Bisphosphonate therapy improves the outcome of conventional periodontal treatment: results of a 12-month, randomized, placebo-controlled study

BACKGROUND: Bone loss in periodontitis results from inflammatory reactions that stimulate osteoclastic bone resorption. Bisphosphonates inhibit bone resorption and increase bone mass. This study evaluated the effect of bisphosphonate therapy as an adjunct to non-surgical periodontal treatment in patients with moderate to severe chronic periodontitis. METHODS: Patients were randomized (2:1) to one of two bisphosphonate therapies or placebo for 1 year. All patients received non-surgical periodontal treatment (scaling, root planing) and periodontal maintenance therapy every 3 months. Clinical assessments at baseline and 6 and 12 months included clinical attachment level (CAL), probing depth (PD), and bleeding on probing (BOP). Periodontal bone mass was assessed by dental radiographs at baseline and 12 months using fractal analysis and digital subtraction radiography (DSR). RESULTS: Seventy patients were randomized, 43 to the bisphosphonate group and 27 to the placebo group. Bisphosphonate therapy significantly improved CAL, PD, and BOP relative to the placebo group during the 6- to 12-month period (CAL, P = 0.0002; PD, P = 0.0156; BOP, P = 0.0079). There was no difference in the change in periodontal bone mass between the bisphosphonate and placebo groups as measured by fractal analysis and DSR. CONCLUSION: These data suggest that bisphosphonate treatment improves the clinical outcome of non-surgical periodontal therapy and may be an appropriate adjunctive treatment to preserve periodontal bone mass.     

Complications of third molar surgery

This article addresses the incidence of specific complications and, where possible, offers a preventive or management strategy. Injuries of the inferior alveolar and lingual nerves are significant issues that are discussed separately in this text. Surgical removal of third molars is often associated with postoperative pain, swelling, and trismus. Factors thought to influence the incidence of complications after third molar removal include age, gender, medical history, oral contraceptives, presence of pericoronitis, poor oral hygiene, smoking, type of impaction, relationship of third molar to the inferior alveolar nerve, surgical time, surgical technique, surgeon experience, use of perioperative antibiotics, use of topical antiseptics, use of intra-socket medications, and anesthetic technique. Complications that are discussed further include alveolar osteitis, postoperative infection, hemorrhage, oro-antral communication, damage to adjacent teeth, displaced teeth, and fractures.     

Parental perceptions of their preschool-aged children's oral health

BACKGROUND: Parents have an important role in making decisions about their children's oral health. The purpose of the authors' study was to determine parental perceptions of their children's oral health status and factors correlated with these perceptions of health. METHODS: The authors analyzed data for 3,424 children (2-5 years of age) from the Third National Health and Nutrition Examination Survey. They based the dependent variable on a question asked of primary caregivers: "How would you describe the condition of [child's name]'s natural teeth?" Explanatory variables included demographic variables, dental visits, perception of child's general health, need for dental care and presence of tooth caries. RESULTS: Eighty-nine percent of parents rated their child's oral health as excellent, very good or good, and 11 percent rated it as fair or poor (mean = 2.7 on a five-point scale, with 1 being excellent and 5 being poor). Tooth caries, perceived need for dental cleaning and treatment, lower income and poorer general health perceptions were associated with poorer parental ratings. CONCLUSIONS: Actual disease and perceived need are associated significantly with parents' perceptions of their children's oral health. PRACTICE IMPLICATIONS: Understanding parents' perceptions of their children's oral health and factors that motivate these perceptions can help dentistry overcome barriers that parents encounter in accessing dental care for their children.     

Determinants of dental referral practices among WIC nutritionists in North Carolina

OBJECTIVES: To examine the effects of knowledge and confidence on dental referral practices among WIC nutritionists in North Carolina. METHODS: A questionnaire consisting of 118 Likert scale-type questions was administered to 92% of all WIC nutritionists in North Carolina (n = 324). The relationship of knowledge and confidence with frequent dental referrals was tested using logistic regression. RESULTS: Regression results found that confidence in performing oral health risk assessments (OR = 2.12; 95% CI = 1.13, 3.96), confidence in making dental referrals (OR = 3.02; 95% CI = 1.45-6.29), and confidence in expected outcomes that parents would seek dental care when advised to do so (OR = 3.11; 95% CI = 1.62, 5.97) were associated with more frequent dental referrals. CONCLUSIONS: The more confident WIC nutritionists feel about oral health, the more likely they are to make dental referrals. Screening and referral by WIC workers may benefit children by improving access to dental care, as the WIC clinic is frequently the first point of contact with a health professional.     

Craniofacial morphology and inclination of the posterior slope of the articular eminence in female patients with and without condylar bone change

This study investigated the association of craniofacial and glenoid fossa shapes and temporomandibular joint (TMJ) pathology in 39 orthodontic patients with signs and symptoms of TMJ disorders, using helical CT scans. Cephalometric measurements showed that 21 subjects with bilateral condylar bone change (BBC) had significantly smaller SNB angles, ramus heights and S-Ar/N-Ba ratios, as well as larger mandibular plane angles and lower anterior facial height than the 18 subjects with no condylar bone change (NBC). The average posterior slope of the left and right articular eminence in their central and lateral sections was significantly steeper in NBC than in BBC. Condylar bone change might, therefore, not only be related to the morphology of the mandible, but also of the glenoid fossa and cranial base. This appears to reflect adaptive changes in the condyle, articular eminence and cranial base in response to changes in loading.     

Two-year incidence of tooth loss among South Australians aged 60+ years

Abstract Tooth loss diminishes oral function and quality of life, and national health targets aim to reduce population levels of tooth loss. Objectives: The purpose of this study was to determine tooth loss incidence and predictors of tooth loss among older adults in South Australia. Methods: Data were obtained from a cohort study of a stratified random sample of community-dwelling dentate people aged 60+ years. Interviews and oral examinations were conducted among 911 individuals at baseline and among 693 of them (76.1%) 2 years later. Incidence rates and relative risks were calculated for population subgroups and multivariate logistic regression was used to construct risk prediction models. A method was developed to calculate 95% confidence intervals (95% CI) for relative risks (RR) from logistic regression models using a Taylor series approximation. Results: Some 19.5% (95% CI = 15.4-23.6%) of people lost one or more teeth during the 2 years. Men, people with a recent extraction, people who brushed their teeth infrequently, smokers and people born outside Australia had significantly (P<0.05) greater risk of tooth loss. Baseline clinical predictors of tooth loss included more missing teeth, retained roots, decayed root surfaces, periodontal pockets and periodontal recession. In a multivariate model that controlled for baseline clinical predictors, former smokers (RR = 2.55, 95% C1=1.48-4.40) and current smokers (RR = 2.06, 95% CI=0.92-4.62) had similarly elevated risks of tooth loss compared with non-smokers. Conclusions: The findings from this population suggest that a history of smoking contributes to tooth loss through mechanisms in addition to clinical disease processes alone.     

The clinical significance of keratinized gingiva around dental implants

Whether or not keratinized tissue is needed around dental implants to maintain peri-implant health is a controversial subject. To clarify this issue a search was conducted for clinical trials that appraised the significance ofkeratinized gingiva (KG) around teeth and dental implants. A critical assessment of the data revealed that the literature is replete with studies that contradict one another with respect to the need for KG as it relates to survivability of implants, gingival response to plaque, inflammation, probing depths, recession, and loss of bone. When groups of patients with and without KG were compared with respect to various clinical parameters, a statistically significant better result in the presence of KG could be interpreted to indicate that having KG is advantageous. However, quantitative differences between groups with and without KG were usually very small. Overall, the data was interpreted to indicate that some patients may need augmentation of keratinized tissue to maintain peri-implant health. Ultimately, the decision to augment KG is a judgment call that needs to be made by the treating clinician, because there are not enough data to facilitate development of definitive guidelines relevant to this subject. Apparently, the need for KG is patient specific, and at present there is no method to reliably predict who would benefit from tissue augmentation.     

Changing periodontal concepts: treatment considerations

Many clinical trials conducted during the last decade have clarified controversial issues and resulted in changed periodontal paradigms. These modified concepts have therapeutic implications. Some salient altered periodontal concepts include the following: The mere presence of pathogens will not initiate periodontal diseases. Most subgingival bacteria reside in biofilms. Periodontal diseases are infections. Periodontal pathogens can be transferred between family members. The host response can be protective and destructive. Gingivitis does not usually proceed to periodontitis. Risk factors in conjunction with bacteria and the host response can affect the severity of disease, patterns of destruction, and the response to therapy. Many medical conditions (eg, diabetes, smoking, and HIV infection) may predispose patients to periodontitis. Associations between periodontitis and a number of systemic ailments (eg, diabetes, adverse pregnancy outcomes, and cardiovascular disease) have been detected and are being investigated to determine if there is a cause-and-effect relationship. Diagnostic and therapeutic implications of these altered paradigms are addressed throughout the article.     

K3 Endo, ProTaper, and ProFile systems: breakage and distortion in severely curved roots of molars

It was the aim of this study to investigate the incidence of file breakage and distortion when the ProTaper, K3 Endo, and ProFile systems were used to instrument canals in the severely curved roots of extracted molars. Forty-five roots of extracted mandibular and maxillary molars with curvatures between 40 and 75 degrees were chosen for this study. The canals in group 1 were instrumented with the ProFile system. Roots in group 2 were instrumented with the ProTaper system, and those in group 3 were instrumented with the K3 Endo system. The three systems were used according to the manufacturers' instructions. The proportion of files distorted was 15.3% for the ProFile group, 2.4% for the ProTaper group, and 8.3% for the K3 Endo group. There was a statistically significant difference between the ProFile and ProTaper groups (p=0.0079). The percentage of broken files was 1.7% for the ProFile group, 6.0% for the ProTaper group, and 2.1% for the K3 Endo group. No statistically significant differences were found between these three groups (p=0.4243). The results of this study showed that these three rotary tapered systems were not significantly different with regard to breakage. There were significantly more distorted files in the ProFile group when compared with the ProTaper group. With regard to distortion, there was no significant difference between the ProTaper and K3 Endo and the ProFile and K3 Endo groups.