In addition to our regular CRI Activities Update, this month’s Research Focus highlights the research and work of Kimon Divaris, DDS, PhD, Associate Professor of Pediatric Dentistry.

Activities Update:

July 23rd marked the arrival of our new Department of Pediatrics Chair, Stephanie D. Davis, MD. Dr. Davis’ research interests focus on improving the understanding of the early pathogenesis of pediatric airway diseases such as cystic fibrosis, primary ciliary dyskinesia, and respiratory disease related to preterm birth. She is currently one of 3 PIs for a large Cystic Fibrosis Foundation-sponsored North American study evaluating the efficacy of hypertonic saline treatment in preschoolers with cystic fibrosis.  She brings with her a clinical trial for Oral Bacterial Extract (ORBEX), a 3-year study to identify if a daily capsule of Broncho-Vaxom (a combination of inactive bacterial extracts) prevents or delays young children from developing wheezing or asthma-like symptoms. For this study, UNC will serve as one of 10 sites recruiting children ages 5 through 18 months who have either eczema, a sibling with asthma or a parent with asthma. Dr. Davis has been part of the NIH-sponsored Genetic Disorders of Mucociliary Clearance Consortium, led by 2 UNC investigators, Drs. Mike Knowles and Margaret Leigh, for many years. Recently, Dr. Davis led this team of investigators in publishing longitudinal data highlighting the progression of lung disease in certain patients with primary ciliary dyskinesia who have distinct genotypes. Dr. Davis is now leading this team of investigators with Tom Ferkol, MD, of Washington University in St. Louis, Dr. Knowles and Dr. Leigh in the U54 renewal submission for the Genetic Disorders of Mucociliary Clearance Consortium of the Rare Diseases Clinical Research network. We are very excited to have her on board and engaging with research in the CRI!

July also marked our first team up with Durham Bulls to generate money for our CRI.  On July 13, the Bulls wore special autographed jerseys and hats to auction off, with all proceeds benefitting the UNC CRI.

Reminder: Kimon Divaris, DDS, PhD is presenting, “The Building Blocks of Precision Oral Health in Early Childhood,” at our next CRI monthly luncheon seminar series. The event will be held on Tuesday, August 14 from 12:15-1:30pm in the Koury Oral Health Sciences Building in room G411(****ROOM CHANGE****). The lecture room is on the ground floor of the building, behind the atrium and café seating to the left. Please mark your calendars. We look forward to seeing you there.

Research Focus of the Month:

Although largely preventable, dental caries remains the most common chronic childhood disease, more common than asthma, obesity, and diabetes. Kimon Divaris, DDS, PhD, is studying the etiology biological underpinnings and heterogeneity of dental disease in early childhood, using a mixture of epidemiologic and molecular methods to build and learn from a pediatric precision medicine cohort of over 6,000 pre-school age children.

Dr. Divaris is focused on early childhood caries (ECC), a common but complex disease affecting children under the age of 6 that results in dental caries and extraction. ECC, and dental caries in general, can be understood as an imbalance of demineralization-remineralization at the tooth surface-biofilm interface. This imbalance is driven by environmental (e.g., fluoride exposure), behavioral (e.g., consumption of sugars) and postulated genetic influences. From a pathogenetic standpoint, the disease is an oral biofilm dysbiosis—its existence and progression are unobservable until it manifests with irreversible impacts on the dentition. Its complex etiology and heterogeneous manifestations result from a convergence of social, behavioral and microbiological factors that make precision-based oral health care a necessity.

To address this knowledge gap in pediatric oral health and other health outcomes, Dr. Divaris and his collaborators, Kari North, PhD, a Professor of Epidemiology at the Gillings School of Global Public Health, Gary Slade, BDS, PhD, a Distinguished Professor of Dental Ecology at the School of Dentistry, Andrea Ferreira Zandoná, DDS, MSD, PhD, an Associate Professor of Operative Dentistry at the School of Dentistry, and John Preisser, PhD a Professor of Biostatistics at the Gillings School of Global Public Health aim to enroll approximately 6,000 preschool-age children across North Carolina in their precision health study called ZOE 2.0 “Genes for Smiles.” They use detailed clinical data on dental caries experience and leverage a wide array of biological (e.g., human DNA from saliva, oral biofilm DNA, RNA and metabolome) information to understand the genomic influences and biological pathways underlying the development of ECC, and ultimately refine the diagnosis and classification of ECC using more precise, biological information.

Dr. Divaris’ work is funded by the National Institute of Dental & Craniofacial Research ((NIH/NIDCR U01DE025046). Links to more information about Dr. Divaris, his work and a selection of publications and sources are listed below.

Divaris K. Fundamentals of precision medicine. Compend Contin Educ Dent. 2017 Sep;38(Spec Iss 2):31-33. PMID: 29227115.

Divaris K. Predicting caries outcomes among children: a “risky” concept. J Dent Res. 2016 Mar;95(3):248-54. PMID: PMID: 26647391.

Divaris K. Precision Dentistry in Early Childhood: The Central Role of Genomics. Dent Clin North Am. 2017 Jul;61(3):619-625.