A family of proteins known as interferon lambdas produced by epithelial cells in the mouth serve to protect humans from viral infection, but the oral bacteria Porphyromonas gingivalis reduces the production and effectiveness of those important frontline defenders.

“Our studies identified certain pathogenic bacterial species, P. gingivalis, which cause periodontal disease, can completely suppress interferon production and severely enhance susceptibility to viral infection,” said Juhi Bagaitkar, assistant professor in the UofL Department of Oral Immunology and Infectious Disease. “These resident oral plaque bacteria play a key role in regulating anti-viral responses.”

Bagaitkar and Richard Lamont, professor and chair of the UofL Department of Oral Immunology and Infectious Disease, led the work, with first author Carlos J. Rodriguez-Hernandez and other colleagues at UofL and at Washington University in St. Louis. The findings were published

The mouth often is a gateway into the body for viruses that infect the gastrointestinal tract and lungs such as SARS-CoV-2, human immunodeficiency virus (HIV), herpes simplex and cancer-causing viruses such as human papillomavirus (HPV).

P. gingivalis, a common oral bacterium that causes periodontal disease, has been linked to numerous other diseases, including Alzheimer’s disease and rheumatoid arthritis. Recent clinical studies have shown that immune suppression in patients with periodontitis can enhance susceptibility to HIV, herpes simplex and HPV.

Improved understanding of how interferons provide broad antiviral protection and activate antiviral genes to protect us from viruses, as well as how P. gingivalis compromises their protection, may lead researchers to clinical approaches to increase that protection.

Research at UofL has revealed connections between P. gingivalis and multiple other diseases and conditions, including rheumatoid arthritis, Alzheimer’s disease and esophageal cancer.

Bagaitkar was one of the first junior faculty members whose research was supported by the Center of Biomedical Research Excellence (CoBRE) for research in microorganism disease research funded by the National Institute of General Medical Sciences.

Geographic and economic conditions create limited access to oral health care — the next closest dentist is a 45- to- 90-minute drive.

“Without Red Bird, most people here would simply have no dental care. It’s extremely important to this community,” said Revelle Berry, a long-time patient of the clinic.

More than a year ago, the began a collaboration with the Red Bird Dental Clinic, offering a new clinical site rotation for students, while expanding Red Bird’s ability to serve more people.

“Generations of poverty have greatly exacerbated health conditions that need extensive, late-stage treatment, follow-up and support,” said Kari Collins, executive director of the Red Bird Clinic Inc., and Red Bird Mission Inc. “Our vision is of one of a stronger, sustainable community and UofL is an important partner in carrying out this vision.”

The Red Bird Clinic Inc., includes both dental and medical components. It grew out of the , which started in 1921 with a private school, and expanded to include job training, clothes closet, food pantry, adult education and senior citizen services.

“The services offered through Red Bird are so important for the people of this region, and we are pleased to have UofL reach across the state to engage with us as we strive to become a healthier community,” said Kentucky Senate President Robert Stivers.

“The clinical experience at Red Bird enhances the education of our students with enriching cultural and clinical practice experiences that will make them compassionate, exceptional dental health care providers,” said the dean of the UofL School of Dentistry, Gerry Bradley, BDS, MS, Dr.Med.Dent.

Fourth-year dental student Sarah Jestel spent much of July at the Red Bird Dental Clinic for an Area Health ����ֱ�� Centers program requirement.

“The patients were so appreciative of the work we completed, especially those individuals requiring extractions,” she said. “Many came in with elevated blood pressure and had been in pain a long time.”

The students learn under the supervision of Bill Collins, DMD, dental director for the Red Bird Dental Clinic. Two other UofL alumni, Susan King, DMD, and Bob McGuinn, DMD, along with former dean of the University of Kentucky College of Dentistry, Sharon Turner, DDS, JD, also serve on rotation as gratis faculty to oversee the UofL students.

“Students encounter varying levels of difficulty, including emergency situations and medically compromised patients. They work out of their comfort zones and increase their confidence levels and speed. They also learn practice management skills,” Collins said.

Since the collaboration started, dental students have helped provide care for almost 600 patients, and completed nearly 700 procedures for many who are uninsured or under-insured.

Individual donors like McGuinn, along with the and help make it possible.

“We fully support the Red Bird Dental Clinic mission and look forward to the continued oral health benefits it will bring southeastern Kentucky,” said Delta Dental of Kentucky’s CEO Jude Thompson. “Without the University of Louisville, access to care would be extremely difficult, and we’re proud Louisville is represented by such an esteemed group of students.”

The use of a mobile dental unit funded by increases the clinic’s ability to serve those without access to care. This includes a new outreach to individuals who are actively engaged in substance use treatment. Adding oral health care helps support their efforts to achieve and maintain recovery.��

“As a Kentucky Medicaid dental benefits administrator serving approximately 1.1 million children and adults, ����ŧ������ endeavors to support new and innovative opportunities that increase access to quality dental health care across the state,” said Jerry Caudill, DMD, State Dental Director for ����ŧ������.

“It takes many partners and donors to help us address the numerous challenges facing the underserved here in Appalachia, and we are thankful to all those who give and serve here,” Collins said.

“The exposure of our teeth to an acid can cause loss of enamel and eventually the dentin or inner layer of the tooth, creating significant problems,” said Paul Boyd, DMD, clinical associate professor, UofL School of Dentistry.

He explains two categories of acid that affect the mouth: extrinsic and intrinsic acids.

The most common extrinsic source of acid comes from food and beverages with a pH of less than 4, where 7 is a neutral pH level. Lemon juice, wines, sport drinks, sodas, oranges, some teas, vinegar, apple juice, tomatoes, cherries and pickles are all examples of food and drink items with high acid.

Other extrinsic acids come from medications such as aspirin, iron tablets and vitamin C supplements. This category also involves occupational exposure for individuals who are battery and ammunition plant workers or frequent swimmers who go to pools where the pH isn’t properly adjusted.

Intrinsic acids originate from gastric fluid in contact with the mouth. Boyd says this can result from gastrointestinal reflux disease (GERD), bulimia and vomiting associated with pregnancy and alcohol abuse. Gastric fluid has a pH around 1, so its erosive potential is extremely high, he said.

“Signs of dental erosion include dulling and yellowing of the teeth, increased translucency at the ends of the teeth and rounding of the teeth,” Boyd said. “If your teeth have an increase in sensitivity to cold and hot foods and drinks, erosion may be a factor.”

Dr. Boyd’s tips for protecting teeth from erosion:

• Wait 30 minutes before brushing after meals. Tooth enamel is constantly
  de-mineralizing after an acid attack and re-mineralizing with the influence of saliva. Brushing too soon impacts the tooth while de-mineralizing and increases the risk of abrading the enamel. And, always use a soft bristle tooth brush.
• Limit warm or hot acidic beverages, which are more erosive than cold acidic beverages.
• Drink through a straw when drinking acidic beverages, and don’t swish.
• Eat and drink acidic food and beverages in one sitting rather than over an extended period of time. Frequency of intake is a factor of erosion.
• Look for toothpastes formulated specifically to fight erosion.
• Make an appointment with a health care provider who can help diagnose and treat sources of acid.
• Schedule a dental check-up. Your dentist can identify tooth erosion and determine its source. Intrinsic acid usually affects the inside and biting surfaces of the teeth whereas extrinsic sources initially are localized on the outside surfaces of the teeth.

“If you suspect that dental erosion is impacting your oral health, be proactive. Early intervention can save significant time and money — and most of us don’t have an excess of either,” Boyd said.

The funding has been awarded to the Kentucky Cabinet for Health and Family Services Department for Public Health HIV/AIDS Services Branch, Ryan White Part B program and contracted to the UofL School of Dentistry.

UofL’s Community Based Dental Partnership Program (CBDPP), is one of only 12 Ryan White CBDPP federally-funded oral health programs in the United States, and the only one in Kentucky.

The two-year grant will allow for increased access to oral health care services for people living with HIV, while providing education and clinical training for dental care providers, especially those practicing in community-based settings.

Dental care is one of the most common unmet needs for people living with HIV/AIDS in Kentucky. These needs include fillings, crowns and bridges, dentures and more. ��

“Patients who have issues with their teeth begin to limit the types of food they eat. This can result in malnourishment, which in turn affects the absorption of HIV medications. The end effect is a more compromised immune system,” said Catherine Binkley, DDS, MSPH, PhD, associate professor, Department of Surgical and Hospital Dentistry, and program director for the Ryan White CBDPP.

“Social interactions also can be negatively impacted by poor oral health. Patients with fractured or missing teeth all too often limit educational and career seeking opportunities, as well as withdraw from friends and group scenarios. Restoring teeth for patients in all these situations impacts their lives in major ways. We want to help our patients put their lives back together and become part of society by providing a new smile,” Binkley said.

The dental school first received funding from the Kentucky HIV/AIDS Branch Ryan White Part B program for a six-month pilot in January 2014. The purpose of this funding was to expand the reach of oral health services and create a statewide network for improving access to comprehensive oral health care and improved oral health outcomes for individuals living with HIV/AIDS enrolled in the Kentucky Ryan White Part B program.

Based on the success of the pilot program, the UofL School of Dentistry’s CBDPP was awarded a $1.2 million 2-year state contract in 2014-2016, and has now received $2 million for 2016-2018 to continue serving the oral health needs of Kentuckians living with HIV/AIDS. Last year, the UofL program performed more than 6,000 procedures for nearly 600 HIV/AIDS patients.