Academics:
Faculty, USC School of Dentistry
Graduate, USC School of Dentistry
Special Qualifications:
Fellow,
Academy of General Dentistry
Fellow, International College of
Cranio- Mandibular Orthopaedics
Fellow, International Academy of
Mini Dental Implants
Fellow, International Congress of
Oral Implantologists
Fellow, Institute for Advanced
Laser Dentistry
Conscious Sedation Permit,
Dental Board of California
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Member, American Dental Association
Member, California Dental Association
Associate Member, American
Academy of Periodontology
Associate Member, Western Society
Academy of Periodontology
Member, American Academy of
Dental Sleep Medicine
Member, American Academy of
Implant Dentistry
Member, American Dental Society
of Anesthesiology
Member, American Academy of
Pain Management
Member, American Academy of
Sleep Medicine
Member, Academy of Microscope
Enhanced Dentistry
Member, Special Care Dentistry
Association
Lectures & Presentations:
San Gabriel Valley Dental Society
San Gabriel Valley Dental
Assistants Society
San Fernando Valley Dental Society
Western Dental Society
Indian Dental Society
Chinese Dental Society
Punjabi Dental Society
Academy for Excellence in Dentistry
University of Texas, Department
of Periodontics
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KSPA
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Columnist, Cascades
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Doctor of Divinity, Chinese for
Christ Theological Seminary
Lifetime Member, ADA, CDA
USC Dentistry Associates, Dean’s
Member
Recognition for Outstanding Service,
USC School of Dentistry
Radio Transcription
Ep 55: Guest Interview: Part 1 of 4 with Dr. Yang Chai, Director of The Center of Craniofacial Molecular Biology at The Herman Ostrow School of Dentistry of USC; Birth Defects and Cleft Palate
Salvador Gaytan: It's time ladies and gentlemen! SmileTalk is on the air, featuring the latest news and developments in dental health, as well as other fascinating topics that make people smile. I'm Salvador Gaytan, and I'm here with…?
Dr. John Chao: Dr. John Chao, hi everybody.
Salvador Gaytan: Dr. John, we have a fascinating show again. We have a special guest from your alma mater, USC, Dr. Yang Chai, and I'm going to go into a few things with him, but he's got some fascinating topics about cell regeneration and other things, doesn't he?
Dr. John Chao: Yes, it's going to be very exciting and very interesting, so stay tuned.
Salvador Gaytan: A lot of futuristic topics too.
Dr. John Chao: Yes, but some of it could have applications in the near future.
Salvador Gaytan: Absolutely, absolutely.
Dr. John Chao: Okay, before we ask questions of our guests, we want to talk about you, Sal. I understand there's some very exciting news coming from you.
Salvador Gaytan: Golf wise, yes.
Dr. John Chao: Golf wise, yes, I understand you won another championship.
Salvador Gaytan: That is correct. A week or so ago, I won the Tustin Ranch Men's Open Championship at Tustin Ranch in Orange County, which I won in '06. So, this is like my -- I repeated. This is my first tournament I've repeated four years later.
Dr. John Chao: I understand it was a cliffhanger.
Salvador Gaytan: It was a cliffhanger, because the conditions were -- we had sand and winds come up as soon as we teed off. So, it was unexpected, pin placements were very difficult, and I basically got into a playoff. I tied with a 22 year old kid that I played with in the past, so we duked it out in the playoff.
Dr. John Chao: So, you won with your mind control, you toughed it out.
Salvador Gaytan: Mind control. I think I had a little advantage, because I played more tournaments than him, and he was probably a little bit more nervous. But I put myself at the first hole, I drove the ball down the fairway, and it actually went into a sand bunker. I was a little disappointed, because he was right in the middle of the fairway, and it was a hard shot in the sand. Somehow I hit probably the shot of the day.
Dr. John Chao: So, did you think to yourself, "I've really messed up. I'm going to lose this tournament," when it went into the bunker? Don't tell me you didn't think about that.
Salvador Gaytan: I wasn't giving up, that I'd lost, but I did look at it and said, "What have I gotten myself into?" I put myself into a pickle, right, but I hit a great shot, it wound up 15 feet by the pin, which was almost a miracle, and it put some pressure on him.
But we both -- we tied the first hole, and then we went to the second hole, which was a par five, and we both hit shots. I shot probably about 12 feet from the pin. He had a little chip, and he chipped it long, so he wound up two-putting from there. So, all I had to do, in the end, was two-putt from about 12 feet to win.
Dr. John Chao: So, did you take two putts?
Salvador Gaytan: I took two putts, and let me tell you, the most nervous moment of the day was that little one and a half foot putt that I had to win, because you think about, "What if I miss this?" And we had about 20, 30 people watching, that came in golf karts to watch, because it was the playoff. So, it was a fun day, it's fun when you win.
Dr. John Chao: Well, I can see me missing one and a half foot putt. I've done that a lot.
Salvador Gaytan: Well, on the pro tour, a nine inch putt has been missed. So, they can, especially when you're nervous.
Dr. John Chao: Yeah. Actually, you know, as a dentist, I should be able to handle that, because that's like putting something into a hole, right?
Salvador Gaytan: That is right.
Dr. John Chao: So, I'm used to filling cavities all day, filling a hole shouldn't be a problem you'd think. You'd think I'll be a good putter; well I am not a good putter.
Salvador Gaytan: Well, we've putted, and you are a good putter. You've putted in {O-high} a few times; you have your own putter now.
Dr. John Chao: Yeah, but I could be better. But anyway, this is your sixth championship in the last…
Salvador Gaytan: Yeah, in about four years, six tournaments.
Dr. John Chao: Wow, you're doing great. And you also qualified for something, didn't you, recently?
Salvador Gaytan: I qualified for the Southern California Mid-Am Championship. That was a one day event, I qualified for that. So, I play in the main event, which will be April 26, 27 at Hill Crest Country Club in Los Angeles.
Dr. John Chao: Wow. Well, good luck to you then, but talking about the main event and the star of our show, another champion.
Salvador Gaytan: Another champion.
Dr. John Chao: Another champion from USC School of Dentistry, the Herman Ostrow School of Dentistry, Dr. Chai. Would you introduce Dr. Chai's qualification?
Salvador Gaytan: Dr. Chai is the Associate Dean of Research of the Herman Ostrow School of Dentistry of USC, and the Director of the Center of Craniofacial Molecular Biology. Man, that is a long title!
Dr. John Chao: You did it really well; hi, Dr. Chai.
Dr. Yang Chai: Hi, thank you for having me on your show. This is really an exciting event.
Dr. John Chao: We're very, very honored to have you, and it's been a great pleasure talking to you before the show. I'm so excited about what we will be talking about.
Salvador Gaytan: You know, Dr. Chai, I think when I go to a party, and people ask me what I do, just for kicks, I'm going to tell them, "Well, I'm the Director of the Center of Craniofacial Molecular Biology at USC." They're going to go, "Wow, really?"
Dr. Yang Chai: They will say, "What is that?"
Dr. John Chao: I didn't know you're that smart, Sal.
Salvador Gaytan: I'm telling you. That will one-ups anybody.
Dr. John Chao: Yeah, that'd be quite a line for you, Sal.
Salvador Gaytan: That's right, that is right.
Dr. Yang Chai: They will say how do you find time to play golf every day?
Dr. John Chao: It doesn't quite fit.
Salvador Gaytan: I'll say, "Well, I'm the director. I get the other people to do the real work. I just oversee."
Dr. Yang Chai: That's right.
Dr. John Chao: Well, I don't think that's the kind of director that Dr. Chai is.
Dr. Yang Chai: We all wish that, right?
Salvador Gaytan: Exactly. Now, Dr. John, you have some very -- there's a number of probably four fascinating areas of research that Dr. Chai is involved in, and what is the first one that you wanted to talk about?
Dr. John Chao: Well, I wanted to ask Dr. Chai, what field of endeavor he's in at USC Dental School, and it has to do with tissue engineering, doesn't it? [Crosstalk] It has to do with craniofacial research, doesn't it?
Dr. Yang Chai: Yes, it does.
Dr. John Chao: Would you explain to our audience, what craniofacial means, and tell us a little bit about the research that you're doing.
Dr. Yang Chai: So, we work on craniofacial birth defects. Basically we're…
Dr. John Chao: Cranial meaning the head and the face?
Dr. Yang Chai: Right.
Dr. John Chao: Okay, so craniofacial.
Dr. Yang Chai: So, a perfect example would be a cleft lip with cleft palate, and that's a congenital birth defect, quite common, and the type of research we're doing is trying to find out what causes that kind of defect.
Dr. John Chao: That kind of defect can only be corrected by multiple surgeries, isn't it?
Dr. Yang Chai: Yeah, and then also followed up with orthodontic work, and also many other procedures.
Dr. John Chao: How prevalent is cleft palate?
Dr. Yang Chai: It's one of the most common congenital birth defect in humans, and it depends on the race and ethnic background. Asians, which have the highest incidents of a cleft lip with a cleft palate, and African-Americans have the lowest rate incidents of a [crosstalk].
So, Asians have the highest incidents of a cleft lip with cleft palate, African-Americans have the lowest. So, obviously there are some genetic factors in this process.
Dr. John Chao: I didn't know that.
Salvador Gaytan: Now, just for people that -- I'm sure most people know, but a cleft palate is what exactly?
Dr. Yang Chai: Basically it's a hole on the roof over your mouth that provides a communication between the oral cavity and the nasal cavity. So, when people with a cleft palate talk, they usually have a very heavy nasal sound.
Salvador Gaytan: So, they have a piece of their upper lip missing, is what it is, right?
Dr. Yang Chai: Or a gap in their upper lip, yes.
Dr. John Chao: So, generally you will see a little scar there.
Dr. Yang Chai: Yeah, following the surgical repair, usually there's a scar, and over the years the surgical procedure has improved quite a bit. Nowadays, with the improvement in plastic surgery, the scar is becoming less visible, and also these patients have to undergo orthodontic work to get their teeth lined up, and also they may need implants in order to replace the missing teeth, so they can have proper function in their oral cavity.
Dr. John Chao: So, the roof of the mouth doesn't come together. So, there's kind of like a gap between the right and left side of the roof of the mouth.
Dr. Yang Chai: Yes.
Dr. John Chao: So, therefore there's a communication between the mouth and the nose. There's nothing separating the mouth and the nose, because there's a gap, and there are no teeth in between. So, the teeth are maybe growing crooked, and the gap has to be filled in somehow with braces, and the teeth can be moved. And do they need bone grafting and things like that?
Dr. Yang Chai: Yeah. So, patients who are born with this type of birth defect, usually will undergo surgery within the first year of their life. So, these defects are usually corrected before the patient turns one, and then after that, they will have to undergo some other surgical procedures to correct a bone defect, and also the defect in the teeth.
Dr. John Chao: So, obviously if we can somehow prevent this from happening, then we can spare these babies and these growing young people from having a lot of traumatic surgery, even though the surgical techniques are very refined now, isn't that right?
Dr. Yang Chai: Yeah.
Dr. John Chao: And your research has to do with possibly in the future preventing this?
Dr. Yang Chai: Right. So, our work is try to find out what genetic factor comes into play in this birth defect. Basically, we're trying to understand when you have a genetic mutation, and then how does that mutation affect the palate formation, and then results in a cleft palate.
Dr. John Chao: So, your research right now is conducted with animal models, right?
Dr. Yang Chai: Yes.
Dr. John Chao: And now, is there a way you can find out ahead of time within these animal models, whether an embryo or a fetus is developing cleft palate?
Dr. Yang Chai: So, we are actually in the process of developing a micro MRI, just like the normal MRI that we use on patients, then we use some small or scaled down version of MRI machine to image these animals, and use that to find out which embryo has a cleft palate.
Dr. John Chao: I see.
Salvador Gaytan: And for anyone just tuning in, you're listening to SmileTalk with Dr. John Chao, spelled C-H-A-O from Alhambra Dental, and you can contact Dr. John Chao at AlhambraDental.com or 626-308-9104. And we have a fascinating guest, Dr. Yang Chai, from the USC School of Dentistry, actually the Herman Ostrow School of Dentistry at USC, and we're talking about right now, cleft palates and his exciting research.
Dr. John Chao: And this research, we just talked about how in your research, you can detect cleft palate by using MRI, right? Is there another way you can find from signals or other ways or chemical testing, testing blood, as to whether a cleft palate case is developing?
Dr. Yang Chai: Yes. So, there are certain genetic mutations that have been linked to cleft palate, but it's not always 100%. So, we do genetic -- we can do genetic testing, but also that has to be coupled with some of these imaging analysis. So, with the two approaches, we'll be able to find out which model, which embryo has a cleft palate.
Dr. John Chao: Okay, now once you find that out, how do you then correct that problem? Now, we're talking about correcting it in the uterus before the baby is born. So, you're going to do some correcting before the baby is even born, so you're doing what's called in-uterine -- or a therapy.
Dr. Yang Chai: Approach, right. So, before we go into that, let me tell you a little bit about how we create these animal models that will develop a cleft palate. So, what we do is we remove a critical gene.
So, there are many genes in our body that control what our cells do, and how we build a body, and then through our research, we learned that there are some critical genes, if you take that gene away from this animal model, and then they will develop a cleft palate with 100% incidence. So, basically if you're missing that gene, you get a cleft palate.
Dr. John Chao: I see. So, you can create this condition.
Dr. Yang Chai: Right.
Dr. John Chao: Because you know the gene that causes it. That's important [crosstalk] helping, yeah.
Dr. Yang Chai: So, if you're missing that chain, you know you will get a cleft palate. But often times, when you remove a gene, not only you will get a cleft palate, but also there are other defects, such as skull defects or cardiac defects.
So, that's why when you look at patients who have cleft palate, they often -- this cleft palate is a part of the syndrome. When you say there is a syndrome, meaning that the patient has multiple defects, not only there's cleft palate, but also maybe there is a small mandible or a concaved face or abnormal skull or cardiac defects, so on and so forth. So, collectively all these defects qualify that particular type of -- qualify for a specific syndrome.
Dr. John Chao: And that's traceable to the missing gene?
Dr. Yang Chai: Or to the malfunction of a gene.
Dr. John Chao: Yeah, the malfunction of a gene. Okay, and once you identify the gene, then you do the testing to confirm that that's missing, and then how do you treat that?
Dr. Yang Chai: So, then we develop an animal model with this genetic mutation or genetic defect, which then has all these defects as we would see in humans. So, that would validate our animal model to be very useful to study this type of a human birth defect.
Then we begin to explore what are the downstream events that this gene controls. So, if I say I take gene A away, then gene B will not be able to work in this environment. Then, I would say what if I can supplement gene B in this animal model without the gene A?
So, using that approach, we have demonstrated in the animal model, that you can actually rescue this type of a congenital birth defect.
Dr. John Chao: Yeah. So, you can actually apply that knowledge, supplementing one gene to cover up for the deficiencies of another gene, and possibly do research on the human level to help human beings cope with that.
Dr. Yang Chai: Right.
Dr. John Chao: I see, okay.
Dr. Yang Chai: And then, of course, when someone has a mutation of a particular gene, you can't say I'm going to manipulate your other gene.
Dr. John Chao: No, no.
Dr. Yang Chai: But what we can do is to use some small molecules or established medication that help to activate the downstream event. So, basically make this missing gene to be irrelevant, and you won't be able to sort of bypass this missing gene, and then to be able to activate what are the downstream event as this gene is still in place.
Dr. John Chao: Yeah. So, this research is pointing towards a possible solution…
Dr. Yang Chai: For the future.
Dr. John Chao: For genetic problems in the future.
Dr. Yang Chai: Right.
Dr. John Chao: Now, do you treat this -- in the animal model, do you treat it with some medication?
Dr. Yang Chai: So, we are in the process of testing that.
Dr. John Chao: Testing that, okay.
Dr. Yang Chai: A perfect example would be -- we all know, for pregnant women, they all have to take vitamin supplements. One of those supplements is folic acid. Previous research work was done many years ago, demonstrated that folic acid can help to prevent neural tube defect. So, that’s why people are -- now pregnant women are taking folic acid to prevent the possibility of having a neural tube birth defect.
Dr. John Chao: The neural tube is what forms the brain. Is that…
Dr. Yang Chai: It forms the brain and the spinal cord.
Dr. John Chao: And the spinal -- so, if the doctor wants a pregnant woman to take certain vitamins, that pregnant person should absolutely follow the doctor's instructions, shouldn't she?
Dr. Yang Chai: Yes.
Dr. John Chao: To prevent the chance of having a birth defect.
Dr. Yang Chai: Right.
Dr. John Chao: This is based on studies of -- gene studies, like such as yours.
Dr. Yang Chai: Or studies based on animal model, in which case we discovered this particular vitamin is very important for a normal embryo development.
Dr. John Chao: Yeah. In terms of your research then, not only does it point to the fact that cleft palate maybe treatable from that point of view, but also perhaps other diseases that have a genetic origin. So, this is exciting in terms of a new field of treatment.
Dr. Yang Chai: Right. So, I work…
Dr. John Chao: Embryonic treatment.
Dr. Yang Chai: Yeah, I work with a craniofacial surgeon. His name is Mark Urata. He also graduated from USC School of Dentistry many years ago, and then became oral and maxillofacial surgeon, and then he decided that was not enough, and he went back to medical school to become an MD, and then later on turned into a plastic and reconstructive surgeon.
And then after that, he specialized in craniofacial surgery. A few years ago, he came to me and -- so, he has been operating on these kids with congenital birth defect for many years, but the first thing he said is he wanted to put himself out of business. So, what he wants to do is to invest in research, to find an alternative other than surgery to treat these kids with congenital birth defects.
Dr. John Chao: Yeah. I've seen some videos and some pictures of what these kids have to go through, and it's really, really hard. It's hard to even watch.
Dr. Yang Chai: Yeah, multiple surgeries and also the emotional toll on these kids, but also more on their parents, it's just enormous.
Dr. John Chao: So, if there's some way to somehow prevent it in the future, it's a very, very worthwhile research.
Dr. Yang Chai: Absolutely.
Dr. John Chao: And the implication is enormous, isn't it?
Dr. Yang Chai: Yes.
Dr. John Chao: And that so many diseases can be treated in the embryonic stage, in the fetal stage, in the prenatal period.
Dr. Yang Chai: Or at least this type of research will teach us how to prevent such kind of birth defect, so we'll be able to find out if you have certain genetic mutation and what we can supplement, and then to help you to basically bypass the requirement of this particular gene's function. So, it will provide a better early diagnosis and prevention, and also a potential treatment.
Dr. John Chao: And this is research at the School of Dentistry…
Dr. Yang Chai: At USC.
Dr. John Chao: Yeah, at USC, that can impact the future of medicine in terms of genetic diseases. That's phenomenal in its application, implication. You said that you also are involved in teaching the students how to be involved with research like this. Would you care to tell us a little bit more about the USC program?
Dr. Yang Chai: Yeah, at the Herman Ostrow School of Dentistry at USC, we have a very robust DDS program, as you well know, and we have over 144 students every year, and plus the ASPID program. So, we have over a 170 students every year.
They have the opportunity to work with faculty members, who are conducting basic and clinical research, and these students will have the opportunity to get training to learn how to do research, and how to review literature.
We don't expect to turn each one of them into a researcher in the future, but what they have learned while they're in dental school is not -- it's the knowledge that is yet to be included in the textbook. So, basically it's something that has just been discovered in our lab or in the clinic, and they get to work with faculty members who are constantly trying to redefine how we provide oral healthcare for our patients.
Dr. John Chao: Yeah. We never know whether one of these students will become a researcher. We'll want that to happen, wouldn't we, at least to a certain number of our students.
Dr. Yang Chai: Absolutely, we do. Right, but also just as an experience and going through school and learning how to do research, and you will become more of a critical thinker, so when you have your own practice, you'll be able to evaluate the literature more critically, and also be able to talk with your peers and write up case reports and then be able to get involved with research in the future.
Dr. John Chao: Yeah, and that's one of the very strong points of USC education at the dental school, is critical thinking. And this applies to research, as well as the ability to think on your own, and be able to successfully practice dentistry or hopefully some of the students will turn to research.
Salvador Gaytan: Absolutely.
Dr. Yang Chai: Yeah. We have really had some very successful cases working with our students, who not only got really excited about doing research, and then eventually getting a PhD, and then becoming really famous faculty members in other dental schools around the country.
Dr. John Chao: Yes, I've heard them a lot.
Salvador Gaytan: Well, we're coming to the last few seconds of our show, Dr. John. We've had our fascinating guest, and we still have a lot to cover, so we're going to keep him around for another show. Is that okay, Dr. Chai?
Dr. John Chao: We'll come back to that again at the next show, and talk about this again. Is that okay, Dr. Chai?
Dr. Yang Chai: Sure.
Salvador Gaytan: A few more things, and anyway we've been talking with Dr. Yang Chai, Associate Dean of Research at the Herman Ostrow School of Dentistry at USC, and we're going to hold him over for another show. We have some more fascinating things, but that's a wrap for right now, Dr. John.
Dr. John Chao: Okay, bye everybody. Thanks for listening.
Salvador Gaytan: Next week. [Crosstalk] And for anyone tuning in late, you've been listening to SmileTalk with Dr. John Chao, spelled C-H-A-O of Alhambra Dental. You can reach Dr. John Chao at AlhambraDental.com or 626-308-9104 and questions are welcome, right Dr. John?
Dr. John Chao: Yes, or you can reach my website at ChaoRadio.com, C-H-A-O Radio.com. We have a domain name now, so you can reach me easily with your questions. Thanks for listening everybody, we'll see you next week.
[END OF AUDIO]
