Factors Contributing to Oral Health Disparities in Appalachia

Despite advances in preventive care, oral diseases (primarily dental caries and periodontal disease) remain significant public health issues. Dental caries remains the most common chronic disease of childhood, five times more common than asthma and seven times more common than environmental allergies, with more than 40% of children exhibiting caries when they enter kindergarten. Although overall caries prevalence has declined over the last 40 years, dental caries in the primary dentition and mean caries rates in children ages 2-11 have increased markedly over the past 12 years. Childhood caries is a serious public health issue because of associated health problems and because disparities in oral health have led to substantially higher average disease prevalence among children in poverty and in under-served racial and ethnic groups. The disparity in childhood caries in the United States is exemplified by the fact that, among children aged 6 to 8 years, the prevalence of untreated decay is 72 percent in Native Americans, 43 percent in Hispanics, 36 percent in African Americans, and 26 percent in whites. The role of the University of Michigan in this study conducted in collaboration with the University of Pittsburgh and University of West Virginia is to test the hypothesis that cariogenesis results from overgrowth of relatively few species against the alternative that cariogenesis is a consequence of complex combinations of many species, i.e., of community structure. A secondary hypothesis is that similarity in microbial composition between any pair of samples is correlated with similarity in known risk factors, such as host genetics, environmental factors, and source of microbiota. Further, the degree of correlation between community similarity and environmental risk factors will depend on dental health status.

Oral and Vaginal Microbes, Human Genotype, and Preterm Birth

Preterm birth and its complications are the single greatest cause of infant deaths in the United States. An infection of the vagina, bacterial vaginosis, and of the mouth, periodontitis, have been associated with two or more fold increases in risk of preterm birth but studies of treating these conditions during pregnancy have shown inconsistent results. We will describe how often the different microbes associated with bacterial vaginosis and periodontitis are found in the mouth and vaginal cavity, and their relative abundance, and if the presence at both sites increases risk of preterm birth over presence in only one site.

The Interdisciplinary Training Program in Infectious Disease (IPID) provided support for pre-doctoral and post-doctoral training at the interface of epidemiology, microbiology, complex systems, mathematics, statistics, and medicine. This training is essential to identify new, more effective strategies to prevent the emergence and spread of antibiotic resistance, predict the spread of infectious agents and identify populations at high risk of disease, compare alternative prevention strategies for pandemic diseases such as influenza and new emerging infections, and explore how human microbiota interacts with the host to mediate risk of various diseases.

Check out our similar program Integrated Training in Microbial Systems (ITiMS)

Host Response, Viral Infection, and Bacterial Pneumonia

Several lines of evidence -- experimental, clinical and epidemiological -- suggest that influenza infection increases risk of bacterial pneumonia with Streptococcus pneumoniae and with Staphylococcus aureus, including methicillin resistant S. aureus (MRSA). We are distilling known empirical information into a mathematical model to explore the interactions among influenza, S. pneumoniae and S. aureus that lead to pneumonia at the individual and population levels. In the short run, the modeling exercise will identify gaps in our knowledge, and serve as a basis for designing studies to fill those gaps. In the long run, the model will help us understand how these interactions lead to pneumonia, and to predict the effects of interventions directed at reducing influenza, S. pneumoniae and S. aureus on the incidence of pneumonia.

Cranberry in the Prevention of Catheter-Associated UTI

Urinary tract infection (UTI) is a common occurrence post gynecological surgery: 1/6 women have a UTI in the 2 weeks following surgery. A variety of evidence suggests that cranberry juice may reduce incidence of UTI. We are conducting a double blind randomized controlled clinical trial to test this hypothesis.

Streptococcus agalactiae (Group B streptococcus)

We are conducting several different studies characterizing the molecular epidemiology of Group B streptococcus. These studies include characterization of the incidence by serotype, transmission patterns, antibiotic resistance patterns and predictors of the emergence and spread of antibiotic resistance.

Uropathogenic Escherichia coli

We are conducting several different studies characterizing the molecular epidemiology of uropathogenic E. coli. These studies include characterization of transmission patterns, reservoirs, antibiotic resistance patterns and predictors of the emergence and spread of antibiotic resistance.