Effects of a standard versus comprehensive oral care protocol among intubated neuroscience ICU patients: results of a randomized controlled trial

The purpose of the study was to compare changes in oral health during intubation until 48 hours after extubation in neuroscience intensive care unit (ICU) patients enrolled in a standard or a comprehensive oral care protocol. The effects of manual toothbrushing (standard group, n = 31) were compared with those of tongue scraping, electric toothbrushing, and moisturizing (comprehensive group, n = 25) in intubated patients in a neuroscience ICU in a 2-year randomized clinical trial. Oral health was evaluated based on the Oral Assessment Guide (OAG) on enrollment, the day of extubation, and 48 hours after extubation. There were no significant differences in the frequency of the oral care protocol. Protocol compliance exceeded 91% in both groups. The total OAG score and all eight categories significantly deteriorated (Friedman test, p < .001, Bonferroni corrected) in the standard oral care group and did not return to baseline after extubation. Large effect sizes were present at all three points in this group. The total OAG score deteriorated during intubation within the comprehensive protocol group (Friedman test, p < .004) but returned to baseline status after extubation. In four categories, the ratings on tongue, mucous membranes, gingiva, and teeth did not deteriorate significantly over time. Published oral care protocols are substandard in promoting and maintaining oral health in intubated patients. A comprehensive oral care protocol, using a tongue scraper, an electrical toothbrush, and pharmacological moisturizers, was more effective for oral hygiene throughout intubation and after extubation than manual toothbrushing alone.     

Osteoporosis and periodontitis in older subjects participating in the Swedish National Survey on Aging and Care (SNAC-Blekinge)

Abstract Objective. We assessed the relationships between (I) ultrasonography calcaneus T-scores (PIXI) and mandibular cortex characteristics on oral panoramic radiographs in older subjects; and (II) osteoporosis and periodontitis. Material and methods. We examined 778 subjects (53% women) aged 59-96 years. Periodontitis was defined by alveolar bone loss assessed from panoramic radiographs. Results. PIXI calcaneus T-values ≤-2.5 (osteoporosis) were found in 16.3% of women and in 8.1% of men. PIXI calcaneus T-values <-1.6 (osteoporosis, adjusted) were found in 34.2% of women and in 21.4% of men. The age of the subjects and PIXI T-values were significantly correlated in women (Pearson's r = 0.37, P < 0.001) and men (Pearson's r = 0.19, P < 0.001). Periodontitis was found in 18.7% of subjects defined by alveolar bone level ≥5 mm. Subjects with osteoporosis defined by adjusted PIXI T-values had fewer remaining teeth [mean difference 4.1, 95% confidence interval (CI) -1.1 to -6.5, P < 0.001]. The crude odds ratio (OR) of an association between the panoramic assessment of mandibular cortex erosions as a sign of osteoporosis and the adjusted T-value (T-value cut-off <-1.6) was 4.8 (95% CI 3.1-7.2, P < 0.001; Pearson χ(2) = 60.1, P < 0.001). A significant OR between osteoporosis and periodontitis was only found in women for the T-value cut-off ≤-2.5 (crude OR 1.8, 95% CI 1.1-3.3, P < 0.03). Conclusions. An association between osteoporosis and periodontitis was only confirmed in women. The likelihood that the mandibular cortex index agrees with adjusted PIXI T-values is significant.     

The effect of permanent grafting materials on the preservation of the buccal bone plate after tooth extraction: an experimental study in the dog

Objectives: The aim of the present study was to evaluate the effects of a novel bone substitute system (Natix^®), consisting of porous titanium granules (PTG) and a bovine‐derived xenograft (Bio‐Oss^®), on hard tissue remodelling following their placement into fresh extraction sockets in dogs. Material and methods: Six modalities were tested; Natix^® granules with and without a covering double‐layered Bio Gide^® membrane; Bio‐Oss^® with and without a covering double‐layered Bio Gide^® membrane; and a socket left empty with and without a covering double‐layered Bio Gide^® membrane. Linear measurements, indicative of buccal bone height loss, and an area measurement indicative of buccal bulk bone loss were made. The statistical analysis was based on the Latin Square design with two blocking factors (dog and site). Tukey's post hoc test was used to adjust for multiple comparisons. Results: Histological observation revealed that while bone formed around both the xenograft and the titanium particles, bone was also noted within titanium granules. Of the five modalities of ridge preservation techniques used in this study, no one technique proved to be superior. Conclusion: The titanium granules were observed to have promising osseoconductive properties. To cite this article:
Bashara H, Wohlfahrt JC, Polyzois I, Lyngstadaas SP, Renvert S, Claffey N. The effect of permanent grafting materials on the preservation of the buccal bone plate after tooth extraction: an experimental study in the dog.
Clin. Oral Impl. Res. 23 , 2012; 911–917
doi: 10.1111/j.1600‐0501.2011.02240.x     

Supracrestal bone growth around partially inserted titantium implants in dogs. A pilot study.

8 titanium implants (Nobel Biocare, Göteborg, Sweden) were inserted into edentulous lower premolar areas of 4 dogs so that 6 threads of the implant protruded from the bone crest. Newly‐developed perforated dome‐shaped titanium space maintainers were fixed to the implant with cover screws. Autogenous bone fragments were placed under the space maintainers. On one side of the arch, the space maintainer was covered with a non resorbable cell occluding barrier. The implant/space maintainers were submerged under coronally postitioned flaps. Following a 3‐month healing period, there was a mean gain of new bone amounting to 2.5mm for all specimems. A greater height of bone was found for those sites in which an e‐PTFE membrane was used; 3.1mm vs. 1.9mm ( p <0.05). This study demonstrated the potential of coronal bone growth of the alveolar bone in a protected space around screw implants with exposed treads when placed in the dog.     

Chronic periodontitis, a significant relationship with acute myocardial infarction.

BACKGROUND: Chronic periodontitis (CP) has been associated with cardiovascular diseases. The study purposes were to identify the odds of acute myocardial infarction (AMI) and CP defined at different thresholds. METHODS AND RESULTS: We studied 80 subjects with clinically confirmed AMI and 80 matched control subjects with no evidence of cardiovascular disease all receiving a comprehensive periodontal examination. Statistical analysis demonstrated a difference in the proportion of sites with a periodontal probing depth >/=6.0mm (2.7% for non-AMI and 12.1% for AMI group, 95% CI: -2.8 to 0.01, P<0.05) but no difference in the extent of gingival bleeding was found between groups. The odds ratio of having AMI and periodontitis varied between 9.2:1 to 14.1:1 with the greatest odds ratio if bone loss exceeded 4mm at >/=50% of the teeth (OR: 14.1:1, 95% CI: 5.5 to 28.2, P<0.0001). The odds ratio remained significant also when only non-smokers were considered (51 subjects) (OR: 7.0:1, 95% CI: 2.0 to 24.3, P<0.01). CONCLUSIONS: Our findings suggest that patients who at routine dental visits demonstrate evidence of bone loss around several teeth can predictably be identified as being at risk for future AMI. Such subjects should be referred for medical and periodontal examinations and treatments.