Medicine and Health Sciences Commons^™

Feasibility Of Dose Escalation Using Intraoperative Radiotherapy Following Resection Of Large Brain Metastases Compared To Post-Operative Stereotactic Radiosurgery, John A. Vargo, Kristie M. Sparks, Rahul Singh, Geraldine M. Jacobson, Joshua D. Hack, Christopher P. Cifarelli

Clinical and Translational Science Institute

Background and purpose Post-operative SRS (stereotactic radiosurgery) for large brain metastases is challenged by risks of radiation necrosis that limit SRS dose. Intraoperative radiotherapy (IORT) is a potential alternative, however standard dose recommendations are lacking. Methods and materials Twenty consecutive brain metastases treated with post-operative SRS were retrospectively compared to IORT plans generated for 10–30 Gy in 1 fraction to 0–5 mm by estimating the applicator size and distance from critical organs using pre-operative and post-operative MRI. Additionally, 7 consecutive patients treated with IORT 30 Gy to surface were compared to retrospectively generated SRS plans using the post-operative MRI to …

Mesenchymal Cox2-Pg Secretome Engages Nr4a-Wnt Signalling Axis In Haematopoietic Progenitors To Suppress Anti-Leukaemia Immunity, Limei Wu, Surya Amarachintha, Jian Xu, Frank Oley Jr., Wei Du

Clinical and Translational Science Institute

The bone marrow (BM) microenvironment (niche) plays important roles in supporting normal/abnormal haematopoiesis. We investigated the interaction between leukaemic mesenchymal niche and haematopoietic stem and progenitor cells (HSPCs) using the model of Fanconi anaemia (FA), a genetic disorder characterized by BM failure and leukaemia. Healthy donor HSPCs co‐cultured on mesenchymal stromal cells (MSCs) derived from FA patients with acute myeloid leukaemia (AML) exhibited higher human engraftment and myeloid expansion in Non‐obese diabetic severe combined immunodeficiency IL‐2γ−/−/SGM3 recipients. Untargeted metabolomics analysis revealed the progressively elevated prostaglandins (PGs) in the MSCs of FA patients with myelodysplastic syndromes (MDS) and AML. Reduced secretion …

Out Of The Basement And Into The Classroom: Pathways For Expanding The Role Of Radiation Oncologists In Medical Student Education, Malcolm D. Mattes, William Small Jr., Neha Vapiwala

Clinical and Translational Science Institute

Purpose To characterize radiation oncologist involvement in undergraduate medical education at US academic medical centers and to incorporate these findings into practical pathways for greater and broader integration of radiation oncology (RO) into medical curricula. Methods Chairpersons and residency program directors at RO departments directly affiliated with a medical school were asked to describe all the ways in which radiation oncologists in their department are involved in medical student education, excluding their elective clerkship. Results Of 75 eligible departments, 49 responded (response rate 65.3%). Twenty departments (40.8%) reported that at least one faculty member participates in a curricular educational session …

Repeat Lactate Level Predicts Mortality Better Than Rate Of Clearance, Zachary D. W. Dezman, Angela C. Comer, Gordon S. Smith, Peter F. Hu, Colin F. Mackenzie, Thomas M. Scalea, Jon Mark Hirshon

Clinical and Translational Science Institute

Background Lactate clearance has been developed into a marker of resuscitation in trauma, but no study has compared the predictive power of the various clearance calculations. Our objective was to determine which method of calculating lactate clearance best predicted 24-hour and in-hospital mortality after injury. Study design Retrospective chart review of patients admitted to a Level-1 trauma center directly from the scene of injury from 2010 to 2013 who survived >15 min, had an elevated lactate at admission (≥3 mmol/L), followed by another measurement within 24 h of admission. Lactate clearance was calculated using five models: actual value of the …

Comparative Study Of Clinical Outcome Of Endovascular Aortic Aneurysms Repair In Large Diameter Aortic Necks (>31 Mm) Versus Smaller Necks, Ali F. Aburahma, Trevor Derderian, Zachary T. Aburahma, Stephen M. Hass, Michael Yacoub, L. Scott Dean, Shadi Abu-Halimah, Albeir Y. Mousa

Clinical and Translational Science Institute

Background This study compares short-term (30 days) and intermediate term (3 years) clinical outcomes in patients with large (≥31 mm) versus small aortic neck diameters (≤28 and ≤31 mm). Methods Prospectively collected data from 741 patients who underwent endovascular aortic aneurysm repair were analyzed. Some surgeons have reported the threshold for a large aortic neck for endovascular aortic aneurysm repair to be 28 mm, whereas for others it is 31 mm. Therefore, we classified aortic neck diameter into less than or equal to 28 versus greater than 28 mm; and less than or equal to 31 versus greater than 31 …

Mertk Is A Therapeutic Target In Combination With Radiation To Promote Adaptive Immune Tumor Responses, Garth Tormoen, Jason R Baird, Gwen Kramer, Shelly Bambina, Marka R Crittenden, Michael J. Gough

Society for Immunotherapy of Cancer 2018 Annual Meeting Posters

Background: Mertk is a member of the Tyro3-Axl-Mertk (TAM) family of receptors and regulates phagocytosis of dying cells by macrophages. Cancer cells killed by radiation therapy direct repolarization of macrophages into immune suppressive phenotypes. Mertk-/- mice grafted with immunogenic tumors have enhanced tumor control following ionizing radiation compared to Mertkwt mice. Gas6 is the endogenous ligand for Mertk and its ability to signal through Mertk requires a post-translational vitamin k-dependent modification that is inhibited by warfarin.

Methods: Mertk-/- and WT mice were injected subcutaneously in the flank with 5E4 CT26 cells (BALB/c) or 5E6 Panc02-SIY cells (C57BL/6) and allowed to …

Mv-626, A Potent And Selective Inhibitor Of Enpp1 Enhances Sting Activation And Augments T-Cell Mediated Anti-Tumor Activity In Vivo, Jason Baird, Gregory Dietsch, Vincent Florio, Michael Gallatin, Clayton Knox, Joshua Odingo, Marka Crittenden, Michael J. Gough

Society for Immunotherapy of Cancer 2018 Annual Meeting Posters

Background: STING is an endogenous sensor of cGAMP, which is synthesized by cGAS following detection of cytoplasmic DNA. STING activation leads to interferon production and activation of inflammatory pathways that facilitate cytolytic T cell priming. STING agonists administered intratumorally show potent anti-tumor efficacy in a range of preclinical models; several agonists are in clinical development. Radiation therapy also increases cytoplasmic DNA levels in cancer cells, resulting in STING activation and secretion of inflammatory cytokines. Ectonucleotide pyrophosphatase/phosphodiesterase 1 (ENPP1) is the phosphodiesterase that negatively regulates STING by hydrolyzing cGAMP. MV-626, a highly potent and selective ENPP1 inhibitor with 100% oral bioavailability …

Preliminary Evaluation Of A Novel Whole Slide Multispectral Assessment Of Seven Markers: Potential To Minimize Bias In The Characterization Of The Tumor Immune Environment, Carmen Ballesteros Merino, Shawn Jensen, Carla Coltharp, Kristin Roman, Chichung Wang, Nikhil Lonberg, Sebastian Marwitz, Tarsem Moudgil, William Miller, William Redmond, Yoshinobu Koguchi, Carlo Bifulco, Clifford Hoyt, Bernard A. Fox

Society for Immunotherapy of Cancer 2018 Annual Meeting Posters

Background: PD-L1 expression and tumor-mutational burden enrich for patients that respond to checkpoint blockade, but these evaluations are only a component of the entire story. Recently, our lab reported that evaluation of specific cell-cell relationships provided a powerful biomarker for overall survival in patients with HPV- head and neck cancer (HNSCC). However, the areas selected for analysis were operator selected “hot spots”. This approach introduces the potential for unconscious bias in the selection process. To address this, we have sought to perform whole slide evaluations of sections to compare with hot spot analysis. This study is a preliminary report applying …

Pegzilarginase In Combination With Agonist Anti-Ox40 Therapy Enhances T Cell Priming And Effector Function Leading To Improved Tumor Regression And Survival, Melissa Kasiewicz, Annah Rolig, Elizabeth Sturgill, Mark Badeaux, Scott Rowlinson, William L. Redmond

Society for Immunotherapy of Cancer 2018 Annual Meeting Posters

Background: Tumor cells defective in enzymes required for arginine biosynthesis are dependent upon arginine uptake from the environment. Extracellular depletion of arginine directly affects tumor cells, inducing autophagy and apoptosis. Pegzilarginase (AEB1102) is a bioengineered, pegylated, human arginase 1 (Aeglea Biotherapeutics) currently in phase I clinical trials. This arginine-depleting agent has been shown to both inhibit arginine auxotrophic tumor growth and to enhance the efficacy of PD-L1 blockade in preclinical models. In the current study, we investigated the therapeutic efficacy and mechanism of action of combined pegzilarginase/anti-OX40 (aOX40) immunotherapy. We hypothesized that pegzilarginase/aOX40 treatment would synergize to enhance T cell …

Integrative Spatially-Resolved, High-Plex Digital Profiling Enables Characterization Of Complex Immune Biology In The Tumor Microenvironment Of Mesothelioma, Carmen Ballesteros-Merino, Moritz Widmaier, Sarah Church, Thomas Herz, Alexei Budco, Das Medrikova, Ivan Kanchev, Andrew White, Douglas Hinerfeld, Shawn Jensen, John Handy, Rachel Sanborn, Carlo Bifulco, Sarah Warren, Joseph Beechem, Bernard .. Fox

Society for Immunotherapy of Cancer 2018 Annual Meeting Posters

Background: Malignant mesothelioma is an aggressive cancer with poor prognosis and few effective therapies. Since mesothelioma is derived from the mesothelium of the lung, we hypothesize that immune cells in the tumor microenvironment (TME) may behave differently than other solid tumors. In our previous studies, utilizing multi-plexed immunofluorescence, we did not find immune phenotypes associated with improved patient survival. Here we describe a novel combination of two technologies to spatially characterize the interface between mesothelioma cells, stroma and immune cells in the TME in a high-plex capacity.

Methods: Ten FFPE mesothelioma tumors were characterized by Definiens’ Immune-Oncology Profiling (IOP) and …

Ethical Implications Of Treatment For Gender Dysphoria In Youth, Kelsey Hayes

Journal of Health Ethics

This manuscript explores ethical implications on treatment for youth with diagnosed gender dysphoria. The ethical considerations outlined and analyzed in this essay involve illuminating an understanding of whether the administration of pubertal suppression with GnRH agonists, and cross-sex hormones to children with gender dysphoria is morally justified as treatment to manage their psychological distress, or if safer more understood alternatives exist. This essay emphasizes that as health care professionals we must ensure youth with gender dysphoria receive adequate medical treatment and care however, this essay concludes through extensive literature review, that the use of inconclusive and under researched methods to …

Preliminary Results From A First-In-Human Phase 1 Study Of The Cd40 Agonist Monoclonal Antibody (Mab) Cdx-1140, Rachel Sanborn, Michael S. Gordon, Mark O'Hara, Nina Bhardwaj, Yi He, Tracey Rawls, Tibor Keler, Michael Yellin

Society for Immunotherapy of Cancer 2018 Annual Meeting Posters

Background: Agonist CD40 mAbs can mediate antitumor immunity through multiple mechanisms, including enhancing tumor antigen presentation, activation of tumoricidal macrophages, and direct growth inhibition/killing of CD40- expressing tumor cells. To fully exploit these mechanisms may require the mAb to be dosed at levels that provide significant tumor and tissue penetration, without dose-limiting-toxicities (DLT) from systemic CD40 activation. Our agonist CD40 mAb, CDX-1140, was selected based on its unique and linear dose-dependent in vitro and in vivo activity and is postulated will achieve maximum agonist activity at dose levels associated with good systemic exposure. CDX-1140 is a fully human IgG2 agonist …

Nktr-214 (Cd122-Biased Agonist) And Nktr-262 (Tlr7/8 Agonist) Combination Treatment Pairs Local Innate Immune Activation With Systemic Cd8+ T Cell Expansion To Enhance Anti-Tumor Immunity, Annah S. Rolig, Daniel Rose, Saul Kivimäe, Deborah Charych, Werner Rubas, Jonathan Zalevsky, William L. Redmond

Society for Immunotherapy of Cancer 2018 Annual Meeting Posters

Background: Radiation therapy (RT) remains the standard of care for many human cancers. Combining NKTR-214, a CD122-biased cytokine agonist conjugated with releasable polyethylene-glycol (PEG) chains, with local RT significantly enhanced therapeutic efficacy in preclinical models. Mechanistically, NKTR-214 provides sustained signaling through the IL-2 receptor pathway (IL-2Rβγ) to preferentially activate and expand effector CD8+ T and NK cells and RT modulates the tumor microenvironment (TME) to induce antigen-release. Together, NKTR-214/RT treatment resulted in improved therapeutic responses compared to either treatment alone. However, abscopal responses in murine tumors were modest, leading us to explore alternative approaches with the potential to elicit more …

Combined Anti-Pd-1 And Anti-Lag-3 Checkpoint Blockade Enhances Cd8+ Til Effector Function While Reducing Tregs Leading To Reduced Immune Suppression And Improved Overall Survival, Elizabeth Sturgill, Courtney Mick, David Jenkins, Johanna Kaufmann, William L. Redmond

Society for Immunotherapy of Cancer 2018 Annual Meeting Posters

Background: Checkpoint inhibition is a potent strategy to reinvigorate T cells. However, aCTLA-4 or aPD-1 monotherapy has not been effective for the majority of patients, resulting in the exploration of combinatorial approaches to improve treatment efficacy. One such target is LAG-3, which is upregulated on T cells that have experienced repeated antigen exposure, such as in the tumor microenvironment (TME), and is associated with reduced T cell effector function. In addition, high LAG-3 expression on regulatory T cells (Tregs) has been reported for patients with varying cancer types, providing an additional rationale for targeting LAG-3 with the aim of reducing …

Development Of A Postburn Pruritus Relief Protocol, Phoebe (Yeon) S. Kim

Nursing Faculty Publications

Background Postburn pruritus is a syndrome of stressful symptoms that is pervasive and occurs in over 90% of burn patients and continues for years after the burn has healed. Postburn pruritus is experienced by burn survivors that may require medical management and effective interventions.

Purpose This article shows how to effectively relieve postburn pruritus by developing a postburn pruritus relief protocol.

Design A descriptive literature review was conducted, and relevant empirical articles written during the years 2000–2014 were appraised to create a postburn pruritus relief protocol. Twenty-six of 79 articles were selected using preestablished inclusion criteria: any age group experiencing …

When Failure Is Not An Option, Lindsey Ago, Caitlin Digirolamo, Dylan Gagner

Dental Hygiene Student Research Posters

This research poster addresses the question, “What treatment modalities are most effective at treating peri-implantitis (PI)?” Dental implants are one of the most innovative ways to support dental prosthetics. They can support heavy physical loads. However, infection causes inflammation and bone loss around implants. Studies indicate that there are many factors that can increase the risk for PI. These factors include: Smoking; pre-existing periodontal disease; oral hygiene, quality of prosthetic reconstruction; some systemic conditions and medications.

There are a significant amount of treatment options for PI that range from surgical, nonsurgical, antibiotics, and even lasers. While reviewing studies related to …

Breastfeeding: The Best Formula For The Oral Microbiome, Eliza Lopes, Alexandra Cabana

Dental Hygiene Student Research Posters

This research poster addresses the question “What differences are seen between formula and breastfed babies in the development of the oral microbiome?” The bacteria that make up the oral microbiome begins accumulating from birth through interactions with the environment and caregivers. When it comes to the oral cavity, bacteria such a Streptococcus mutans and Lactobacilli, can be transferred through saliva or feeding. Breastfeeding provides important nutritional and immunological benefits to the development of infants but it also plays a vital role in the development of the oral microbiome that may be superior to that of formula-feeding. Studies show that the …

Ada Code Of Ethics (November 2018), American Dental Association

Code of Ethics

The ADA Code of Ethics has three main components: The Principles of Ethics, the Code of Professional Conduct and the Advisory Opinions. Contents may also include: Amendment to ADA Principles of Ethics and Code of Professional Conduct and Insert for the ADA Principles of Ethics and Code of Professional Conduct. The most current issue is available on the ADA’s website.

Obesity: The Elephant In The Room We Can No Longer Afford To Ignore, Joanie Sompayrac, Katharine Linehart Trundle

Journal of Health Ethics

Everyone pays the price for the obesity-related illnesses of our fellow citizens – through increased premiums on our group health insurance policies, through reduced productivity of our co-workers, through taxpayer support of hospitals that provide indigent care and through soaring Medicare costs, to name a few. The fact that our entire society often ends up paying many of the costs for the obesity-related illnesses of not only ourselves but also our family members, our friends, our co-workers and even strangers raises questions: Why doesn’t insurance pay to help overweight and obese people to make lifestyle changes that could save us …

Euthanasia, Assisted-Suicide, And Palliative Sedation: A Brief Clarification And Reinforcement Of The Moral Logic, Peter A. Depergola Ii

Journal of Health Ethics

A persistent misunderstanding of the moral distinctions between the practices of euthanasia, assisted suicide, and palliative sedation suggests a critical need to revisit the relationship each shares with licit medical practice in the context of palliative care. To that end, this essay grounds its arguments in two, straightforward premises: (i) the licitness of medical practice is largely determined by the balance between (a) good ends, (b) proportionate means, (c) appropriate circumstances, and (d) benevolent intentions; and (ii) whereas palliative sedation employs criteria A-D (above), both euthanasia and assisted suicide fail to secure criteria A-C. Drawing from this syllogism, the aim …

Nicotine Vaccines For Smoking Prevention And Treatment From Utilitarian And Deontological Ethical Perspectives, Enam A. Alsrayheen, Khaldoun Aldiabat

Journal of Health Ethics

Nicotine vaccines are a new prevention and treatment method for smoking addiction. They are promoted as a method to cease smoking among those who smoke and possibly prevent this behaviour from taking place among those who do not smoke. However, offering these vaccines to adults, adolescents, and children will undoubtedly raise an ethical debate among policy-makers, health professionals, and the public. This paper discusses the possibility of using nicotine vaccines treat and prevent smoking among adults/children/adolescents through the lenses of two ethical theories: utilitarianism and deontology (Kantianism). From an utilitarian perspective, nicotine vaccines are good for society because they provide …

Tumor Infiltrating Lymphocyte Recruitment After Peri-Lymphatic Irx-2 Cytokine Immunotherapy In Resectable Breast Cancer And Head And Neck Carcinoma, Joanna Pucilowska, Venkatesh Rajamanickam, Nikki Moxon, Monil Shah, Maritza Martel, Alison Conlin, James E. Egan, David B. Page

Society for Immunotherapy of Cancer 2018 Annual Meeting Posters

Background: The IRX-2 biologic is a subcutaneous injectable immunotherapy composed of IL-2 and other cytokines derived from stimulated lymphocytes. Preclinically, IRX-2 activates T cells, natural killer cells, macrophages, and dendritic cells, and facilitates maturation of antigen-presenting cells.Tumor-infiltrating lymphocytes (TILs) are associated with improved outcomes in many cancers including early stage breast cancer (ESBC) and head and neck squamous cell carcinoma (HNSCC). We report data on TIL recruitment associated with pre-operative IRX-2 in a phase Ib ESBC trial, as well as phase Ib and IIa HNSCC trials.

Methods: The pre-operative IRX-2 regimen was evaluated in both ESBC and HNSCC trials for …

Single Cell Sequencing To Identify Tcrs That Recognize Autologous Tumor Cells After Vaccination With Allogeinic Dribble Vaccine, Hong-Ming Hu, Christopher C. Paustian, Zhifa Wen, Tarsem L. Moudgil, Traci L. Hilton, Sam Bookhardt, Guangjie Yu, Eric Tran, Venkatesh Rajamanickam, Walter Urba, Rachel E. Sanborn, Bernard A. Fox

Society for Immunotherapy of Cancer 2018 Annual Meeting Posters

Background: Adoptive immunotherapy with tumor-specific TCR gene-modified T cells has the potential to eradicate bulky disease. Traditional methods of TCR identification require lengthy in vitro culture to generate clonal T-cell populations, which adds time and complexity to this promising therapy. Here we described a simplified and reliable method to identify TCRs by single cell TCR sequencing of cells sorted with antibodies against T-cell surface markers that are up-regulated only when they are stimulated with specific tumor cell antigens.

Methods: A tumor-infiltrating lymphocyte (TIL) culture with T cells reactive against autologous tumor was generated from a brain metastasis of a patients …

Delayed Immune-Related Events After Discontinuation Of Immunotherapy – Dire Syndrome?, Marcus Couey, R. Bryan Bell, Ashish Patel, Marka R Crittenden, Brendan Curti, Rom Leidner

Society for Immunotherapy of Cancer 2018 Annual Meeting Posters

Background: Although the temporality of immune-related adverse events (irAE) is well-recognized during immunotherapy to be highly variable and often delayed,[1] post-immunotherapy irAE are rarely described and potentially under-recognized. In 2013, two cases were reported in abstract form in Deutschen Dermatologischen Gesellschaft.[2] In July 2018 a case of autoimmune hepatitis eight months post-immunotherapy was reported in The Oncologist[3] and a dermatologic series appeared online in JAMA Dermatology.[4] With expanding indications for IO and an increasing number of clinical trials in the curative-neoadjuvant setting, larger numbers of patients are being treated in earlier stages of disease and often for short courses. Given …

Odontogenic Abscesses In Rhesus Macaques (Macaca Mulatta) Of Cayo Santiago, Hong Li, Wenjing Luo, Anna Feng, Michelle L. Tang, Terry B. Kensler, Elizabeth Maldonado, Octavio A. Gonzalez, Matthew J. Kessler, Paul C. Dechow, Jeffrey L. Ebersole, Qian Wang

Center for Oral Health Research Faculty Publications

Objectives
Odontogenic abscesses are one of the most common dental diseases causing maxillofacial skeletal lesions. They affect the individual's ability to maintain the dental structures necessary to obtain adequate nutrition for survival and reproduction. In this study, the prevalence and pattern of odontogenic abscesses in relation to age, sex, matriline, and living periods were investigated in adult rhesus macaque skeletons of the free-ranging colony on Cayo Santiago, Puerto Rico.

Materials and Methods
The skulls used for this study were from the skeletons of 752 adult rhesus macaques, aged 8–31 years, and born between 1951 and 2000. They came from 66 …

College Of Health Sciences E-Newsletter, November 2018, Irvin B. Harrell (Editor)

Ellmer College of Health Sciences Newsletters

November 2018 issue of Old Dominion University's College of Health Sciences Newsletter.

The Impact Of A Poverty Simulation On Baccalaureate Nursing Students’ Attitudes, Kristen Smith

Doctor of Nursing Practice Scholarly Projects

Poverty is an ongoing issue in the United States, with major implications for the health of U.S. citizens. In order to provide compassionate care, nurses must understand their own attitudes towards those living in poverty. The purpose of this study was to evaluate for possible changes in attitudes towards poverty in junior level BSN students after a poverty simulation intervention. Participants were surveyed using the Yun and Weaver’s Short Form Attitudes towards Poverty (SFATP) tool, which looks three factors of poverty attitudes: personal deficiency, stigma, and structural perspective.

The Adult Learning Theory provided the theoretical framework for the study. This …

Native Elder And Youth Perspectives On Mental Well-Being, The Value Of The Horse, And Navigating Two Worlds, Mary J. Isaacson, Rebecca Bott-Knutson, Mary Beth Fishbeck, Angela Varnum, Shelly Brandenburger

College of Nursing Faculty Publications

Purpose: Native American youth experience significant challenges to mental well-being. As part of a larger study to evaluate hope and resilience in a Plains tribal population, the purpose of this study was to learn from Native American elders and youths what they feel is needed to for youth to grow up healthy on the reservation, and to identify connections between horse use and mental well-being.
Sample: Six Native American elders and eight Native American youths from the same Plains tribe.
Method: The research team conducted Talking Circles with youths and elders. during the Talking Circles, participants identified community-specific questions for …

Querying Rural Content Experts Using An Online Questionnaire, Marilyn A. Swan, Barbara B. Hobbs

College of Nursing Faculty Publications

Purpose: Obtaining feedback from rural content experts is critical in developing valid and reliable instruments to advance the science of rural health. However, traditional methods, i.e., focus groups are impractical due to location and distance. Using an online questionnaire combined with telephone and email contacts to obtain content experts’ feedback is discussed. Item statement analysis and efficiency and effectiveness of the process are presented.
Methods: The process included the development of an online questionnaire, asking experts to rate 51 item statement for their relevancy, sufficiency of description, and clarity and readability. To increase the response rate, a series of four …

The Ketogenic Diet: The Effects You’D Yeast Expect, Bryce Edwards, Samantha M. Waters

Dental Hygiene Student Research Posters

This research poster addresses the question: How does the ketogenic diet affect the oral cavity? Ketogenic ‘keto’ diet emphasizes high fat, low carbohydrate consumption and avoids simple carbohydrate and sugars. Sugar substitutes are almost always utilized. Fat heavy diets causes the body to go into ketosis: a process in which the body burns fat for energy because glucose isn’t available. The keto diet has many positive effects for the body, including several specific to the oral cavity: Decreased caries risk, gingival inflammation, and bleeding; reduction of acidity and plaque mutans when paired with the keto approved sugar substitute: erythritol. The …