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Inside Dentistry
June 2009
Volume 5, Issue 6

Detection of Disease Outbreaks by the Use of Oral Manifestations

Howard E. Strassler, DMD

Torres-Urquidy MH, Wallstrom G, Schleyer TKL. J Dent Res. 2009;88:89-94.


Oral manifestations of diseases caused by bioterrorist agents could be a potential data source for biosurveillance. This study had the objectives of determining the oral manifestations of diseases caused by bioterrorist agents, measuring the prevalence of these manifestations in emergency department reports, and constructing and evaluating a detection algorithm based on them. We developed a software application to detect oral manifestations in free text and identified positive reports over three years of data. The normal frequency in reports for oral manifestations related to anthrax (including buccal ulcers-sore throat) was 7.46%. The frequency for tularemia was 6.91%. For botulism and smallpox, the frequencies were 0.55% and 0.23%. We simulated outbreaks for these bioterrorism diseases and evaluated the performance of our system. The detection algorithm performed better for smallpox and botulism than for anthrax and tularemia. We found that oral manifestations can be a valuable tool for biosurveillance.


Early detection of disease outbreaks are a significant concern. We remember the letters sent through the mail that contained anthrax in 2001 and the outbreak of Severe Acute Respiratory Syndrome (SARS) in 2003. Naturally occur-ring disease outbreaks and bioterrorism require “extreme timeliness of detection” as a safeguard to public health and to minimize any potential devastating effects.1 As dentists we would not think that we are participating in overall surveillance against biologic agents and natural disease outbreaks, but a number of dental schools have implemented courses to orient dental students to recognizing and reporting these events.

This study examined a novel data source for electronic biosurveillance of oral manifestations. Some diseases resulting from bioterrorist agents cause oral manifestations that are likely to be detected in dental or medical care settings. Also, a dental practitioner can note signs and symptoms of respiratory infections. Biosurveillance systems use a three-phase approach to detect outbreaks. They gather early-symptom data, aggregate those data in real time to create an electronic signal, and, finally, the system issues an alarm when the signal deviates from predictions so that public health officials can investigate and take action. The methodology of this study used a software application to detect oral manifestations and then created simulations to record data. Of interest, the conclusion was that oral manifestations can be a valuable tool in biosurveillance.


1. Wagner MM, Tsui FC, Espino JU, et al. The emerging science of early detection of disease outbreaks. J Public Health Manag Pract. 2001;7:51-59.

About the Author

Howard E. Strassler, DMD
Professor and Director of Operative Dentistry
Department of Endodontics
Prosthodontics and Operative Dentistry
University of Maryland Dental School
Baltimore, Maryland

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