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OBJECTIVES: Obstructive sleep apnea (OSA) is the most prevalent life-threatening sleeping disorder with adverse consequences. Tooth loss is a suggested morphologic risk factor for OSA with a scope of racial variation. The goal of this study is to examine the racial variations that different group experiences for the tooth loss-Obstructive Sleep Apnea relationship. METHODS: A cross-sectional study was done to assess the racial variation for the tooth loss-Obstructive Sleep Apnea relationship using data from the 2005–2006 and 2007–2008 cycles of NHANES. It included the sleep health questionnaire to identify the primary outcome variable, OSA, and received an oral health examination that counted the number of teeth. We chose to explore OSA using the OSA questions and summary OSA variables based on Sanders et al who used the STOP questionnaire including snoring, snorting/gasping daytime sleepiness, and hypertension based on signs and symptoms recommended by the Academy of Sleep Medicine. RESULTS: Non-Hispanic whites constituted the highest percentage of people with high-risk OSA based on the STOP questionnaire. They had the highest percentage of individuals responding ‘yes’ to the OSA component questions for snorting/gasping, daytime sleepiness, and having been told by a healthcare professional that they had a sleep disorder. After controlling for potential confounders, in our race/ ethnicity stratified models, Hispanics had lower odds of OSA for each additional tooth present. CONCLUSION: OSA is underdiagnosed in the US population, and in a consistent manner across various race categories. Dentists should consider identifying individuals who are currently underdiagnosed or undiagnosed and refer them to a specialist. The effects of tooth loss on OSA are stronger for Hispanics than for other races, hence Hispanics should be targeted since they have the lowest diagnosis rate.

When a patient comes to a dental office and needs a tooth replaced, there are a variety of approaches that can be used to remedy the problem. These solutions include using a bridge, dentures, or dental implants each coming with advantages and disadvantages. This thesis will focus specifically on dental implants, the newest of these techniques and highlight the history, advantages, patient risk factors, and complications that both patients and doctors should be aware before an implant procedure is performed. The concept of dental implants is not novel, and in fact it dates to ancient civilization. Items such as bamboo pegs, stones, seashells, animal bones, and other people’s teeth have all been used to fill the gap left by a missing tooth. As technology and our understanding of dentistry and medicine has advanced significantly over time, dental implants have become more popular today than at any other point in history. This is because implants have a very high success rate and have long term predictable outcomes for most patients. The main advantage implants have over other forms of tooth restoration is that osseointegration occurs when properly placed. This is where the bone grows on the implant securing it in place. Osseointegration enables bone to continue to remodel and prevents bone loss. This is not often seen in other forms of restoration. For osseointegration to occur, bone quality plays an integral role in the success. If the bone is not very dense, there is a higher rate of osseointegration not occurring, and fibrous tissue forming around the implant. This is a risk factor that is most often present in the posterior maxilla where the bone is less dense. Another risk factor for implant failure is smoking. Smoking slows healing and can lead to a higher rate of infection. Additionally, patient health complications can lead to implant failure. Patients who are on SSRIs or have a penicillin allergy have a higher rate of implant failure than those who are not on medication. Patients who are either obese, have well controlled diabetes, osteoporosis, or take bisphosphonates intraorally have a greater risk of complications such as peri-implantitis after an implant procedure. These conditions may or may not lead to a greater rate of implant failure, however, having them does not help with implant success. Since placing implants is an elective procedure, doctors should evaluate their patients to help mitigate any complications that may arise. Additionally, during surgery there can be surgical complications. These do not happen often but can occur. Post-surgery, if there is premature loading where the prothesis is placed on the implant before osseointegration fully occurs, or if there is inadequate prosthetic construction, both can lead to the implant moving and implant failure. The advantages implants provide such as longevity, comfort and aesthetic appeal make them an attractive option, so they are becoming more and more popular. Along with the advantages and risk factors of implants, this thesis will address the relevant factors that dentists must take into consideration prior to recommending implant surgery. This study should help to provide an overview of the current state of the field as well as where it will be heading in the future. In addition, it will provide considerations for clinicians to assist in making evidence-based decisions when guiding patients who are deciding between implants and other restoration approaches.

BACKGROUND: Oral squamous cell carcinoma is one of the most commonly found cancer and often metastasizes to bone. Bone-cancer models were developed throughout the years in order to replicate true bone-cancer relationships with dynamic 3D ex-vivo model utilizing calvarial bone displaying the closest relationship to natural bone cancer environment. AIM : to create a closer ex-vivo environment to study the relationship between bone and OSCC, utilizing the dynamic three-dimensional ex-vivo model in combination with the abundant vasculature from CAM. MATERIALS AND METHODS: Mice calvarial bone were extracted and incubated in roller tube then transferred to chicken chorioallantoic membrane. Experimental samples were introduced to oral squamous cell carcinoma prior to incubation. Samples were separated into bone resorption phenomenon and bone formation phenomenon by including ascorbic acid into the environment. Samples were collected at 7 and 14 days and was processed under histological analysis and fluorescent assay. RESULTS: Histological analysis showed that in both bone resorption and bone formation phenomenon, OSCC stimulate bone resorption process and causes bone necrosis with large mass of inflammatory cells. There is a significant reduction in OSCC in samples that were incubated in roller tube and chicken CAM compared to samples that were incubated in roller tube only. CONCLUSION: OSCC has the natural characteristic of osteoclasts similar to those findings for breast cancer cells. It also induced bone necrosis and data suggests OSCC may metastasize through the chick’s circulation to other embryo sites. Future investigations need to be conducted due to small sample size and high standard deviation.

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