Tobacco smoke makes germs more resilient

UofL dental researcher explores microbiological mechanisms as World Health Organization urges for a day of abstinence from tobacco use

University of Louisville- logoThe mouth is one of the dirtiest parts of the body, home to millions of germs. But puffing cigarettes can increase the likelihood that certain bacteria like Porphyromonas gingivalis will not only set up camp but will build a fortified city in the mouth and fight against the immune system.

University of Louisville School of Dentistry researcher David A. Scott, Ph.D., explores how cigarettes lead to colonization of bacteria in the body. Scott and his research team have identified how tobacco smoke, composed of thousands of chemical components, is an environmental stressor and promotes bacteria colonization and immune invasion.

Scott says since this initial finding several years ago, a recent literature review published in Tobacco Induced Diseases revealed that cigarette smoke and its components also promote biofilm formation by several other pathogens including Staphylococcus aureus, Streptococcus mutans, Klebsiella pneumonia and Pseudomonas aeruginosa.

Biofilms are composed of numerous microbial communities often made up of complex, interacting and co-existing multispecies structures. Bacteria can form biofilms on most surfaces including teeth, heart valves and the respiratory tract.

“Once a pathogen establishes itself within a biofilm, it can be difficult to eradicate as biofilms provide a physical barrier against the host immune response, can be impermeable to antibiotics and act as a reservoir for persistent infection,” Scott said. “Furthermore, biofilms allow for the transfer of genetic material among the bacterial community and this can lead to antibiotic resistance and the propagation of other virulence factors that promote infection.”

One of the most prevalent biofilms is dental plaque, which can lead to gingivitis – a gum disease found in almost half the world’s population – and to more severe oral diseases, such as chronic periodontitis. Bacterial biofilms also can form on heart valves resulting in heart-related infections, and they also can cause a host of other problems.

“We are continuing research to understand the interactions of the elaborate communities within biofilms and how they relate to disease. Many studies have investigated biofilms using single species, but more relevant multispecies models are emerging. Novel treatments for biofilm-induced diseases also are being investigated, but we have a long way to go,” Scott said. 

Scott elaborates on this research in a short question and answer style blog published today on the BioMedCentral website.

Attention to Scott’s work comes as the World Health Organization observes World No Tobacco Day on May 31 to encourage a global 24-hour abstinence from all forms of tobacco consumption. The effort points to the annual 6 million worldwide deaths linked to the negative health effects of tobacco use.

In the United States, Kentucky ranks second for cigarette use among adults, according the Centers for Disease Control and Prevention (CDC). Only West Virginia has more smokers. Kentucky also brings up the rear among youth in grades 9-12 who use tobacco; according to 2011 CDC data, about 24-percent of high school students smoke cigarettes.

FDA to require boxed warnings on opioid medications

FDA to require boxed warnings on opioid medications

 

March 22, 2016 Rockville, Md. — As part of the government's commitment to ending the U.S. opioid epidemic, the Food and Drug Administration announced March 22 major label changes for all prescription opioid products, including new boxed warnings about the serious risks of misuse, abuse, addiction, overdose and death.

The FDA also said it will require several more safety labeling changes to include additional information on the risk of these medications as part of the agency's efforts to "help inform prescribers about the importance of balancing the serious risks of opioids with their role in managing pain," according to an FDA release.

"Opioid addiction and overdose have reached epidemic levels over the past decade, and the FDA remains steadfast in our commitment to do our part to help reverse the devastating impact of the misuse and abuse of prescription opioids," said Robert Califf, M.D., FDA commissioner. "Today's actions are one of the largest undertakings for informing prescribers of risks across opioid products, and one of many steps the FDA intends to take this year as part of our comprehensive action plan to reverse this epidemic."

Opioid pain medications, such as hydrocodone and oxycodone, are a leading source of drug abuse in the United States. As prescribers of these painkilling medications, the ADA believes dentists have a role to play in preventing their diversion, misuse, and abuse. The ADA has long encouraged continuing education about the appropriate use of opioid pain medications in order to promote both responsible prescribing practices and limit instances of abuse and diversion.

According to FDA, prescription opioids are divided into two main categories: immediate release products intended for use every four to six hours; and extended-release/long-acting products, which are primarily intended to be taken once or twice a day.

As part of the boxed warning on IR opioid analgesics, the FDA now requires a precaution that chronic maternal use of opioids during pregnancy can result in neonatal opioid withdrawal syndrome, which may be life-threatening if not recognized and treated using protocols developed by neonatology experts.

Additionally, in the March 22 Drug Safety Communication, FDA outlined its plans to require labels to include safety information about opioids and their potentially harmful drug interactions with other medicines. This includes a serious central nervous system condition called serotonin syndrome as well as information on the effects opioid abuse can have on the endocrine system, including a rare but serious disorder of the adrenal glands and decreased sex hormone levels androgen deficiency.

The agency also said it is "carefully reviewing" all available scientific information about potentially serious outcomes related to interactions between benzodiazepines and opioids.

In October 2015, the White House announced a multi-agency initiative aimed at combatting opioid abuse and other forms of drug abuse. The Association has pledged to provide training on opioid prescribing in the next two years as part of the American Medical Association Task Force on this issue. To date, more than 66,000 providers have completed prescriber training, putting the task force on pace to meet that goal, according to the release.

For more information about opioids, including upcoming webinars and prescriber tips, visit ADA.org/opioids.