Dr. Genco's laboratories and clinics are involved in studies of oral infections. Initial studies focus on the role of oral flora in periodontal diseases, specifically the virulence factors of P. gingivalis, concentrating on molecular genetic studies of fimbriae and fimbrial-mediated interactions and more recently on toll-like receptors as they are stimulated by bacterial products. On the host side, we have assessed risk factors for periodontal disease among behavioral, environmental, and genetic factors. His group convincingly showed that smoking, stress, and calcium deficiency are important risk factors for periodontal disease. His group has carried out extensive studies on diabetes mellitus as a risk factor for periodontal disease using Native American and Caucasian populations for these studies. Dr. Genco and his colleagues were among the first to show that periodontal infections in people with diabetes mellitus led to worsened glycemic control, and increased risk for heart disease and kidney disease. His group also showed that treatment of periodontal disease in diabetes leads to improved glycemic control, and the treatment procedures developed for this study are used nationally in Native American populations who suffer from severe diabetes and periodontal disease. Also studied are the effects of reduced bone density as found in postmenopausal women, and estrogen deficiency on oral bone loss. He also has carried out a series of studies on the effects of oral infections on cardiovascular and cerebrovascular disease. Another area of interest and activity is in tissue engineering. We are developing regenerative procedures using growth factors and other materials for regeneration of the periodontium and bone around implants. We are developing nonoparticle ceramics for bone regeneration and repair.