Did a Goals-of-Care Discussion Happen? Differences in the Occurrence of Goals-of-Care Discussions as Reported by Patients,Clinicians, and in the Electronic Health Record

Context

Goals-of-care discussions are associated with improved end-of-life care for patients and therefore may be used as a process measure in quality improvement, research, and reimbursement programs.

Arsenic association with circulating oxidized low-density lipoprotein in a Native American community

More than 500 abandoned uranium (U) mines within the Navajo Nation contribute U, arsenic (As) and other metals to groundwater, soil and potentially air through airborne transport. The adverse cardiovascular health effects attributed to cumulative exposure to these metals remains uncertain. The aim of this study was to examine whether environmental exposure to these metals may promote or exacerbate the oxidation of low-density lipoprotein (LDL) cholesterol in this Native American population. The correlation of cardiovascular biomarkers (oxidized LDL (oxLDL) and C-reactive protein (CRP)) from a Navajo cohort (n = 252) with mean annual As and U intakes from water and urine metals was estimated using linear regression. Proof-of-concept assays were performed to investigate whether As and U directly oxidize human LDL. Mean annual As intake from water was positively and significantly associated with oxLDL, but not CRP in this study population, while U intake estimates were negatively associated with oxLDL. In an acellular system, As, but not U, directly oxidized the apolipoprotein B-100 component of purified human LDL. Neither metal promoted lipid peroxidation of the LDL particle. Both the population and lab results are consistent with the hypothesis that As promotes oxidation of LDL, a crucial step in vascular inflammation and chronic vascular disease. Conversely, for outcomes related to U, negative associations were observed between U intake and oxLDL, and U only minimally altered human LDL in direct exposure experiments. Only urine U was correlated with CRP, whereas no other metals in water or urine were apparently reliable predictors of this inflammatory marker.     

Transitioning patients: teeth to implants

The transition of patients from a dentate state to an implant-supported restoration requires significant planning. Traditionally, protocols have included the extraction of teeth and interim use of a removable prosthesis. Newer protocols include approaches to decrease the period of time a patient is required to use a traditional denture. The authors' purpose is to outline options and provide clinical examples when transitioning patients from natural dentition to an implant-supported prosthesis.     

The effect of casting procedures on rotational misfit in castable abutments

PURPOSE: Misfit of implant components has been linked to restorative complications such as screw loosening. Although previous studies have shown a correlation between rotational misfit and screw loosening, the impact of casting procedures on rotational misfit is lacking. The aim of this in vitro study was to evaluate the effect of casting procedures on rotational misfit of cast abutments when compared to machined titanium abutments. MATERIALS AND METHODS: Forty-eight external hexagonal implants and 48 abutments were placed in 4 groups of 12 samples each: (1) machined titanium abutments, (2) premachined palladium abutments cast-on with palladium, (3) plastic burnout abutments cast with nickel chromium, and (4) plastic burnout abutments cast with cobalt chromium. Rotational misfit between the external hexagon of the implant and the internal hexagon of the abutment was measured using standardized techniques and recorded in degrees. Mean values for each group were analyzed with analysis of variance and Tukey test. RESULTS: The mean rotational misfit was 1.21 +/- 0.57 degrees for machined titanium abutments, 1.77 +/- 130 degrees for cast-on abutments, 1.98 +/- 0.72 degrees for cast NiCr abutments, and 2.79 +/- 1.13 degrees for cast CoCr abutments. Significantly greater rotational misfit was recorded with cast CoCr abutments when compared to machined titanium abutments (P < .05). CONCLUSION: Rotational misfit was less than 2 degrees for all groups except for cast CoCr abutments, which demonstrated a significantly greater rotational misfit.     

The influence of simulated masticatory loading regimes on the bi-axial flexure strength and reliability of a Y-TZP dental ceramic

OBJECTIVES: The purpose of the current study was to examine the influence of simulated masticatory loading regimes, to which all-ceramic crown or bridge restorations will routinely be subjected during their service-life, on the performance of a yttria-stabilised tetragonal zirconia polycrystalline (Y-TZP) dental ceramic. METHODS: Ten sets of 30 Y-TZP ceramic discs (13 mm diameter, 1.48-1.54 mm thickness) supplied by the manufacturer were randomly selected. Six groups were loaded for 2000 cycles at 500 N (383-420 MPa), 700N (536-588 MPa) and 800 N (613-672 MPa) with three groups maintained dry and the remaining three groups loaded while immersed in water at 37+/-1 degrees C. A further two groups underwent extended simulated masticatory loading regimes at 80 N (61-67 MPa) for 10(4) and 10(5)cycles under dry conditions. The mean bi-axial flexure strengths, standard deviations and associated Weibull moduli (m) were determined. The surface hardness was also determined using the Vickers hardness indentation technique. RESULTS: No significant difference (P>0.05) was identified in the bi-axial flexure strength of the simulated masticatory loading regimes and the control specimens loaded dry or wet. A significant increase in m was identified for the Y-TZP specimens following loading while immersed in water (8.6+/-1.6, 8.5+/-1.6 and 10.3+/-1.9) compared with the control (7.1+/-1.3). However, the extended loading regime to 10(5)cycles resulted in a significant reduction in the m of the Y-TZP specimens (5.3+/-1.0) compared with the control. Localised areas of increased surface hardness were identified to occur directly beneath the spherical indenter. CONCLUSIONS: The occurrence of localised areas of increased surface hardness could be the result of either a transformation toughening mechanism or crushing and densification of the material beneath the indentor manifested as the formation of a surface layer of compressive stresses that counteracted the tensile field generated at the tip of a propagating crack which increased the Weibull modulus of the Y-TZP specimens. The reduced reliability of the Y-TZP specimens loaded to 80 N for 10(5)cycles was associated with the accumulation of subcritical damage as a result of the extended nature of loading.     

Molecular mediators of Porphyromonas gingivalis‐induced T‐cell apoptosis

Porphyromonas gingivalis produces virulence factors which can modify the molecular and cellular components of the host immune response. In the present work we investigated the role of specific virulence factors from P. gingivalis in the induction of apoptosis in Jurkat T cells. P. gingivalis culture supernatants mimicked the effect of butyric acid on T‐cell apoptosis and this effect was associated with an increase in histone H4 acetylation. A role for proteases was excluded in experiments which demonstrated that neither protease inhibitors nor use of P. gingivalis mutants defective in protease synthesis had any effect on the stimulation of T‐cell apoptosis in this system.     

Clinical evaluation of the anti-plaque effect of a commercial chewing gum

OBJECTIVE: The objective of this research was to evaluate the dental plaque control effect of a chewing gum versus brushing with a dentifrice via four clinical studies. METHODOLOGY: Study 1 compared a commercial chewing gum (Colgate Dental Gum, CDG) with a water control after 24 hours post-brushing; Studies 2 and 3 compared CDG to two different brands of commercially available fluoride dentifrices after 24 hours post-brushing; Study 4 examined the anti-plaque effect of CDG plus a regular fluoride dentifrice (Colgate Winterfresh Gel, CWG) versus brushing with CWG alone for five days. The 24-hour clinical tests employed the Modified Gingival Margin Plaque Index (MGMPI), while the Quigley-Hein Plaque Index (QHPI) was used for the five-day study. All studies utilized a randomized, crossover design with a one-week washout period, and were single-blinded to the clinical evaluator. RESULTS: In Study 1, the mean MGMPI score for CDG was significantly lower (p < 0.05) compared to the water control. In Studies 2 and 3, while brushing with regular fluoride dentifrices provided improved plaque control compared to CDG, the chewing gum alone with no tooth brushing delivered a plaque reduction 60% as effective as brushing with a fluoride dentifrice. In Study 4, the group using the combination of chewing with CDG and brushing with CWG provided a significantly lower (p < 0.05) mean QHPI score compared to the group using the dentifrice only, particularly on the hard-to-brush lingual surfaces. CONCLUSIONS: Four clinical studies demonstrated that CDG provides a plaque control benefit. The results suggest that chewing gum may serve as an effective oral hygiene device when brushing may not be possible and, additionally, that chewing gum may serve as an effective adjunct to brushing for enhanced oral health.     

Occupation-related allergies in dentistry

BACKGROUND: Allergies to natural rubber latex (NRL) were unknown in dentistry until 1987. That changed with the publication of a report documenting NRL-based anaphylaxis in a dental worker. This case and others prompted regulatory and manufacturing changes in rubber products and increased awareness throughout the profession. However, other common dental chemicals cause allergic reactions and irritation and often are handled with insufficient precautions. Although recognition of NRL allergy has improved, awareness of other potential allergens and irritants in dentistry still is limited. OVERVIEW: Recent research indicates that the prevalence of NRL protein allergy may be decreasing. In contrast, occupation-related dermatoses associated with other dental products may be more common. Encounters with bonding agents, disinfectants, rubber, metals and detergents can cause occupation-based irritant contact dermatitis and allergic contact dermatitis. These conditions may be found in more than one-quarter of dental and medical personnel. Therefore, dental-specific information about the recognition and management of allergic and irritant reactions is needed. CONCLUSIONS AND CLINICAL IMPLICATIONS: The prevalence of occupation-related dermatitis may be increasing in dentistry. Reducing exposure to potential irritants and allergens and educating personnel about proper skin care are essential to reversing this trend.