“Any mouthguard helps prevent injuries,” she said. “But no mouthguard can prevent injuries if it isn’t worn.”

Earlier this month, students at West High School benefited from Mendel’s expertise, as well as that of her colleagues and students in the Sports Dentistry Club. Twenty-five high school football players saw dental students who made molds of their mouths that will be turned into free, custom mouthguards. 

Players are more likely to wear mouthguards that fit well, Mendel said, and a custom mouthguard will have a more comfortable fit.  In addition to being more comfortable, the mouthguards have one more alluring feature.

“The dentistry students can put logos on them, names,” she said. “You can personalize it, which makes the mouthguard a little bit cooler. Hopefully they’ll want to wear them.”

Founded last year by third-year dentistry student Ethan Leonard and his classmate Logan Shope, the Sports Dentistry Club has only hosted one mouthguard event but plans to do more based on this year’s success. Community engagement is a pillar of the club’s mission.

“We wanted it to be educational and service-led,” he said. “We want to give back because dental school is such a privilege.”

West High School, part of the Columbus City Schools, has long needed upgrades for its sports teams. Resurrected in 2023, the school’s booster program has pitched in to raise money for athletic uniforms and facilities. In its first year, Sports Dentistry Club donated toothbrushes and so-called “bite and boil” mouthguards that West High players could mold at home.

Wanting to do more this year, Leonard organized the mouthguard event, which was held at Postle Hall. Cardinal Transportation, a local charter service, volunteered to drive the students to Ohio State’s campus.

Each West High student was assigned three dental students: one who made the mold, one who assisted and one who shepherded the high schooler from the lobby to the procedure room and back again. Mendel and four other faculty members oversaw the work.

“I was blown away by the camaraderie of the College of Dentistry,” Mendel said. “Faculty volunteered; students volunteered. We had staff that helped, too. It made me feel so good that everyone pitched in – that brought the school together.” 

The West High students enjoyed the event just as much, Leonard said.

“I didn’t expect that,” he said. “But they seemed to really enjoy it. We got a lot of ‘thank yous.’ It was neat to see that as a provider after playing high school sports myself.”

Commenting on the event’s success, Carroll Ann Trotman, the college’s dean, said, “I’m proud that our staff, faculty and students are pitching in to provide care for student-athletes at Columbus area schools. These are great opportunities for our students to help meet an important need and to have a positive impact on the lives of others.”

Trotman added, “This is just one example of what can be accomplished when the college community works together. I’m grateful to the Sports Dentistry Club members, to Dr. Mendel, and everyone who helped with this worthwhile effort.”

Leonard and Mendel agree that the club will host more mouthguard events in the future, focusing on area schools that may not have easy access to dentists.

This type of community work is important, Mendel said. Dentistry students get to hone a skill they’ll be using in their careers while they help student athletes stay healthy.

“You do hope that if they do it as a College of Dentistry student, it will carry over into their practices as well,” she said. “You want students to learn that skill but also to learn the philosophy.”

The small Ohio State University study also found that some people with the earliest COVID-19 infections were continuing to experience loss of these senses months later and didn’t even realize it.

In participants with active infections during the delta surge, a majority (22 of 25) had been vaccinated. Objective screenings found that 100% were experiencing a diminished or lost sense of smell – but only 54.5% self-reported any problem with odor detection.

“We’re getting this quick communication out as an early warning. We need to continue to take a closer look at COVID infection’s impact on smell and taste,” said Dr. Kai Zhao, associate professor of otolaryngology in Ohio State’s College of Medicine and senior author of the study. “Even if COVID doesn’t cause death or hospitalization, it can have long-lasting effects on some of our sensory functions.

“A lot of people are potentially suffering, which is probably not appreciated by society.”

The study is published in the journal Med.

Data for this study emerged from a project the researchers began in early 2021 to test the effectiveness of using hard candy as a screening tool for the loss of taste and smell in populations at risk for exposure to the SARS-CoV-2 virus.

As part of that work, the team used an existing objective screening tool to collect sensory function data from 123 never-infected control participants and 65 people who had previous or active COVID-19 infections. During the delta surge, the researchers became alarmed by what they found.

“At that time, there were a lot of speculations about whether smell loss is associated with the delta variant and whether the vaccine could protect against these symptoms. So we decided to do this interim data analysis,” Zhao said.

In addition, about three-fourths of participants whose mostly mild COVID infections had occurred before delta’s dominance reported no ongoing smell and taste losses – however, over half of those participants were found by the objective screening, conducted between 102 and 785 days after their infection diagnosis, to have a loss of smell. 

“Many people who had COVID in the past, probably with the original variants of the virus,  underwent some degree of smell loss, even if they didn’t think they did,” said co-author Susan Travers, professor of biosciences in Ohio State’s College of Dentistry. “This suggests the long-term impact on sensory function isn’t captured by self-reporting.”

Beyond these silent smell and taste losses, there were also people who reported that they hadn’t regained taste or smell function for longer than six months, said first author Kym Man, a graduate student in food science and technology. 

“We’re still collecting data on these long haulers, some of whom have been experiencing smell and taste loss for over a year,” she said. 

Effects on the senses include diminished or complete loss of smell and/or taste, disordered smell and/or taste and, least common, smelling odors that are not present at all. 

The sensory function screenings were conducted with a National Institutes of Health tool consisting of a 9-item scratch-and-sniff odor identifier and an intensity rating of bitterness in a sip of quinine. The odor-detection results were adjusted for age – in general, we lose some sensitivity to smell as we get older, Zhao said. 

Beyond affecting the quality of life, the loss of smell and taste has health ramifications that include negative effects on nutrition intake and a reduced ability to detect danger – such as a fire or spoiled food.

“The disease’s impact on smell and taste is underreported. This is a public health concern that there may potentially be some broader impacts of COVID-19 that we don’t realize are there,” Zhao said. 

Since submitting this article for publication in January 2022, the team has been consistently collecting data related to sensory loss and is paying particular attention to long haulers.

“There’s a substantial number of these people, and we want to characterize how long smell and/or taste loss lasts,” said co-author Christopher Simons, associate professor of food science and technology. “We’d also like to enroll them in the surveillance component of the candy screening study to see if we can track their recovery over time as well.” 

People interested in more information on the team’s ongoing study of hard candy’s effectiveness as a screening and surveillance tool can contact the researchers by emailing COVIDCandyTest@osu.edu. 

This work was supported by a grant from the National Institute for Deafness and Other Communication Disorders. Aayah Mohamed-Osman was also a co-author on the paper.

Ohio State University researchers assessed participants’ immune response to a typhoid vaccine, which was used in the study to stimulate the immune system in the same way unfamiliar disease-causing bacteria or viruses do.

The study measured same-day changes in inflammatory proteins and white blood cells that occurred during the women’s innate immune response – the first line of defense when an unrecognized substance invades the body. While all study participants produced the expected signs of inflammation after receiving the vaccine, three conditions led to a smaller response: previous chemo treatment, greater abdominal obesity, or belly fat, and a low fitness level.

The fitness-related findings, however, also showed that participants whose fitness level exceeded the average by just a bit – as measured by peak oxygen consumption during exercise – produced a significantly larger immune response. 

“As a group, breast cancer survivors, on average, have a lower level of fitness than their peers. In this study, women representing the average were in a low fitness category. Even within this group, moderate differences in fitness were associated with a better vaccine response,” said lead author Janice Kiecolt-Glaser, director of the Institute for Behavioral Medicine Research (IBMR), professor of psychiatry in the College of Medicine and a member of the Comprehensive Cancer Center at Ohio State.

“It’s important to tell breast cancer survivors, and others, that this doesn’t mean you have to be at an Arnold Schwarzenegger level of fitness to benefit innate immunity. Relatively mild fitness can make a difference in response to a vaccine, and probably in response to an infection in real life.”

The research is published in the journal Brain, Behavior, and Immunity.

Of the 158 postmenopausal participants, 108 had received chemo treatment between one and 10 years before the study began. Researchers assessed the women for central obesity based on abdominal fat composition and cardiorespiratory fitness level based on their maximum oxygen consumption while riding a stationary bike.

The uniform dose of the typhoid vaccine functioned as a model immune challenge, Kiecolt-Glaser said, which offered a window into how breast cancer survivors’ innate immunity would respond to a viral or bacterial pathogen. Participants received either the vaccine or placebo over the course of two visits – as expected, the vaccine produced a significantly higher inflammatory response than the placebo.

To gauge the participants’ natural immune response in the 7 1/2 hours after vaccination, researchers measured levels of two pro-inflammatory proteins, IL-6 and IL-1Ra, and white blood cells in blood draws taken every 90 minutes and compared them to pre-vaccination levels.

“We are born with innate immunity. As soon as you inject something that’s foreign, you’re going to stimulate these responses,” said study co-author John Sheridan, associate director of the IBMR and professor of biosciences in Ohio State’s College of Dentistry. “You need that inflammatory response, which is associated with immediate protection, to ultimately generate the other forms of the adaptive immune response.

“Anything that knocks down the early proinflammatory response puts you at risk for delayed development of adaptive immunity.”

The adaptive immune response is specific to invading pathogens and is carried out by neutralizing antibodies and specialized white blood cells called T cells and B cells.

After controlling for participants’ baseline differences in inflammatory markers, the results showed past chemo treatment, greater abdominal obesity and lower fitness were associated with lower IL-6 and white blood cell responses. Prior chemo had the strongest effect – generating 44% and 35% lower levels of IL-6 and white blood cells, respectively, than levels produced by participants who did not receive chemo. This effect was consistent, regardless of how long ago the women had undergone treatment 

More promising, however, were results showing that a fitness level just slightly above the average increased IL-6 and the white blood cell count by at least 33%.

Kiecolt-Glaser said the study has important public health implications: greater awareness that innate immunity against infections may be reduced in breast cancer survivors even 10 years out from chemo treatment, and the health upside for just about anybody of engaging in a daily walk – or even sitting less.

“The paper gives us more data in terms of why cancer survivors may have additional risks,” she said. “And the findings send a clear message of just how important physical activity and minimizing belly fat is for robust immune function among breast cancer survivors, and particularly for those who received chemotherapy.”

Kiecolt-Glaser also said that routine vaccinations, as recommended by a physician, are important for maximizing protective immunity in breast cancer survivors.

“Chemotherapy is life-saving for so many breast cancer patients, but there is a trade-off with some long-term side effects,” said Dr. Peter Shields, deputy director of the Comprehensive Cancer Center. “While we do not know if the immune effects in this study translate to actual later illness, exercise is an important antidote.”

This study was funded by the National Cancer Institute.

Trotman joins Ohio State from the Tufts University School of Dental Medicine, where she is associate dean for faculty development and chair of the Department of Orthodontics.  Subject to Board of Trustees approval, her five-year appointment will be effective Aug. 15, 2021.

Trotman will build on the achievements of the college’s current dean, Patrick M. Lloyd, who announced in November that he would be stepping down after his term ends in August. Throughout his decade of leadership, the College of Dentistry has continued its ascension as one of the nation’s outstanding dental schools.

“It’s a great honor to serve the College of Dentistry as dean, and I look forward to working with Dean Patrick Lloyd and my other colleagues as I prepare to join Ohio State,” Trotman said. “I am thrilled to be part of the president’s and provost’s bold vision for the college and university.”

Trotman has deep experience as an educator, clinician, researcher and academic leader focused on integrating clinical training, patient care, didactic education and research. Throughout her career, she has also demonstrated her commitment to faculty development and diversity and inclusion, Executive Vice President and Provost Bruce A. McPheron said in a statement announcing the appointment.

Specializing in the treatment and care of patients with cleft lip and palate, she is the principal investigator on two National Institutes of Health-funded grants through her Facial Animation Laboratory. Using three-dimensional modeling of facial soft tissues, she has developed measures that enable surgeons to more accurately assess facial soft tissue movements and, ultimately, to tailor corrective surgeries to individual patient needs. More recently, this research has been extended to assessing surgical outcomes in patients with facial paralysis.

Before joining Tufts, Trotman was a professor and associate dean for academic and student affairs at the University of Maryland School of Dentistry. Previously, she taught at the University of North Carolina School of Dentistry, serving as interim associate dean for academic affairs and then assistant dean for graduate education. She began her teaching career at the University of Michigan as an assistant professor of orthodontics.

Trotman is a diplomate of the American Board of Orthodontics, a fellow of the American College of Dentists and a fellow of the American Council on Education. She has authored more than 60 peer-reviewed journal articles and edited or contributed to nine books.

Trotman received her Bachelor of Dental Surgery degree from University of Dundee, Scotland, and her orthodontic certificate and MA in oral biology from Columbia University. She completed a fellowship in craniofacial anomalies at the Hospital for Sick Children in Toronto. She earned an MS in clinical research design and statistical analysis from the Horace Rackham School of Graduate Studies at the University of Michigan.

SARS-CoV-2 spreads mainly through respiratory droplets, and dental procedures are known to produce an abundance of aerosols – leading to fears that flying saliva during a cleaning or a restorative procedure could make the dentist’s chair a high-transmission location.

Ohio State University researchers set out to determine whether saliva is the main source of the spray, collecting samples from personnel, equipment and other surfaces reached by aerosols during a range of dental procedures.

By analyzing the genetic makeup of the organisms detected in those samples, the researchers determined that watery solution from irrigation tools, not saliva, was the main source of any bacteria or viruses present in the spatter and spurts from patients’ mouths.

Even when low levels of the SARS-CoV-2 virus were detected in the saliva of asymptomatic patients, the aerosols generated during their procedures showed no signs of the coronavirus. In essence, from a microbial standpoint, the contents of the spray mirrored what was in the office environment.

“Getting your teeth cleaned does not increase your risk for COVID-19 infection any more than drinking a glass of water from the dentist’s office does,” said lead author Purnima Kumar, professor of periodontology at Ohio State.

“These findings should help us open up our practices, make ourselves feel safe about our environment and, for patients, get their oral and dental problems treated – there is so much evidence emerging that if you have poor oral health, you are more susceptible to COVID,” Kumar said.

The study was published Wednesday, May 12, in the Journal of Dental Research.

Previous research has shown that dental-procedure aerosols tend to land on providers’ faces and the patient’s chest, and can travel as far as 11 feet. But the studies, catching the spray in petri dishes placed on people, equipment and around the room, found only that bacteria existed – they rarely identified the organisms and never determined where they came from. Saliva has been the presumptive source for a long time.

When saliva was considered potentially deadly at the start of the pandemic, Kumar decided a long-term answer was needed to settle the question of whether saliva is the source of dental aerosols.

For the study, the team enrolled 28 patients receiving dental implants and restorations using high-speed drills or ultrasonic scaling procedures in Ohio State’s College of Dentistry between May 4 and July 10, 2020. Researchers collected samples of saliva and irrigant (the water-based cleaning solutions used to flush out the mouth) before each procedure and, 30 minutes after the procedure, aerosol remnants – condensate – from providers’ face shields, the patient’s bib and an area 6 feet away from the chair.

Kumar and colleagues then put genome sequencing technology to use that wasn’t available in the petri-dish days. This allowed them to first characterize the microbial mix in pre-procedure saliva and irrigants, which they could then compare to organisms in the aerosol samples collected later.

With the analytical method they used, the researchers did not need to characterize the microbes – they instead looked for variations in sequences that provided enough information to identify the family of bacteria or viruses to which they belonged.

“Some species that live in your mouth can closely resemble those in water and the environment. Using this method, we don’t even have to know the names of these organisms – you can tell whether they are exactly genetically identical or genetically different,” Kumar said. “If you use this granular approach to see these very nuanced differences in the genetic code, you can very accurately identify where they’re coming from.”

No matter the procedure or where the condensate had landed, microbes from irrigants contributed to about 78% of the organisms in aerosols while saliva, if present, accounted for 0.1% to 1.2% of the microbes distributed around the room.

Salivary bacteria were detected in condensate from only eight cases and of those, five patients had not used a pre-procedural mouth rinse. The SARS-CoV-2 virus was identified in the saliva of 19 patients, but was undetectable in aerosols in any of the cases.

The findings are reassuring, but also make sense, Kumar said: Irrigant dilutes saliva – a “thick, viscous” substance – by an estimated 20- to 200-fold, and the research is validated by a 2020 study that reported a less than 1% COVID-19 positivity rate among dentists.

Kumar noted that dentistry has long been at the forefront of infection-control practices in health care. During the pandemic, new protocols have included strengthened ventilation systems, extra aerosol suction equipment, N95 masks and face shields on top of goggles, and extended downtime between patients. She is hopeful this study’s findings will make practitioners and patients feel at ease about being in the dentist’s office – with continued stringent protection in place.

“Dental surgeons and hygienists are always at the forefront of the war against bacteria in the mouth, and they of course did not feel safe because they are front-line workers surrounded by aerosol,” said Kumar, who has a periodontology practice of her own and was one of the procedure operators in the study.

“Hopefully this will set their mind at rest because when you do procedures, it is the water from the ultrasonic equipment that’s causing bacteria to be there. It’s not saliva. So the risk of spreading infection is not high,” she said. “However, we should not lose sight of the fact that this virus spreads through aerosol, and speaking, coughing or sneezing in the dental office can still carry a high risk of disease transmission.”

Co-authors of the study include Archana Meethil, Shwetha Saraswat and Shareef Dabdoub of Ohio State and Prem Prashant Chaudhary of the National Institute of Allergy and Infectious Diseases.

The healthy human oral microbiome consists of not just clean teeth and firm gums, but also energy-efficient bacteria living in an environment rich in blood vessels that enables the organisms’ constant communication with immune-system cells and proteins.

A growing body of evidence has shown that this system that seems so separate from the rest of our bodies is actually highly influential on, and influenced by, our overall health, said Purnima Kumar, professor of periodontology at The Ohio State University, speaking at a science conference this week.

For example, type 2 diabetes has long been known to increase the risk for gum disease. Recent studies showing how diabetes affects the bacteria in the mouth help explain how periodontitis treatment that changes oral bacteria also reduces the severity of the diabetes itself.

Connections have also been found between oral microbes and rheumatoid arthritis, cognitive abilities, pregnancy outcomes and heart disease, supporting the notion that an unhealthy mouth can go hand-in-hand with an unhealthy body.

“What happens in your body impacts your mouth, and that in turn impacts your body. It’s truly a cycle of life,” Kumar said.

When the American Association for the Advancement of Science (AAAS) themed this year’s annual meeting around dynamic ecosystems, Kumar saw an opportunity to put the mouth on the map, so to speak, as a vibrant microbial community that can tell us a lot about ourselves.

“What is more dynamic than the gateway to your body – the mouth? It’s so ignored when you think about it, and it’s the most forward-facing part of your body that interfaces with the environment, and it’s connected to this entire tubing system,” she said. “And yet we study everything but the mouth.”

Kumar organized a session at the AAAS meeting today (Feb. 8, 2021) that she titled “Killer Smile: The Link Between the Oral Microbiome and Systemic Diseases.”

The oral microbiome refers to the collection of bacteria – some helpful to humans and some not – that live inside our mouths.

Kumar has led and collaborated on recent research further explaining the link between oral health and type 2 diabetes, which was first described in the 1990s. She was the lead author of a 2020 study that compared the oral microbiomes of people with and without type 2 diabetes and how they responded to nonsurgical treatment of chronic periodontitis.

The team found that periodontitis allows bacteria – rather than the human host – to take the reins in determining the mix of microbes and inflammatory molecules in the mouth. Treating the gum disease led to eventual restoration of a normal host-microbiome relationship, but it happened more slowly in people with diabetes.

“Our studies have led up to the conclusion that people with diabetes have a different microbiome from people who are not diabetic,” Kumar said. “We know that changing the bacteria in your mouth and restoring them back to what your body knows as healthy and friendly bacteria actually improves your glycemic control.”

Though there remains a lot to learn, the basics of these relationship between the oral microbiome and systemic disease have become clear.

Oral bacteria use oxygen to breathe and break down simple molecules of carbohydrates and proteins to stay alive. Something as simple as not brushing your teeth for a few days can set off a cascade of changes, choking off the oxygen supply and causing microbes to shift to a fermentative state.

“That creates a septic tank, which produces byproducts and toxins that stimulate the immune system,” Kumar said. An acute inflammatory response follows, producing signaling proteins that bacteria see as food.

“Then this community – it’s an ecosystem – shifts. Organisms that can break down protein start growing more, and organisms that can breathe in an oxygen-starved environment grow. The bacterial profile and, more importantly, the function of the immune system changes,” she said.

The inflammation opens pores between cells that line the mouth and blood vessels get leaky, allowing what have become unhealthy bacteria to enter circulation throughout the body.

“The body is producing inflammation in response to these bacteria, and those inflammatory products are also moving to the bloodstream, so now you’re getting hammered twice. Your body is trying to protect you and turning against itself,” Kumar said. “And these pathogens are having a field day, crossing boundaries they were never supposed to cross.”

The exact mechanisms of the links between the oral microbiome and specific diseases are complex and still being investigated, but the secret to a healthy mouth is no secret at all: Prevention of oral disease is as simple as brushing and flossing, and visiting the dentist twice a year for a professional cleaning, Kumar said.

The Office of the U.S. Surgeon General announced in 2018 that it had commissioned an update to its 2000 report on oral health, which was the first to be published on the topic.

Kumar said the national emphasis on oral health as an integral element of overall well-being bolsters her argument that the mouth should be an “equal opportunity player” in determinants of health.

“Putting the mouth back into the body – that’s my goal here,” she said.

The Ohio State University research team received $305,000 in National Institutes of Health funding in a competitive bid to develop easy-to-deploy strategies that can identify people who are potentially infected with SARS-CoV-2.

While symptoms like fever, chills, a cough and body aches vary widely among COVID-19 patients, an estimated 86% of people who test positive report a loss of smell, “which makes it a much better predictor, especially if it’s sudden loss,” said project co-leader Christopher Simons, associate professor of food science and technology at Ohio State.

Eight flavors of hard candies that are uniform in color will be manufactured for the test of the method’s effectiveness. Asking people to identify flavors by smelling and tasting the candies allows for sophisticated assessment of the function of two routes – via the nose and the back of the throat – by which our sense of smell helps tell us what we’re eating, Simons said.

Plus, the sweet treat is hard to resist as a scientific screening tool.

“Who doesn’t like candy? It’s an ideal stimulus because for this to work, people have to want to do it,” he said.

Simons’ lab in the College of Food, Agricultural and Environmental Sciences focuses on understanding the neural and physiological underpinnings of how we perceive food. The research team also includes taste biologist Susan Travers, professor of biosciences in the College of Dentistry, and Kai Zhao, associate professor of otolaryngology in the College of Medicine, who specializes in olfaction – the sense of smell. The new funding is a competitive revision to one of Travers’ existing NIH grants.

Simons has personal experience with COVID-19 symptoms. His entire family tested positive for SARS-CoV-2 in March after a trip to Spain before the borders closed. As his family raved about how good the Spanish food tasted, Simons was less impressed. But it wasn’t until he couldn’t detect the flavor of his cocktail back in Columbus that he realized he had lost his sense of smell – which ended up being his only symptom.

If this method is adopted as a screening strategy, it would complement existing tools for this purpose: a scratch-and-sniff card for smell and/or a one-time evaluation of the bitter medication quinine for taste, both of which are more expensive than candy (less than 5 cents for a piece of candy versus more than 50 cents per scratch-and-sniff card). The first phase of the Ohio State project is validating the use of candy against those established methods. Preliminary assessments have been promising.

“Quinine isn’t long-term. No one will sip on that every day,” Simons said. “We see factors that potentially indicate our method will be a long-term effective tool for long-term tracking of sensitivity.”

That long-term tracking occurs in the project’s second phase, when the team plans to follow about 2,800 people for 90 days. Ohio State students are the primary recruitment target for the study.

Participants will be asked to sniff and consume a piece of hard candy once per day and log into an app to report what they smell and taste – not only by identifying the flavor, but also rating its intensity. If they report a sudden drop in either sense, they’ll receive a message that they should quarantine and get a COVID-19 test.

Using candy will activate both the orthonasal (through the nose) and retronasal (through the back of the throat) sense of smell pathways that allow us to know what we’re tasting. Those two pathways give us a more nuanced sense of what we’re consuming than what the taste buds on our tongues actually “taste,” which are sweet, sour, salty, bitter and savory “flavors.”

“Theoretically, it’s possible that you could have some smell loss that’s more or less prominent in the orthonasal or retronasal condition that you would miss if you were only doing scratch and sniff for detection,” Simons said.

“With our assessment, you unwrap the candy and smell it to assess orthonasal olfaction, and pop it into your mouth to rate how strong the flavor is, assessing the retronasal component. You also assess sweetness and sourness, which is the taste component. It allows us to tackle three different aspects of flavor perception.”

Though the researchers have hypothesized that both olfactory pathways are affected by SARS-CoV-2, their first order of business is providing what the NIH is looking for: “a fairly simple, inexpensive and deployable technology to support public health,” Simons said.

The collection of oral bacteria in daily e-cigarette users’ mouths is teeming with potent infection-causing organisms that put vapers at substantial risk for ailments ranging from gum disease to cancer, researchers found.

Though they didn’t have active disease, participants’ oral bacteria composition resembled that of people with periodontitis, a gum infection that can lead to tooth loss and, left untreated, is a risk factor for heart and lung disease.

The damaging effects were seen with or without nicotine, leading the scientists to believe that the heated and pressurized liquids in e-cigarette cartridges are likely the key culprit in transforming vapers’ mouths into a welcoming home for a dangerous combination of microbes.

“Vaping is such a big assault on the oral environment, and the change happens dramatically and over a short period of time,” said Purnima Kumar, professor of periodontology at The Ohio State University and senior author of the study.

Even longtime current and former cigarette smokers in the study, whose tobacco habit would have given disease-causing microbes easier access to the mouth, had the more damaging oral profiles linked to vaping after only three to 12 months of e-cigarette use. Kumar said this finding calls into question claims that vaping reduces the harm caused by smoking.

“If you stop smoking and start vaping instead, you don’t move back toward a healthy bacterial profile but shift up to the vaping profile,” she said. “Knowing the vaping profile is pathogen-rich, you’re not doing yourself any favors by using vaping to quit smoking.”

The research is published today (May 27) in the journal Science Advances.

The researchers collected plaque samples from under the gums of 123 people who showed no current signs of oral disease: 25 smokers, 25 nonsmokers, 20 e-cigarette users, 25 former smokers using e-cigarettes and 28 people maintaining both cigarette smoking and vaping habits at the same time.

The bacteria below the gums are the last line of defense against disease because they are the least likely to be disrupted by environmental changes in the mouth, such as food, toothpaste and tobacco.

Kumar and colleagues conducted DNA deep sequencing of the bacteria genomes to identify not just the types of microbes living in those mouths, but also what their functions were.

The profile of the oral microbiome in the vapers who had never smoked, who were young (age 21-35) and healthy and had used e-cigarettes for four to 12 months, was startling to the researchers.

The most concerning characteristics were the levels of stress in the microbial community, which were detected by the activation of genes that contribute to the creation of a mucus-like slime layer surrounding bacterial communities. The immune system is used to seeing assembled bacteria look like clearly defined communities, but Kumar said that in e-cigarette users, these communities cloaked in slime look like foreign invaders and trigger a destructive inflammatory response.

She said this change in the microbial landscape – accompanied by higher levels of proteins in vapers’ mouths that signaled the immune system was on standby to activate and produce inflammation – exponentially increases the likelihood for disease.

“The reason we’re all healthy is because our immune system has recognized these bacteria and their functions since birth and has established a sense of harmony,” Kumar said. “The problem is when you throw a curve ball with an environmental shift like this, your immune system doesn’t recognize the bacteria as friends anymore. You have to call the police on them, and that causes a huge inflammatory response.”

After that finding, Kumar and colleagues hoped to find that people who had replaced or supplemented cigarette smoking with vaping might be better off using e-cigarettes. Instead, they found that people who had traded cigarettes for a vape pen had a more vape-driven microbial profile.

“And if you smoked and vaped at the same time, which of these two effects overwhelms your system? It was vape,” Kumar said.

A longer duration of the vapers’ habit, with or without the use of nicotine or flavoring agents, made the oral conditions more severe.

Knowing the bacteria samples represented a snapshot of a person’s oral environment, the scientists used a “fake mouth” to validate what they had found in the human participants. They created conditions simulating normal oral bacteria in artificial saliva and introduced a vape cloud or clean air to the fake mouth.

The presence of e-cigarette aerosol set in motion development of the more harmful bacterial profile seen in human vapers’ mouths. And the nicotine-free aerosol consisting of glycerol and glycol, viscous sugar alcohol fluids that generate the cloud when vapers exhale, functioned as a nutrition source to fuel the altered oral environment.

“To mimic a smoking effect, the glycerol-glycol combination holds the nicotine to your throat to give you that sensation of a nicotine hit, and it produces a giant vapor cloud. It’s a very essential component of vaping,” Kumar said. “I’m not saying nicotine is good for you. But even without the nicotine, vaping has a pretty large impact on the bacterial communities our bodies have regarded as friends.”

This work was supported by grants from the National Institutes of Health and the U.S. Food and Drug Administration.

Co-authors include first author Sukirth Ganesan, a former graduate student in Kumar’s lab and now an assistant professor at the University of Iowa, and Shareef Dabdoub, Haikady Nagaraja, Michelle Scott, Surya Pamulapati, Micah Berman, Peter Shields and Mary Ellen Wewers, all at Ohio State.

Health systems worldwide have struggled because of the critical shortage of test kit components, including the swabs used to collect samples and the sterile solution needed to transport the swabs. The testing kits include the swabs and vials filled with a liquid called viral transport media (VTM).

Recognizing the threat, a rapidly assembled team of Ohio State researchers worked overnight and, within 24 hours, created an in house “recipe” to make the crucial VTM. Essentially, it’s a salt solution buffered in the way necessary to stabilize the virus.

In addition, the Ohio State Wexner Medical Center and Ohio State’s Center for Design and Manufacturing Excellence, Infectious Diseases Institute and Institute for Materials Research collaborated with a national consortium that rapidly deployed a design and testing program for 3D printed testing swabs.

Ohio State is part of the academic-industry-government consortium led by Harvard that designed the swabs. Ohio State’s College of Dentistry and Battelle are also involved in this project, along with doctors and nurses from Ohio State’s Emergency Department and COVID-19 testing tents who volunteered as test subjects to confirm the new swab as an adequate collection device.

Ohio State is partnering with several outside firms in Ohio to create the 3D printed swabs. By mid-April, the first order of 3D printed swabs for COVID-19 test kits will be delivered to Ohio State to be shared with hospitals across Ohio, allowing more people to be tested. Ohio State will continue to work on eliminating swab manufacturing and design constraints through a rapid product development cycle, including clinical testing.

“We’re fortunate to have the scientists and the resources at Ohio State’s seven health sciences colleges and across campus to create these vital materials and to be able to serve other hospital systems in Ohio and around the country that need them,” said Dr. Hal Paz, executive vice president and chancellor for Health Affairs at Ohio State and CEO of the Ohio State Wexner Medical Center. “This is what Buckeyes do. We collaborate to solve society’s biggest problems. We’re all in this together.”

In mid-March, Peter J. Mohler, vice dean of research at The Ohio State College of Medicine and director of the Dorothy M. Davis Heart and Lung Research Institute, asked a diverse team of immunologists, microbiologists, pathologists and pharmacists to create this new solution. He asked Jacob Yount in the Department of Microbial Infection and Immunity to lead the project.

Yount found a Centers for Disease Control and Prevention recipe that he and Ana Sarkar, an assistant professor in the Department of Internal Medicine, and Amit Sharma, assistant professor of veterinary biosciences, were able to re-create in the lab. Yount’s research team shared the VTM with the pathology department for quality-control testing and the pharmacy team for packaging in sterile tubes. The supply chain department distributed these to the testing sites and emergency departments for use. The lab has continued to expand to produce VTM for health care teams around the state.

Each test kit uses about 3ml (a little more than half a teaspoon) of VTM. Ohio State has created more than 100 liters of VTM, which is enough for up to 30,000 test kits, Mohler said. Ohio State continues to use commercially produced VTM when it is available, but it’s still in short supply.

“Because of this new viral transport media, thousands of people will be tested for COVID-19 who otherwise would have had no other option,” said Dr. Andrew Thomas, chief clinical officer at the Ohio State Wexner Medical Center. He said that sharing the VTM recipe and the actual solution with other health systems is key to making testing more widely available.

“This has been a team effort across the medical center, university and our colleagues across the state. The coronavirus crisis has mobilized the scientific community, and I’m pleased to see how quickly we’re exchanging ideas of what works and what doesn’t work,” Mohler said.

For example, last month Ohio State Wexner Medical Center and Battelle announced a jointly developed new rapid, sensitive diagnostic test for COVID-19. The Ohio State Wexner Medical Center is administering the new test in alignment with FDA guidelines. The new rapid test allows for substantially faster turnaround time on test results and increased processing volume, which will help “flatten the curve.”

“Researchers at Battelle and Ohio State continue to work each day to refine the testing platform to increase accuracy, speed and capacity. Testing will continue to be critical both during the surge and the immediate future,” Mohler said.

Another example of ingenuity and creativity involves new protective plastic shields for use during intubation and extubation. Ohio State engineers, in collaboration with colleagues in the College of Medicine, have made the portable shields for use during intubation and other aerosol-generating procedures, helping to shield front-line providers. This device reduces the need for PPE during these procedures, conserving this vital equipment that’s in short supply nationwide.

Much more COVID-19 research is happening at Ohio State University, with almost 80 research projects underway across campus.

“As an academic health center, we have the unique ability to quickly move treatments and innovations from the lab to the bedside to help patients receive the most current treatments when they need it most,” Paz said. “This, combined with the unique collaborative culture of Ohio State and Columbus, has allowed us to accelerate these discoveries by leveraging all of our resources and talent around the common enemy of COVID-19.”

Ohio State will seek approval for the $155.9 million health sciences center during next week’s Board of Trustees meeting. Funding sources are to be determined. The project is poised to benefit colleges, including medicine, dentistry, nursing, optometry, pharmacy, public health and veterinary medicine, and strengthen the interdisciplinary curriculum of Ohio State.

“A healthier future demands health care leaders who are prepared to work together to address health challenges,” said Bruce A. McPheron, Ohio State’s executive vice president and provost. “Ohio State’s new health sciences education building is the place where students will become those leaders.”

The multiphase project advances Framework 2.0, the university’s long-term planning vision. It includes a 150,000-square-foot renovation of Hamilton Hall and construction of a new 100,000-square-foot building featuring flexible facilities to serve multiple disciplines. Program space will include:

• 33 interdisciplinary, state-of-the-art classrooms, each with new teaching technology, including virtual reality and enhanced anatomy and surgical practice labs
• 6,000-square-foot informal learning space
• 125-seat grand reading room

“Ohio State is in the process of creating a new model to replace the 100-year-old-plus model of academic medicine in use today,” said Dr. Hal Paz, executive vice president and chancellor for health affairs at Ohio State and Wexner Medical Center CEO. “This new academic health model takes advantage of the latest technology and brightest minds to educate professionals prepared to address the changing health needs of diverse populations. This is the key to building healthier communities.”

The Interdisciplinary Health Sciences Center will focus on inclusive work environments to create:

• Spaces for students in the health sciences to convene conversations and build team approaches to health care — a way to quickly assess patients’ needs and work with the right colleagues to design the best care plans for each individual.
• Opportunities for students to be at the forefront of innovation through modern technology — whether by using realistic virtual reality models to simulate patient care or learning how video chats, texting and other emerging “telehealth” innovations can help health care providers and patients stay in regular communication between in-person office visits.
• Warm and welcoming environments that support Ohio State’s work to build diverse communities of medical students. Research has shown that diversity in medicine — including increasing representation of women and people of color — leads to better health outcomes.

Design for the new Interdisciplinary Health Sciences Center began in August 2018. Pending board approval, construction could begin in October 2019, with completion targeted for late summer 2023.

Progress continues on a separate Health Sciences Faculty Office and Optometry Clinic at 11th and Neil avenues. The 106,000-square-foot building will be home to optometry clinics, retail spaces and faculty offices. The $35.9 million project is 60% of the way through steel work and targeting an October 2020 opening.

For more information about these projects and other major initiatives advancing Framework 2.0, visit Time and Change: Building the Future.