Browsing by Author "Felix Gomez, Grace Gomez"
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Item Characterizing clinical findings of Sjögren's Disease patients in community practices using matched electronic dental-health record data(Public Library of Science, 2023-07-31) Felix Gomez, Grace Gomez; Hugenberg, Steven T.; Zunt, Susan; Patel, Jay S.; Wang, Mei; Rajapuri, Anushri Singh; Lembcke, Lauren R.; Rajendran, Divya; Smith, Jonas C.; Cheriyan, Biju; Boyd, LaKeisha J.; Eckert, George J.; Grannis, Shaun J.; Srinivasan, Mythily; Zero, Domenick T.; Thyvalikakath, Thankam P.; Cariology, Operative Dentistry and Dental Public Health, School of DentistryEstablished classifications exist to confirm Sjögren's Disease (SD) (previously referred as Sjögren's Syndrome) and recruit patients for research. However, no established classification exists for diagnosis in clinical settings causing delayed diagnosis. SD patients experience a huge dental disease burden impairing their quality of life. This study established criteria to characterize Indiana University School of Dentistry (IUSD) patients' SD based on symptoms and signs in the electronic health record (EHR) data available through the state-wide Indiana health information exchange (IHIE). Association between SD diagnosis, and comorbidities including other autoimmune conditions, and documentation of SD diagnosis in electronic dental record (EDR) were also determined. The IUSD patients' EDR were linked with their EHR data in the IHIE and queried for SD diagnostic ICD9/10 codes. The resulting cohorts' EHR clinical findings were characterized and classified using diagnostic criteria based on clinical experts' recommendations. Descriptive statistics were performed, and Chi-square tests determined the association between the different SD presentations and comorbidities including other autoimmune conditions. Eighty-three percent of IUSD patients had an EHR of which 377 patients had a SD diagnosis. They were characterized as positive (24%), uncertain (20%) and negative (56%) based on EHR clinical findings. Dry eyes and mouth were reported for 51% and positive Anti-Ro/SSA antibodies and anti-nuclear antibody (ANA) for 17% of this study cohort. One comorbidity was present in 98% and other autoimmune condition/s were present in 53% respectively. Significant differences were observed between the three SD clinical characteristics/classifications and certain medical and autoimmune conditions (p<0.05). Sixty-nine percent of patients' EDR did not mention SD, highlighting the huge gap in reporting SD during dental care. This study of SD patients diagnosed in community practices characterized three different SD clinical presentations, which can be used to generate SD study cohorts for longitudinal studies using EHR data. The results emphasize the heterogenous SD clinical presentations and the need for further research to diagnose SD early in community practice settings where most people seek care.Item Effect of Violet-Blue Light on Streptococcus mutans-Induced Enamel Demineralization(MDPI, 2018-03-21) Felix Gomez, Grace Gomez; Lippert, Frank; Ando, Masatoshi; Zandona, Andrea Ferreira; Eckert, George J.; Gregory, Richard L.; Biomedical and Applied Sciences, School of DentistryBackground: This in vitro study determined the effectiveness of violet-blue light (405 nm) on inhibiting Streptococcus mutans-induced enamel demineralization. Materials and Methods: S. mutans UA159 biofilm was grown on human enamel specimens for 13 h in 5% CO2 at 37 °C with/without 1% sucrose. Wet biofilm was treated twice daily with violet-blue light for five minutes over five days. A six-hour reincubation was included daily between treatments excluding the final day. Biofilms were harvested and colony forming units (CFU) were quantitated. Lesion depth (L) and mineral loss (∆Z) were quantified using transverse microradiography (TMR). Quantitative light-induced fluorescence Biluminator (QLF-D) was used to determine mean fluorescence loss. Data were analyzed using one-way analysis of variance (ANOVA) to compare differences in means. Results: The results demonstrated a significant reduction in CFUs between treated and non-treated groups grown with/without 1% sucrose. ∆Z was significantly reduced for specimens exposed to biofilms grown without sucrose with violet-blue light. There was only a trend on reduction of ∆Z with sucrose and with L on both groups. There were no differences in fluorescence-derived parameters between the groups. Conclusions: Within the limitations of the study, the results indicate that violet-blue light can serve as an adjunct prophylactic treatment for reducing S. mutans biofilm formation and enamel mineral loss.Item Effects of artificial honey and epigallocatechin-3-gallate on streptococcus pyogenes(Springer, 2022-08-26) Jiang, Xiaoge; Lin, An; Li, Shijia; Shi, Yangyang; Zhou, Fangjie; Felix Gomez, Grace Gomez; Gregory, Richard L.; Zhang, Chaoliang; Chen, Song; Huang, Ruijie; Oral Pathology, Medicine and Radiology, School of DentistryBackground Streptococcus pyogenes is an important global human pathogen that causes pharyngitis, and antibacterial therapy has become an important part of the overall therapy for pharyngitis. As natural derivatives, honey and green tea are often recommended for patients with pharyngitis in traditional Chinese medicine without experimental theoretical basis on wether the combined effect of honey and green tea on pharyngitis is better than they alone. The aims of this study were to explore the effects of artificial honey (AH) and epigallocatechin-3-gallate (EGCG) on S. pyogenes and elucidate the possible mechanisms, which were investigated using MIC (the minimum inhibitory concentration), FIC (fractional inhibitory concentration) index, growth pattern, biofilm formation and RT-qPCR. Results The MIC of AH on S. pyogenes was 12.5% (v/v) and the MIC of EGCG was 1250 μg/ml. The FIC index of AH and EGCG was 0.5. The planktonic cell growth, growth pattern and biofilm formation assays showed that AH and EGCG mixture had stronger inhibitory effect on S. pyogenes than they alone. RT-qPCR confirmed that the expression of hasA and luxS gene were inhibited by AH and EGCG mixture. Conclusions AH and EGCG mixture can inhibit the planktonic cell growth, biofilm formation and some virulence genes expression of S. pyogenes, better than they alone. The combination of honey and green tea have the potential to treat pharyngitis as natural derivatives, avoiding drug resistance and double infection.Item How Do Dental Clinicians Obtain Up-To-Date Patient Medical Histories? Modeling Strengths, Drawbacks, and Proposals for Improvements(Frontiers, 2022-03) Li, Shuning; Rajapuri, Anushri Singh; Felix Gomez, Grace Gomez; Schleyer, Titus; Mendonca, Eneida A.; Thyvalikakath, Thankam P.; Cariology, Operative Dentistry and Dental Public Health, School of DentistryBackground: Access to up-to-date patient medical history is essential for dental clinicians (DCs) to avoid potential harm to patients and to improve dental treatment outcomes. The predominant approach for dental clinicians (DCs) to gather patients' medical history is through patient-reported medical histories and medical consults. However, studies reported varied concordance and reliability of patient-reported medical conditions and medication histories compared to the patient medical records and this process also places a significant burden on patients. Information technology tools/platforms such as an integrated electronic health record containing an electronic dental record module may address these issues. However, these integrated systems are expensive and technically complex and may not be easily adopted by DCs in solo and small group practice who provide the most dental care. The recent expansion of regional healthcare information exchange (HIE) provides another approach, but to date, studies on connecting DCs with HIE are very limited. Our study objectives were to model different aspects of the current approaches to identify the strengths and weaknesses, and then model the HIE approach that addresses the weaknesses and retain the strengths of current approaches. The models of current approaches identified the people, resources, organizational aspects, workflow, and areas for improvement; while models of the HIE approach identified system requirements, functions, and processes that may be shared with software developers and other stakeholders for future development. Methods: There are three phases in this study. In Phase 1, we retrieved peer-reviewed PubMed indexed manuscripts published between January 2013 and November 2020 and extracted modeling related data from selected manuscripts. In Phase 2, we built models for the current approaches by using the Integrated DEFinition Method 0 function modeling method (IDEF0), the Unified Modeling Language (UML) Use Case Diagram, and Business Process Model and Notation (BPMN) methods. In Phase 3, we created three conceptual models for the HIE approach. Results: From the 47 manuscripts identified, three themes emerged: 1) medical consult process following patient-reported medical history, 2) integrated electronic dental record-electronic health record (EDR-EHR), and 3) HIE. Three models were built for each of the three themes. The use case diagrams described the actions of the dental patients, DCs, medical providers and the use of information systems (EDR-EHR/HIE). The IDEF0 models presented the major functions involved. The BPMN models depicted the detailed steps of the process and showed how the patient's medical history information flowed through different steps. The strengths and weaknesses revealed by the models of the three approaches were also compared. Conclusions: We successfully modeled the DCs' current approaches of accessing patient medical history and designed an HIE approach that addressed the current approaches' weaknesses as well as leveraged their strengths. Organizational management and end-users can use this information to decide the optimum approach to integrate dental and medical care. The illustrated models are comprehensive and can also be adopted by EHR and EDR vendors to develop a connection between dental systems and HIEs.Item Nutritional Assessment of Denture Wearers Using Matched Electronic Dental-Health Record Data(Wiley, 2022-08) Felix Gomez, Grace Gomez; Cho, Sopanis D.; Varghese, Roshan; Rajendran, Divya; Eckert, George J.; Bhamidipalli, Sruthi Surya; Gonzalez, Theresa; Khan, Babar Ali; Thyvalikakath, Thankam Paul; Cariology, Operative Dentistry and Dental Public Health, School of DentistryPurpose To assess the nutritional profile of denture wearers through a retrospective cohort study using nutritional biomarkers from matched electronic dental and health record (EDR-EHR) data. Materials and methods The case group (denture wearers) included matched EDR-EHR data of patients who received removable partial, complete, and implant-supported prosthodontic treatments between January 1, 2010 and December 31, 2018, study time. The control (nondenture wearers) group did not have recorded denture treatments and included patient records within 1 year of the denture index date (first date of case patients’ receiving complete or partial denture) of the matching cases. The qualified patients’ EDR were matched with their EHR based on the availability of laboratory reports within 2 years of receiving the dentures (index date). Nutritional biomarkers were selected from laboratory reports for complete blood count, comprehensive and basic metabolic profile, lipid, and thyroid panels. Summary statistics were performed, and general linear mixed effect models were used to evaluate the rate of change over time (slope) of nutritional biomarkers before and after the index date. Likelihood ratio tests were performed to determine the differences between dentures and controls. Results The final cohort included 10,481 matched EDR-EHR data with 3,519 denture wearers and 6,962 controls that contained laboratory results within the study time. The denture wearers’ mean age was 57 ±10 years and the control group was 56 ±10 years with 55% females in both groups. Pre-post analysis among denture wearers revealed decreased serum albumin (p = 0.002), calcium (p = 0.039), creatinine (p < 0.001) during the post-index time. Hemoglobin (Hb) was higher pre-index, and was decreasing during the time period but did not change post-index (p < 0.001). Among denture wearers, completely edentulous patients had a significant decrease in serum albumin, creatinine, blood urea nitrogen (BUN), but increased estimated glomerular filtration rate (eGFR). In partially edentulous patients, total cholesterol decreased (p = 0.018) and TSH (p = 0.004), BUN (p < 0.001) increased post-index. Patients edentulous in either upper or lower arch had decreased BUN and eGFR during post-index. Compared to controls, denture wearers showed decreased serum albumin and protein (p = 0.008), serum calcium (p = 0.001), and controls showed increased Hb (p = 0.035) during post-index. Conclusions The study results indicate nutritional biomarker variations among denture wearers suggesting a risk for undernutrition and the potential of using selected nutritional biomarkers to monitor nutritional profile.Item Photoinhibition of Streptococcus mutans Biofilm-Induced Lesions in Human Dentin by Violet-Blue Light(MDPI, 2019-12-11) Felix Gomez, Grace Gomez; Lippert, Frank; Ando, Masatoshi; Zandona, Andrea F.; Andrea F., George J.; Gregory, Richard L.; Biomedical Sciences and Comprehensive Care, School of DentistryThis in vitro study determined the effectiveness of violet-blue light on Streptococcus mutans (UA159) biofilm induced dentinal lesions. Biofilm was formed on human dentin specimens in a 96-well microtiter plate and incubated for 13 h in the presence of tryptic soy broth (TSB) or TSB supplemented with 1% sucrose (TSBS). Violet-blue light (405 nm) from quantitative light-induced fluorescence (QLFTM) was used to irradiate the biofilm. Supernatant liquid was removed, and the biofilm was irradiated continuously with QLF for 5 min twice daily with an interval of 6 h for 5 d, except with one treatment on the final day. Colony forming units (CFU) of the treated biofilm, changes in fluorescence (∆F; QLF-Digital BiluminatorTM), lesion depth (L), and integrated mineral loss (∆Z; both transverse microradiography) were quantified at the end of the fifth day. Statistical analysis used analysis of variance (ANOVA), testing at a 5% significance level. In the violet-blue light irradiated groups, there was a significant reduction (p < 0.05) of bacterial viability (CFU) of S. mutans with TSB and TSBS. Violet-blue light irradiation resulted in the reduction of ∆F and L of the dentinal surface with TSBS. These results indicate that violet-blue light has the capacity to reduce S. mutans cell numbers.Item Violet-blue light and streptococcus mutans biofilm-induced carious lesions(2018-07) Felix Gomez, Grace Gomez; Gregory, Richard L.; Zandona, Andrea; Ando, Masatoshi; Lee, Chao-Hung; Anderson, GregoryDental caries is a continuum of disease process. Early carious lesions are reversible and preventable. The primary etiological factor of dental caries is oral biofilm also known as dental plaque. It is an aggregate of oral bacteria, and one of the principal cariogenic bacteria is a facultative anaerobic microbe, Streptococcus mutans, which is indispensable for the initiation of caries. Management of prevention of carious lesions at the microbial level begins with reducing, eliminating and inhibiting the attachment of oral biofilm. Non-invasive phototherapy is widely studied to control oral biofilm as an alternative method to overcome the emergence of antibiotic resistant strains. In vitro studies demonstrated that Violet-Blue light with a peak wavelength of 405 nm had an inhibitory effect on S. mutans biofilm cells irradiated for 5 min. Metabolic activity of S. mutans cells was significantly reduced immediately after treatment with some recovery at 2 and 6 hrs. An in vitro translational study was conducted to determine the inhibitory effect of Violet-Blue light with twice daily treatments for 5 min over a period of 5 days on S. mutans biofilm cells grown on human enamel and dentin specimens. Bacterial viability was significantly reduced in the Violet-Blue light treated group for both dentin and enamel. Lesion depth, obtained by imaging fluorescence loss through Quantitative Light Induced Fluorescence (QLF-D) Biluminator and through transverse microradiography (TMR), was significantly reduced in S. mutans grown in tryptic soy broth with 1% sucrose (TSBS) for dentin. Mineral loss obtained through TMR in the absence of sucrose (TSB) was significant with enamel. However, all the parameters in the Violet-Blue treated groups were numerically reduced, albeit some being not significant. Accurate Mass Quadrupole Time of Flight Mass Spectrometry was used to identify Protoporphyrin IX (PP-IX) in S. mutans biofilm that may play a role in the photoinactivation and emission of fluorescence within specific wavelengths of the visible spectrum namely Violet-Blue light.