Category: News

In February 2022, the University of Washington (UW) Timothy A. DeRouen Center team travelled to Kenya as part of our National Institute of Health’s D71 Grant entitled “TABASAMU: A multidisciplinary collaboration on building up research capacity in oral health and HIV/AIDS.” The purpose of this interdisciplinary planning grant is to develop a training program with the ultimate goal of creating sustainable institutional capacity in research and training for oral health and HIV/AIDS.

Team members from UW (Dr. Ana Lucia Seminario, Dr. Matthew Saxton, and Sara Stanley), University of Nairobi (Dr. Arthur Kemoli), and Maseno University (Dr. Immaculate Opondo) visited with University, Hospital, County, and Federal representatives in four cities in Kenya – Kisumu, Eldoret, Mombasa, and Nairobi. We were grateful to be able to visit multiple areas of the country in order to help with cultural competency, meeting with various stakeholders, and get to know more about the strengths and challenges in different areas. We were able to gain a robust representation of future mentors and trainees from the whole country.

During the two-week trip, the team conducted 11 virtual and 15 in-person stakeholder interviews and conducted 33 informational meetings in preparation for writing and submitting an NIH D43 Training Grant in Summer, 2023. Our team was well-received, and we were also able to visit with our Global Innovation Fund grant students, and with the AMPATH group in Eldoret. This trip was a successful beginning to expanding oral health and HIV research capacity in Kenya, and we are excited about the next steps towards the NIH D43 5-year training grant to expand research capacity.

Children and adolescents living with HIV (CALHIV) have a higher risk of oral tissue diseases than those without HIV. Increasing awareness regarding the need to integrate oral health within medical care among pediatric HIV populations is crucial. Our study published in JDR Clinical & Translational Research entitled “Oral diseases and oral health-related quality of life among Kenyan children and adolescents with HIV” examines the associations between oral diseases and oral health-related quality of life (OHRQoL) in Kenyan CALHIV.

This cross-sectional study conducted in Nairobi, Kenya, administered oral examinations and oral health surveys (via the parent or guardian of the child/adolescent) to 71 children and adolescents ranging in age from 10 to <21 years. The survey measured oral symptoms, functional limitations, and emotional and social well-being. The overall mean OHRQoL score was 12.6. Results indicated that children/adolescents with ulcers had the worst overall OHRQoL scores (mean of 21.8). Children/adolescents with other oral diseases such as dry mouth and untreated caries had overall higher OHRQoL scores than those without disease.

Access to oral health care for CALHIV could be significantly improved by integrating it within the ongoing comprehensive medical care received in HIV treatment programs throughout Kenya.

Because dental care is included in the National Health Insurance, integration of oral care into HIV care could be efficient, cost-effective, and highly acceptable. Incorporating oral health protocols into children’s HIV care programs has the potential to increase surveillance of HIV disease trajectory, monitor the effectiveness of HIV anti-retroviral therapy, and improve the quality of life for children and adolescents living with HIV.

A 2021 report by the U.S. National Institutes of Dental and Craniofacial Research (NIDCR) at the Department of Health and Human Services entitled “Oral Health in America: Advances and Challenges” examines the current state of oral health in the United States, and the progress that has been made over the past twenty years. The report touches on all aspects of oral health including the effect of oral health on the overall well-being, community, and the economy; oral health across the lifespan; oral health workforce, education, and practice; oral health and pain, substance abuse, and mental illness; and emerging sciences and technologies.

While there have been a few improvements in areas such the medical community acknowledging that oral health is important for overall health, and access to care has improved for children from low-income families in part due to increased collaboration between oral health professionals and pediatricians, there are still troubling trends in oral disease prevalence in the U.S. For example, 47% of U.S. adults 30 years of age or older have periodontal disease, and nine out of ten adults 20 to 64 years of age have had dental caries. Dental caries in permanent teeth still rank among the most common childhood diseases.

In order to improve oral health for Americans there are several areas of reform that would make a large impact, such as increasing access to dental care and tackling high costs associated with oral health. Over the past twenty years, per-person oral care costs have increased 30%, with $55 billion paid in out-of-pocket expenses. Communities that are the disproportionally impacted by oral health diseases have the least access to health services. To improve oral health across the spectrum, policies are needed to integrate medical, behavioral, and oral health. Adding preventive services to all aspects of the community including schools, assisted-living facilities, primary care clinics, community care clinics, and dental clinics would improve access.

The 2000 NIDCR report recognized that oral health is crucial to overall health. It’s critical that oral health be included in all aspects of health care, discovery, and policy in order to fully integrate and improve oral health for all Americans.

The war currently raging in Ukraine has created one of the largest refugee crises in modern history, according to the latest data from the Pew Research Center. After a month of the war, nearly 4 million Ukrainian’s have fled to other countries. So far, it’s the sixth-largest refugee exodus in the past sixty years. This number doesn’t include the amount of internally displaced Ukrainians who are still within the countries borders. All told, approximately ten million Ukrainians have been either internally or externally displaced, which amounts to nearly a fourth of the country’s population.

This massive geographical displacement of refugees will significantly impact public health systems of the welcoming countries. The current United States administration announced in March that they will be accepting up to 100,000 people fleeing the war in Ukraine, with priority to those who already have family in the US. US policy for arriving refugees mandates a medical assessment within 30 days after arrival. In the state of Washington, while medical assessments does not formally mandate oral health evaluation, all clinics allowed by the government to conduct such assessments include some aspect of oral health and therefore assisting with establishing a dental home as soon as possible. Inter-professional collaboration within the public health system is an opportunity to increase awareness and access to dental care among refugee populations.

Grant to study the impact of alcohol-use disorder on progression of dental disease in MSM with HIV

Despite successful antiretroviral therapy (ART), dental caries and periodontal disease remain more prevalent in persons with HIV (PWHIV) than those without HIV. Pain, xerostomia, lower quality of life, and impaired masticatory functions lead to reduced nutritional intake, which can increase HIV progression and amplify systemic co-morbidities. In Lima, Peru, HIV prevalence is 100-fold higher in men who have sex with men (MSM) relative to the general population (22.3% vs 0.2%), a proportion comparable to generalized epidemics in Sub-Saharan countries. Prior data confirms high levels (55%) of alcohol use disorder (AUD) which is defined as hazardous, harmful and dependent drinking, a co-morbid NCD, among MSM in Peru.

Men’s health is often neglected in global health research according in the January/February 2022 Global Health Matters newsletter through Global Fogarty International Center. There have been significant improvements in global health over the past few decades with many of those advancements focus on maternal and child health. The collaborative research between the UW School of Dentistry and the DeRouen Center for Global Health (PI Dr. Ana Lucia Seminario, and Drs. Philippe Hujoel, Brian Leroux, Noel Weiss, and Caroline Shiboski – University of California San Fancisco), Yale University (Co-PI Dr. Fredrick Altice), Centro de Investigaciones Tecnológicas, Biomédicas y Medioambientales (CITBM) (Dr. Jorge Sanchez), and Asociación Civil Impacta Salud y Educación (IMPACTA) (Dr. Javier Valencia) will address the oral health implications of MSM living with HIV.

In April, the DeRouen research team will visit the CITBM and IMPACTA clinics in Lima Peru to discuss and begin to implement the first phase of the study. The Peruvian research teams will administer a survey to their MSM patients and assess past and current alcohol consumption behavioral risk, use of dental care services as well as knowledge, attitudes, and behaviors towards oral health. The Peruvian team, UW team, and Yale team have begun the preliminary work for the launch of the of study in April 2022. These processes and procedures being developed will be used as part of the planning of a future R01 submission that aims to assess the impact of HIV and AUD on dental disease in Peruvian MSM.

Oral diseases are among the most prevalent non-communicable diseases worldwide, disproportionally affecting vulnerable populations. Oral diseases manifest as pain, impairment, and loss of function, and can affect individuals throughout their lifetime. Our study published in Brazilian Dental Journal entitled “Dental caries and anthropometrics of children living in an informal floating Amazonian community: a cross-sectional pilot study” examines the associations between poor oral health and growth in children in the community of Claverito, on the outskirts of Iquitos, Peru.

InterACTION Labs is a transdisciplinary research program where researchers collaborate with the Claverito community on health research and interventions to improve conditions in the slum community. In 2017 the University of Washington (UW) Population Health Initiative, the Centro de Investigaciones Technologicas, Biomedicas y Medio Ambientales (CITBM), and 100,000 Strong in the Americas awarded InterACTION Labs a pilot study to understand and address health disparities in Claverito.

For this project, the focus was on the relationship between poor oral health and growth in children ages 1 to 18 years old. To quantify oral health status, we looked at traditional decayed, missing, filled teeth (dmft/DMFT) scores as well as an innovative metric of the Significant Caries Index (SiC). To quantify growth, we calculated age-sex-specific scores for height and weight: height-for-age (HAZ), weight-for-age (WAZ), and body mass index for age (ZBMI). Results found that there was a statistically significant negative association between SiC and HAZ scores. Based on our results, there is evidence to suggest a relationship between dental disease and poor growth in children.

Floating communities living in poverty are found globally, and dental caries (tooth decay) is the most common chronic disease affecting children. This research contributes to the growing body of literature demonstrating the relationship between dental disease and anthropometric deprivation in underserved communities – knowledge which is critical to promoting an integrated response to the World Health Organization’s Sustainable Development Goals.

Recently, the Faculty of Dentistry from Khon Kaen University were selected by the Education Equality Fund (EEF) to participate in the project, “Advanced Vocational Innovation Scholarships” to promote and support 30 underprivileged youth to study in the Dental Assistant Certificate Program, a one-year course certified by the Dental Council. Faculty of Dentistry at Khon Kaen University is the only dental school in the country to receive such support.

The “Advanced Vocational Innovation Scholarship” project is a full scholarship that creates educational opportunities for youth from households with the lowest incomes in the bottom 20 percent of Thailand. The scholarship provides an opportunity for these youth to pursue vocational studies in fields that are in demand in the labor market. The characteristics of support include 1) Scholarships for students that have been selected by education institutions, helping support monthly expenses and tuition fees, 2) Educational Institution Development Fund, for use in activities to improve teaching quality and promote well-being and welfare, as well as creating the work opportunities for scholarship participants, and 3) Activities to support the quality development of educational institutions and scholarship recipients academic support by local and international experts exchange of learning innovations between educational institutions and enterprises.

The EEF is a government agency under the supervision of the Prime Minister of Thailand, established according to the Education Equality Fund Act, B.E. 2561, aiming to create equality in education. (www.eef.or.th.). This opportunity will expand current KKU efforts to increase research capacities in global oral health.

The School of Dentistry at Khon Kaen University, led by Dr. Waranuch Pitiphat, has been awarded a D43 training grant to sustainably strengthen the oral health research capacity among Low- and Middle-Income Countries (LMICs) in Southeast Asia. This grant proposes to build upon and expand two established training programs on “Clinical, Public Health, and Behavioral Oral Health Research Training for Thailand” which were awarded by the National Institutes of Health (NIH). These programs are joint efforts between the University of Washington School of Dentistry (UW) and affiliated Schools of Dentistry at Khon Kaen University (KKU) and Thammasat University (TU) in Thailand. Dr. Pitiphat, was a major collaborator and Associate Director of the previous training programs.

Investing in research has not only impacted trainees’ career development but enhanced advancement of oral health research of Southeast Asia. The leaders of the previous programs bring in their expertise in research along with their broad experience in working with and providing trainings to a network of international trainees from the region. The KKU and TU faculty members who were previous PhD-level trainees on the previous grants have now graduated, started to conduct their own research, and are ready to pass on their knowledge to the next generations of trainees. The Faculties at both KKU and TU also provide full support to the proposed program and aspire to become a major center for oral health research for the Southeast Asia region. As a result of these capacity building efforts, KKU and TU are now in a position where they could serve as a hub to provide further trainings to Southeast Asian researchers.

The DeRouen Center manuscript publishing class for junior researchers in Kenya is steadily moving forward, making strides in the publication process. This project, which was made possible by the University of Washington’s (UW) Global Innovation Fund (GIF), with collaborative efforts between the UW Dentistry, Global Health, and Libraries, the University of Nairobi (UoN), and Moi University (MU), is assisting Kenyan oral health professionals in transforming their masters’ theses into manuscripts for publication.

One of our students, Dr. Kerre Nduguyu, is hoping to publish his project entitled “Comparison of measured and predicted mesiodistal tooth-widths in 13-17-year-old Kenyans.” To determine orthodontic treatment plans adolescents and teens, mixed dentition analysis is carried out to estimate the mesiodistal tooth-widths of unerupted permanent teeth. Currently, this analysis includes radiographic analysis, regression/prediction equations, or a combination of the two. The most utilized analysis method is the Tanaka and Johnston formula. However, this analysis was based on Caucasian populations. While it continues to be used worldwide, racial and ethnic differences have shown challenges when the Tanaka and Johnston analysis is applied to other populations besides Caucasians. The aim of Dr. Nduguyu’s study was to develop an analysis tool pilot that better predicts space for the Kenyan population.

The project was a cross-sectional study carried out in sixty-eight 13–17-year-old Kenyans of African descent. Dr. Nduguyu’s research team obtained dentition casts from the children to measure for mesiodistal tooth-widths. Results indicate that there are significant differences between predicted values from the Tanaka Johnston analysis, compared to actual tooth measurements from the casts. Findings from this exciting pilot study will be used in a larger project aimed at validating a proposed space analysis equation to be used by Kenyan oral health providers.

The government of Kenya has established a company named Kenya Biovax Institute Ltd, in order to manufacture vaccines and other biologics within the country. Currently, Kenya imports 70% of required biologics and medications, but with the establishment of Kenya Biovax Institute, the hope is to manufacture the bulk of required vaccines and other biologics at home.

The shortage of COVID-19 vaccines in Kenya and through the African continent throughout the pandemic was the impetus for the new company. Supply chain issues created difficulties in vaccinating the Kenya population. Local manufacturing of COVID-19 vaccines is set to begin in April.

The creation of Kenya Biovax Institute will be a significant step towards self-sustenance in supply and availability of medical commodities. The hope is that local production of vaccines will support public healthcare programs, economic growth, national security, and the ability to more adequately control future disease outbreaks.