TAG: "Dentistry"

California children with health insurance, regular dental care show big gains


UCLA research shows significant increases over past decade, but disparities persist.

Photo by Elena Zhukova

By Venetia Lai, UCLA

An impressive 3 in 4 California children ages 2 to 5 had a regular dental checkup in 2012, including those from poorer households, according to a new policy brief by the UCLA Center for Health Policy Research.

A decade earlier, just half the children in low-income households made an annual visit to the dentist, along with 60 percent of those from higher-income households.

The findings are part of a comprehensive new study that tracked young children’s health in California from 2003 to 2012. The study found gains in many areas, including health insurance coverage and dental care, but showed a drop in preschool participation, perhaps because of the associated costs.

“These are really encouraging trends for the health and well-being of children in California,” said Sue Holtby of the Public Health Institute, who is lead author of the study. “But some beneficial services remain out of reach for low-income families. The challenge for policymakers is to continue to improve access to, and quality of, the care children receive.”

Using data from 10 years of California Health Interview Survey from 2003 to 2012, the report assessed trends in the health of young children in areas linked to health and school readiness. The report focused on Latino, white, Asian and African-American children ages 5 and younger. According to CHIS, more than 3 million children in that age range lived in the state in 2012.

The safety net expands

Much of the time period covered by the study took place during the recession from 2008 to 2012, when many families lost access to employer-funded health coverage. As more low-income families gained health coverage through two public programs — Medi-Cal and Healthy Families —  ––the share of children ages 5 and younger who had private health insurance plummeted, from 57 percent in 2003 to 44 percent in 2011–12. The change meant a bigger share of young children relied on public coverage: 1 in 2 overall, compared to 1 in 3 a decade earlier.

The dramatic improvements in dental care for young children during the time period may be attributable, in part, to expanded public support.  Specifically, the study notes that a $7 million grant from First 5 California, which funded the study, provided preventive dental health training and education for dental and medical providers at Women, Infants and Children and Head Start programs from 2004 to 2008, the same time period in which annual child dental visits increased. In addition, Medi-Cal and Healthy Families promoted greater awareness of dental benefits.

More parents reading to their children

Another bright spot: More families participated in activities that promote social skills and brain development in young children. The percentage of parents who sang or played music with their child every day rose from 64 percent in 2003 to 68 percent in 2011–12, and those who took their children out on an excursion increased from 32 percent to 37 percent. The biggest jump was in the share of parents who read to their children daily: from 53 percent in 2003 to 62 percent a decade later.

However, the report found the proportion of 3- and 4-year-olds going to preschool at least 10 hours a week dropped over the decade, from 37 percent to 30 percent.

“Parents have gotten the message that there’s a lot they can do for their children’s development at home,” said Elaine Zahnd, a faculty associate at the Center for Health Policy Research and co-author of the study. “But there is more work to do to help parents who want their children to go to preschool.”

Other findings from the report:

  • More young children had access to health care. Access to health care improved for poor children as the decade progressed: the rate of uninsured poor children dropped from 13 percent in 2003 to 8.9 percent in 2012.
  • There are disparities in the sources of medical care. In 2012, far more young Latino children (40 percent) obtained care at community clinics or public hospitals compared to white (14.6 percent) and Asian (20.1 percent) children. However, the share of white children who visited a private doctor’s office or an HMO declined 5.3 points over the decade to 82 percent.
  • Almost all young children (97 percent) had a usual source of medical care in 2012, with two-thirds being treated by private practice doctors and HMOs and the rest at community clinics and hospitals.

“Parents are getting coverage for their children, but can they access health care for their children when they need it?” asked David Grant, director of the California Health Interview Survey and co-author of the report. “As more children rely on the safety net, policymakers must ensure that the clinics and public hospitals that serve them are adequately funded.”

The report found noteworthy improvements in young children’s health over the decade — especially in closing the income gap in dental and health care. But authors say continued monitoring and further research are needed to understand what prompted negative changes in private insurance coverage and preschool enrollment.

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UCSF, San Francisco community partner to address oral health epidemic


Plan aims to move toward making the city cavity-free.

A UCSF dental resident gives a free dental screening to a child during a Sunday Streets fair in the Bayview, one of several annual outreach events for the local community. (Photo by Cindy Chew)

By Scott Maier, UC San Francisco

In San Francisco, nearly 40 percent of children have experienced tooth decay by the time they reach kindergarten, and low-income kindergartners are eight times more likely to have untreated tooth decay, reports the San Francisco Children’s Oral Health Collaborative (SF COH).

Oral health disparities are specific to local neighborhoods, with the highest rates in Chinatown, where more than 50 percent of all kindergarteners suffer from cavities.

To inform and elicit community feedback about the importance of children’s oral health – and continue to learn why some ethnicities are more at-risk – the SF COH, which includes UC San Francisco, the SF Department of Public Health and community health providers and advocates, hosted a community stakeholder meeting on April 30 in Chinatown.

Attendees at the two-hour meeting at the Chinatown YMCA included San Francisco Supervisors Julie Christensen and Scott Wiener, and Health Commissioner Ed Chow.

“Good oral health is critical to the well-being of our city, and we need to expand access to dental care as well as healthy and nutritious food, particularly in our low-income communities,” Wiener said.

Similar stakeholder meetings are planned for Latino and African American communities in San Francisco.

“Because of this meeting, we were able to raise the level of awareness of children’s dental caries that is disproportionately affecting the Chinatown neighborhood,” said Lisa Chung, D.D.S., M.P.H., associate professor in the UCSF School of Dentistry Department of Preventive and Restorative Dental Sciences and SF COH co-director. “We were able to bring together local health and child care providers and organizations and engage in a spirited discussion about what could be causing these Chinatown disparities, existing barriers to addressing them, and how we can collaborate and move forward.”

A silent epidemic

Tooth decay and periodontal disease are the two biggest threats to oral health and among the most common chronic diseases in the United States. In fact, former U.S. Surgeon General Regina Benjamin called oral diseases a “silent epidemic.”

Children with untreated cavities may experience pain, dysfunction, school absences, difficulty concentrating and low self-esteem, according to the SF COH.

“It is better to prevent tooth decay than to provide extensive dental treatment for a very young child,” said Dr. Steven Ambrose, director of dental services for the San Francisco Department of Public Health, a co-leading agency of the Children’s Oral Health Collaborative. “If we can help parents understand how to keep their babies’ teeth healthy, we can prevent unnecessary disease and pain, and promote and protect our children’s oral health in a far easier and cost effective manner.”

Dental caries is largely preventable through dental sealants, fluoride varnish, healthy eating habits, daily oral care at home and routine dental visits. However, many parents, medical providers and even dental providers do not fully understand their critical roles in preventing this disease.

Plan to make San Francisco cavity-free

A cross-sector initiative designed to improve the health and wellness of all San Franciscans, the San Francisco Children’s Oral Health Collaborative coordinated the San Francisco Children’s Oral Health Strategic Plan 2014-2017 toward making the city cavity-free. The plan identifies the most effective, evidence-based actions each group can take to make the most impact. Target groups are children under 10, pregnant women, low-income communities of color, recent immigrants and other populations most at risk.

“Involving the community and collaborating with its members are essential in efforts to improve public health, and is at the core of SF HIP’s Children’s Oral Health Collaborative,” Chung said. “We prioritized this first meeting in Chinatown on public and private health professionals and Chinatown program planners, community leaders, and school administrators as they are working closest with the target population – young children and their caregivers. We look forward to working to have similar community briefings throughout San Francisco.”

The San Francisco Children’s Oral Health Collaborative is supported by the Hellman Foundation. The Chinatown community stakeholder meeting was sponsored by the Chinatown YMCA, the Asian Pacific Islander Health Parity Coalition, APA Family Support Services, NICOS Chinese Health Coalition and API Council.

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UC Davis leads $4M NIH grant to study skull disorder in infants


International team includes researchers from UC Irvine, UCSF.

Simeon Boyd, UC Davis

By Phyllis Brown, UC Davis

Simeon Boyd, UC Davis professor of genetics and pediatrics, has received a nearly $4 million, five-year grant from the National Institute of Dental and Craniofacial Research to lead a team of physicians and scientists from more than 10 centers in the United States and seven international sites, including Australia, Brazil, Bulgaria, Germany, Hungary, Italy and the United Kingdom, to study craniosynostosis, the premature fusion of the bony plates of the skull in infants.

The researchers are members of the International Craniosynostosis Consortium, whose goal is to identify the genetic and environmental causes of craniosynostosis, which affects approximately 1 in 2,500 newborns worldwide, in order to find clues to prevention, better treatments and, eventually, a cure.

“Our goal is not only to identify the genetic causes of all types of craniosynostosis, but also to facilitate the early detection of the condition, by identifying biomarkers. This may allow for nonsurgical therapeutic intervention in utero in the future,” said Boyd, who is a researcher affiliated with the UC Davis MIND Institute. The conditions also have neurodevelopmental consequences: Approximately 50 percent of patients with craniosynostosis also may have learning disabilities.

During fetal development, the skull is made up of separate bony plates that allow the child’s head to grow after birth. The borders between the plates do not normally fuse completely until a child is about 2, leaving temporary soft spots at the intersections of the seams of the skull.

In craniosynostosis the bones fuse early, causing the child to have an abnormally shaped head. The disorder can lead to complications due to brain compression, such as visual problems and learning disabilities.

“This is not only a skull disease,” Boyd said. “It is a perturbation of the brain and the skull, in which the growing brain is abnormal and causes increased distension of the envelope of the brain so that signaling molecules that normally would keep the sutures open do not function properly.”

Depending upon the severity of the condition, children born with craniosynostosis frequently may require extensive neurosurgical intervention to separate the fused bones of the skull so that the child’s brain can grow.

There are a number of different types of craniosynostosis, depending on which suture is prematurely fused. For example, when the sagittal suture at the top of the head is fused the condition is called in sagittal synostosis, also known as scaphocephaly. Sagittal synostosis is the most common form of the disorder. In coronal synostosis the coronal sutures, which run from the top of the head to the ears, are fused. Several named conditions, such as Muenke syndrome, have craniosynostosis among their symptoms.

In 2012, Boyd and his consortium colleagues published a landmark study in Nature Genetics, which found that two areas of the human genome are associated with a form of the disorder, sagittal craniosynostosis. Although the condition had long been believed to be partially determined by genes – it is three times more common in boys than in girls, and identical twins are much more likely to both be affected than fraternal twins – the genes associated with the disorder had not been previously identified.

Identification of the genetic basis for the conditions is only a first step in preventive and therapeutic strategies, Boyd said.

“We want to prevent babies from being born with these disorders,” he said.

Consortium researchers from the United States include:

  • Jon Bernstein, Stanford University
  •  Michael Cunningham, University of Washington
  •  John Graham, Cedars-Sinai
  •  Virginia Kimonis, UC Irvine
  •  Ophir Klein, UC San Francisco
  •  Pedro Sanchez-Lara, Children’s Hospital Los Angeles
  •  Joan Richtsmeier, Pennsylvania State University
  •  Paul Romitti, University of Iowa
  •  Joan Stoler, Boston Children’s Hospital

International collaborators include:

  •  Andrew Wilkie, Oxford University, United Kingdom
  •  Wanda Lattanzi, Universita Cattolica del Sacro Cuore, Italy
  •  Tony Roscioli, University of Sydney, Australia
  •  Emil Simeonov and Radka Kaneva, Medical University, Sofia Bulgaria
  •  Bernd Wollnik, University of Cologne, Germany
  •  Eva Olah, University of Debrecen, Hungary
  •  Maria Rita Passos-Bueno, University of Sao Paolo, Brazil

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New reality of California ‘DREAMers’ takes shape at UCSF


Three undocumented immigrants chosen to join UCSF School of Dentistry’s class of 2019.

By Marc Fredson, UC San Francisco

José Carrasco Sandoval, Laura Aguilar and Angie Celis typify the caliber of talent UC San Francisco attracts. These California residents are standout students and want to give back to their communities after they graduate. All three have been chosen to join the School of Dentistry’s class of 2019.

Unlike most of their peers, all three are “DREAMers,” a term used to describe undocumented immigrants under the age of 31 who entered the United States before the age of 16 and have lived continuously in the country for at least five years while staying out of legal trouble. Those who meet these criteria outlined by the federal Development, Relief and Education for Alien Minors (DREAM) Act are often referred to as “DREAMers.”

Carrasco Sandoval, Aguilar and Celis’ acceptance and enrollment at UCSF represent a particular milestone in the midst of shifting political winds. They will join Jirayut Latthivongskorn, a first-year DREAMer student in the School of Medicine.

“I was always hopeful that this day would come,” said Celis, who was born in Guatemala and immigrated to the San Fernando Valley with her family when she was two. “It took me longer to make it, but now I’m here.”

“Ever since I was in high school, I knew I wanted to be a doctor,” said Carrasco Sandoval, who graduated from UC Berkeley with a degree in molecular and cell biology. “I also knew from an early age that our family had a special condition we called sin papeles, which means ‘without papers’ in Spanish, and that realizing my dream would be a challenge without having legal citizenship.” His parents left their native Jalisco, Mexico, and settled down in Napa when he was 2 years old.

Aguilar’s story is similar to Celis’ and Carrasco Sandoval’s. Her parents also made Napa their home after leaving Guadalajara, Mexico, when she was four. “I’ve wanted to be a dentist since I was young but remember thinking it didn’t seem possible because of my status,” she said. “I decided to just keep trying and to stay positive.”

The door to their dreams edged open with the Deferred Action for Childhood Arrivals (DACA) program, a new American immigration policy implemented by the Obama administration in June 2012. The policy allows certain immigrants — otherwise known as “DREAMers,” to receive a renewable two-year work permit and exemption from deportation.

Because of DACA, “for the first time, I could apply for programs, internships, jobs, scholarships and financial aid to help pursue my professional goals,” Aguilar said. “Not to mention simpler things like getting a driver’s license, establishing credit and opening a bank account.”

UCSF has a long-standing commitment to building a broadly diverse student community. As such, its leadership, faculty and staff work hard to create programs that provide additional support for students from underrepresented groups.

“Students with diverse backgrounds, such as those with DACA status, bring an important component to the University,” said John D.B. Featherstone, Ph.D., dean of the UCSF School of Dentistry. “One of my highest priorities is that we do everything possible to open the doors to dental education for the best and the brightest, regardless of their social or economic backgrounds.”

All three dreamers are products of the UC system. Carrasco Sandoval and Aguilar pursued their undergraduate studies at UC Berkeley and UC Riverside, respectively, while Celis received a Master of Science degree in oral biology from UCLA.

As an initial introduction to UCSF, Aguilar attended the Office of Diversity and Outreach’s “Inside UCSF” program, an annual two-day event geared toward students at two- and four-year degree schools who are interested in pursuing careers in health and science. “The students and faculty I met at ‘Inside UCSF’ were very inspiring, welcoming and supportive,” she said. “They encouraged us to keep working and made us aware of available resources.”

Carrasco Sandoval enrolled in a first-of-its-kind post-baccalaureate program offered by the School of Dentistry. “The purpose of the program is to help those who have demonstrated the ability to overcome hardship and who we think will ultimately be successful here,” said James Betbeze, assistant dean for enrollment management and outreach at the School of Dentistry.

“These students are three of the brightest, most driven individuals I’ve encountered,” said Daniel Ramos, D.D.S., Ph.D., a professor at the UCSF School of Dentistry who supported them through the process. “They’ve overcome insurmountable odds to be in a position to be able to help the community from which they came.

“DACA students are often particularly committed to underserved populations, because they may grow up in communities without ready access to dental care. They personally understand those challenges and have an inherent motivation to try and address them.”

Celis plans to continue being an activist in the immigrant community. “I feel an obligation to help the underserved community and to use my experience to help those who have hopes and dreams of going into higher education,” she said.

Carrasco Sandoval envisions working in a community dental practice. “At some point, I’d like to be a director for a community clinic, where I can help low-income and immigrant populations,” he said.

When Aguilar volunteered at a health clinic in Riverside, “I saw the adversities that others face and realized how lucky I was to have parents that supported my education,” she said. “I saw huge disparities, not just in health, but in education and in the way that people’s lives played out.” Aguilar tentatively plans to be a general dentist, and is also considering specializing in periodontics.

“The incredible and proud accomplishments of these students demonstrate that their aspirations go beyond the pursuit on an undergraduate degree,” said Alejandra Rincón, Ph.D., chief of staff to the vice chancellor of diversity and outreach, and an author of a book focused on undocumented immigrants’ access to higher education. “We welcome these students and congratulate their families as they enter this new face of their professional lives.”

Like other young people with DACA status, Carrasco Sandoval, Aguilar and Celis see themselves as more than future dentists. Because of their backgrounds and the opportunities they’ve been given, each seeks to make life better for others.

“I’ve seen the good that comes from when someone believes in you and gives you a chance,” said Aguilar. “It has shaped the kind of role model I want to become.”

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‘Sugar Papers’ reveal industry role in 1970s dental program


Sugar industry worked closely with NIH on research agenda on preventing tooth decay.

By Kristen Bole, UC San Francisco

A newly discovered cache of industry documents reveals that the sugar industry worked closely with the National Institutes of Health in the 1960s and ‘70s to develop a federal research program focused on approaches other than sugar reduction to prevent tooth decay in American children.

An analysis of those papers by researchers at UC San Francisco appears today (March 10) in the open-source scientific journal, PLoS Medicine.

The archive of 319 industry documents, which were uncovered in a public collection at the University of Illinois, revealed that a sugar industry trade organization representing 30 international members had accepted the fact that sugar caused tooth decay as early as 1950, and adopted a strategy aimed at identifying alternative approaches to reducing tooth decay.

Meanwhile, the National Institutes of Health had come to the conclusion in 1969 that focusing on reducing consumption of sucrose, “while theoretically possible,” was not practical as a public health measure.

Thus aligned, the sugar industry trade organization and the NIH worked in parallel and ultimately together on developing alternative research approaches, with a substantial portion of the trade organization’s own research priorities — 78 percent — directly incorporated into the 1971 National Caries Program’s first request for research proposals from scientists.

“The dental community has always known that preventing tooth decay required restricting sugar intake,” said first author Cristin Kearns, D.D.S., M.B.A., a UCSF postdoctoral scholar who discovered the archives. “It was disappointing to learn that the policies we are debating today could have been addressed more than 40 years ago.”

While tooth decay is largely preventable, it remains the leading chronic disease among U.S. children, according to the Centers for Disease Control and Prevention. The CDC estimates that more than half of American children and teens have cavities in their adult teeth, and 15.6 percent of children age 6 to 19 have untreated tooth decay, which can lead to tooth loss, infections and abscesses.

Kearns discovered the papers in a collection that was left to the University of Illinois library by the late Roger Adams, a professor emeritus of organic chemistry who served on the Sugar Research Foundation (SRF) and the scientific advisory board of the International Sugar Research Foundation (ISRF), which became the World Sugar Research Organization.

They include 1,551 pages of correspondence among sugar industry executives, meeting minutes and other relevant reports from between 1959 and 1971. Kearns and UCSF co-authors Stanton A. Glantz, Ph.D., and Laura A. Schmidt, Ph.D., analyzed the papers against documents from the National Institute of Dental Research (NIDR) to explore how the sugar industry may have influenced the research policies of the 1971 National Caries (Tooth Decay) Program.

The analysis showed that in the late 1960s and early 1970s, the sugar industry funded research in collaboration with allied food industries on enzymes to break up dental plaque and a vaccine against tooth decay. It also shows they cultivated relationships with the NIDR and that a sugar industry expert panel overlapped by all but one member with the NIDR panel that influenced the priorities for the NIH tooth decay program. The majority of the research priorities and initial projects largely failed to produce results on a large scale, the authors found.

“These tactics are strikingly similar to what we saw in the tobacco industry in the same era,” said Glantz, whose similar discovery in the 1990s of tobacco industry papers led to massive settlements between the industry and every U.S. state, and to the Department of Justice’s successful prosecution of the major tobacco companies and their research organizations under the Racketeer Influenced and Corrupt Organizations Act. The Legacy Tobacco Documents Library at UCSF now contains 14 million of those documents.

“Our findings are a wake-up call for government officials charged with protecting the public health, as well as public health advocates, to understand that the sugar industry, like the tobacco industry, seeks to protect profits over public health,” Glantz added.

While the authors recognize that the Adams papers provide a narrow window into the activities of one sugar industry trade association, they noted that the sugar industry’s current position remains that public health should focus on fluoride toothpaste, dental sealants and other ways to reduce the harm of sugar, rather than reducing consumption. They concluded that industry opposition to current policy proposals — including the World Health Organization’s newly released guidelines to reduce added sugar to less than 10 percent of daily caloric intake — should not be allowed to block this prudent public health standard.

“There is robust evidence now linking excess sugar consumption with heart disease, diabetes and liver disease, in addition to tooth decay,” said Schmidt, who also is principal investigator on the UCSF-led SugarScience initiative. “Times have definitely changed since that era, but this is a stark lesson in what can happen if we are not careful about maintaining scientific integrity.”

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Laughter is the best medicine for jittery dental students


Comedy improv class helps them communicate with patients.

By Brianna Aldrich and Judy Lin, UCLA

Seven students in a classroom at the UCLA School of Dentistry are cracking each other up.

In a course far removed from “The Fundamentals of Caries” and “Oral Pathology,” dental students pair off and take turns improvising scenes based on characters and situations suggested by their instructor and fellow classmates. Two students role-play madcap bank robbers. Another pair pretends to be obsessive-compulsive campers gushing over the high thread count of their bed sheets. Then there are the lovers who, stunned at the revelation that they have syphilis, respond by microwaving popcorn and tuning into Netflix.

It’s all part of the silliness that surfaces in “Medical Improv,” a highly unusual class that teaches dental students how to implant a bit of comedy improv into their personas. But it isn’t laughter they’re after, explained instructor Dr. Craig Woods.

Woods’ students don’t learn to perform funny routines to help their patients get rid of their pre-procedure jitters. To the contrary, the techniques they learn in class help them as dentists to “come out of themselves, be a little more relaxed and confident,” Woods said, especially when they start to work with live patients in the dental clinic for the first time.

Third-year student Roya Mahmoodi said she’s already noticed a change in her chair-side manner. “When I first started in the clinic, I was very caught up in what I would say to my patient. I thought I had to have this very serious persona,” she said. “But being in this class — letting loose and just being silly — I’ve started bringing out my personality. I can kind of joke around with my patients, and I feel closer to them.

“There should always be a doctor-patient professional relationship,” Mahmoodi said, “but you can definitely tweak that relationship a little bit.”

Woods is as unusual as his class. He’s an adjunct professor of oral medicine and orofacial pain, director of the Advanced Treatment Planning Clinic and the dental school’s psychological counselor with an M.A. in clinical psychology on top of his D.D.S. He’s also a cast member of JumpStart Comedy, a Hermosa Beach-based troupe.

He got hooked on doing improv when, on a whim, he took a workshop about five years ago and liked it so much he enrolled in ImprovOlympic, a training program that also produced Tina Fey and Amy Poehler.

“I was amazed at the number of parallels there are in improv comedy to interacting with patients,” Woods said. “Improv comedy became a way to release stress and to enhance my skills at picking up on other people’s emotional cues in my professional life.”

His class is based in part on the Medical Improv program developed by Dr. Katie Watson, a physician educator at Northwestern University’s medical school. She’s also a trainer for Second City’s comedy improv program in Chicago. After Woods took a workshop with Watson, he decided to create a dental-school version to help the many bright students he has seen suffer self-confidence meltdowns in the clinics.

“Something happens when they get into their clinical instruction, where they have to interact with patients and perform a procedure while being supervised by faculty evaluating everything they do,” Woods said. “Their command of the situation falls apart.”

Gaining that sense of “command” is often less about taking charge and more about going with the flow, a skill that Woods gets across with exercises like “Search and Toss.” Standing in a circle, students “toss” the name of a country to another student, who “tosses” the name of another country to another student until everyone has a turn. Then Woods asked them to continue with the country names but weave in a second layer, this time with car names, and then a third layer with something they might tell a patient at the end of an appointment.

“Canada … Honda … Remember to floss.” “Austria … Chevy … Call me if you have any problems” went the dizzying exercise, the students starting to sweat – and giggle — as they as they struggled to keep track.

In dentistry, it’s a familiar feeling, Woods said. “You’re juggling different things — seeing your patient, working with faculty and hearing from the front office that your next patient is waiting. Be open to crazy things coming up. Expect the unexpected” — like encountering a patient who swears she isn’t afraid of dentists but starts to cry the moment she sits down in the chair.

“You’re doing surgery in someone’s mouth,” Woods said. “You have to convince them that they need to allow you to put a drill in their mouth that’s going 400,000 rpm. You have to come across as being able to do that, and they have to have confidence and trust in you.”

Key to building trust is having deep listening skills that pick up not just words but emotional affect and body language. Confidence also comes through in clear, succinct communication. “Students have a tendency to ramble when they’re not comfortable,” said Woods, who took students through a scene where one explained a form of modern technology — an iPhone, for example — to another student who pretended to be a time-traveler from 250 years ago. The result: a huge download of incomprehensible information.

Keegan Quadros, a fourth-year student, commented that the exercise reminded him of talking with a patient about a procedure. “He doesn’t want to know everything … He just wants to know what it is, what it costs and what I recommend.”

International dental students taking the class report that it’s helped them better understand American culture and humor.

Reena Guttha, a student from India, said she’s been working with a patient who likes to “crack jokes with me. But I don’t get it,” she said. “He knows that I don’t get it, and he’s okay with that. But I will enjoy my work more when I can communicate with patients like him and their sense of humor.”

Woods said he would like to expand the class to include medical and nursing students to enhance teamwork among medical professionals.

“Life is improvised,” Woods said. “Everyone could benefit from a course like this.”

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Technology optimizes cancer therapy with nanomedicine drug combinations


UCLA bioengineers develop platform that offers personalized approach to treatment.

By Brianna Aldrich, UCLA

In greater than 90 percent of cases in which treatment for metastatic cancer fails, the reason is that the cancer is resistant to the drugs being used. To treat drug-resistant tumors, doctors typically use multiple drugs simultaneously, a practice called combination therapy. And one of their greatest challenges is determining which ratio and combination — from the large number of medications available — is best for each individual patient.

Dr. Dean Ho, a professor of oral biology and medicine at the UCLA School of Dentistry, and Dr. Chih-Ming Ho, a professor of mechanical engineering at the UCLA Henry Samueli School of Engineering and Applied Science, have developed a revolutionary approach that brings together traditional drugs and nanotechnology-enhanced medications to create safer and more effective treatments. Their results are published in the peer-reviewed journal ACS Nano.

Chih-Ming Ho, the paper’s co-corresponding author, and his team have developed a powerful new tool to address drug resistance and dosing challenges in cancer patients. The tool, Feedback System Control.II, or FSC.II, considers drug efficacy tests and analyzes the physical traits of cells and other biological systems to create personalized “maps” that show the most effective and safest drug-dose combinations.

Currently, doctors use people’s genetic information to identify the best possible combination therapies, which can make treatment difficult or impossible when the genes in the cancer cells mutate. The new technique does not rely on genetic information, which makes it possible to quickly modify treatments when mutations arise: the drug that no longer functions can be replaced, and FSC.II can immediately recommend a new combination.

“Drug combinations are conventionally designed using dose escalation,” said Dean Ho, a co-corresponding author of the study and the co-director of the Jane and Jerry Weintraub Center for Reconstructive Biotechnology at the School of Dentistry. “Until now, there hasn’t been a systematic way to even know where the optimal drug combination could be found, and the possible drug-dose combinations are nearly infinite. FSC.II circumvents all of these issues and identifies the best treatment strategy.”

The researchers demonstrated that combinations identified by FSC.II could treat multiple lines of breast cancer that had varying levels of drug resistance. They evaluated the commonly used cancer drugs doxorubicin, mitoxantrone, bleomycin and paclitaxel, all of which can be rendered ineffective when cancer cells eject them before they have had a chance to function.

The researchers also studied the use of nanodiamonds to make combination treatments even more effective. Nanodiamonds — byproducts of conventional mining and refining operations — have versatile characteristics that allow drugs to be tightly bound to their surface, making it much harder for cancer cells to eliminate them and allowing toxic drugs to be administered over a longer period of time.

The use of nanodiamonds to treat cancer was pioneered by Dean Ho, a professor of bioengineering and member of the UCLA Jonsson Comprehensive Cancer Center and the California NanoSystems Institute.

“This study has the capacity to turn drug development, nano or non-nano, upside-down,” he said. “Even though FSC.II now enables us to rapidly identify optimized drug combinations, it’s not just about the speed of discovering new combinations. It’s the systematic way that we can control and optimize different therapeutic outcomes to design the most effective medicines possible.”

The study found that FSC.II-optimized drug combinations that used nanodiamonds were safer and more effective than optimized drug-only combinations. Optimized nanodrug combinations also outperformed randomly designed nanodrug combinations.

“This optimized nanodrug combination approach can be used for virtually every type of disease model and is certainly not limited to cancer,” said Chih-Ming Ho, who also holds UCLA’s Ben Rich Lockheed Martin Advanced Aerospace Tech Endowed Chair. “Additionally, this study shows that we can design optimized combinations for virtually every type of drug and any type of nanotherapy.”

Both Dean Ho and Chih-Ming Ho have collaborated with other researchers and have validated FSC.II’s efficacy in many other types of cancers, infectious diseases and other diseases.

Other co-authors were Hann Wang, Dong-Keun Lee, Kai-Yu Chen and Kangyi Zhang, all of UCLA’s department of bioengineering, School of Dentistry, California NanoSystems Institute and Jonsson Cancer Center; Jing-Yao Chen of UCLA’s department of chemical and biomolecular engineering; and Aleidy Silva of UCLA’s department of mechanical and aerospace engineering.

The work was supported in part by the National Cancer Institute, the National Science Foundation, the V Foundation for Cancer Research, the Wallace H. Coulter Foundation, the Society for Laboratory Automation and Screening, and Beckman Coulter Life Sciences.

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Researchers shed light on how ‘microbial dark matter’ might cause disease


Scientific breakthrough may be roadmap for study of other elusive bacteria.

By Brianna Aldrich, UCLA

One of the great recent discoveries in modern biology was that the human body contains 10 times more bacterial cells than human cells. But much of that bacteria is still a puzzle to scientists.

It is estimated by scientists that roughly half of bacteria living in human bodies is difficult to replicate for scientific research — which is why biologists call it “microbial dark matter.” Scientists, however, have long been determined to learn more about these uncultivable bacteria, because they may contribute to the development of certain debilitating and chronic diseases.

For decades, one bacteria group that has posed a particular challenge for researchers is the Candidate Phylum TM7, which has been thought to cause inflammatory mucosal diseases because it is so prevalent in people with periodontitis, an infection of the gums.

Now, a landmark discovery by scientists at the UCLA School of Dentistry, the J. Craig Venter Institute and the University of Washington School of Dentistry has revealed insights into TM7’s resistance to scientific study and to its role in the progression of periodontitis and other diseases. Their findings shed new light on the biological, ecological and medical importance of TM7, and could lead to better understanding of other elusive bacteria.

The team’s findings are published online in the December issue of the Proceedings of the National Academy of Sciences.

“I consider this the most exciting discovery in my 30-year career,” said Dr. Wenyuan Shi, a UCLA professor of oral biology. “This study provides the roadmap for us to make every uncultivable bacterium cultivable.”

The researchers cultivated a specific type of TM7 called TM7x, a version of TM7 found in people’s mouths, and found the first known proof of a signaling interaction between the bacterium and an infectious agent called Actinomyces odontolyticus, or XH001, which causes mucosal inflammation.

“Once the team grew and sequenced TM7x, we could finally piece together how it makes a living in the human body,” said Dr. Jeff McLean, acting associate professor at the University of Washington School of Dentistry. “This may be the first example of a parasitic long-term attachment between two different bacteria — where one species lives on the surface of another species gaining essential nutrients and then decides to thank its host by attacking it.”

To prove that TM7x needs XH001 to grow and survive, the team attempted to mix isolated TM7x cells with other strains of bacteria. Only XH001 was able to establish a physical association with TM7x, which led researchers to believe that TM7x and XH001 might have evolved together during their establishment in the mouth.

What makes TM7x even more intriguing are its potential roles in chronic inflammation of the digestive tract, vaginal diseases and periodontitis. The co-cultures collected in this study allowed researchers to examine, for the first time ever, the degree to which TM7x helps cause these conditions.

“Uncultivable bacteria presents a fascinating ‘final frontier’ for dental microbiologists and are a high priority for the NIDCR research portfolio,” said Dr. R. Dwayne Lunsford, director of the National Institute of Dental and Craniofacial Research’s microbiology program. “This study provides a near-perfect case of how co-cultivation strategies and a thorough appreciation for interspecies signaling can facilitate the recovery of these elusive organisms. Although culture-independent studies can give us a snapshot of microbial diversity at a particular site, in order to truly understand physiology and virulence of an isolate, we must ultimately be able to grow and manipulate these bacteria in the lab.”

It was previously known that XH001 induces inflammation. But by infecting bone marrow cells with XH001 alone and then with the TM7x/XH001 co-culture, the researchers also found that inflammation was greatly reduced when TM7x was physically attached to XH001. This is the only known study that has provided evidence of this relationship between TM7 and XH001.

The researchers plan to further study the unique relationship between TM7X and XH001 and how they jointly cause mucosal disease. Their findings could have implications for potential treatment and therapeutics.

Other collaborators on the study were Drs. Xuesong He, Renate Lux and Anna Edlund of the UCLA School of Dentistry; Shibu Yooseph, Adam Hall and Karen Nelson of the Venter Institute; Su-Yang Liud and Genhong Cheng of the UCLA department of microbiology, immunology and molecular genetics; Pieter Dorresteine of UC, San Diego; Eduardo Esquenazi of Sirenas Marine Discovery; and Ryan Hunter of the University of Minnesota.

Dr. Shi is part-time chief science officer at C3 Jian Inc., which has licensed technologies from the University of California Regents that could be indirectly related to this research project.

The work was supported in part by the NIH’s National Institute of Dental and Craniofacial Research (grants 1R01DE023810-01, 1R01DE020102 and 1R01DE021108, and T90 training award DE022734) and the National Institute of General Medical Sciences (grant 1R01GM095373).

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2 UCSF-led programs receive funding to tackle S.F. health issues


Hellman Foundation supports fruit and vegetable voucher program, kids’ oral health program.

A woman shops for fresh produce at UCSF Parnassus' farmers market.

By Leland Kim, UC San Francisco

Two UC San Francisco-sponsored programs beat out more than 80 others to win major funding to help advance meaningful solutions to local health issues in San Francisco.

The Hellman Foundation announced the award of the first Hellman Collaborative Change Initiative grants to the EatSF Fruit and Vegetable Voucher Program and the Children’s Oral Health Collaborative. Each program will receive $400,000 — coupled with strategic support from the Hellman Foundation — to strengthen their partnerships and support their efforts to improve lives in San Francisco.

The EatSF Fruit and Vegetable Voucher Program is creating a San Francisco where underserved communities can enjoy fresh fruits and vegetables from their local market.

Diets low in fresh fruits and vegetables are associated with obesity, diabetes, cardiovascular diseases and some cancers.  But many low-income families simply do not have access to these vitally important foods. By creating a citywide network where vouchers are redeemable at local vendors for fresh fruits and vegetables, EatSF is improving nutrition for San Franciscans most in need.

“In 2012, it is estimated that San Francisco’s underserved population had to scramble to afford 67.8 million meals. That is appalling in a city that is as wealthy as ours,” said Hilary Seligman, M.D., an associate professor in the UCSF School of Medicine, who is leading the EatSF Fruit and Vegetable Voucher Program. “We are committed to finding strategies that allow all members of our community to eat the healthy foods that prevent the development of chronic disease.”

The Children’s Oral Health Collaborative is committed to eradicating health disparities in childhood tooth decay, with the aim of making San Francisco cavity-free. The program is co-led by UCSF’s Lisa Chung, D.D.S., M.P.H., and San Francisco Department of Public Health’s Margaret Fisher, R.D.H.A.P.

Tooth decay is the most common chronic childhood disease. In San Francisco, emergency department visits for preventable dental problems are higher than that for asthma and diabetes combined, and untreated tooth decay is two to three times more common for children of color.

“Our success is due to many dedicated partners, some individuals who have spent much of their careers to combat tooth decay, a pervasive health problem that all too often goes unacknowledged and untreated in children,” said Chung, an associate professor in the UCSF School of Dentistry’s Department of Preventive and Restorative Dental Sciences.

“Our collaboration recently formed thanks to the coordination and strong support from UCSF SF HIP (San Francisco Health Improvement Partnership) and SF DPH (San Francisco Department of Public Health), and funding from the Metta Fund. We hope this support from Hellman will bring greater awareness to the problem, our work to address it, and more partners to join us in our efforts.”

In choosing from an impressive array of active collaborations, the Hellman Foundation focused on cross-sector partnerships that had strong leadership, targeted a significant San Francisco challenge, and had the potential to make a real difference.

To learn more about the EatSF Fruit and Vegetable Voucher, please email eatsfvoucher@gmail.com. To get more information about the Children’s Oral Health Collaborative, please read its strategic plan.

Established in 2011, the Hellman Foundation finds and supports the creative change-makers improving the lives and livelihoods for all who call the San Francisco Bay Area home. For more information, visit its website.

Editor’s note: Content from the Hellman Foundation was used in this story.

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Student veteran gives back for all doors Army has opened for her


She will speak at UCLA’s Veterans Day salute on Nov. 10.

Tigon Abalos, now a dental student at UCLA, volunteered to work with Afghan refugees when she was in the Army stationed in Afghanistan. Abalos, a former Vietnam refugee, will speak about what her military service means to her at UCLA's Veterans Day ceremony on Nov. 10. (Photo courtesy of tigon Abalos)

When 9/11 happened, it jolted Tigon Abalos with such force that she felt she had to do something for the country that had given her and her family, former refugees from Vietnam, opportunities for a better life in a new country.

Two years later, Abalos, who was already serving part time in the California Army National Guard, interrupted her college career to enlist in the Army and train as a counter-intelligence specialist. That was the beginning of a six-year, military career that opened up more opportunities for Abalos: She met her future husband, a fellow soldier, and she discovered her life’s calling in Afghanistan when she began volunteering to help Afghan refugees.

Abalos, now a UCLA School of Dentistry student and one of more than 400 student veterans, will draw on her deep appreciation for her service experience when she speaks at UCLA’s annual Veterans Day ceremony Monday, Nov. 10, at 10:30 a.m. in Wilson Plaza, a time  when the campus community comes together to salute veterans and remember the sacrifices they’ve made. Also speaking will be Chancellor Gene Block and Kelly Schmader, assistant vice chancellor of facilities management at UCLA and a 28-year veteran of the U.S. Navy Civil Engineer Corps.

“Serving in the Army allowed me to see the world,” said Abalos. “My experiences gave me a whole new perspective on life. While serving, I also became motivated to complete my college degree.” And it was while working with the refugees in Afghanistan that Abalos became aware of a critical shortage of dentists.

The daughter of a former South Vietnamese former military police officer, Abalos knew very little English and nothing about American culture when she arrived with her family in Fresno in 1996, five years before the terrorist attacks of 9/11. Nevertheless, she managed to become the first in her family to finish high school, graduating with honors, and then enrolling at UC Berkeley, only to leave for military service two years later.

When Abalos was discharged from the Army in 2008 as a staff sergeant with a string of medals and an Army Combat Action Badge for working under enemy fire in Afghanistan, she set her sights on a college degree and a career in dentistry. In 2012, she graduated from Cal State Fresno with a degree in chemistry degree and an invitation to enter UCLA School of Dentistry, her top choice.

“I wouldn’t have even considered dental school had it not been for my humanitarian work in Afghanistan,” she said. “The military taught me about teamwork and to never give up, both traits that I now use in dental school.”

As an older dental student and a mother — she gave birth to a son about the same time she started at UCLA — Abalos has faced challenges with the same “can-do” attitude that she learned in the Army.

“I have my own struggles, much like anyone would in a demanding training program,” said Abalos. “But, I feel like I’ve lived a lot of life already, compared to some of my younger colleagues. I’ve seen the world. I can handle stressful situation and have realistic expectations.”

She and her husband, who is now stationed in Long Beach after transferring to the California Army National Guard, share in the care of their 2-year-old son. “It is a lot of time and sacrifice, but we make it work,” she said.

Even with these added responsibilities, Abalos has continued to be actively involved in veterans’ affairs. As an undergrad, she was part of Fresno State’s Student Veterans Organization and received the National Student Veterans Association STEM Scholarship Award.

At UCLA, she is currently on a student committee in the dental school that provides services and oral health education to veterans in the Los Angeles area. She also volunteers in the dental clinic assisting patients at the West Los Angeles VA Medical Center.

UCLA supports many such initiatives for veterans, ranging from programs that help student veterans navigate the benefits process to efforts to bring injured vets and their families to UCLA’s medical facilities through the nationally acclaimed Operation Mend.

After graduation, Abalos hopes to enter a hospital dentistry residency program that integrates medicine and dentistry. Patients who require this type of dental care have severe medical, physical or mental impairments. Her goal is to return to the military as an officer in the Naval Reserve and practice at a VA hospital somewhere in California.

“I feel that given my background in combat and the military, I can better relate to people who have experienced trauma,” said Abalos. “For example, patients who have posttraumatic stress disorder are going to trust someone that has gone through what they have gone through.”

For now Abalos is concentrating on graduating and going onto the next step of her career. “My career path has been a bit of a winding road,” she said. “But I know where I’m going now.

“The timeworn Army slogan when I enlisted was ‘Be all you can be.’ I guess I just really took that heart,” she said.

The campus community is invited to UCLA’s Veterans Day ceremony on Monday, Nov. 10, at 10:30 a.m. at Wilson Plaza. In addition to speeches, the event will also feature an ROTC color guard and information fair. Visit UCLA Veterans to learn more about campus programs and resources for veterans.

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‘Treasure in saliva’ may reveal deadly diseases early enough to treat them


UCLA research holds promise for diagnosing Type 2 diabetes, gastric cancer, other diseases.

Xinshu (Grace) Xiao and David Wong, UCLA (Photo by Reed Hutchinson, UCLA)

UCLA research could lead to a simple saliva test capable of diagnosing — at an early stage — diabetes and cancer, and perhaps neurological disorders and autoimmune diseases.

The study, the most comprehensive analysis ever conducted of RNA molecules in human saliva, reveals that saliva contains many of the same disease-revealing molecules that are contained in blood. It was published online today (Oct. 29) by the peer-reviewed journal Clinical Chemistry and will be published in the journal’s January 2015 special print issue, “Molecular Diagnostics: A Revolution in Progress.”

“If we can define the boundaries of molecular targets in saliva, then we can ask what the constituents in saliva are that can mark someone who has pre-diabetes or the early stages of oral cancer or pancreatic cancer — and we can utilize this knowledge for personalized medicine,” said Dr. David Wong, a senior author of the research and UCLA’s Felix and Mildred Yip Endowed Professor in Dentistry.

Wong said the test also holds promise for diagnosing Type 2 diabetes, gastric cancer and other diseases. “If you don’t look in saliva, you may miss important indicators of disease,” Wong said. “There seems to be treasure in saliva, which will surprise people.”

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$2M donated for endowed scholarship at UCLA dental school


Gift by Bob and Marion Wilson is largest scholarship donation the dental school has received.

Bob and Marion Wilson

A $2 million gift from Bob and Marion Wilson, longtime supporters of the UCLA School of Dentistry, will give a significant boost to scholarship funding for future generations of dentists. The Wilsons’ donation will establish the Bob and Marion Wilson Endowed Scholarship Fund, which will be used in support of annual scholarships to students who excel in the classroom and are dedicated to public service.

The Wilsons’ gift, which is the largest scholarship donation the dental school has ever received, comes at an optimal time, with state support having decreased substantially over the years. Scholarships help students defray educational expenses, ensuring that the broad array of professional options — including teaching, research and practice in underserved communities — remains open to each student after graduating.

“Being able to establish an endowed scholarship allows Marion and me to support future generations of dental students,” Bob Wilson said. “The UCLA School of Dentistry is a top choice among dental school applicants and our hope is that this donation will allow the school to support students who exhibit academic excellence and exemplary public service.”

The dental school attracts world-class students who go on to be leaders in the fields of oral and systemic health in California, the nation and the world.

The School of Dentistry awards an average of roughly $3 million per year in scholarships and grants to students. The Wilson endowed scholarship will increase the school’s ability to give even more financial aid.

“Increasing our scholarship endowment is one of our top priorities,” said Dr. No-Hee Park, dean of the UCLA School of Dentistry. “This very generous gift made by the Wilsons allows the school to reward those students who excel academically and give back to the community. I cannot thank the Wilsons enough for their investment in our students’ future.”

For nearly three decades, the Wilsons have been loyal supporters of the dental school. Bob Wilson is a dedicated member of the school’s board of counselors and now serves on the dean’s Centennial Campaign Cabinet for UCLA, which launched in May.

The Wilsons both attended UCLA. Bob graduated with a bachelor of science degree in 1953 and Marion graduated with a bachelor of arts degree in 1950. Bob went on to a successful career in commercial real estate development, and the couple has remained dedicated to helping their alma mater fulfill its mission of educational excellence. In 1989, they helped establish the Wilson-Jennings-Bloomfield UCLA Venice Dental Center, a community clinic that provides dental care to predominantly low-income patients.

The impact of the Wilson’s philanthropy is evident across the UCLA campus, most notably in Wilson Plaza, which was dedicated in their name in 2000 in recognition of their longtime generous support for the university. In 2006, they were awarded the UCLA Medal, the university’s highest honor.

For everything that the couple has done for the School of Dentistry and UCLA, the dental school will recognize them as an official honoree at the dental school’s upcoming 50th Anniversary Gala event next spring.

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