretion containing mucopolysaccharides and protein that is the chief constituent of mucus. [NIH] Mucosa: A mucous membrane, or tunica mucosa. [EU] Muscle relaxant: An agent that specifically aids in reducing muscle tension, as those acting at the polysynaptic neurons of motor nerves (e.g. meprobamate) or at the myoneural junction (curare and related compounds). [EU]

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Muscle tension: A force in a material tending to produce extension; the state of being stretched. [NIH] Mustard Gas: Severe irritant and vesicant of skin, eyes, and lungs. It may cause blindness and lethal lung edema and was formerly used as a war gas. The substance has been proposed as a cytostatic and for treatment of psoriasis. It has been listed as a known carcinogen in the Fourth Annual Report on Carcinogens (NTP-85-002, 1985) (Merck, 11th ed). [NIH] Mutagen: Any agent, such as X-rays, gamma rays, mustard gas, TCDD, that can cause abnormal mutation in living cells; having the power to cause mutations. [NIH] Myocardial infarction: Gross necrosis of the myocardium as a result of interruption of the blood supply to the area; it is almost always caused by atherosclerosis of the coronary arteries, upon which coronary thrombosis is usually superimposed. [NIH] Myocardial Reperfusion: Generally, restoration of blood supply to heart tissue which is ischemic due to decrease in normal blood supply. The decrease may result from any source including atherosclerotic obstruction, narrowing of the artery, or surgical clamping. Reperfusion can be induced to treat ischemia. Methods include chemical dissolution of an occluding thrombus, administration of vasodilator drugs, angioplasty, catheterization, and artery bypass graft surgery. However, it is thought that reperfusion can itself further damage the ischemic tissue, causing myocardial reperfusion injury. [NIH] Myocardial Reperfusion Injury: Functional, metabolic, or structural changes in ischemic heart muscle thought to result from reperfusion to the ischemic areas. Changes can be fatal to muscle cells and may include edema with explosive cell swelling and disintegration, sarcolemma disruption, fragmentation of mitochondria, contraction band necrosis, enzyme washout, and calcium overload. Other damage may include hemorrhage and ventricular arrhythmias. One possible mechanism of damage is thought to be oxygen free radicals. Treatment currently includes the introduction of scavengers of oxygen free radicals, and injury is thought to be prevented by warm blood cardioplegic infusion prior to reperfusion. [NIH]

Myocardium: The muscle tissue of the heart composed of striated, involuntary muscle known as cardiac muscle. [NIH] Myristic Acids: 14-carbon saturated monocarboxylic acids. [NIH] Narcosis: A general and nonspecific reversible depression of neuronal excitability, produced by a number of physical and chemical aspects, usually resulting in stupor. [NIH] Narcotic: 1. Pertaining to or producing narcosis. 2. An agent that produces insensibility or stupor, applied especially to the opioids, i.e. to any natural or synthetic drug that has morphine-like actions. [EU] NCI: National Cancer Institute. NCI, part of the National Institutes of Health of the United States Department of Health and Human Services, is the federal government's principal agency for cancer research. NCI conducts, coordinates, and funds cancer research, training, health information dissemination, and other programs with respect to the cause, diagnosis, prevention, and treatment of cancer. Access the NCI Web site at http://cancer.gov. [NIH] Necrosis: A pathological process caused by the progressive degradative action of enzymes that is generally associated with severe cellular trauma. It is characterized by mitochondrial swelling, nuclear flocculation, uncontrolled cell lysis, and ultimately cell death. [NIH] Need: A state of tension or dissatisfaction felt by an individual that impels him to action toward a goal he believes will satisfy the impulse. [NIH] Neonatal: Pertaining to the first four weeks after birth. [EU]

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Neoplasia: Abnormal and uncontrolled cell growth. [NIH] Neoplasm: A new growth of benign or malignant tissue. [NIH] Neoplastic: Pertaining to or like a neoplasm (= any new and abnormal growth); pertaining to neoplasia (= the formation of a neoplasm). [EU] Nephropathy: Disease of the kidneys. [EU] Nerve: A cordlike structure of nervous tissue that connects parts of the nervous system with other tissues of the body and conveys nervous impulses to, or away from, these tissues. [NIH] Nervous System: The entire nerve apparatus composed of the brain, spinal cord, nerves and ganglia. [NIH] Neural: 1. Pertaining to a nerve or to the nerves. 2. Situated in the region of the spinal axis, as the neutral arch. [EU] Neurons: The basic cellular units of nervous tissue. Each neuron consists of a body, an axon, and dendrites. Their purpose is to receive, conduct, and transmit impulses in the nervous system. [NIH] Neutrons: Electrically neutral elementary particles found in all atomic nuclei except light hydrogen; the mass is equal to that of the proton and electron combined and they are unstable when isolated from the nucleus, undergoing beta decay. Slow, thermal, epithermal, and fast neutrons refer to the energy levels with which the neutrons are ejected from heavier nuclei during their decay. [NIH] Neutrophil: A type of white blood cell. [NIH] Nicotine: Nicotine is highly toxic alkaloid. It is the prototypical agonist at nicotinic cholinergic receptors where it dramatically stimulates neurons and ultimately blocks synaptic transmission. Nicotine is also important medically because of its presence in tobacco smoke. [NIH] Nitrogen: An element with the atomic symbol N, atomic number 7, and atomic weight 14. Nitrogen exists as a diatomic gas and makes up about 78% of the earth's atmosphere by volume. It is a constituent of proteins and nucleic acids and found in all living cells. [NIH] Norepinephrine: Precursor of epinephrine that is secreted by the adrenal medulla and is a widespread central and autonomic neurotransmitter. Norepinephrine is the principal transmitter of most postganglionic sympathetic fibers and of the diffuse projection system in the brain arising from the locus ceruleus. It is also found in plants and is used pharmacologically as a sympathomimetic. [NIH] Norgestrel: (+-)-13-Ethyl-17-hydroxy-18,19-dinorpregn-4-en-20-yn-3-one. A progestational agent with actions similar to those of progesterone. This racemic or (+-)-form has about half the potency of the levo form (levonorgestrel). Norgestrel is used as a contraceptive and ovulation inhibitor and for the control of menstrual disorders and endometriosis. [NIH] Nuclear: A test of the structure, blood flow, and function of the kidneys. The doctor injects a mildly radioactive solution into an arm vein and uses x-rays to monitor its progress through the kidneys. [NIH] Nuclei: A body of specialized protoplasm found in nearly all cells and containing the chromosomes. [NIH] Nucleic acid: Either of two types of macromolecule (DNA or RNA) formed by polymerization of nucleotides. Nucleic acids are found in all living cells and contain the information (genetic code) for the transfer of genetic information from one generation to the next. [NIH] Nucleus: A body of specialized protoplasm found in nearly all cells and containing the

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chromosomes. [NIH] Odds Ratio: The ratio of two odds. The exposure-odds ratio for case control data is the ratio of the odds in favor of exposure among cases to the odds in favor of exposure among noncases. The disease-odds ratio for a cohort or cross section is the ratio of the odds in favor of disease among the exposed to the odds in favor of disease among the unexposed. The prevalence-odds ratio refers to an odds ratio derived cross-sectionally from studies of prevalent cases. [NIH] Ointments: Semisolid preparations used topically for protective emollient effects or as a vehicle for local administration of medications. Ointment bases are various mixtures of fats, waxes, animal and plant oils and solid and liquid hydrocarbons. [NIH] Oral Health: The optimal state of the mouth and normal functioning of the organs of the mouth without evidence of disease. [NIH] Oral Hygiene: The practice of personal hygiene of the mouth. It includes the maintenance of oral cleanliness, tissue tone, and general preservation of oral health. [NIH] Organelles: Specific particles of membrane-bound organized living substances present in eukaryotic cells, such as the mitochondria; the golgi apparatus; endoplasmic reticulum; lysomomes; plastids; and vacuoles. [NIH] Ornithine: An amino acid produced in the urea cycle by the splitting off of urea from arginine. [NIH] Orofacial: Of or relating to the mouth and face. [EU] Orthodontics: A dental specialty concerned with the prevention and correction of dental and oral anomalies (malocclusion). [NIH] Ossicles: The hammer, anvil and stirrup, the small bones of the middle ear, which transmit the vibrations from the tympanic membrane to the oval window. [NIH] Ovum: A female germ cell extruded from the ovary at ovulation. [NIH] Oxidation: The act of oxidizing or state of being oxidized. Chemically it consists in the increase of positive charges on an atom or the loss of negative charges. Most biological oxidations are accomplished by the removal of a pair of hydrogen atoms (dehydrogenation) from a molecule. Such oxidations must be accompanied by reduction of an acceptor molecule. Univalent o. indicates loss of one electron; divalent o., the loss of two electrons. [EU]

Oxidative metabolism: A chemical process in which oxygen is used to make energy from carbohydrates (sugars). Also known as aerobic respiration, cell respiration, or aerobic metabolism. [NIH] Palate: The structure that forms the roof of the mouth. It consists of the anterior hard palate and the posterior soft palate. [NIH] Palliative: 1. Affording relief, but not cure. 2. An alleviating medicine. [EU] Pancreas: A mixed exocrine and endocrine gland situated transversely across the posterior abdominal wall in the epigastric and hypochondriac regions. The endocrine portion is comprised of the Islets of Langerhans, while the exocrine portion is a compound acinar gland that secretes digestive enzymes. [NIH] Patch: A piece of material used to cover or protect a wound, an injured part, etc.: a patch over the eye. [NIH] Pathogen: Any disease-producing microorganism. [EU] Pathogenesis: The cellular events and reactions that occur in the development of disease. [NIH]

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Pathologic: 1. Indicative of or caused by a morbid condition. 2. Pertaining to pathology (= branch of medicine that treats the essential nature of the disease, especially the structural and functional changes in tissues and organs of the body caused by the disease). [EU] Pathologies: The study of abnormality, especially the study of diseases. [NIH] Pathophysiology: Altered functions in an individual or an organ due to disease. [NIH] Patient Education: The teaching or training of patients concerning their own health needs. [NIH]

Pediatric Dentistry: The practice of dentistry concerned with the dental problems of children, proper maintenance, and treatment. The dental care may include the services provided by dental specialists. [NIH] Pediatrics: A medical specialty concerned with maintaining health and providing medical care to children from birth to adolescence. [NIH] Peptide: Any compound consisting of two or more amino acids, the building blocks of proteins. Peptides are combined to make proteins. [NIH] Peptide Hydrolases: A subclass of enzymes from the hydrolase class that catalyze the hydrolysis of peptide bonds. Exopeptidases and endopeptidases make up the sub-subclasses for this group. EC 3.4. [NIH] Pericoronitis: Inflammation of the gingiva surrounding the crown of a tooth. [NIH] Periodontal Abscess: Localized circumscribed purulent area of inflammation in the periodontal tissue. It is a derivative of marginal periodontitis and commonly associated with suprabony and infrabony pockets and interradicular involvements, in contrast to periapical abscess which is attributable to pulp necrosis. [NIH] Periodontal Attachment Loss: Loss or destruction of periodontal tissue caused by periodontitis or other destructive periodontal diseases or by injury during instrumentation. Attachment refers to the periodontal ligament which attaches to the alveolar bone. It has been hypothesized that treatment of the underlying periodontal disease and the seeding of periodontal ligament cells enable the creating of new attachment. [NIH] Periodontal disease: Disease involving the supporting structures of the teeth (as the gums and periodontal membranes). [NIH] Periodontal Ligament: Fibrous connective tissue surrounding the root of a tooth that separates it from and attaches it to the alveolar bone. [NIH] Periodontal Pocket: An abnormal extension of a gingival sulcus accompanied by the apical migration of the epithelial attachment and bone resorption. [NIH] Periodontics: A dental specialty concerned with the histology, physiology, and pathology of the tissues that support, attach, and surround the teeth, and of the treatment and prevention of disease affecting these tissues. [NIH] Periodontist: A specialist in the treatment of diseases of the gums. [NIH] Periodontitis: Inflammation of the periodontal membrane; also called periodontitis simplex. [NIH]

Peripheral stem cells: Immature cells found circulating in the bloodstream. New blood cells develop from peripheral stem cells. [NIH] PH: The symbol relating the hydrogen ion (H+) concentration or activity of a solution to that of a given standard solution. Numerically the pH is approximately equal to the negative logarithm of H+ concentration expressed in molarity. pH 7 is neutral; above it alkalinity increases and below it acidity increases. [EU] Pharmacologic: Pertaining to pharmacology or to the properties and reactions of drugs. [EU]

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Pharynx: The hollow tube about 5 inches long that starts behind the nose and ends at the top of the trachea (windpipe) and esophagus (the tube that goes to the stomach). [NIH] Phospholipids: Lipids containing one or more phosphate groups, particularly those derived from either glycerol (phosphoglycerides; glycerophospholipids) or sphingosine (sphingolipids). They are polar lipids that are of great importance for the structure and function of cell membranes and are the most abundant of membrane lipids, although not stored in large amounts in the system. [NIH] Phosphorus: A non-metallic element that is found in the blood, muscles, nevers, bones, and teeth, and is a component of adenosine triphosphate (ATP; the primary energy source for the body's cells.) [NIH] Phosphorylated: Attached to a phosphate group. [NIH] Physiologic: Having to do with the functions of the body. When used in the phrase "physiologic age," it refers to an age assigned by general health, as opposed to calendar age. [NIH]

Physiology: The science that deals with the life processes and functions of organismus, their cells, tissues, and organs. [NIH] Pilot study: The initial study examining a new method or treatment. [NIH] Pituitary Gland: A small, unpaired gland situated in the sella turcica tissue. It is connected to the hypothalamus by a short stalk. [NIH] Plants: Multicellular, eukaryotic life forms of the kingdom Plantae. They are characterized by a mainly photosynthetic mode of nutrition; essentially unlimited growth at localized regions of cell divisions (meristems); cellulose within cells providing rigidity; the absence of organs of locomotion; absense of nervous and sensory systems; and an alteration of haploid and diploid generations. [NIH] Plaque: A clear zone in a bacterial culture grown on an agar plate caused by localized destruction of bacterial cells by a bacteriophage. The concentration of infective virus in a fluid can be estimated by applying the fluid to a culture and counting the number of. [NIH] Plasma: The clear, yellowish, fluid part of the blood that carries the blood cells. The proteins that form blood clots are in plasma. [NIH] Plasma cells: A type of white blood cell that produces antibodies. [NIH] Plasma Volume: Volume of plasma in the circulation. It is usually measured by indicator dilution techniques. [NIH] Plasmin: A product of the lysis of plasminogen (profibrinolysin) by plasminogen activators. It is composed of two polypeptide chains, light (B) and heavy (A), with a molecular weight of 75,000. It is the major proteolytic enzyme involved in blood clot retraction or the lysis of fibrin and quickly inactivated by antiplasmins. EC 3.4.21.7. [NIH] Plasminogen: Precursor of fibrinolysin (plasmin). It is a single-chain beta-globulin of molecular weight 80-90,000 found mostly in association with fibrinogen in plasma; plasminogen activators change it to fibrinolysin. It is used in wound debriding and has been investigated as a thrombolytic agent. [NIH] Plasminogen Activator Inhibitor 2: Member of the serpin family of proteins. It inhibits both the tissue-type and urokinase-type plasminogen activators. [NIH] Plasminogen Activators: A heterogeneous group of proteolytic enzymes that convert plasminogen to plasmin. They are concentrated in the lysosomes of most cells and in the vascular endothelium, particularly in the vessels of the microcirculation. EC 3.4.21.-. [NIH] Poisoning: A condition or physical state produced by the ingestion, injection or inhalation

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of, or exposure to a deleterious agent. [NIH] Polymers: Compounds formed by the joining of smaller, usually repeating, units linked by covalent bonds. These compounds often form large macromolecules (e.g., polypeptides, proteins, plastics). [NIH] Polymorphism: The occurrence together of two or more distinct forms in the same population. [NIH] Polypeptide: A peptide which on hydrolysis yields more than two amino acids; called tripeptides, tetrapeptides, etc. according to the number of amino acids contained. [EU] Polysaccharide: A type of carbohydrate. It contains sugar molecules that are linked together chemically. [NIH] Porphyromonas: A genus of gram-negative, anaerobic, nonsporeforming, nonmotile rods or coccobacilli. Organisms in this genus had originally been classified as members of the Bacteroides genus but overwhelming biochemical and chemical findings indicated the need to separate them from other Bacteroides species, and hence, this new genus was created. [NIH]

Porphyromonas gingivalis: A species of gram-negative, anaerobic, rod-shaped bacteria originally classified within the Bacteroides genus. This bacterium produces a cell-bound, oxygen-sensitive collagenase and is isolated from the human mouth. [NIH] Postoperative: After surgery. [NIH] Potassium: An element that is in the alkali group of metals. It has an atomic symbol K, atomic number 19, and atomic weight 39.10. It is the chief cation in the intracellular fluid of muscle and other cells. Potassium ion is a strong electrolyte and it plays a significant role in the regulation of fluid volume and maintenance of the water-electrolyte balance. [NIH] Potentiates: A degree of synergism which causes the exposure of the organism to a harmful substance to worsen a disease already contracted. [NIH] Potentiation: An overall effect of two drugs taken together which is greater than the sum of the effects of each drug taken alone. [NIH] Practice Guidelines: Directions or principles presenting current or future rules of policy for the health care practitioner to assist him in patient care decisions regarding diagnosis, therapy, or related clinical circumstances. The guidelines may be developed by government agencies at any level, institutions, professional societies, governing boards, or by the convening of expert panels. The guidelines form a basis for the evaluation of all aspects of health care and delivery. [NIH] Precursor: Something that precedes. In biological processes, a substance from which another, usually more active or mature substance is formed. In clinical medicine, a sign or symptom that heralds another. [EU] Predisposition: A latent susceptibility to disease which may be activated under certain conditions, as by stress. [EU] Preeclampsia: A toxaemia of late pregnancy characterized by hypertension, edema, and proteinuria, when convulsions and coma are associated, it is called eclampsia. [EU] Pregnancy Outcome: Results of conception and ensuing pregnancy, including live birth, stillbirth, spontaneous abortion, induced abortion. The outcome may follow natural or artificial insemination or any of the various reproduction techniques, such as embryo transfer or fertilization in vitro. [NIH] Prevalence: The total number of cases of a given disease in a specified population at a designated time. It is differentiated from incidence, which refers to the number of new cases in the population at a given time. [NIH]

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Probe: An instrument used in exploring cavities, or in the detection and dilatation of strictures, or in demonstrating the potency of channels; an elongated instrument for exploring or sounding body cavities. [NIH] Progesterone: Pregn-4-ene-3,20-dione. The principal progestational hormone of the body, secreted by the corpus luteum, adrenal cortex, and placenta. Its chief function is to prepare the uterus for the reception and development of the fertilized ovum. It acts as an antiovulatory agent when administered on days 5-25 of the menstrual cycle. [NIH] Progression: Increase in the size of a tumor or spread of cancer in the body. [NIH] Progressive: Advancing; going forward; going from bad to worse; increasing in scope or severity. [EU] Projection: A defense mechanism, operating unconsciously, whereby that which is emotionally unacceptable in the self is rejected and attributed (projected) to others. [NIH] Proline: A non-essential amino acid that is synthesized from glutamic acid. It is an essential component of collagen and is important for proper functioning of joints and tendons. [NIH] Promoter: A chemical substance that increases the activity of a carcinogenic process. [NIH] Proportional: Being in proportion : corresponding in size, degree, or intensity, having the same or a constant ratio; of, relating to, or used in determining proportions. [EU] Prospective study: An epidemiologic study in which a group of individuals (a cohort), all free of a particular disease and varying in their exposure to a possible risk factor, is followed over a specific amount of time to determine the incidence rates of the disease in the exposed and unexposed groups. [NIH] Prostaglandin: Any of a group of components derived from unsaturated 20-carbon fatty acids, primarily arachidonic acid, via the cyclooxygenase pathway that are extremely potent mediators of a diverse group of physiologic processes. The abbreviation for prostaglandin is PG; specific compounds are designated by adding one of the letters A through I to indicate the type of substituents found on the hydrocarbon skeleton and a subscript (1, 2 or 3) to indicate the number of double bonds in the hydrocarbon skeleton e.g., PGE2. The predominant naturally occurring prostaglandins all have two double bonds and are synthesized from arachidonic acid (5,8,11,14-eicosatetraenoic acid) by the pathway shown in the illustration. The 1 series and 3 series are produced by the same pathway with fatty acids having one fewer double bond (8,11,14-eicosatrienoic acid or one more double bond (5,8,11,14,17-eicosapentaenoic acid) than arachidonic acid. The subscript a or ß indicates the configuration at C-9 (a denotes a substituent below the plane of the ring, ß, above the plane). The naturally occurring PGF's have the a configuration, e.g., PGF2a. All of the prostaglandins act by binding to specific cell-surface receptors causing an increase in the level of the intracellular second messenger cyclic AMP (and in some cases cyclic GMP also). The effect produced by the cyclic AMP increase depends on the specific cell type. In some cases there is also a positive feedback effect. Increased cyclic AMP increases prostaglandin synthesis leading to further increases in cyclic AMP. [EU] Prostaglandins A: (13E,15S)-15-Hydroxy-9-oxoprosta-10,13-dien-1-oic acid (PGA(1)); (5Z,13E,15S)-15-hydroxy-9-oxoprosta-5,10,13-trien-1-oic acid (PGA(2)); (5Z,13E,15S,17Z)-15hydroxy-9-oxoprosta-5,10,13,17-tetraen-1-oic acid (PGA(3)). A group of naturally occurring secondary prostaglandins derived from PGE. PGA(1) and PGA(2) as well as their 19hydroxy derivatives are found in many organs and tissues. [NIH] Protease: Proteinase (= any enzyme that catalyses the splitting of interior peptide bonds in a protein). [EU] Protein C: A vitamin-K dependent zymogen present in the blood, which, upon activation by thrombin and thrombomodulin exerts anticoagulant properties by inactivating factors Va

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and VIIIa at the rate-limiting steps of thrombin formation. [NIH] Protein S: The vitamin K-dependent cofactor of activated protein C. Together with protein C, it inhibits the action of factors VIIIa and Va. A deficiency in protein S can lead to recurrent venous and arterial thrombosis. [NIH] Proteins: Polymers of amino acids linked by peptide bonds. The specific sequence of amino acids determines the shape and function of the protein. [NIH] Proteinuria: The presence of protein in the urine, indicating that the kidneys are not working properly. [NIH] Proteolytic: 1. Pertaining to, characterized by, or promoting proteolysis. 2. An enzyme that promotes proteolysis (= the splitting of proteins by hydrolysis of the peptide bonds with formation of smaller polypeptides). [EU] Protocol: The detailed plan for a clinical trial that states the trial's rationale, purpose, drug or vaccine dosages, length of study, routes of administration, who may participate, and other aspects of trial design. [NIH] Protons: Stable elementary particles having the smallest known positive charge, found in the nuclei of all elements. The proton mass is less than that of a neutron. A proton is the nucleus of the light hydrogen atom, i.e., the hydrogen ion. [NIH] Protozoa: A subkingdom consisting of unicellular organisms that are the simplest in the animal kingdom. Most are free living. They range in size from submicroscopic to macroscopic. Protozoa are divided into seven phyla: Sarcomastigophora, Labyrinthomorpha, Apicomplexa, Microspora, Ascetospora, Myxozoa, and Ciliophora. [NIH] Proximal: Nearest; closer to any point of reference; opposed to distal. [EU] Proxy: A person authorized to decide or act for another person, for example, a person having durable power of attorney. [NIH] Psyllium: Dried, ripe seeds of Plantago psyllium, P. indica, and P. ovata (Plantaginaceae). Plantain seeds swell in water and are used as demulcents and bulk laxatives. [NIH] Puberty: The period during which the secondary sex characteristics begin to develop and the capability of sexual reproduction is attained. [EU] Public Health: Branch of medicine concerned with the prevention and control of disease and disability, and the promotion of physical and mental health of the population on the international, national, state, or municipal level. [NIH] Public Policy: A course or method of action selected, usually by a government, from among alternatives to guide and determine present and future decisions. [NIH] Publishing: "The business or profession of the commercial production and issuance of literature" (Webster's 3d). It includes the publisher, publication processes, editing and editors. Production may be by conventional printing methods or by electronic publishing. [NIH]

Pulmonary: Relating to the lungs. [NIH] Pulmonary Artery: The short wide vessel arising from the conus arteriosus of the right ventricle and conveying unaerated blood to the lungs. [NIH] Pulmonary Edema: An accumulation of an excessive amount of watery fluid in the lungs, may be caused by acute exposure to dangerous concentrations of irritant gasses. [NIH] Pulse: The rhythmical expansion and contraction of an artery produced by waves of pressure caused by the ejection of blood from the left ventricle of the heart as it contracts. [NIH]

Purulent: Consisting of or containing pus; associated with the formation of or caused by

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pus. [EU] Pyogenic: Producing pus; pyopoietic (= liquid inflammation product made up of cells and a thin fluid called liquor puris). [EU] Quackery: The fraudulent misrepresentation of the diagnosis and treatment of disease. [NIH] Quiescent: Marked by a state of inactivity or repose. [EU] Race: A population within a species which exhibits general similarities within itself, but is both discontinuous and distinct from other populations of that species, though not sufficiently so as to achieve the status of a taxon. [NIH] Radiation: Emission or propagation of electromagnetic energy (waves/rays), or the waves/rays themselves; a stream of electromagnetic particles (electrons, neutrons, protons, alpha particles) or a mixture of these. The most common source is the sun. [NIH] Radiation therapy: The use of high-energy radiation from x-rays, gamma rays, neutrons, and other sources to kill cancer cells and shrink tumors. Radiation may come from a machine outside the body (external-beam radiation therapy), or it may come from radioactive material placed in the body in the area near cancer cells (internal radiation therapy, implant radiation, or brachytherapy). Systemic radiation therapy uses a radioactive substance, such as a radiolabeled monoclonal antibody, that circulates throughout the body. Also called radiotherapy. [NIH] Radioactive: Giving off radiation. [NIH] Radiolabeled: Any compound that has been joined with a radioactive substance. [NIH] Radiological: Pertaining to radiodiagnostic and radiotherapeutic procedures, and interventional radiology or other planning and guiding medical radiology. [NIH] Radiology: A specialty concerned with the use of x-ray and other forms of radiant energy in the diagnosis and treatment of disease. [NIH] Radiosensitization: The use of a drug that makes tumor cells more sensitive to radiation therapy. [NIH] Radiotherapy: The use of ionizing radiation to treat malignant neoplasms and other benign conditions. The most common forms of ionizing radiation used as therapy are x-rays, gamma rays, and electrons. A special form of radiotherapy, targeted radiotherapy, links a cytotoxic radionuclide to a molecule that targets the tumor. When this molecule is an antibody or other immunologic molecule, the technique is called radioimmunotherapy. [NIH] Randomized: Describes an experiment or clinical trial in which animal or human subjects are assigned by chance to separate groups that compare different treatments. [NIH] Reabsorption: 1. The act or process of absorbing again, as the selective absorption by the kidneys of substances (glucose, proteins, sodium, etc.) already secreted into the renal tubules, and their return to the circulating blood. 2. Resorption. [EU] Reagent: A substance employed to produce a chemical reaction so as to detect, measure, produce, etc., other substances. [EU] Receptor: A molecule inside or on the surface of a cell that binds to a specific substance and causes a specific physiologic effect in the cell. [NIH] Recombinant: A cell or an individual with a new combination of genes not found together in either parent; usually applied to linked genes. [EU] Rectum: The last 8 to 10 inches of the large intestine. [NIH] Recur: To occur again. Recurrence is the return of cancer, at the same site as the original (primary) tumor or in another location, after the tumor had disappeared. [NIH]

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Recurrence: The return of a sign, symptom, or disease after a remission. [NIH] Refer: To send or direct for treatment, aid, information, de decision. [NIH] Reflex: An involuntary movement or exercise of function in a part, excited in response to a stimulus applied to the periphery and transmitted to the brain or spinal cord. [NIH] Refraction: A test to determine the best eyeglasses or contact lenses to correct a refractive error (myopia, hyperopia, or astigmatism). [NIH] Refractory: Not readily yielding to treatment. [EU] Regeneration: The natural renewal of a structure, as of a lost tissue or part. [EU] Regimen: A treatment plan that specifies the dosage, the schedule, and the duration of treatment. [NIH] Relapse: The return of signs and symptoms of cancer after a period of improvement. [NIH] Relative risk: The ratio of the incidence rate of a disease among individuals exposed to a specific risk factor to the incidence rate among unexposed individuals; synonymous with risk ratio. Alternatively, the ratio of the cumulative incidence rate in the exposed to the cumulative incidence rate in the unexposed (cumulative incidence ratio). The term relative risk has also been used synonymously with odds ratio. This is because the odds ratio and relative risk approach each other if the disease is rare ( 5 percent of population) and the number of subjects is large. [NIH] Relaxant: 1. Lessening or reducing tension. 2. An agent that lessens tension. [EU] Remission: A decrease in or disappearance of signs and symptoms of cancer. In partial remission, some, but not all, signs and symptoms of cancer have disappeared. In complete remission, all signs and symptoms of cancer have disappeared, although there still may be cancer in the body. [NIH] Reperfusion: Restoration of blood supply to tissue which is ischemic due to decrease in normal blood supply. The decrease may result from any source including atherosclerotic obstruction, narrowing of the artery, or surgical clamping. It is primarily a procedure for treating infarction or other ischemia, by enabling viable ischemic tissue to recover, thus limiting further necrosis. However, it is thought that reperfusion can itself further damage the ischemic tissue, causing reperfusion injury. [NIH] Reperfusion Injury: Functional, metabolic, or structural changes, including necrosis, in ischemic tissues thought to result from reperfusion to ischemic areas of the tissue. The most common instance is myocardial reperfusion injury. [NIH] Reproduction Techniques: Methods pertaining to the generation of new individuals. [NIH] Resorption: The loss of substance through physiologic or pathologic means, such as loss of dentin and cementum of a tooth, or of the alveolar process of the mandible or maxilla. [EU] Respiration: The act of breathing with the lungs, consisting of inspiration, or the taking into the lungs of the ambient air, and of expiration, or the expelling of the modified air which contains more carbon dioxide than the air taken in (Blakiston's Gould Medical Dictionary, 4th ed.). This does not include tissue respiration (= oxygen consumption) or cell respiration (= cell respiration). [NIH] Restoration: Broad term applied to any inlay, crown, bridge or complete denture which restores or replaces loss of teeth or oral tissues. [NIH] Retina: The ten-layered nervous tissue membrane of the eye. It is continuous with the optic nerve and receives images of external objects and transmits visual impulses to the brain. Its outer surface is in contact with the choroid and the inner surface with the vitreous body. The outer-most layer is pigmented, whereas the inner nine layers are transparent. [NIH]

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Retrospective: Looking back at events that have already taken place. [NIH] Rheumatism: A group of disorders marked by inflammation or pain in the connective tissue structures of the body. These structures include bone, cartilage, and fat. [NIH] Rheumatoid: Resembling rheumatism. [EU] Rheumatoid arthritis: A form of arthritis, the cause of which is unknown, although infection, hypersensitivity, hormone imbalance and psychologic stress have been suggested as possible causes. [NIH] Ribosome: A granule of protein and RNA, synthesized in the nucleolus and found in the cytoplasm of cells. Ribosomes are the main sites of protein synthesis. Messenger RNA attaches to them and there receives molecules of transfer RNA bearing amino acids. [NIH] Risk factor: A habit, trait, condition, or genetic alteration that increases a person's chance of developing a disease. [NIH] Rod: A reception for vision, located in the retina. [NIH] Root Canal Therapy: A treatment modality in endodontics concerned with the therapy of diseases of the dental pulp. For preparatory procedures, root canal preparation is available. [NIH]

Root Planing: A procedure for smoothing of the roughened root surface or cementum of a tooth after subgingival curettage or scaling, as part of periodontal therapy. [NIH] Saliva: The clear, viscous fluid secreted by the salivary glands and mucous glands of the mouth. It contains mucins, water, organic salts, and ptylin. [NIH] Salivary: The duct that convey saliva to the mouth. [NIH] Salivary glands: Glands in the mouth that produce saliva. [NIH] Salivary Proteins: Proteins found in saliva and the salivary glands. These proteins show some enzymatic activity, but their composition varies in different individuals. [NIH] Screening: Checking for disease when there are no symptoms. [NIH] Scurvy: A deficiency disease due to lack of vitamin C in the diet. [NIH] Sebaceous: Gland that secretes sebum. [NIH] Sebaceous gland: Gland that secretes sebum. [NIH] Secretion: 1. The process of elaborating a specific product as a result of the activity of a gland; this activity may range from separating a specific substance of the blood to the elaboration of a new chemical substance. 2. Any substance produced by secretion. [EU] Secretory: Secreting; relating to or influencing secretion or the secretions. [NIH] Sedative: 1. Allaying activity and excitement. 2. An agent that allays excitement. [EU] Selenium: An element with the atomic symbol Se, atomic number 34, and atomic weight 78.96. It is an essential micronutrient for mammals and other animals but is toxic in large amounts. Selenium protects intracellular structures against oxidative damage. It is an essential component of glutathione peroxidase. [NIH] Self Mutilation: The act of injuring one's own body to the extent of cutting off or permanently destroying a limb or other essential part of a body. [NIH] Semisynthetic: Produced by chemical manipulation of naturally occurring substances. [EU] Sepsis: The presence of bacteria in the bloodstream. [NIH] Septic: Produced by or due to decomposition by microorganisms; putrefactive. [EU] Septicemia: Systemic disease associated with the presence and persistence of pathogenic microorganisms or their toxins in the blood. Called also blood poisoning. [EU]

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Sequence Homology: The degree of similarity between sequences. Studies of amino acid and nucleotide sequences provide useful information about the genetic relatedness of certain species. [NIH] Serine: A non-essential amino acid occurring in natural form as the L-isomer. It is synthesized from glycine or threonine. It is involved in the biosynthesis of purines, pyrimidines, and other amino acids. [NIH] Serine Endopeptidases: Any member of the group of endopeptidases containing at the active site a serine residue involved in catalysis. EC 3.4.21. [NIH] Serous: Having to do with serum, the clear liquid part of blood. [NIH] Serum: The clear liquid part of the blood that remains after blood cells and clotting proteins have been removed. [NIH] Sex Characteristics: Those characteristics that distinguish one sex from the other. The primary sex characteristics are the ovaries and testes and their related hormones. Secondary sex characteristics are those which are masculine or feminine but not directly related to reproduction. [NIH] Shock: The general bodily disturbance following a severe injury; an emotional or moral upset occasioned by some disturbing or unexpected experience; disruption of the circulation, which can upset all body functions: sometimes referred to as circulatory shock. [NIH]

Side effect: A consequence other than the one(s) for which an agent or measure is used, as the adverse effects produced by a drug, especially on a tissue or organ system other than the one sought to be benefited by its administration. [EU] Signs and Symptoms: Clinical manifestations that can be either objective when observed by a physician, or subjective when perceived by the patient. [NIH] Silver Compounds: Inorganic compounds that contain silver as an integral part of the molecule. [NIH] Skeleton: The framework that supports the soft tissues of vertebrate animals and protects many of their internal organs. The skeletons of vertebrates are made of bone and/or cartilage. [NIH] Skull: The skeleton of the head including the bones of the face and the bones enclosing the brain. [NIH] Small intestine: The part of the digestive tract that is located between the stomach and the large intestine. [NIH] Smiling: A facial expression which may denote feelings of pleasure, affection, amusement, etc. [NIH] Smooth muscle: Muscle that performs automatic tasks, such as constricting blood vessels. [NIH]

Soaps: Sodium or potassium salts of long chain fatty acids. These detergent substances are obtained by boiling natural oils or fats with caustic alkali. Sodium soaps are harder and are used as topical anti-infectives and vehicles in pills and liniments; potassium soaps are soft, used as vehicles for ointments and also as topical antimicrobials. [NIH] Sodium: An element that is a member of the alkali group of metals. It has the atomic symbol Na, atomic number 11, and atomic weight 23. With a valence of 1, it has a strong affinity for oxygen and other nonmetallic elements. Sodium provides the chief cation of the extracellular body fluids. Its salts are the most widely used in medicine. (From Dorland, 27th ed) Physiologically the sodium ion plays a major role in blood pressure regulation, maintenance of fluid volume, and electrolyte balance. [NIH]

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Soft tissue: Refers to muscle, fat, fibrous tissue, blood vessels, or other supporting tissue of the body. [NIH] Somatic: 1. Pertaining to or characteristic of the soma or body. 2. Pertaining to the body wall in contrast to the viscera. [EU] Spasm: An involuntary contraction of a muscle or group of muscles. Spasms may involve skeletal muscle or smooth muscle. [NIH] Spasmodic: Of the nature of a spasm. [EU] Specialist: In medicine, one who concentrates on 1 special branch of medical science. [NIH] Species: A taxonomic category subordinate to a genus (or subgenus) and superior to a subspecies or variety, composed of individuals possessing common characters distinguishing them from other categories of individuals of the same taxonomic level. In taxonomic nomenclature, species are designated by the genus name followed by a Latin or Latinized adjective or noun. [EU] Specificity: Degree of selectivity shown by an antibody with respect to the number and types of antigens with which the antibody combines, as well as with respect to the rates and the extents of these reactions. [NIH] Spectrum: A charted band of wavelengths of electromagnetic vibrations obtained by refraction and diffraction. By extension, a measurable range of activity, such as the range of bacteria affected by an antibiotic (antibacterial s.) or the complete range of manifestations of a disease. [EU] Sperm: The fecundating fluid of the male. [NIH] Spinal cord: The main trunk or bundle of nerves running down the spine through holes in the spinal bone (the vertebrae) from the brain to the level of the lower back. [NIH] Spontaneous Abortion: The non-induced birth of an embryo or of fetus prior to the stage of viability at about 20 weeks of gestation. [NIH] Spotting: A slight discharge of blood via the vagina, especially as a side-effect of oral contraceptives. [EU] Sterilization: The destroying of all forms of life, especially microorganisms, by heat, chemical, or other means. [NIH] Steroids: Drugs used to relieve swelling and inflammation. [NIH] Stillbirth: The birth of a dead fetus or baby. [NIH] Stimulant: 1. Producing stimulation; especially producing stimulation by causing tension on muscle fibre through the nervous tissue. 2. An agent or remedy that produces stimulation. [EU]

Stimulus: That which can elicit or evoke action (response) in a muscle, nerve, gland or other excitable issue, or cause an augmenting action upon any function or metabolic process. [NIH] Stomach: An organ of digestion situated in the left upper quadrant of the abdomen between the termination of the esophagus and the beginning of the duodenum. [NIH] Streptococcal: Caused by infection due to any species of streptococcus. [NIH] Streptococci: A genus of spherical Gram-positive bacteria occurring in chains or pairs. They are widely distributed in nature, being important pathogens but often found as normal commensals in the mouth, skin, and intestine of humans and other animals. [NIH] Streptococcus: A genus of gram-positive, coccoid bacteria whose organisms occur in pairs or chains. No endospores are produced. Many species exist as commensals or parasites on man or animals with some being highly pathogenic. A few species are saprophytes and

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occur in the natural environment. [NIH] Stress: Forcibly exerted influence; pressure. Any condition or situation that causes strain or tension. Stress may be either physical or psychologic, or both. [NIH] Stroke: Sudden loss of function of part of the brain because of loss of blood flow. Stroke may be caused by a clot (thrombosis) or rupture (hemorrhage) of a blood vessel to the brain. [NIH] Stupor: Partial or nearly complete unconsciousness, manifested by the subject's responding only to vigorous stimulation. Also, in psychiatry, a disorder marked by reduced responsiveness. [EU] Subacute: Somewhat acute; between acute and chronic. [EU] Subclinical: Without clinical manifestations; said of the early stage(s) of an infection or other disease or abnormality before symptoms and signs become apparent or detectable by clinical examination or laboratory tests, or of a very mild form of an infection or other disease or abnormality. [EU] Subspecies: A category intermediate in rank between species and variety, based on a smaller number of correlated characters than are used to differentiate species and generally conditioned by geographical and/or ecological occurrence. [NIH] Substance P: An eleven-amino acid neurotransmitter that appears in both the central and peripheral nervous systems. It is involved in transmission of pain, causes rapid contractions of the gastrointestinal smooth muscle, and modulates inflammatory and immune responses. [NIH]

Substrate: A substance upon which an enzyme acts. [EU] Substrate Specificity: A characteristic feature of enzyme activity in relation to the kind of substrate on which the enzyme or catalytic molecule reacts. [NIH] Sulfadiazine: A short-acting sulfonamide used in combination with pyrimethamine to treat toxoplasmosis in patients with acquired immunodeficiency syndrome and in newborns with congenital infections. [NIH] Sulfides: Chemical groups containing the covalent sulfur bonds -S-. The sulfur atom can be bound to inorganic or organic moieties. [NIH] Sulfur: An element that is a member of the chalcogen family. It has an atomic symbol S, atomic number 16, and atomic weight 32.066. It is found in the amino acids cysteine and methionine. [NIH] Sulfuric acid: A strong acid that, when concentrated is extemely corrosive to the skin and mucous membranes. It is used in making fertilizers, dyes, electroplating, and industrial explosives. [NIH] Superoxide: Derivative of molecular oxygen that can damage cells. [NIH] Suppression: A conscious exclusion of disapproved desire contrary with repression, in which the process of exclusion is not conscious. [NIH] Surfactant: A fat-containing protein in the respiratory passages which reduces the surface tension of pulmonary fluids and contributes to the elastic properties of pulmonary tissue. [NIH]

Synaptic: Pertaining to or affecting a synapse (= site of functional apposition between neurons, at which an impulse is transmitted from one neuron to another by electrical or chemical means); pertaining to synapsis (= pairing off in point-for-point association of homologous chromosomes from the male and female pronuclei during the early prophase of meiosis). [EU] Synaptic Transmission: The communication from a neuron to a target (neuron, muscle, or

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secretory cell) across a synapse. In chemical synaptic transmission, the presynaptic neuron releases a neurotransmitter that diffuses across the synaptic cleft and binds to specific synaptic receptors. These activated receptors modulate ion channels and/or secondmessenger systems to influence the postsynaptic cell. Electrical transmission is less common in the nervous system, and, as in other tissues, is mediated by gap junctions. [NIH] Synergistic: Acting together; enhancing the effect of another force or agent. [EU] Systemic: Affecting the entire body. [NIH] Systemic disease: Disease that affects the whole body. [NIH] Systolic: Indicating the maximum arterial pressure during contraction of the left ventricle of the heart. [EU] Tartar: A mass of calcium and magnesium salts deposited around the teeth and upon artificial dentures. [NIH] Taste Buds: Small sensory organs which contain gustatory receptor cells, basal cells, and supporting cells. Taste buds in humans are found in the epithelia of the tongue, palate, and pharynx. They are innervated by the chorda tympani nerve (a branch of the facial nerve) and the glossopharyngeal nerve. [NIH] Tear Gases: Gases that irritate the eyes, throat, or skin. Severe lacrimation develops upon irritation of the eyes. [NIH] Temporal: One of the two irregular bones forming part of the lateral surfaces and base of the skull, and containing the organs of hearing. [NIH] Tetracycline: An antibiotic originally produced by Streptomyces viridifaciens, but used mostly in synthetic form. It is an inhibitor of aminoacyl-tRNA binding during protein synthesis. [NIH] Therapeutics: The branch of medicine which is concerned with the treatment of diseases, palliative or curative. [NIH] Threshold: For a specified sensory modality (e. g. light, sound, vibration), the lowest level (absolute threshold) or smallest difference (difference threshold, difference limen) or intensity of the stimulus discernible in prescribed conditions of stimulation. [NIH] Thrombin: An enzyme formed from prothrombin that converts fibrinogen to fibrin. (Dorland, 27th ed) EC 3.4.21.5. [NIH] Thrombolytic: 1. Dissolving or splitting up a thrombus. 2. A thrombolytic agent. [EU] Thrombomodulin: A cell surface glycoprotein of endothelial cells that binds thrombin and serves as a cofactor in the activation of protein C and its regulation of blood coagulation. [NIH]

Thrombosis: The formation or presence of a blood clot inside a blood vessel. [NIH] Thrombus: An aggregation of blood factors, primarily platelets and fibrin with entrapment of cellular elements, frequently causing vascular obstruction at the point of its formation. Some authorities thus differentiate thrombus formation from simple coagulation or clot formation. [EU] Thymidine: A chemical compound found in DNA. Also used as treatment for mucositis. [NIH]

Tissue: A group or layer of cells that are alike in type and work together to perform a specific function. [NIH] Tissue Plasminogen Activator: A proteolytic enzyme in the serine protease family found in many tissues which converts plasminogen to plasmin. It has fibrin-binding activity and is immunologically different from urinary plasminogen activator. The primary sequence,

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composed of 527 amino acids, is identical in both the naturally occurring and synthetic proteases. EC 3.4.21.68. [NIH] Tooth Loss: The failure to retain teeth as a result of disease or injury. [NIH] Tooth Movement: Orthodontic techniques used to correct the malposition of a single tooth. [NIH]

Topical: On the surface of the body. [NIH] Toxaemia: 1. The condition resulting from the spread of bacterial products (toxins) by the bloodstream. 2. A condition resulting from metabolic disturbances, e.g. toxaemia of pregnancy. [EU] Toxic: Having to do with poison or something harmful to the body. Toxic substances usually cause unwanted side effects. [NIH] Toxicity: The quality of being poisonous, especially the degree of virulence of a toxic microbe or of a poison. [EU] Toxicology: The science concerned with the detection, chemical composition, and pharmacologic action of toxic substances or poisons and the treatment and prevention of toxic manifestations. [NIH] Toxins: Specific, characterizable, poisonous chemicals, often proteins, with specific biological properties, including immunogenicity, produced by microbes, higher plants, or animals. [NIH] Toxoplasmosis: The acquired form of infection by Toxoplasma gondii in animals and man. [NIH]

Trachea: The cartilaginous and membranous tube descending from the larynx and branching into the right and left main bronchi. [NIH] Transfection: The uptake of naked or purified DNA into cells, usually eukaryotic. It is analogous to bacterial transformation. [NIH] Translation: The process whereby the genetic information present in the linear sequence of ribonucleotides in mRNA is converted into a corresponding sequence of amino acids in a protein. It occurs on the ribosome and is unidirectional. [NIH] Transmitter: A chemical substance which effects the passage of nerve impulses from one cell to the other at the synapse. [NIH] Trauma: Any injury, wound, or shock, must frequently physical or structural shock, producing a disturbance. [NIH] Triad: Trivalent. [NIH] Trichomoniasis: An infection with the protozoan parasite Trichomonas vaginalis. [NIH] Triclosan: A diphenyl ether derivative used in cosmetics and toilet soaps as an antiseptic. It has some bacteriostatic and fungistatic action. [NIH] Triglyceride: A lipid carried through the blood stream to tissues. Most of the body's fat tissue is in the form of triglycerides, stored for use as energy. Triglycerides are obtained primarily from fat in foods. [NIH] Trypsin: A serine endopeptidase that is formed from trypsinogen in the pancreas. It is converted into its active form by enteropeptidase in the small intestine. It catalyzes hydrolysis of the carboxyl group of either arginine or lysine. EC 3.4.21.4. [NIH] Tryptophan: An essential amino acid that is necessary for normal growth in infants and for nitrogen balance in adults. It is a precursor serotonin and niacin. [NIH] Tuberculosis: Any of the infectious diseases of man and other animals caused by species of

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Mycobacterium. [NIH] Tumor Necrosis Factor: Serum glycoprotein produced by activated macrophages and other mammalian mononuclear leukocytes which has necrotizing activity against tumor cell lines and increases ability to reject tumor transplants. It mimics the action of endotoxin but differs from it. It has a molecular weight of less than 70,000 kDa. [NIH] Type 2 diabetes: Usually characterized by a gradual onset with minimal or no symptoms of metabolic disturbance and no requirement for exogenous insulin. The peak age of onset is 50 to 60 years. Obesity and possibly a genetic factor are usually present. [NIH] Ulcer: A localized necrotic lesion of the skin or a mucous surface. [NIH] Ulceration: 1. The formation or development of an ulcer. 2. An ulcer. [EU] Unconscious: Experience which was once conscious, but was subsequently rejected, as the "personal unconscious". [NIH] Urea: A compound (CO(NH2)2), formed in the liver from ammonia produced by the deamination of amino acids. It is the principal end product of protein catabolism and constitutes about one half of the total urinary solids. [NIH] Urethra: The tube through which urine leaves the body. It empties urine from the bladder. [NIH]

Urinary: Having to do with urine or the organs of the body that produce and get rid of urine. [NIH] Urinary Plasminogen Activator: A proteolytic enzyme that converts plasminogen to plasmin where the preferential cleavage is between arginine and valine. It was isolated originally from human urine, but is found in most tissues of most vertebrates. EC 3.4.21.73. [NIH]

Urine: Fluid containing water and waste products. Urine is made by the kidneys, stored in the bladder, and leaves the body through the urethra. [NIH] Urokinase: A drug that dissolves blood clots or prevents them from forming. [NIH] Uterus: The small, hollow, pear-shaped organ in a woman's pelvis. This is the organ in which a fetus develops. Also called the womb. [NIH] Vaccine: A substance or group of substances meant to cause the immune system to respond to a tumor or to microorganisms, such as bacteria or viruses. [NIH] Vagina: The muscular canal extending from the uterus to the exterior of the body. Also called the birth canal. [NIH] Vaginal: Of or having to do with the vagina, the birth canal. [NIH] Vaginitis: Inflammation of the vagina characterized by pain and a purulent discharge. [NIH] Vascular: Pertaining to blood vessels or indicative of a copious blood supply. [EU] Vasodilator: An agent that widens blood vessels. [NIH] Vector: Plasmid or other self-replicating DNA molecule that transfers DNA between cells in nature or in recombinant DNA technology. [NIH] Vein: Vessel-carrying blood from various parts of the body to the heart. [NIH] Venoms: Poisonous animal secretions forming fluid mixtures of many different enzymes, toxins, and other substances. These substances are produced in specialized glands and secreted through specialized delivery systems (nematocysts, spines, fangs, etc.) for disabling prey or predator. [NIH] Venous: Of or pertaining to the veins. [EU] Ventricle: One of the two pumping chambers of the heart. The right ventricle receives

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oxygen-poor blood from the right atrium and pumps it to the lungs through the pulmonary artery. The left ventricle receives oxygen-rich blood from the left atrium and pumps it to the body through the aorta. [NIH] Veterinary Medicine: The medical science concerned with the prevention, diagnosis, and treatment of diseases in animals. [NIH] Viral: Pertaining to, caused by, or of the nature of virus. [EU] Virulence: The degree of pathogenicity within a group or species of microorganisms or viruses as indicated by case fatality rates and/or the ability of the organism to invade the tissues of the host. [NIH] Virulent: A virus or bacteriophage capable only of lytic growth, as opposed to temperate phages establishing the lysogenic response. [NIH] Virus: Submicroscopic organism that causes infectious disease. In cancer therapy, some viruses may be made into vaccines that help the body build an immune response to, and kill, tumor cells. [NIH] Viscosity: A physical property of fluids that determines the internal resistance to shear forces. [EU] Vivo: Outside of or removed from the body of a living organism. [NIH] Warts: Benign epidermal proliferations or tumors; some are viral in origin. [NIH] White blood cell: A type of cell in the immune system that helps the body fight infection and disease. White blood cells include lymphocytes, granulocytes, macrophages, and others. [NIH]

Wound Healing: Restoration of integrity to traumatized tissue. [NIH] Xerostomia: Decreased salivary flow. [NIH] X-ray: High-energy radiation used in low doses to diagnose diseases and in high doses to treat cancer. [NIH] Yeasts: A general term for single-celled rounded fungi that reproduce by budding. Brewers' and bakers' yeasts are Saccharomyces cerevisiae; therapeutic dried yeast is dried yeast. [NIH] Zymogen: Inactive form of an enzyme which can then be converted to the active form, usually by excision of a polypeptide, e. g. trypsinogen is the zymogen of trypsin. [NIH]

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INDEX A Abscess, 135, 168 Acceptor, 135, 167 Acetylcholine, 135, 143 Acne, 59, 121, 135 Acridine Orange, 70, 135 Actinomyces, 47, 55, 56, 81, 135 Acupuncture Therapy, 4, 135 Adjunctive Therapy, 8, 135 Adolescence, 135, 168 Adrenal Cortex, 135, 146, 171 Adrenergic, 29, 135, 151 Adverse Effect, 9, 10, 135, 176 Affinity, 50, 71, 135, 136, 176 Agar, 136, 169 Age Groups, 22, 136 Age of Onset, 49, 136, 181 Aged, 80 and Over, 136 Agonist, 136, 166 Airway, 136, 141 Algorithms, 136, 141 Alkaline, 136, 137, 142 Alkaloid, 136, 164, 166 Alleles, 25, 136 Allylamine, 136, 137 Alpha Particles, 136, 173 Alpha-Defensins, 136, 147 Alternative medicine, 96, 136 Alveolar Bone Loss, 4, 8, 47, 59, 136 Alveolar Process, 136, 174 Alveoli, 136, 148 Amebiasis, 136, 163 Amine, 44, 48, 136, 156 Amino Acid Sequence, 137, 138, 153 Amino Acids, 45, 73, 137, 153, 168, 170, 172, 175, 176, 178, 180, 181 Ammonia, 48, 137, 181 Amoxicillin, 37, 137 Ampicillin, 137 Amplification, 6, 75, 137 Anaerobic, 36, 46, 48, 73, 137, 170 Anaesthesia, 137, 158 Anal, 65, 137, 161 Analgesic, 121, 137, 145, 164 Analogous, 70, 137, 180 Anaphylatoxins, 137, 145 Anatomical, 137, 139, 150, 157, 161 Androgens, 135, 137, 146

Anemia, 28, 137, 153, 162 Anesthesia, 136, 137, 145, 147 Angiogenesis, 138, 162 Anionic, 68, 138 Anions, 138, 159 Anomalies, 138, 167 Anorexia, 138 Anorexiant, 121, 138 Antiallergic, 138, 146 Antibacterial, 48, 61, 75, 121, 138, 177 Antibiotic, 13, 37, 97, 137, 138, 141, 164, 177, 179 Antibodies, 45, 47, 55, 138, 155, 157, 162, 164, 169 Antibody, 16, 44, 55, 59, 65, 73, 78, 135, 138, 144, 151, 155, 156, 157, 158, 163, 164, 173, 177 Anticoagulant, 138, 171 Antigen, 12, 44, 56, 135, 138, 144, 156, 157, 158, 162 Antigen-Antibody Complex, 138, 144 Antihistamine, 121, 138 Anti-infective, 138, 143, 176 Anti-inflammatory, 52, 121, 138, 146, 154, 158, 160 Anti-Inflammatory Agents, 138, 146, 160 Antimetabolite, 138, 141 Antimicrobial, 10, 41, 44, 48, 50, 60, 65, 67, 72, 76, 139, 147, 149 Antineoplastic, 139, 141, 146, 164 Antioxidant, 19, 45, 139 Antiplasmin, 74, 139 Antiseptic, 10, 59, 139, 180 Antiviral, 139, 141 Anxiety, 121, 139, 145 Aorta, 139, 182 Aqueous, 68, 139, 140, 147, 160, 161 Arachidonic Acid, 139, 160, 171 Arginine, 73, 137, 139, 167, 180, 181 Argon, 77, 139 Arterial, 136, 139, 154, 157, 172, 179 Arteries, 139, 141, 146, 159, 163, 165 Aspartate, 25, 139 Aspartic, 139, 150 Aspartic Endopeptidases, 139, 150 Astringent, 10, 139 Atrium, 139, 182 Atypical, 9, 139

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B Bacterial Infections, 8, 9, 86, 118, 139 Bacteriophage, 69, 70, 139, 169, 182 Bacteriostatic, 140, 180 Bacterium, 46, 69, 73, 140, 170 Basal cells, 140, 179 Base, 67, 140, 153, 160, 179 Basement Membrane, 140, 151, 160 Basophils, 140, 160 Benign, 5, 45, 140, 166, 173, 182 Beta-Defensins, 140, 147 Binding agent, 46, 140 Binding Sites, 79, 140 Bioassays, 40, 140 Bioavailability, 50, 71, 72, 140 Biochemical, 39, 136, 138, 140, 160, 170 Biofilms, 71, 74, 140 Biological therapy, 140, 155 Biopsy, 45, 140 Biosynthesis, 39, 139, 140, 176 Biotechnology, 11, 85, 96, 107, 141 Bladder, 141, 181 Blood Coagulation, 141, 142, 179 Blood Glucose, 40, 123, 141, 155 Blood pressure, 141, 142, 154, 157, 164, 176 Blood vessel, 138, 141, 142, 143, 150, 159, 176, 177, 178, 179, 181 Body Composition, 13, 141 Bone Marrow, 12, 141, 155, 162, 164 Bowel, 137, 141, 149, 159 Bowel Movement, 141, 149 Brachytherapy, 141, 159, 173 Branch, 131, 141, 143, 168, 172, 177, 179 Breakdown, 12, 60, 141, 153 Broad-spectrum, 137, 141 Bromodeoxyuridine, 70, 141 Bronchi, 141, 151, 180 Bronchial, 141, 156 Bronchodilator, 121, 141 Buccal, 45, 141 Buccal mucosa, 45, 141 C Cachexia, 78, 79, 142 Calcium, 32, 46, 142, 144, 162, 165, 179 Calcium Carbonate, 46, 142 Calculus I, 5, 142 Candidiasis, 86, 142 Candidosis, 142 Capsular, 47, 142 Carbohydrate, 142, 146, 154, 170 Carcinogen, 142, 163, 165 Carcinogenesis, 40, 142

Carcinogenic, 44, 142, 158, 171 Carcinoma, 142 Cardiovascular, 6, 49, 75, 94, 114, 115, 117, 121, 142, 160 Cardiovascular disease, 6, 49, 75, 94, 117, 142 Case report, 3, 142 Cations, 142, 159 Cause of Death, 69, 142 Cell Division, 139, 143, 155, 164, 169 Cell membrane, 143, 169 Cell Survival, 143, 155 Cellulose, 143, 153, 169 Central Nervous System, 135, 143, 154, 160, 164 Cerebral, 19, 20, 143, 146, 151, 152, 162 Cerebrovascular, 142, 143 Chelation, 50, 71, 143 Chemokines, 18, 143 Chemoprevention, 40, 143 Chemotactic Factors, 143, 145 Chlorhexidine, 39, 86, 100, 143 Chlorine, 59, 143 Chlorophyll, 143, 153 Cholesterol, 41, 143, 146, 161 Cholinergic, 121, 143, 166 Chorda Tympani Nerve, 143, 179 Chromosomal, 137, 143 Chromosome, 14, 143, 161 Chronic Disease, 79, 80, 121, 142, 144 Clear cell carcinoma, 144, 148 Clinical trial, 8, 10, 37, 40, 41, 107, 144, 146, 172, 173 Cloning, 141, 144 Coenzyme, 29, 30, 48, 66, 144 Cofactor, 144, 172, 179 Coliphages, 139, 144 Collagen, 12, 14, 35, 47, 48, 73, 77, 140, 144, 152, 155, 162, 171 Collagenases, 47, 144 Collapse, 141, 144 Colostrum, 72, 144 Complement, 73, 137, 144, 145, 164 Complementary and alternative medicine, 10, 27, 33, 145 Complementary medicine, 27, 145 Computational Biology, 107, 145 Conception, 145, 170 Concretion, 142, 145, 147 Congestion, 145, 147 Conjugated, 44, 50, 55, 71, 145

Index 185

Connective Tissue, 67, 141, 144, 145, 146, 154, 155, 168, 175 Connective Tissue Cells, 145 Conscious Sedation, 3, 145 Consciousness, 137, 145, 149 Consumption, 4, 45, 145, 174 Contraception, 38, 145, 161 Contraindications, ii, 145 Conventional therapy, 145, 146 Conventional treatment, 78, 146 Convulsions, 146, 149, 170 Cooperative group, 40, 146 Coronary, 6, 15, 16, 23, 69, 95, 142, 146, 163, 165 Coronary heart disease, 16, 95, 142, 146 Coronary Thrombosis, 6, 146, 163, 165 Cortex, 47, 146, 152 Corticosteroid, 5, 146 Cranial, 108, 143, 146, 152, 154 Criterion, 55, 146 Crown Lengthening, 84, 146 Crowns, 85, 146, 148 Cryptosporidium, 60, 146 Curare, 147, 164 Curative, 147, 179 Curettage, 4, 53, 78, 147, 175 Curette, 147 Cutaneous, 142, 147, 159 Cyclic, 147, 171 Cysteine, 143, 147, 150, 178 Cysteine Endopeptidases, 147, 150 Cytokine, 58, 79, 147 Cytoplasm, 140, 143, 147, 151, 164, 175 Cytotoxic, 79, 147, 173 Cytotoxins, 73, 147 D Data Collection, 75, 147 Databases, Bibliographic, 107, 147 Decarboxylation, 147, 156 Decongestant, 121, 147 Defense Mechanisms, 76, 117, 147 Defensins, 76, 136, 140, 147 Dental Abutments, 147, 148 Dental Calculus, 86, 147, 148 Dental Care, 5, 6, 72, 85, 90, 108, 115, 118, 119, 121, 123, 147, 168 Dental Caries, 10, 23, 24, 38, 54, 61, 63, 64, 66, 69, 70, 72, 81, 90, 148, 152 Dental implant, 7, 60, 84, 85, 123, 148 Dental Plaque, 4, 10, 38, 51, 54, 64, 68, 70, 75, 117, 148 Dental Polishing, 148

Dental Prophylaxis, 53, 148 Dental Scaling, 148 Dentifrices, 48, 148 Dentists, 6, 44, 45, 83, 90, 94, 115, 121, 123, 148 Dentition, 61, 86, 90, 117, 148 Dentures, 121, 148, 179 DES, 46, 137, 148 Deuterium, 148, 156 Dextrans, 69, 148 Diabetes Mellitus, 4, 6, 7, 17, 18, 40, 41, 78, 148, 154, 156, 158 Diagnostic procedure, 43, 68, 96, 148 Dialyzer, 148, 155 Diastolic, 148, 157 Digestive system, 42, 149 Digestive tract, 149, 176 Dilatation, 149, 171 Direct, iii, 65, 66, 69, 99, 149, 154, 161, 174 Disease Progression, 6, 8, 12, 18, 23, 24, 25, 39, 46, 53, 86, 149 Disinfectant, 59, 60, 143, 149 Dissociation, 135, 149, 159 Diuretic, 121, 149 Dose-dependent, 79, 149 Doxycycline, 37, 38, 95, 100, 149 Drug Interactions, 100, 149 Duct, 149, 157, 175 Dyes, 140, 149, 178 E Eclampsia, 149, 170 Edema, 149, 165, 170 Effector, 135, 144, 149 Efficacy, 10, 44, 45, 55, 66, 72, 149 Elastin, 144, 149, 152 Electrolyte, 146, 149, 164, 170, 176 Electrons, 139, 140, 150, 159, 167, 173 Electroplating, 150, 178 Embryo, 150, 158, 170, 177 Embryo Transfer, 150, 170 Emollient, 150, 154, 167 Enamel, 7, 53, 55, 81, 148, 150 Endemic, 150, 162 Endocarditis, 113, 142, 150 Endodontics, 12, 16, 150, 175 Endometriosis, 150, 161, 166 Endopeptidases, 73, 139, 147, 150, 163, 168, 176 Endothelial cell, 58, 150, 179 Endotoxic, 79, 150 Endotoxin, 48, 150, 181 Enteropeptidase, 150, 180

186 Gum Disease

Environmental Health, 106, 108, 150 Enzymatic, 45, 50, 71, 142, 145, 148, 150, 156, 175 Eosinophils, 151, 160 Epidemic, 51, 151 Epidermal, 151, 182 Epinephrine, 135, 151, 166 Epithelial, 75, 76, 77, 140, 151, 154, 155, 160, 168 Epithelial Cells, 75, 140, 151, 160 Epithelium, 76, 140, 146, 151 Epitope, 56, 151 Erythrocytes, 137, 141, 151 Esophagus, 149, 151, 169, 177 Ether, 151, 180 Ethnic Groups, 119, 151 Exhaustion, 151, 162 Exogenous, 151, 181 Exotoxins, 79, 151 External-beam radiation, 151, 173 Extracellular, 47, 73, 140, 145, 151, 162, 176 Extracellular Matrix, 145, 151, 162 Extracellular Matrix Proteins, 151, 162 Extraction, 44, 55, 66, 152 F Facial, 143, 152, 176, 179 Facial Nerve, 152, 179 Family Planning, 107, 152 Fat, 139, 141, 144, 146, 152, 154, 161, 175, 177, 178, 180 Fatty acids, 64, 152, 154, 161, 171, 176 Fertilization in Vitro, 152, 170 Fertilizers, 152, 178 Fibrin, 139, 141, 152, 169, 179 Fibrinogen, 73, 152, 169, 179 Fibronectin, 22, 73, 152 Fissure, 90, 143, 152 Flatus, 152, 153 Fluorescence, 135, 152 Fluoridation, 122, 152 Fluorine, 152 Folate, 33, 152, 153 Fold, 39, 55, 152 Folic Acid, 32, 52, 152 Fractionation, 10, 153 Fungi, 9, 76, 153, 155, 163, 182 Fungistatic, 153, 180 Fungus, 59, 142, 153 G Gallbladder, 149, 153 Gamma Rays, 153, 165, 173

Gas, 77, 81, 137, 139, 143, 152, 153, 156, 165, 166 Gastric, 40, 137, 153, 156 Gastric Acid, 137, 153 Gastrin, 153, 156 Gastrointestinal, 60, 151, 153, 160, 162, 178 Gastrointestinal tract, 153, 160 Gels, 44, 45, 53, 153 Gene, 14, 15, 36, 75, 78, 79, 85, 94, 95, 136, 141, 153, 161 Gene Expression, 36, 78, 79, 153 Genetic Code, 153, 166 Genetic testing, 22, 153 Genetics, 14, 97, 153 Genotype, 13, 153 Gestation, 7, 154, 177 Giardiasis, 154, 163 Gingival Pocket, 48, 154 Gingival Recession, 6, 86, 154 Glossopharyngeal Nerve, 154, 179 Glucocorticoids, 135, 146, 154 Glucose, 41, 141, 143, 148, 154, 155, 158, 173 Glucose Intolerance, 148, 154 Glutamic Acid, 152, 154, 171 Glutathione Peroxidase, 154, 175 Glycerol, 154, 169 Glycerophospholipids, 154, 169 Glycoprotein, 139, 152, 154, 160, 179, 181 Governing Board, 154, 170 Grade, 3, 154 Graft, 78, 155, 156, 165 Grafting, 155, 157 Graft-versus-host disease, 78, 155 Gram-negative, 46, 48, 73, 76, 79, 150, 155, 170 Gram-Negative Bacteria, 48, 150, 155 Gram-positive, 76, 79, 135, 155, 177 Granuloma, 87, 155 Grasses, 153, 155 Growth factors, 16, 155 Guided Tissue Regeneration, 4, 155 H Halitosis, 45, 155 Hammer, 57, 155, 167 Haptens, 135, 155 Health Education, 123, 155 Health Promotion, 89, 121, 155 Heart attack, 6, 49, 94, 142, 155 Hemodialysis, 21, 142, 148, 155 Hemoglobin, 41, 137, 151, 155 Hemorrhage, 156, 165, 178

Index 187

Heredity, 153, 156 Herpes, 59, 86, 156 Herpes Zoster, 156 Heterogeneity, 135, 156 Heterotrophic, 153, 156 Histamine, 48, 137, 138, 156 Histidine, 156 Histology, 156, 168 Homologous, 136, 156, 178 Hormonal, 5, 7, 38, 115, 117, 118, 146, 156 Hormone, 7, 117, 140, 146, 148, 151, 153, 156, 158, 161, 163, 171, 175 Host, 16, 25, 39, 47, 55, 58, 60, 66, 71, 73, 76, 78, 84, 139, 142, 144, 147, 156, 160, 182 Humoral, 48, 156, 157 Humour, 156 Hydrogen, 48, 68, 135, 137, 140, 142, 148, 151, 154, 156, 164, 166, 167, 168, 172 Hydrolysis, 139, 156, 168, 170, 172, 180 Hydroxylysine, 144, 156 Hydroxyproline, 144, 156 Hygienic, 53, 157 Hyperplasia, 87, 157 Hypersensitivity, 157, 160, 175 Hypertension, 13, 142, 157, 170 Hypertrophy, 157 I Id, 28, 113, 124, 125, 130, 132, 157 Immune response, 74, 75, 84, 138, 146, 155, 157, 164, 178, 182 Immune system, 8, 48, 66, 140, 157, 160, 162, 181, 182 Immunity, 14, 23, 47, 52, 60, 70, 75, 97, 147, 157 Immunocompetence, 9, 157 Immunocompromised, 60, 157 Immunodeficiency, 9, 79, 157, 178 Immunodeficiency syndrome, 157, 178 Immunoelectrophoresis, 136, 139, 157 Immunogen, 45, 157 Immunogenic, 46, 157 Immunoglobulin, 47, 138, 157, 164 Immunologic, 46, 143, 157, 173 Immunology, 12, 14, 15, 17, 135, 157 Impaction, 148, 157 Impairment, 157, 163 Implant radiation, 157, 159, 173 Implantation, 73, 100, 145, 157 In vitro, 150, 158 In vivo, 48, 158 Incision, 146, 158, 159

Incisor, 49, 158 Indicative, 84, 158, 168, 181 Indomethacin, 158, 160 Induction, 70, 78, 137, 158 Infant, Newborn, 136, 158 Infarction, 6, 158, 174 Infection Control, 122, 158 Ingestion, 155, 158, 169 Initiation, 59, 66, 76, 158 Inlay, 158, 174 Inorganic, 158, 176, 178 Insulin, 40, 158, 181 Interleukin-1, 13, 15, 22, 23, 158 Interleukin-2, 158 Interleukins, 48, 159 Intermittent, 5, 79, 80, 159 Internal radiation, 159, 173 Intestinal, 136, 146, 150, 159 Intestine, 141, 159, 160, 177 Intracellular, 158, 159, 163, 170, 171, 175 Intravenous, 57, 159 Intrinsic, 136, 140, 159 Invasive, 54, 157, 159 Involuntary, 159, 165, 174, 177 Ionization, 159 Ionizing, 54, 136, 159, 173 Ions, 53, 67, 140, 149, 156, 159 Irritants, 49, 50, 51, 159 Ischemia, 159, 165, 174 Ischemic stroke, 19, 159 Isoelectric, 63, 159 Isoelectric Point, 63, 159 J Joint, 90, 108, 160 K Kb, 106, 160 Keratolytic, 148, 160 Ketorolac, 39, 160 Ketorolac Tromethamine, 39, 160 Kidney Disease, 21, 42, 106, 115, 160 Kinetic, 159, 160 L Labile, 144, 160 Lactation, 144, 160 Laminin, 73, 140, 152, 160 Large Intestine, 149, 159, 160, 173, 176 Larynx, 160, 180 Latent, 160, 170 Lectins, 64, 160 Lens, 142, 160 Lesion, 45, 155, 160, 164, 181

188 Gum Disease

Leukocytes, 48, 140, 141, 143, 151, 158, 159, 160, 164, 181 Leukoplakia, 39, 45, 160 Leukotrienes, 48, 139, 160 Levonorgestrel, 38, 161, 166 Library Services, 130, 161 Life cycle, 153, 161 Ligament, 74, 75, 76, 161, 168 Ligands, 68, 161 Linkages, 155, 161 Lipid, 154, 158, 161, 180 Lipopolysaccharide, 48, 79, 155, 161 Lipoprotein, 155, 161 Liposomes, 56, 57, 161 Lipoxygenase, 160, 161 Liquor, 161, 173 Liver, 139, 149, 152, 153, 154, 161, 181 Localized, 17, 49, 76, 148, 158, 160, 161, 164, 168, 169, 181 Longitudinal study, 25, 161 Lucida, 160, 161 Lymph, 150, 156, 161, 162 Lymphatic, 158, 161, 162 Lymphocyte, 138, 162, 163 Lymphoid, 138, 157, 162 Lysine, 55, 73, 156, 162, 180 Lytic, 70, 162, 182 M Macrophage, 58, 158, 162 Maintenance therapy, 51, 162 Malaria, 78, 162 Malaria, Falciparum, 162 Malaria, Vivax, 162 Malignant, 45, 139, 162, 166, 173 Malnutrition, 142, 162 Mammary, 144, 162 Mammography, 55, 162 Mandible, 136, 162, 174 Mannans, 153, 162 Matrix metalloproteinase, 61, 162 Mediate, 17, 47, 162 Mediator, 58, 158, 162 Medicament, 63, 79, 80, 163 MEDLINE, 107, 163 Megaloblastic, 153, 163 Membrane, 5, 47, 54, 79, 143, 145, 148, 150, 155, 160, 161, 163, 164, 167, 168, 169, 174 Membrane Proteins, 161, 163 Menopause, 117, 118, 163 Menstruation, 117, 118, 163 Mental Disorders, 42, 163 Mental Health, iv, 9, 42, 106, 109, 163, 172

Metabolite, 64, 163 Metalloendopeptidases, 150, 163 Metastasis, 162, 163 Metronidazole, 13, 37, 38, 163 MI, 6, 85, 133, 163 Microbe, 163, 180 Microbiological, 25, 37, 38, 163 Microbiology, 12, 14, 15, 70, 139, 140, 163 Microorganism, 44, 73, 144, 163, 167 Micro-organism, 76, 81, 148, 163 Migration, 76, 154, 163, 168 Milligram, 60, 163 Mineralocorticoids, 135, 146, 164 Mitomycin, 70, 164 Mitosis, 160, 164 Mobility, 6, 164 Molecule, 78, 138, 140, 144, 149, 151, 156, 164, 167, 173, 176, 178, 181 Monitor, 122, 164, 166 Monoclonal, 46, 61, 65, 164, 173 Monoclonal antibodies, 46, 61, 164 Monocytes, 58, 158, 160, 164 Monokines, 78, 164 Mononuclear, 155, 164, 181 Morphine, 164, 165 Morphological, 150, 153, 164 Motor nerve, 164 Mouth Ulcer, 56, 164 Mucins, 148, 164, 175 Mucosa, 67, 164 Muscle relaxant, 121, 164 Muscle tension, 164, 165 Mustard Gas, 159, 165 Mutagen, 55, 165 Myocardial infarction, 6, 19, 146, 163, 165 Myocardial Reperfusion, 165, 174 Myocardial Reperfusion Injury, 165, 174 Myocardium, 163, 165 Myristic Acids, 64, 165 N Narcosis, 165 Narcotic, 121, 164, 165 NCI, 1, 39, 41, 105, 165 Necrosis, 158, 163, 165, 168, 174 Need, 3, 53, 59, 61, 68, 71, 79, 83, 85, 89, 97, 108, 115, 117, 118, 119, 126, 162, 165, 170 Neonatal, 55, 165 Neoplasia, 166 Neoplasm, 166 Neoplastic, 80, 166 Nephropathy, 160, 166

Index 189

Nerve, 135, 137, 143, 152, 154, 162, 164, 166, 174, 177, 180 Nervous System, 143, 162, 166, 178, 179 Neural, 156, 166 Neurons, 164, 166, 178 Neutrons, 136, 166, 173 Neutrophil, 17, 21, 58, 62, 76, 166 Nicotine, 120, 166 Nitrogen, 136, 137, 139, 151, 166, 180 Norepinephrine, 135, 166 Norgestrel, 161, 166 Nuclear, 79, 150, 153, 165, 166 Nuclei, 135, 136, 150, 164, 166, 172 Nucleic acid, 49, 78, 153, 166 Nucleus, 140, 147, 148, 151, 153, 164, 166, 172 O Odds Ratio, 4, 55, 167, 174 Ointments, 48, 167, 176 Oral Hygiene, 4, 5, 6, 8, 10, 45, 53, 56, 61, 62, 64, 85, 86, 90, 115, 118, 119, 123, 155, 167 Organelles, 147, 164, 167 Ornithine, 56, 167 Orofacial, 80, 86, 87, 167 Orthodontics, 85, 90, 167 Ossicles, 155, 167 Ovum, 154, 161, 167, 171 Oxidation, 19, 73, 135, 139, 154, 167 Oxidative metabolism, 160, 167 P Palate, 154, 167, 179 Palliative, 167, 179 Pancreas, 149, 158, 167, 180 Patch, 45, 160, 167 Pathogen, 39, 79, 167 Pathogenesis, 16, 17, 24, 36, 86, 167 Pathologic, 140, 142, 146, 157, 168, 174 Pathologies, 45, 168 Pathophysiology, 84, 168 Patient Education, 84, 115, 116, 120, 122, 124, 128, 130, 133, 168 Pediatric Dentistry, 86, 168 Pediatrics, 90, 168 Peptide, 75, 144, 150, 168, 170, 171, 172 Peptide Hydrolases, 150, 168 Pericoronitis, 87, 113, 168 Periodontal Abscess, 87, 168 Periodontal Attachment Loss, 5, 49, 168 Periodontal Ligament, 47, 67, 75, 76, 80, 116, 155, 168

Periodontal Pocket, 6, 8, 37, 47, 51, 52, 53, 57, 60, 63, 67, 77, 78, 80, 83, 116, 148, 168 Periodontics, 10, 55, 168 Periodontist, 116, 117, 168 Peripheral stem cells, 155, 168 PH, 55, 168 Pharmacologic, 137, 168, 180 Pharynx, 169, 179 Phospholipids, 56, 152, 161, 169 Phosphorus, 142, 169 Phosphorylated, 144, 169 Physiologic, 136, 140, 163, 169, 171, 173, 174 Physiology, 90, 122, 160, 168, 169 Pilot study, 13, 20, 40, 169 Pituitary Gland, 146, 169 Plants, 136, 147, 154, 166, 169, 180 Plasma, 73, 138, 139, 143, 148, 152, 154, 156, 164, 169 Plasma cells, 138, 169 Plasma Volume, 148, 164, 169 Plasmin, 139, 169, 179, 181 Plasminogen, 80, 139, 169, 179, 181 Plasminogen Activator Inhibitor 2, 80, 169 Plasminogen Activators, 169 Poisoning, 169, 175 Polymers, 140, 148, 170, 172 Polymorphism, 21, 23, 51, 170 Polypeptide, 78, 137, 144, 152, 169, 170, 182 Polysaccharide, 44, 138, 143, 170 Porphyromonas, 8, 16, 21, 25, 36, 44, 46, 48, 73, 78, 170 Porphyromonas gingivalis, 8, 16, 21, 25, 44, 46, 73, 78, 170 Postoperative, 160, 170 Potassium, 59, 164, 170, 176 Potentiates, 158, 170 Potentiation, 58, 170 Practice Guidelines, 109, 124, 170 Precursor, 139, 149, 150, 166, 169, 170, 180 Predisposition, 14, 51, 170 Preeclampsia, 16, 114, 170 Pregnancy Outcome, 120, 170 Prevalence, 6, 8, 20, 51, 167, 170 Probe, 57, 63, 64, 77, 171 Progesterone, 161, 166, 171 Progressive, 35, 49, 53, 74, 83, 155, 165, 171 Projection, 147, 166, 171 Proline, 144, 156, 171 Promoter, 21, 75, 78, 79, 171 Proportional, 73, 171

190 Gum Disease

Prospective study, 161, 171 Prostaglandin, 39, 47, 58, 171 Prostaglandins A, 158, 171 Protease, 58, 171, 179 Protein C, 73, 137, 139, 161, 171, 181 Protein S, 47, 85, 141, 153, 172, 175, 179 Proteinuria, 170, 172 Proteolytic, 73, 144, 150, 152, 169, 172, 179, 181 Protocol, 5, 172 Protons, 136, 156, 159, 172, 173 Protozoa, 163, 172 Proximal, 148, 172 Proxy, 71, 172 Psyllium, 65, 172 Puberty, 49, 86, 117, 118, 119, 120, 172 Public Health, 10, 73, 109, 172 Public Policy, 107, 172 Publishing, 3, 11, 86, 121, 172 Pulmonary, 84, 141, 143, 145, 160, 172, 178, 182 Pulmonary Artery, 141, 172, 182 Pulmonary Edema, 143, 172 Pulse, 164, 172 Purulent, 135, 168, 172, 181 Pyogenic, 87, 173 Q Quackery, 108, 173 Quiescent, 58, 173 R Race, 4, 161, 163, 166, 173 Radiation, 54, 69, 121, 151, 152, 153, 159, 163, 173, 182 Radiation therapy, 121, 151, 153, 159, 173 Radioactive, 156, 157, 159, 164, 166, 173 Radiolabeled, 173 Radiological, 18, 173 Radiology, 12, 16, 173 Radiosensitization, 70, 173 Radiotherapy, 141, 173 Randomized, 39, 149, 173 Reabsorption, 76, 173 Reagent, 143, 173 Receptor, 25, 68, 138, 173, 179 Recombinant, 78, 173, 181 Rectum, 141, 149, 152, 153, 160, 173 Recur, 9, 173 Recurrence, 143, 173, 174 Refer, 1, 141, 144, 153, 156, 166, 174 Reflex, 108, 174 Refraction, 174, 177 Refractory, 55, 174

Regeneration, 48, 54, 77, 84, 174 Regimen, 49, 149, 174 Relapse, 9, 174 Relative risk, 49, 174 Relaxant, 174 Remission, 162, 174 Reperfusion, 50, 71, 165, 174 Reperfusion Injury, 50, 71, 174 Reproduction Techniques, 170, 174 Resorption, 75, 136, 168, 173, 174 Respiration, 147, 164, 167, 174 Restoration, 54, 146, 165, 174, 182 Retina, 160, 174, 175 Retrospective, 12, 19, 175 Rheumatism, 175 Rheumatoid, 78, 79, 175 Rheumatoid arthritis, 78, 79, 175 Ribosome, 175, 180 Risk factor, 4, 5, 7, 8, 12, 14, 16, 17, 21, 27, 49, 75, 84, 94, 97, 117, 123, 171, 174, 175 Rod, 73, 89, 135, 140, 170, 175 Root Canal Therapy, 108, 175 Root Planing, 5, 8, 37, 39, 53, 55, 61, 84, 97, 116, 123, 175 S Saliva, 15, 19, 38, 47, 59, 68, 117, 119, 175 Salivary, 47, 143, 148, 149, 152, 175, 182 Salivary glands, 143, 148, 149, 152, 175 Salivary Proteins, 47, 175 Screening, 65, 144, 175 Scurvy, 80, 175 Sebaceous, 159, 175 Sebaceous gland, 159, 175 Secretion, 146, 154, 156, 159, 160, 164, 175 Secretory, 60, 136, 175, 179 Sedative, 121, 175 Selenium, 33, 45, 175 Self Mutilation, 86, 175 Semisynthetic, 137, 175 Sepsis, 78, 175 Septic, 79, 175 Septicemia, 12, 175 Sequence Homology, 75, 176 Serine, 150, 176, 179, 180 Serine Endopeptidases, 150, 176 Serous, 144, 176 Serum, 6, 21, 41, 55, 56, 137, 144, 164, 176, 181 Sex Characteristics, 135, 137, 172, 176 Shock, 79, 176, 180 Side effect, 5, 38, 40, 99, 135, 140, 176, 180 Signs and Symptoms, 4, 124, 174, 176

Index 191

Silver Compounds, 67, 176 Skeleton, 160, 171, 176 Skull, 176, 179 Small intestine, 76, 154, 156, 159, 176, 180 Smiling, 115, 176 Smooth muscle, 136, 137, 141, 145, 156, 164, 176, 177, 178 Soaps, 176, 180 Sodium, 164, 173, 176 Soft tissue, 4, 51, 53, 55, 75, 78, 79, 84, 141, 176, 177 Somatic, 135, 154, 156, 164, 177 Spasm, 177 Spasmodic, 121, 177 Specialist, 125, 168, 177 Species, 45, 56, 135, 147, 149, 151, 162, 163, 164, 170, 173, 176, 177, 178, 180, 182 Specificity, 135, 150, 177 Spectrum, 9, 44, 177 Sperm, 137, 143, 177 Spinal cord, 143, 166, 174, 177 Spontaneous Abortion, 170, 177 Spotting, 38, 177 Sterilization, 69, 177 Steroids, 68, 146, 177 Stillbirth, 170, 177 Stimulant, 156, 177 Stimulus, 174, 177, 179 Stomach, 149, 151, 153, 156, 169, 176, 177 Streptococcal, 55, 56, 70, 177 Streptococci, 56, 70, 81, 177 Streptococcus, 47, 56, 81, 177 Stress, 5, 8, 14, 20, 36, 118, 120, 121, 170, 175, 178 Stroke, 16, 19, 20, 42, 49, 95, 106, 121, 142, 159, 178 Stupor, 165, 178 Subacute, 158, 178 Subclinical, 158, 178 Subspecies, 177, 178 Substance P, 163, 175, 178 Substrate, 47, 48, 59, 74, 178 Substrate Specificity, 74, 178 Sulfadiazine, 67, 178 Sulfides, 60, 178 Sulfur, 151, 178 Sulfuric acid, 76, 178 Superoxide, 47, 58, 178 Suppression, 12, 44, 146, 178 Surfactant, 68, 178 Synaptic, 166, 178 Synaptic Transmission, 166, 178

Synergistic, 10, 45, 50, 51, 72, 179 Systemic disease, 7, 79, 80, 115, 118, 120, 175, 179 Systolic, 157, 179 T Tartar, 45, 53, 72, 115, 116, 179 Taste Buds, 120, 179 Tear Gases, 159, 179 Temporal, 58, 179 Tetracycline, 55, 100, 149, 179 Therapeutics, 64, 101, 179 Threshold, 157, 179 Thrombin, 152, 171, 179 Thrombolytic, 169, 179 Thrombomodulin, 171, 179 Thrombosis, 172, 178, 179 Thrombus, 146, 158, 159, 165, 179 Thymidine, 141, 179 Tissue, 5, 9, 17, 40, 47, 48, 49, 51, 52, 53, 54, 58, 61, 64, 66, 67, 72, 73, 74, 76, 77, 79, 80, 81, 83, 115, 116, 121, 138, 140, 141, 143, 145, 147, 149, 150, 151, 152, 153, 155, 157, 160, 161, 162, 163, 165, 166, 167, 168, 169, 174, 176, 177, 178, 179, 180, 182 Tissue Plasminogen Activator, 80, 179 Tooth Loss, 8, 19, 20, 25, 39, 45, 52, 53, 55, 60, 64, 67, 80, 86, 90, 97, 115, 118, 121, 123, 124, 180 Tooth Movement, 146, 180 Topical, 48, 80, 139, 143, 176, 180 Toxaemia, 170, 180 Toxic, iv, 48, 147, 155, 157, 166, 175, 180 Toxicity, 108, 149, 180 Toxicology, 108, 180 Toxins, 48, 51, 138, 151, 158, 164, 175, 180, 181 Toxoplasmosis, 178, 180 Trachea, 76, 141, 160, 169, 180 Transfection, 141, 180 Translation, 78, 180 Transmitter, 135, 162, 166, 180 Trauma, 4, 87, 165, 180 Triad, 23, 180 Trichomoniasis, 163, 180 Triclosan, 22, 48, 50, 72, 180 Triglyceride, 41, 180 Trypsin, 74, 150, 180, 182 Tryptophan, 144, 180 Tuberculosis, 145, 180 Tumor Necrosis Factor, 18, 181 Type 2 diabetes, 40, 181

192 Gum Disease

U Ulcer, 86, 181 Ulceration, 80, 181 Unconscious, 147, 157, 181 Urea, 167, 181 Urethra, 181 Urinary, 179, 181 Urinary Plasminogen Activator, 179, 181 Urine, 68, 141, 149, 172, 181 Urokinase, 169, 181 Uterus, 163, 171, 181 V Vaccine, 8, 172, 181 Vagina, 142, 148, 163, 177, 181 Vaginal, 68, 181 Vaginitis, 142, 181 Vascular, 20, 69, 136, 158, 169, 179, 181 Vasodilator, 156, 165, 181 Vector, 78, 181 Vein, 159, 166, 181 Venoms, 147, 181 Venous, 172, 181

Ventricle, 13, 172, 179, 181 Veterinary Medicine, 107, 182 Viral, 182 Virulence, 45, 47, 73, 180, 182 Virulent, 73, 182 Virus, 9, 70, 79, 86, 139, 169, 182 Viscosity, 77, 182 Vivo, 182 W Warts, 59, 182 White blood cell, 138, 144, 160, 162, 166, 169, 182 Wound Healing, 52, 119, 162, 182 X Xerostomia, 117, 121, 182 X-ray, 55, 57, 77, 152, 153, 165, 166, 173, 182 Y Yeasts, 81, 142, 153, 182 Z Zymogen, 171, 182

Index 193

194 Gum Disease

Index 195

196 Gum Disease