Skip to main content
Top
Published in: BMC Oral Health 1/2014

Open Access 01-12-2014 | Research article

Association between polymorphism of TGFA Taq I and cleft Lip and/or palate: a meta-analysis

Authors: Cuijuan Feng, Enjiao Zhang, Weiyi Duan, Zhongfei Xu, Yang Zhang, Li Lu

Published in: BMC Oral Health | Issue 1/2014

Login to get access

Abstract

Background

Cleft lip and palate (CL/P) is one of the most common malformations in humans. Transforming growth factor alpha (TGFA) is a well characterized mammalian growth factor which might contribute to the development of CL/P. This meta-analysis aimed to summarize the association between the TGFA Taq I polymorphisms and CL/P.

Methods

We retrieved the relevant articles from PubMed, EMBASE, ISI Web of Science and SCOPUS databases. Studies were selected using specific inclusion and exclusion criteria. The odds ratios (ORs) and their 95% confidence intervals (95% CIs) were calculated to assess the association between TGFA Taq I polymorphism and CL/P risk. Meta-analyses were performed on the total data set and separately for the major ethnic groups, disease type and source of control. All analyses were performed using the Stata software.

Results

Twenty articles were included in the present analysis. There is a significant association between the TGFA Taq I polymorphism and CL/P (C1C2 vs C1C1: OR=1.67, 95% CI=1.23-2.25, C2C2+C1C2 vs C1C1C1: OR=1.52, 95% CI=1.15-2.01; C2 vs C1:OR=1.41, 95% CI=1.12-1.78). Stratified analyses suggested that the TGFA Taq I polymorphism was significantly associated with CL/P in Caucasians (C1C2 vs C1C1: OR=1.95, 95% CI=1.34-2.86; C2C2+C1C2 vs C1C1: OR=1.68, 95% CI=1.18-2.38; C2 vs V1: OR=1.52, 95% CI=1.14 -2.02).

Conclusion

TGFA Taq I polymorphism may be associated with the risk of CL/P.
Appendix
Available only for authorised users
Literature
1.
go back to reference Melnick M, Jaskoll T, Marazita M: Localization of H-2K in developing mouse palates using monoclonal antibody. J Embryol Exp Morphol. 1982, 70: 45-60.PubMed Melnick M, Jaskoll T, Marazita M: Localization of H-2K in developing mouse palates using monoclonal antibody. J Embryol Exp Morphol. 1982, 70: 45-60.PubMed
2.
go back to reference Wyszynski DF, Beaty TH: Review of the role of potential teratogens in the origin of human nonsyndromic oral clefts. Teratology. 1996, 53: 309-317.CrossRefPubMed Wyszynski DF, Beaty TH: Review of the role of potential teratogens in the origin of human nonsyndromic oral clefts. Teratology. 1996, 53: 309-317.CrossRefPubMed
3.
go back to reference Czeizel A, Nagy E: A recent aetiological study on facial clefting in Hungary. Acta Pediatr Hung. 1986, 27: 145-166. Czeizel A, Nagy E: A recent aetiological study on facial clefting in Hungary. Acta Pediatr Hung. 1986, 27: 145-166.
4.
go back to reference Khoury MJ, Gomez-Farias M, Mulinare J: Does maternal cigarette smoking during pregnancy cause cleft lip and palate in offspring?. Am J Dis Child. 1989, 143: 333-337.PubMed Khoury MJ, Gomez-Farias M, Mulinare J: Does maternal cigarette smoking during pregnancy cause cleft lip and palate in offspring?. Am J Dis Child. 1989, 143: 333-337.PubMed
5.
go back to reference Werler MM, Lammer EJ, Rosenberg L, Mitchell AA: Maternal cigarette smoking during pregnancy in relation to oral clefts. Am J Epidemiol. 1990, 132: 926-932.PubMed Werler MM, Lammer EJ, Rosenberg L, Mitchell AA: Maternal cigarette smoking during pregnancy in relation to oral clefts. Am J Epidemiol. 1990, 132: 926-932.PubMed
6.
go back to reference Shaw GM, Wasserman CR, Lammer EJ, O’Malley CD, Murray JC, Basart AM, Tolarova MM: Orofacial clefts, parental cigarette smoking, and transforming growth factor-alpha gene variants. Am J Hum Genet. 1996, 58: 551-561.PubMedPubMedCentral Shaw GM, Wasserman CR, Lammer EJ, O’Malley CD, Murray JC, Basart AM, Tolarova MM: Orofacial clefts, parental cigarette smoking, and transforming growth factor-alpha gene variants. Am J Hum Genet. 1996, 58: 551-561.PubMedPubMedCentral
7.
go back to reference Tolarova MM: Orofacial clefts in Czechoslovakia: incidence, genetics and prevention of cleft lip and palate over a 19-year period. Scand J Plast Reconstr Surg. 1987, 21: 19-25.CrossRef Tolarova MM: Orofacial clefts in Czechoslovakia: incidence, genetics and prevention of cleft lip and palate over a 19-year period. Scand J Plast Reconstr Surg. 1987, 21: 19-25.CrossRef
8.
go back to reference Tolarova MM, Harris JA: Reduced recurrence of orofacial clefts after periconceptional supplementation with high-dose folic acid and multivitamins. Teratology. 1995, 51: 71-78.CrossRefPubMed Tolarova MM, Harris JA: Reduced recurrence of orofacial clefts after periconceptional supplementation with high-dose folic acid and multivitamins. Teratology. 1995, 51: 71-78.CrossRefPubMed
9.
go back to reference Hayes C, Werler MM, Willett WC, Mitchell AA: Case–control study of periconceptional folic acid supplementation and oral clefts. Am J Epidemiol. 1996, 143: 1229-1234.CrossRefPubMed Hayes C, Werler MM, Willett WC, Mitchell AA: Case–control study of periconceptional folic acid supplementation and oral clefts. Am J Epidemiol. 1996, 143: 1229-1234.CrossRefPubMed
10.
go back to reference Munger RG, Romitti PA, Daack-Hirsch S, Burns TL, Murray JC, Hanson J: Maternal alcohol use and risk of orofacial cleft birth defects. Teratology. 1996, 54: 27-33.CrossRefPubMed Munger RG, Romitti PA, Daack-Hirsch S, Burns TL, Murray JC, Hanson J: Maternal alcohol use and risk of orofacial cleft birth defects. Teratology. 1996, 54: 27-33.CrossRefPubMed
11.
go back to reference Christensen K, Olsen J, Nørgaard-Pedersen B, Basso O, Støvring H, Milhollin-Johnson L, Murray JC: Oral clefts, transforming growth factor alpha gene variants, and maternal smoking: a population-based case–control study in Denmark, 1991–1994. Am J Epidemiol. 1999, 149: 248-255.CrossRefPubMed Christensen K, Olsen J, Nørgaard-Pedersen B, Basso O, Støvring H, Milhollin-Johnson L, Murray JC: Oral clefts, transforming growth factor alpha gene variants, and maternal smoking: a population-based case–control study in Denmark, 1991–1994. Am J Epidemiol. 1999, 149: 248-255.CrossRefPubMed
12.
go back to reference Ardinger HH, Buetow KH, Bell GI, Bardach J, Van-Demark DR, Murray JC: Association of genetic variation of the transforming growth factor-alpha gene with cleft lip and palate. Am J Hum Genet. 1989, 45: 348-353.PubMedPubMedCentral Ardinger HH, Buetow KH, Bell GI, Bardach J, Van-Demark DR, Murray JC: Association of genetic variation of the transforming growth factor-alpha gene with cleft lip and palate. Am J Hum Genet. 1989, 45: 348-353.PubMedPubMedCentral
13.
go back to reference Dixon MJ, Garner J, Fergusson MW: Immunolocalization of epidermal growth factor (EGF), EGF receptor and transforming growth factor alpha (TGFa) during murine palatogenesis in vivo and in vitro. Anat Embryol. 1991, 184: 83-91.CrossRefPubMed Dixon MJ, Garner J, Fergusson MW: Immunolocalization of epidermal growth factor (EGF), EGF receptor and transforming growth factor alpha (TGFa) during murine palatogenesis in vivo and in vitro. Anat Embryol. 1991, 184: 83-91.CrossRefPubMed
14.
15.
go back to reference Tanabe A, Taketani S, Endo-Ichikawa Y, Tokunaga R, Ogawa Y, Hiramoto M: Analysis of the candidate genes responsible for nonsyndromic cleft lip and palate in Japanese people. Clin Sci. 2000, 99: 105-111.CrossRefPubMed Tanabe A, Taketani S, Endo-Ichikawa Y, Tokunaga R, Ogawa Y, Hiramoto M: Analysis of the candidate genes responsible for nonsyndromic cleft lip and palate in Japanese people. Clin Sci. 2000, 99: 105-111.CrossRefPubMed
16.
go back to reference Vieira AR: Association between the transforming growth factor alpha gene and nonsyndromic oral clefts: a HuGE review. Am J Epidemiol. 2006, 163: 790-810.CrossRefPubMed Vieira AR: Association between the transforming growth factor alpha gene and nonsyndromic oral clefts: a HuGE review. Am J Epidemiol. 2006, 163: 790-810.CrossRefPubMed
17.
go back to reference Holder SE, Vintiner GM, Farren B, Malcolm S, Winter RM: Confirmation of an association between RFLPs at the transforming growth factor-alpha locus and non-syndromic cleft lip and palate. J Med Genet. 1992, 29: 390-392.CrossRefPubMedPubMedCentral Holder SE, Vintiner GM, Farren B, Malcolm S, Winter RM: Confirmation of an association between RFLPs at the transforming growth factor-alpha locus and non-syndromic cleft lip and palate. J Med Genet. 1992, 29: 390-392.CrossRefPubMedPubMedCentral
18.
go back to reference Chenevix-Trench G, Jones K, Green AC, Duffy DL, Martin NG: Cleft lip with or without cleft palate: associations with transforming growth factor alpha and retinoic acid receptor loci. Am J Hum Genet. 1992, 51: 1377-1385.PubMedPubMedCentral Chenevix-Trench G, Jones K, Green AC, Duffy DL, Martin NG: Cleft lip with or without cleft palate: associations with transforming growth factor alpha and retinoic acid receptor loci. Am J Hum Genet. 1992, 51: 1377-1385.PubMedPubMedCentral
19.
go back to reference Sassani R, Bartlett SP, Feng H, Goldner-Sauve A, Haq AK, Buetow KH, Gasser DL: Association between alleles of the transforming growth factor-alpha locus and the occurrence of cleft lip. Am J Hum Genet. 1993, 45: 565-569.CrossRef Sassani R, Bartlett SP, Feng H, Goldner-Sauve A, Haq AK, Buetow KH, Gasser DL: Association between alleles of the transforming growth factor-alpha locus and the occurrence of cleft lip. Am J Hum Genet. 1993, 45: 565-569.CrossRef
20.
go back to reference Shiang R, Lidral AC, Ardinger HH, Buetow KH, Romitti PA, Munger RG, Murray JC: Association of transforming growth-factor alpha gene polymorphisms with nonsyndromic cleft palate only (CPO). Am J Hum Genet. 1993, 53: 836-843.PubMedPubMedCentral Shiang R, Lidral AC, Ardinger HH, Buetow KH, Romitti PA, Munger RG, Murray JC: Association of transforming growth-factor alpha gene polymorphisms with nonsyndromic cleft palate only (CPO). Am J Hum Genet. 1993, 53: 836-843.PubMedPubMedCentral
21.
go back to reference Jara L, Blanco R, Chiffelle I, Palomino H, Carreño H: Association between alleles of the transforming growth factor alpha locus and cleft lip and palate in the Chilean population. Am J Hum Genet. 1995, 57: 548-551.CrossRef Jara L, Blanco R, Chiffelle I, Palomino H, Carreño H: Association between alleles of the transforming growth factor alpha locus and cleft lip and palate in the Chilean population. Am J Hum Genet. 1995, 57: 548-551.CrossRef
22.
go back to reference Hwang SJ, Beaty TH, Panny SR, Street NA, Joseph JM, Gordon S, McIntosh I, Francomano CA: Association study of transforming growth factor alpha (TGF alpha) TaqI polymorphism and oral clefts: indication of gene-environment interaction in a population-based sample of infants with birth defects. Am J Epidemiol. 1995, 141: 629-636.PubMed Hwang SJ, Beaty TH, Panny SR, Street NA, Joseph JM, Gordon S, McIntosh I, Francomano CA: Association study of transforming growth factor alpha (TGF alpha) TaqI polymorphism and oral clefts: indication of gene-environment interaction in a population-based sample of infants with birth defects. Am J Epidemiol. 1995, 141: 629-636.PubMed
23.
go back to reference Shaw GM, Wasserman CR, Murray JC, Lammer EJ: Infant TGF-alpha genotype, orofacial clefts, and maternal periconceptional multivitamin Use. Cleft Palate Craniofcial J. 1998, 35: 366-370.CrossRef Shaw GM, Wasserman CR, Murray JC, Lammer EJ: Infant TGF-alpha genotype, orofacial clefts, and maternal periconceptional multivitamin Use. Cleft Palate Craniofcial J. 1998, 35: 366-370.CrossRef
24.
go back to reference Hecht JT, Wang YP, Blanton SH, Michels VV, Daiger SP: Cleft lip and palate: no evidence of linkage to transforming growth factor alpha. Am J Hum Genet. 1991, 49: 682-686.PubMedPubMedCentral Hecht JT, Wang YP, Blanton SH, Michels VV, Daiger SP: Cleft lip and palate: no evidence of linkage to transforming growth factor alpha. Am J Hum Genet. 1991, 49: 682-686.PubMedPubMedCentral
25.
go back to reference Stoll C, Qian JF, Feingold J, Sauvage P, May E: Genetic variation in transforming growth factor alpha: possible association of Bam HI polymorphism with bilateral sporadic cleft lip and palate. Hum Genet. 1993, 92: 81-82.CrossRefPubMed Stoll C, Qian JF, Feingold J, Sauvage P, May E: Genetic variation in transforming growth factor alpha: possible association of Bam HI polymorphism with bilateral sporadic cleft lip and palate. Hum Genet. 1993, 92: 81-82.CrossRefPubMed
26.
go back to reference Beaty TH, Maestri NE, Hetmanski JB, Wyszynski DF, Vanderkolk CA, Simpson JC: Testing for interaction between materrnal somking and TGFA genotype among oral cleft case born in Maryland 1992–1996. Cleft Palate Craniofcial J. 1997, 34: 447-454.CrossRef Beaty TH, Maestri NE, Hetmanski JB, Wyszynski DF, Vanderkolk CA, Simpson JC: Testing for interaction between materrnal somking and TGFA genotype among oral cleft case born in Maryland 1992–1996. Cleft Palate Craniofcial J. 1997, 34: 447-454.CrossRef
27.
go back to reference Lidral AC, Murray JC, Buetow KH, Basart AM, Schearer H, Shiang R, Naval A, Layda E, Magee K, Magee W: Studies of the candidate genes TGFB2, MSX1, TGFA and TGFB3 in the etiology of cleft lip and palate in the Philippines. Cleft Palate Craniofac J. 1997, 34: 1-6.CrossRefPubMed Lidral AC, Murray JC, Buetow KH, Basart AM, Schearer H, Shiang R, Naval A, Layda E, Magee K, Magee W: Studies of the candidate genes TGFB2, MSX1, TGFA and TGFB3 in the etiology of cleft lip and palate in the Philippines. Cleft Palate Craniofac J. 1997, 34: 1-6.CrossRefPubMed
28.
go back to reference Lidral AC, Romitti PA, Basart AM, Doetschman T, Leysens NJ, Daack-Hirsch S, Semina EV, Johnson LR, Machida J, Burds A, Parnell TJ, Rubenstein JL, Murray JC: Association of MSX1 and TGFB3 with nonsyndromic clefting in humans. Am J Hum Genet. 1998, 63: 557-568.CrossRefPubMedPubMedCentral Lidral AC, Romitti PA, Basart AM, Doetschman T, Leysens NJ, Daack-Hirsch S, Semina EV, Johnson LR, Machida J, Burds A, Parnell TJ, Rubenstein JL, Murray JC: Association of MSX1 and TGFB3 with nonsyndromic clefting in humans. Am J Hum Genet. 1998, 63: 557-568.CrossRefPubMedPubMedCentral
29.
go back to reference Chenevix-Trench G, Jones K, Green A, Martin N:Further Evidence for an Association Between Genetic Variation in Transforming Growth Factor Alpha and Cleft Lip and Palate. Am J Hum Genet. 1991, 48: 1012-1013.PubMedPubMedCentral Chenevix-Trench G, Jones K, Green A, Martin N:Further Evidence for an Association Between Genetic Variation in Transforming Growth Factor Alpha and Cleft Lip and Palate. Am J Hum Genet. 1991, 48: 1012-1013.PubMedPubMedCentral
30.
go back to reference Romitti PA, Lidral AC, Munger RG, Daack-Hirsch S, Burns TL, Murray JC: Candidate genes for nonsyndromic cleft lip and palate and maternal cigarette smoking and alcohol consumption: evaluation of genotype-environment interactions from a population-based case–control study of orofacial clefts. Teratology. 1999, 59: 39-50.CrossRefPubMed Romitti PA, Lidral AC, Munger RG, Daack-Hirsch S, Burns TL, Murray JC: Candidate genes for nonsyndromic cleft lip and palate and maternal cigarette smoking and alcohol consumption: evaluation of genotype-environment interactions from a population-based case–control study of orofacial clefts. Teratology. 1999, 59: 39-50.CrossRefPubMed
31.
go back to reference Beaty TH, Wang H, Hetmanski JB, Fan YT, Zeiger JS, Liang KY, Chiu YF, Vanderkolk CA, Seifert KC, Wulfsberg EA, Raymond G, Panny SR, McIntosh I: A case–control study of nonsyndromic oral clefts in Maryland. Ann Epidemiol. 2001, 11: 434-442.CrossRefPubMed Beaty TH, Wang H, Hetmanski JB, Fan YT, Zeiger JS, Liang KY, Chiu YF, Vanderkolk CA, Seifert KC, Wulfsberg EA, Raymond G, Panny SR, McIntosh I: A case–control study of nonsyndromic oral clefts in Maryland. Ann Epidemiol. 2001, 11: 434-442.CrossRefPubMed
32.
go back to reference Passos-Bueno MR, Gaspar DA, Kamiya T, Tescarollo G, Rabanéa D, Richieri-Costa A, Alonso N, Araújo B: Transforming growth factor-ɑ and nonsyndromic cleft lip with or without palate in Brazilian patients: results of a large case–control study. Cleft Palate Craniofcial J. 2004, 41: 387-391.CrossRef Passos-Bueno MR, Gaspar DA, Kamiya T, Tescarollo G, Rabanéa D, Richieri-Costa A, Alonso N, Araújo B: Transforming growth factor-ɑ and nonsyndromic cleft lip with or without palate in Brazilian patients: results of a large case–control study. Cleft Palate Craniofcial J. 2004, 41: 387-391.CrossRef
33.
go back to reference Chevrier C, Bahuau M, Perret C, Iovannisci DM, Nelva A, Herman C, Vazquez MP, Francannet C, Robert-Gnansia E, Lammer EJ, Cordier S: Genetic susceptibilities in the association between maternal exposure to tobacco smoke and the risk of nonsyndromic oral cleft. Am J Med Genet A. 2008, 146A: 2396-2406.CrossRefPubMed Chevrier C, Bahuau M, Perret C, Iovannisci DM, Nelva A, Herman C, Vazquez MP, Francannet C, Robert-Gnansia E, Lammer EJ, Cordier S: Genetic susceptibilities in the association between maternal exposure to tobacco smoke and the risk of nonsyndromic oral cleft. Am J Med Genet A. 2008, 146A: 2396-2406.CrossRefPubMed
34.
go back to reference Ehlers Bertoja A, Sampaio Alho C, De Franca E, Menegotto B, Miriam Robinson W: TGFA/TAQ I polymorphism in nonsyndromic cleft lip and palate patients from Rio Grande Do Sul, Brazil. Cleft Palate Craniofcial J. 2008, 45: 539-544.CrossRef Ehlers Bertoja A, Sampaio Alho C, De Franca E, Menegotto B, Miriam Robinson W: TGFA/TAQ I polymorphism in nonsyndromic cleft lip and palate patients from Rio Grande Do Sul, Brazil. Cleft Palate Craniofcial J. 2008, 45: 539-544.CrossRef
35.
go back to reference Zhu J, Hao L, Li S, Bailey LB, Tian Y, Li Z: MTHFR, TGFB3, and TGFA polymorphisms and their association with the risk of non-syndromic cleft lip and cleft palate in China. Am J Med Genet A. 2010, 152A: 291-298.CrossRefPubMed Zhu J, Hao L, Li S, Bailey LB, Tian Y, Li Z: MTHFR, TGFB3, and TGFA polymorphisms and their association with the risk of non-syndromic cleft lip and cleft palate in China. Am J Med Genet A. 2010, 152A: 291-298.CrossRefPubMed
36.
go back to reference Begg CB, Mazumdar M: Operating characteristics of a rank correlation test for publication bias. Biometrics. 1994, 50: 1088-1101.CrossRefPubMed Begg CB, Mazumdar M: Operating characteristics of a rank correlation test for publication bias. Biometrics. 1994, 50: 1088-1101.CrossRefPubMed
38.
go back to reference Mann GB, Fowler KJ, Gabriel A, Nice EC, Williams RL, Dunn AR: Mice with a null mutation of the TGFa gene have abnormal skin architecture, wavy hair, and curly whiskers and often develop corneal inflammation. Cell. 1993, 73: 249-261.CrossRefPubMed Mann GB, Fowler KJ, Gabriel A, Nice EC, Williams RL, Dunn AR: Mice with a null mutation of the TGFa gene have abnormal skin architecture, wavy hair, and curly whiskers and often develop corneal inflammation. Cell. 1993, 73: 249-261.CrossRefPubMed
39.
go back to reference Luetteke NC, Qiu TH, Peiffer RL, Oliver P, Smithies O, Lee DC: TGFa deficiency results in hair follicle and eye abnormalities in targeted and waved-1 mice. Cell. 1993, 73: 263-278.CrossRefPubMed Luetteke NC, Qiu TH, Peiffer RL, Oliver P, Smithies O, Lee DC: TGFa deficiency results in hair follicle and eye abnormalities in targeted and waved-1 mice. Cell. 1993, 73: 263-278.CrossRefPubMed
40.
go back to reference Miettinen PJ, Chin JR, Shum L, Slavkin HC, Shuler CF, Derynck R, Werb Z: Epidermal growth factor receptor function is necessary for normal craniofacial development and palate closure. Nat Genet. 1999, 22: 69-73.CrossRefPubMed Miettinen PJ, Chin JR, Shum L, Slavkin HC, Shuler CF, Derynck R, Werb Z: Epidermal growth factor receptor function is necessary for normal craniofacial development and palate closure. Nat Genet. 1999, 22: 69-73.CrossRefPubMed
41.
go back to reference Mitchell LE: Transforming growth factor alpha locus and nonsyndromic cleft lip with or without cleft palate: a reappraisal. Genet Epidemiol. 1997, 14: 231-240.CrossRefPubMed Mitchell LE: Transforming growth factor alpha locus and nonsyndromic cleft lip with or without cleft palate: a reappraisal. Genet Epidemiol. 1997, 14: 231-240.CrossRefPubMed
42.
go back to reference Zeiger JS, Beaty TH, Liang KY: Oral clefts, maternal smoking, and TGFA: a meta-analysis of gene-environment interaction. Cleft Palate Craniofac J. 2005, 42: 58-63.CrossRefPubMed Zeiger JS, Beaty TH, Liang KY: Oral clefts, maternal smoking, and TGFA: a meta-analysis of gene-environment interaction. Cleft Palate Craniofac J. 2005, 42: 58-63.CrossRefPubMed
43.
go back to reference Griffith OL, Melck A, Jones SJ, Wiseman SM: Meta-analysis and meta-review of thyroid cancer gene expression profiling studies identifies important diagnostic biomarkers. J Clin Oncol. 2006, 24: 5043-5051.CrossRefPubMed Griffith OL, Melck A, Jones SJ, Wiseman SM: Meta-analysis and meta-review of thyroid cancer gene expression profiling studies identifies important diagnostic biomarkers. J Clin Oncol. 2006, 24: 5043-5051.CrossRefPubMed
Metadata
Title
Association between polymorphism of TGFA Taq I and cleft Lip and/or palate: a meta-analysis
Authors
Cuijuan Feng
Enjiao Zhang
Weiyi Duan
Zhongfei Xu
Yang Zhang
Li Lu
Publication date
01-12-2014
Publisher
BioMed Central
Published in
BMC Oral Health / Issue 1/2014
Electronic ISSN: 1472-6831
DOI
https://doi.org/10.1186/1472-6831-14-88

Other articles of this Issue 1/2014

BMC Oral Health 1/2014 Go to the issue