The Influences of Periodontal Status and Periodontal Pathogen Quantity on Salivary 8‐Hydroxydeoxyguanosine and Interleukin‐17 Levels

Background: Periodontitis is a biofilm‐initiated disease that is characterized by elevated inflammatory status. 8‐Hydroxydeoxyguanosine (8‐OHdG) and interleukin (IL)‐17 are highly associated with inflammation and bone resorption and therefore are regarded as potential biomarkers for periodontitis. In this study, the associations between salivary 8‐OHdG and IL‐17 levels and clinical and microbial parameters before and after non‐surgical treatment are investigated. Methods: Forty‐five patients with chronic periodontitis (CP) and 47 periodontally healthy volunteers were recruited for the study. Clinical parameters, including the probing depth (PD), clinical attachment level (CAL), sulcular bleeding index, and simplified oral hygiene index (OHI‐S), were examined for each participant. Microbial parameters including the quantities of Porphyromonas gingivalis, Tannerella forsythia, and Treponema denticola in the subgingival plaque and saliva were determined by real‐time polymerase chain reaction at baseline and 1 and 3 months after the non‐surgical treatment. Salivary 8‐OHdG and IL‐17 levels were detected by enzyme‐linked immunosorbent assays. Results: Compared with healthy volunteers, CP group patients had significantly higher salivary 8‐OHdG and IL‐17 levels at baseline. Baseline salivary 8‐OHdG and IL‐17 levels were positively correlated with all clinical parameters as well as the quantities of T. forsythia and T. denticola. After non‐surgical treatment, baseline levels of salivary 8‐OHdG and IL‐17 were reduced significantly at both the 1‐ and 3‐month follow‐ups. The hierarchical linear model revealed that variations in the PD, CAL, and OHI‐S had significant positive effects on variation in the salivary 8‐OHdG level. However, variations in the PD; quantity of T. forsythia in the subgingival plaque; and quantities of P. gingivalis, T. forsythia, and T. denticola in saliva were associated significantly with variation in the salivary IL‐17 levels. Conclusions: There was a strong association between salivary 8‐OHdG and IL‐17 levels and periodontitis. Variation in the salivary 8‐OHdG level was correlated with variations in the clinical parameters, whereas variation in the IL‐17 level was correlated with variation in the microbial parameters.     

Point-of-care oral-based diagnostics

Many of the target molecules that reside in blood are also present in oral fluids, albeit at lower concentrations. Oral fluids are, however, relatively easy and safe to collect without the need for specialized equipment and training. Thus, oral fluids provide convenient samples for medical diagnostics. Recent advances in lab-on-a-chip technologies have made minute, fully integrated diagnostic systems practical for an assortment of point-of-care tests. Such systems can perform either immunoassays or molecular diagnostics outside centralized laboratories within time periods ranging from minutes to an hour. The article briefly reviews recent advances in devices for point-of-care testing with a focus on work that has been carried out by the authors as part of a NIH program.     

Attenuation of radiation‐ and chemoradiation‐induced mucositis using gamma‐d‐glutamyl‐l‐tryptophan (SCV‐07)

Oral Diseases (2010) 16 , 655–660 Objective: To evaluate the efficacy of a novel immunomodulating peptide (SCV‐07) in attenuating the course of radiation‐induced mucositis in an established animal model of oral mucositis (OM). Material and Methods: In three separate experiments, golden Syrian hamsters received either an acute radiation challenge to the buccal mucosa of eight fractionated doses of 7.5 Gy of radiation over a 2‐week‐period, or a combination of acute radiation and cisplatin. In each experiment, animals were treated with varying doses or schedules of SCV‐07 or placebo. OM was scored in a blinded fashion using digital images obtained during the experimental period. Results: We found that SCV‐07 reduced the severity and duration of both acute and fractionated radiation‐induced OM. Similarly, when radiation and chemotherapy were used to induce OM, treatment with SCV‐07 significantly reduced the duration of ulcerative OM. The therapeutic benefit was dependent on both dose and schedule of administration. Conclusion: Taken together, we found SCV‐07 was able to modify the duration and severity of oral mucositis and was dependent on schedule and dose.     

Payment systems and incentives in dentistry

In this commentary, we discuss the advantages and disadvantages of the following incentive‐based remuneration systems in dentistry: fee‐for‐service remuneration, per capita remuneration, a mixed payment system (a combination of fee‐for‐service remuneration and per capita remuneration) and pay‐for‐performance. The two latter schemes are fairly new in dentistry. Fee‐for‐service payments secure high quality, but lead to increased costs, probably due to supplier‐induced demand. Per capita payments secure effectiveness, but may lead to under‐treatment and patient selection. A mixed payment scheme produces results somewhere between over‐ and under‐treatment. The prospective component (the per capita payment) promotes efficiency, while the retrospective component (the fee‐for‐service payment) secures high quality of the care that is provided. A pay‐for‐performance payment scheme is specifically designed towards improvements in dental health. This is done by linking provider reimbursements directly to performance indicators measuring dental health outcomes and quality of the services. Experience from general health services is that pay‐for‐performance payment has not been very successful. This is due to significant design and implementation obstacles and lack of provider acceptance. A major criticism of all the incentive‐based remuneration schemes is that they may undermine the dentists’ intrinsic motivation for performing a task. This is a crowding‐out effect, which is particularly strong when monetary incentives are introduced for care that is cognitively demanding and complex, for example as in dentistry. One way in which intrinsic motivation may not be undermined is to introduce a fixed salary component into the remuneration scheme. Dentists would then be able to choose their type of contract according to their abilities and their preferences for nonmonetary rewards as opposed to monetary rewards. If a fixed salary component cannot be introduced into the remuneration scheme, the fees should be ‘neutral’; that is, they should just cover the costs of the services provided. This is one way in which supplier‐induced demand can be limited and costs contained.     

Modified Complete‐Arch Impression Technique for Facilitating Esthetic and Biomechanical Precision in Complete‐Arch Rehabilitation

Treating complex cases is clinically and technically challenging, yet highly rewarding to both patient and clinician when successfully completed. Precision in the fit of the restorations, the definitive occlusal scheme, and the esthetic result are the key elements to long‐term success. Clinicians should aim to achieve the same level of precision when treating these cases as they do when treating simple cases; however, with the numerous stages and increased complexity involved comes the potential for errors to compound and magnify as treatment progresses. Areas particularly prone to difficulties are the making of a complete‐arch impression and the ability to maintain patient comfort and eliminate unwanted dental emergencies throughout the time‐consuming treatment. This report illustrates the techniques and concepts used to achieve esthetic and biomechanical precision when treating complex cases. Specific emphasis is placed on the importance of an accurate complete‐arch impression technique, the detail of which is described in the article.     

Instability of self-esteem, self-confidence, self-liking, self-control, self-competence and perfectionism: associations with oral health status and oral health-related behaviours

To cite this article:
Int J Dent Hygiene 10 , 2012; 22–29
DOI: 10.1111/j.1601‐5037.2011.00519.x
Dumitrescu AL, Zetu L, Teslaru S. Instability of self‐esteem, self‐confidence, self‐liking, self‐control, self‐competence and perfectionism: associations with oral health status and oral health‐related behaviours. Abstract: Aim: Our aim was to explore whether instability of self‐esteem, self‐confidence, self‐liking, self‐control, self‐competence and perfectionism each has an independent contribution to the self‐rated oral health and oral health‐related behaviours. Material and methods: A cross‐sectional study design was used. Data were collected between November 2008 and May 2009. The sample consisted of 205 Romanian adults (mean age: 29.84 years; 65.2% women; 40% married) who were a random population drawn consecutively from the registry file of two private dental practices in the Iasi area. The questionnaire included information about demographic, psychological, self‐reported oral health and oral health‐related behaviour items. Results: The comparison of participants who never flossed their teeth with those who flossed everyday showed statistically significant lower levels of self‐confidence (P < 0.05), self‐liking (P = 0.001), self‐competence (P < 0.0001), self‐control (P < 0.05) and Perfectionism Scores (P < 0.05). Significant higher levels of self‐competence were scored in persons who used weekly mouthrinses comparing with never users (P = 0.012). Also patients who visited the dentist mainly when treatment is needed or when pain presented lower levels of self‐competence and self‐control comparing with those who visited the dentist mainly for check‐up or for tooth cleaning and scaling (P < 0.05). Oral health behaviours (toothbrushing and mouthrinse frequencies) were predicted by multiple regression analyses using sociodemographic (age, gender), self‐competence and perfectionism variables. Conclusions: Our study showed that instability of self‐esteem, self‐confidence, self‐competence, self‐liking, self‐control and perfectionism was associated not only with self‐rated dental health but also with oral health behaviours. Understanding the psychological factors associated with oral hygiene can further the development and improvement in therapeutic strategies to be used in oral health‐improving programs, as well as of programs aimed at prevention and education.     

Bespoke video vignettes – an approach to enhancing reflective learning developed by dental undergraduates and their clinical teachers

This study explores the selective use of video as a medium to support reflective processes as related to dental undergraduate learning. With the objective of developing and enhancing high‐quality adult dental care, the use of compiled video materials created in an undergraduate clinical setting was investigated. Video cameras were used to capture elements of reflection‐in‐action and reflection‐on‐action typically found during everyday clinical practice. ‘Gold standard’ or ‘textbook outcomes’ are rarely, if ever, fully achieved in dental practice. Real‐life clinical experiences offer challenges and opportunities for both teachers and students to engage with reflective learning processes. The materials generated allowed for an experience of individual reflective learning and the creation of a data bank or archive with potential use for the benefit of a wider student cohort. Various aspects of the students’ views and comments on the process of reflection were reported and explored by means of a semi‐structured focus group moderated by a linked educational advisor.     

Altered redox homeostasis in human diabetes saliva

J Oral Pathol Med (2012) 41 : 235–241 Background: Oxidative stress has been implicated in the pathogenesis of diabetes mellitus (DM). Levels of 8‐hydroxy‐2′‐deoxyguanosine (8‐OHdG), 8‐epi‐prostaglandin‐F_2α (8‐epi‐PGF2α), and total protein carbonyls were measured to assess whether DM is associated with altered salivary redox homeostasis. Methods: A total of 215 patients with diabetes and 481 healthy controls were recruited from the Department of Endocrinology at the Jewish General Hospital in Montreal. Levels of oxidative biomarkers were assayed using enzyme‐linked immunosorbent assay (ELISA) in whole unstimulated saliva. Associations of the redox data with exposure to insulin, metformin and dietary control were assessed by logistic regression analyses. Results: We observed (i) significantly higher mean levels of 8‐OHdG and protein carbonyls in whole unstimulated saliva of patients with diabetes compared to controls, (ii) higher mean levels of protein carbonyls in type 1 diabetes as well as higher mean levels of 8‐OHdG and protein carbonyls in type 2 diabetes compared to controls, (iii) elevated levels of protein carbonyls in diet‐controlled patients and in patients with diabetes on insulin and metformin, (iv) elevated levels of 8‐OHdG in patients on metformin, and (v) significant associations between subjects with DM and salivary 8‐OHdG and protein carbonyls. Conclusion: DM is associated with increased oxidative modification of salivary DNA and proteins. Salivary redox homeostasis is perturbed in DM and may inform on the presence of the disease and efficacy of therapeutic interventions.     

Insulin‐like growth factor‐binding protein‐2 and ‐3 in gingival crevicular fluid

Takenouchi Y, Ohshima M, Yamaguchi Y, Nishida T, Senda N, Idesawa M, Otsuka K, Ito K. Insulin‐like growth factor‐binding protein‐2 and ‐3 in gingival crevicular fluid. J Periodont Res 2010; 45: 803–808. © 2010 John Wiley & Sons A/S Background and Objective: Insulin‐like growth factor‐binding proteins (IGFBPs) are crucial regulators of insulin‐like growth factor (IGF). They enhance or inhibit IGF functions, but also exhibit IGF‐independent effects. In a previous study, we detected, qualitatively, IGFBP‐2 and ‐3 in gingival crevicular fluid using a cytokine antibody array. Here we extended these results using an ELISA to determine the concentrations of IGFBP‐2 and ‐3 in gingival crevicular fluid. In addition, we explored whether the expression of IGFBP‐2 and IGFBP‐3 correlates with periodontal disease severity. Material and Methods: Gingival crevicular fluid samples from 92 sites of 12 patients affected with periodontal disease and from 100 sites of 19 healthy volunteers, were collected, divided into two groups and analyzed by ELISA for IGFBP‐2 and ‐3 expression. The potential correlation among probing depth, gingival index and the concentrations of IGFBP‐2 and ‐3 was analyzed. Results: Positive correlations were observed between the concentration of IGFBP‐2 and probing depth and gingival index, but not for IGFBP‐3. The IGFBP‐2 concentrations at bleeding on probing‐positive sites and at sites with a probing depth of ≥ 4 mm were higher than at bleeding on probing‐negative sites and at sites with a probing depth of ≤ 3 mm. Conclusion: These results indicate that IGFBP‐2 is a potential novel marker for periodontal disease progression. As IGFBP‐2 modulates bone metabolism and cell migration, IGFBP‐2 in the gingival crevicular fluid may reflect periodontal disease activity.     

Phenotypic plasticity and epithelial‐to‐mesenchymal transition in the behaviour and therapeutic response of oral squamous cell carcinoma

It is increasingly recognised that phenotypic plasticity, apparently driven by epigenetic mechanisms, plays a key role in tumour behaviour and markedly influences the important processes of therapeutic survival and metastasis. An important source of plasticity in malignancy is epithelial‐to‐mesenchymal transition (EMT), a common epigenetically controlled event that results in transition of malignant cells between different phenotypic states that confer motility and enhance survival. In this review, we discuss the importance of phenotypic plasticity and its contribution to cellular heterogeneity in oral squamous cell carcinoma with emphasis on aspects of drug resistance and EMT.     

Evaluation of the adhesion of fiber posts cemented using different adhesive approaches

The aim of this study was to investigate the adhesion of fiber posts cemented with luting agents that utilize three currently available adhesive approaches: etch‐and‐rinse, self‐etch, and self‐adhesive. Forty‐two intact single‐rooted human premolars were used in the study. Teeth were divided into six groups. In each group, a different resin cement with its adhesive system (if needed) and a fiber post were used. The groups were classified, according to the adhesive approach, into the following three categories. (i) Etch‐and‐rinse groups: Calibra resin cement/XPBond adhesive + self‐curing activator (SCA)/RadiX Fiber Post (Dentsply Caulk), FluoroCore 2 core build‐up material/XPBond + SCA/RadiX Fiber Post (Dentsply Caulk), and MultiCore Flow luting and core build‐up material/Excite DSC adhesive/FRC Postec Plus fiber post (Ivoclar Vivadent). (ii) Self‐etch group: Panavia F 2.0/ED primer (Kuraray)/RadiX Fiber Post (Dentsply Caulk). (iii) Self‐adhesive groups: experimental self‐adhesive cement/RadiX Fiber Post (Dentsply Caulk), and RelyX Unicem/RelyX Fiber Post (3M ESPE). The adhesion between the post and the root canal walls was assessed using the ‘thin‐slice’ push‐out test. In the test arrangement used, the self‐etching approach may offer less favourable adhesion to root canal dentin in comparison with etch‐and‐rinse and self‐adhesive approaches.