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Dental symptoms can cause severe health problems. Yet, while dental insurance is seen by many as a luxury, medical insurance is widely considered to be essential. Born in the legislative advent of Medicare, which covers no dental costs, and Medicaid, which covers few, the medical-dental divide has created and exacerbated health inequity between those who can afford dental care and those who cannot. This article offers a brief visual and narrative history of how this happened and why dentistry exists outside medicine rather than as a specialty within it.Since 1840, when the first dental school in the United States was founded, educational and policy outcomes have reinforced the separation of dentistry from medicine. Originating in serial historical divides, this separation has produced grave health inequity. Selleckchem Vorinostat The COVID-19 pandemic illuminates differences in medical and dental care delivery streams and also suggests how to design a unified health care system that transcends historical precedent.Rural residents in the United States are less likely to have dental insurance and more likely to face environmental and geographic barriers to oral health and dental care. This article discusses oral health inequity, evidence of oral health's influence on overall health, and why the primary care workforce is well positioned to provide prevention, screening, and referrals for oral health and dental care. Six strategies by which oral health and dental care are integrated into primary care delivery streams can help mitigate rural health inequity.Integrating primary and oral health care is critical to improving population health and addressing health inequity exacerbated by the COVID-19 pandemic. Leaders of the patient-centered medical home (PCMH) movement focused on building consensus for the PCMH model among diverse stakeholders in order to enhance infrastructure investment, care innovation, and payment reforms that support access and equity. This article offers 5 lessons from the PCMH movement to inform primary and oral health care integration.Training, service delivery, and financing are done separately in dentistry and general health care, which has influenced reimbursement structures, access to services, and outcomes. This article considers how medical and dental separation exacerbates health inequity and canvasses data demonstrating that oral health and dental services are the least affordable health services. This article also proposes how dental and general medical care coverage can be meaningfully integrated through better health policy to motivate health equity.People who are poor or members of communities of color face inequitable oral disease burden. Continued separation of dental and oral health from general medical care exacerbates inequity and forces members of underserved communities to seek nontraumatic dental emergency care in hospital emergency departments. This trend is unnecessarily costly and results in antibiotic prescriptions and pain management that are neither restorative nor responsive to patients' primary complaints. Value-based approaches to health care need to unify mouth care with general medical care, motivate medical-dental interprofessional practice, promote oral disease prevention, and support restorative dental care. Value-based approaches to health care must also innovate fiscal structures (eg, payment models, data sharing) to improve health outcomes for everyone.
Access to dental care in mixed-race and predominantly African American wards in the District of Columbia (DC) was investigated in relation to community development.

This study used high-resolution geographic information system (GIS) tools to map all general dentistry and periodontal practice locations in DC wards. The spatial analysis contextualized each ward's land use and demographic data obtained from DC government reports.

The analysis revealed inter-ward inequity in dental care access, which was measured by proximity to and number of dental clinics in each DC ward. Residents in affluent wards had access to many dental practices and superior amenities. Residents in wards poorly served by public transportation and with few resources had few, if any, dental clinics.

Dental practices are inequitably distributed across DC wards. DC policy should prioritize community development-specifically, resource allocation and community outreach-to promote health equity and improve access to and quality of dental care among residents of color.
Dental practices are inequitably distributed across DC wards. DC policy should prioritize community development-specifically, resource allocation and community outreach-to promote health equity and improve access to and quality of dental care among residents of color.
Successful medical-dental integration is key to achieving children's health equity. In 2015, a community health center (CHC) in Boston, Massachusetts, implemented a model of interdisciplinary care in a nationwide pilot. Based on the Oral Health Delivery Framework, pediatricians were trained to assess dental caries risk and apply fluoride varnish. They were trained to offer education materials to patients, incorporate oral health assessment in pediatric practice, and document preventive dental care in the electronic health record. This study assessed the level of medical-dental integration achieved by the pilot and maintained over 2 years after program implementation.

Deidentified data were provided by the CHC on all well-child visits during 2014 to 2018 for children 72 months or younger, including appointment dates, age, ethnicity, race, insurance status, and outcomes of interest (ie, whether a dental assessment was performed and whether fluoride varnish was applied). Outcomes were stratified by visit yea(2016) and by at least 5% from 2016 to 2018. The success of this medical-dental integration pilot underscores the need for broader implementation of interprofessional education and practice to promote children's health equity.Arbitrarily cordoning off the mouth from the rest of the body is the educational approach that, since 1840, has been responsible for the medical-dental schism that persists today, preventing oral health's integration with overall health. This divide has also thwarted oral disease prevention initiatives, access to services, and health equity. This article offers an educational plan for reunifying medicine and dentistry, which involves interprofessional education, dual degree training, integrating oral health into medical education, and integrated residency training.Most medical schools and primary care residency programs do not teach proper oral examination skills. Despite the existence of proven national oral health curricula for medical professionals, many medical trainees and graduates are ill-equipped to identify oral cancers, make proper referrals, avoid unnecessary referrals, or help patients focus on oral disease prevention. This commentary on a case suggests the importance of educating clinicians to promote and evaluate patients' oral health and proposes curricula for and reasonable scope of such training.The division between medical and dental care exacerbates health inequity and forces many with compromised access to seek oral health care in emergency departments (EDs). Since dentists are best positioned to offer quality care for most patients' oral health problems, this commentary on a case suggests why ED clinicians should offer appropriate oral health referrals and resources to those they serve and why all health professionals should advocate for systems-level policy and organizational changes to increase patients' access to oral health care.Dental treatment is contraindicated by some health conditions. As patients live longer and dentists treat more patients with underlying disease, patients often need general medical care before dental care can proceed. For US patients without access to health care and their dentists, lack of medical-dental integration can generate inequity, poor outcomes, and ethical questions. Individual dentists should advocate for patients who need general health care prior to dental care, but the professions of dentistry and medicine must also respond to macro-level health system gaps and failures.Astrocytes are the second most abundant cell type in the central nervous system and serve various functions, many of which maintain homeostasis of the intracellular milieu in the face of constant change. In order to accomplish these important functions, astrocytes must regulate their cell volume. In astrocytes, cell volume regulation involves multiple channels and transporters, including AQP4, TRPV4, TRPM4, VRAC, Na+/K+ ATPase, NKCC1 and Kir4.1. AQP4 is a bidirectional water channel directly involved in astrocyte cell volume regulation. AQP4 also forms heteromultimeric complexes with other channels and transporters involved in cell volume regulation. TRPV4, a mechanosensitive channel in involved in osmotic regulation in various cell types, forms a complex with AQP4 to decrease cell volume in response to cell swelling. TRPM4 also forms a complex with AQP4 and SUR1 in response to injury resulting in cell swelling. Another complex forms between Na+/K+ ATPase, AQP4, and mGluR5 to regulate the perisynaptic space. NKCC1 is a co-transporter involved in cell volume increases either independently through cotransport of water or a functional interaction with AQPs. VRAC is implicated in regulatory volume decreases and may also functionally interact with AQP4. Although Kir4.1 colocalizes with AQP4, its role in cell volume regulation is debated. In diseases where fluid/electrolyte homeostasis is disturbed such as stroke, ischemic injury, inflammation, traumatic brain injury and hydrocephalus, cell volume regulation is challenged, sometimes past the point of recovery. Thus, a greater understanding of signaling pathways which regulate transport proteins as well as the functional and physical interactions that exist between transporters will provide a basis for the development of pharmaceutical targets to treat these prevalent and often devastating diseases.
Since cell lines are cultured and extensively used in a variety of different research disciplines, we determined the effects of passage numbers on a commonly used embryonic zebrafish cell line (Z3).

Senescence markers, DNA damage, the redox state, gene expression, and metabolic parameters have been investigated in young (passage 5) up to very old (passage 40 and higher) cells.

Besides increasing DNA damage, we also found elevated metabolic capacity and a shift to a more reduced cellular redox state in the cells. Interestingly, several parameters showed a non-linear course regarding the passage number or cell age, so that for example young and mid-aged cells appeared to cluster with very old rather than with old cells.

This study illustrates the importance of passage number and suggests pre-testing specific parameters to assure the generation of accurate and reproducible data.
This study illustrates the importance of passage number and suggests pre-testing specific parameters to assure the generation of accurate and reproducible data.Most cis-prenyltransferases (cPTs) use all-trans-oligoprenyl diphosphate, such as (E,E)-farnesyl diphosphate (FPP, C15 ), but scarcely accept dimethylallyl diphosphate (DMAPP, C5 ), as an allylic diphosphate primer in consecutive cis-condensations of isopentenyl diphosphate. Consequently, naturally occurring cis-1,4-polyisoprenoids contain a few trans-isoprene units at their ω-end. However, some Solanum plants have distinct cPTs that primarily use DMAPP as a primer to synthesize all-cis-oligoprenyl diphosphates, such as neryl diphosphate (NPP, C10 ). However, the mechanism underlying the allylic substrate preference of cPTs remains unclear. In this study, we determined the crystal structure of NDPS1, an NPP synthase from tomato, and investigated critical residues for primer substrate preference through structural comparisons of cPTs. Highly conserved Gly and Trp in the primer substrate-binding region of cPTs were discovered to be substituted for Ile/Leu and Phe, respectively, in DMAPP-preferring cPTs. An I106G mutant of NDPS1 exhibited a low preference for DMAPP, but a higher preference for FPP.
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