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Thursday, December 19 2013

ATLANTA, USA: The Centers for Disease Control and Prevention has released its second report on health disparities and inequalities across a wide range of diseases and in health care access in the U.S. For the first time, the document includes statistics on the prevalence of periodontitis in U.S. adults.

According to the report, more than 47 percent of adults aged 30 and over (approximately 65 million adults) had periodontitis during 2009–2010. While an estimated 8.7 percent had mild periodontitis, the prevalence of moderate periodontitis was 30 percent. Severe periodontitis was estimated to occur in 8.5 percent.

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Posted by: Suzanne newkirk, RDH AT 09:22 am   |  Permalink   |  0 Comments  |  Email
Wednesday, December 18 2013

This 59 year old patient received twice yearly cleanings by her general practioner and no history of previous periodontal treatment. Her chief complaint was that her bridge (#’s 9-11) “keeps losing gum tissue” and the patient “felt it was ugly”. This was the third bridge that had been placed. A comprehensive periodontal examination revealed periodontal probing depths of 4- 9mm, with associated generalized bleeding on probing. Localized Class I mobility and recession of 1-3 mm was noted throughout the dentition. Radiographic bone loss around the bridge was noted and a diagnosis of generalized AAP case type III-IV (moderate to severe) periodontal disease was made.

The patient was initially recommended full mouth laser surgery (Laser Assisted New Attachment Procedure), implant placement in the edentulous area #10 and crown lengthening, but the patient declined all surgical options. A non-surgical treatment plan of ultrasonic endoscopic debridement was made and the patient was prescribed azithromycin (250mg x 6), 2 to be taken the day of treatment, then 1 per day until gone. Endoscopic debridement with adjunctive non-surgical laser pocket disinfection was completed in 2 visits under local anesthesia. Periodontal maintenance was provided every 3 months to include full mouth periodontal charting, instrumentation and polish. Bridge replacement of #’s 7-9 was coordinated with the referring general dentist

3 years post ultrasonic endoscopic debridement the patient is maintaining a generalized favorable clinical outcome. Periodontal charting reveals overall improvement with generalized decreased probing depths and radiographic bone repair is evident on the bridge abutments #’s 9 and 11.

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Posted by: Suzanne newkirk, RDH AT 09:17 am   |  Permalink   |  0 Comments  |  Email
Wednesday, December 18 2013

The Effect of Nonsurgical Periodontal Therapy
on Hemoglobin A1c Levels in Persons With Type 2 Diabetes and Chronic Periodontitis.
A Randomized Clinical Trial. JAMA. 2013;310(23):2523-2532. doi:10.1001/jama.2013.282431. December 18, 2013 Volume 310, Number 23

Abstract Conclusions and study design: The Diabetes and Periodontal Therapy Trial (DPTT), a 6-month, single-masked, multicenter, randomized clinical trial. Participants had type 2 diabetes, were taking stable doses of medications, had HbA1c levels between 7%and less than 9%, and untreated chronic periodontitis. Five hundred fourteen participants were enrolled between November 2009 and March 2012 from diabetes and dental clinics and
communities affiliated with 5 academic medical centers. The treatment group (n = 257) received scaling and root planing plus chlorhexidine oral rinse at baseline and supportive periodontal therapy at 3 and 6 months.
The control group (n = 257) received no treatment for 6 months.
Results: Enrollment was stopped early because of futility. At 6 months, mean HbA1c levels in the periodontal therapy group increased 0.17%(SD, 1.0), compared with 0.11% (SD, 1.0) in the control group, with no significant difference between groups based on a linear regression model adjusting for clinical site (mean difference, −0.05%[95%CI, −0.23%to 0.12%]; P = .55).
Periodontal measures improved in the treatment group compared with the control group at 6 months, with adjusted between-group differences of 0.28mm(95%CI, 0.18 to 0.37) for probing depth, 0.25mm(95%CI, 0.14 to 0.36) for clinical attachment loss, 13.1%(95%CI, 8.1% to 18.1%) for bleeding on probing, and 0.27 (95%CI, 0.17 to 0.37) for gingival index (P < .001 for all).

Conclusions and Relevance: Nonsurgical periodontal therapy did not improve glycemic control in patients with type 2 diabetes and moderate to advanced chronic periodontitis. These findings do not support the use of nonsurgical periodontal treatment in patients with diabetes for the purpose of lowering levels of HbA1c.

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Posted by: Frieda Picket, RDH AT 09:12 am   |  Permalink   |  0 Comments  |  Email
Wednesday, December 18 2013

One in two adults takes a daily vitamin pill, and Americans spend tens of billions of dollars each year on supplements. Now, a small coterie of physicians writing in a leading medical journal has offered this blunt advice: “Stop wasting money.”

In an unusually direct opinion piece, the five authors say that for healthy Americans worried about chronic disease, there’s no clear benefit to taking vitamin and mineral pills. And in some instances, they may even cause harm.

The authors make an exception for supplemental vitamin D, which they say needs further research. Even so, widespread use of vitamin D pills “is not based on solid evidence that benefits outweigh harms,” the authors wrote. For other vitamins and supplements, “the case is closed.”

“The message is simple,” the editorial continued. “Most supplements do not prevent chronic disease or death, their use is not justified, and they should be avoided.”

“We have so much information from so many studies,” Dr. Cynthia Mulrow, senior deputy editor of Annals of Internal Medicine and an author of the editorial, said in an interview. “We don’t need a lot more evidence to put this to bed.”

Officials with the Natural Products Association, a trade organization that represents supplement suppliers and retailers, said they were shocked by what they termed “an attack” on their industry, pointing to a study published last year that found a modest reduction in overall cancers in a long, randomized, controlled trial of 15,000 male doctors.

“Our members market and sell their products in order to assist people to achieve a healthier lifestyle,” said John Shaw, executive director of the association, adding that he could not understand why the industry was being criticized “for trying to promote health and wellness.”

Demand for vitamin and mineral supplements has grown markedly in recent years, with domestic sales totaling some $30 billion in 2011. More than half of Americans used at least one dietary supplement from 2003-06, up from 42 percent from 1988-94, according to national health surveys conducted by the Centers for Disease Control and Prevention. The most popular products are multivitamin and mineral supplements, which are consumed by some 40 percent of men and women in the United States, according to data from the National Health and Nutrition Examination Survey.

Whether regular long-term use can prevent heart disease and cancer has never been clearly established, and the authors of the editorial are not the first to point that out.

The Cochrane Collaboration, which publishes reviews of medical evidence, has also concluded that taking vitamins does not extend life. An updated review of the evidence by the United States Preventive Services Task Force, published online on Nov. 12, likewise concluded that there was limited evidence that vitamin and mineral supplementation could prevent cancer or cardiovascular disease.

The task force pointed out, however, that two clinical trials had found slight cancer reductions among men who took multivitamins. Yet other studies have found that beta-carotene supplements may actually increase the risk of lung cancer in smokers, the task force review noted, and that high doses of vitamins A and E cause harm and may increase the risk of death.

The editorial in the Annals is accompanied by two new studies reporting dismal results for multivitamins in helping preserve cognitive function and preventing heart attacks. In one study of nearly 6,000 male physicians 65 and older, participants who took a multivitamin for over a decade were no more likely to retain cognitive function as they aged than similar doctors who took a dummy pill.

But Dr. Francine Grodstein, one of the lead authors of that study, said that since physicians tend to have healthy diets and be well-nourished, the added nutrients may not have made a difference in their cases. “I do think there’s room for more research,” said Dr. Grodstein, who did not write or sign the editorial.

Demonstrating the prevention of chronic diseases can take decades and conducting long-term, randomized, controlled trials is both tricky and very costly. “We don’t and probably never will have randomized trial data over decades,” she said.

The results of another clinical trial published in the journal found that high-dose vitamins and minerals did not protect heart attack patients 50 and older from experiencing additional cardiovascular events, though the research was marred by a high dropout rate.

There have been few randomized clinical studies of the effects of multivitamins and minerals on heart disease, cancer and risk of death, said Dr. Stephen P. Fortmann, of the Kaiser Center of Health Research, who led the task force review. A draft of new task force recommendations, based on the updated review, said there was insufficient evidence to recommend taking or not taking vitamins.

But Dr. Fortmann, who also did not write or sign the editorial, suggested that those who buy vitamins may be “throwing their money away,” adding: “Don’t think it makes up for a bad diet, that you can eat a lot of fast food and then take a bunch of supplements. That’s not a good idea.”

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Posted by: Georgia DH Association AT 09:03 am   |  Permalink   |  0 Comments  |  Email
Friday, December 14 2012

Article one delves into the complexities of external root resorption.

Root Resorption:
In their Abstract “Root resorption – diagnosis, classification and treatment choices based on stimulation factors”, Fuss, Tsesis and Lin stated “etiology of different types of root resorption requires two phases: mechanical or chemical injury to the protective tissues and stimulation by infection or pressure.”

The Abstract classifies various types of root resorptions according to their stimulation factors:

• Pulpal infection resorption
• Periodontal infection resorption
• Orthodontic pressure resorption
• Impacted tooth or tumor pressure resorption
• Ankylotic resorption

We have found that a history of trauma including excessive occlusal loading and idiopathic pathology are also factors in external root resorption.

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Posted by: AT 08:21 am   |  Permalink   |  0 Comments  |  Email
Friday, December 14 2012

The benefits of occlusal adjustment as a component of periodontal treatment have not been adequately demonstrated in the clinical research to date, according to a new systematic review in the Journal of Dentistry (December 2012, Vol. 40:12, pp. 1025-1035).

"The relationship between trauma from occlusion (TfO) and periodontal disease has been discussed for more than a century," wrote the study authors from University of São Paulo dental school. "A few observational studies reported a positive relationship between TfO and [clinical attachment loss (CAL)] and demonstrated that periodontally compromised teeth presenting TfO had less bone support and greater pocket probing depth."

Based on these studies, "if TfO had any relationship to the progression of periodontitis, then its elimination could also enhance clinical periodontal conditions," they noted.

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Posted by: AT 08:19 am   |  Permalink   |  0 Comments  |  Email
Friday, December 14 2012

Diode lasers can significantly improve clinical parameters when used as an adjunct to scaling and root planing (SRP) during periodontal treatment, according to a new study in Lasers in Medical Science (November 16, 2012).

Laser treatment was performed by using a 940-nm indium-gallium-aluminum phosphate (InGaAIP) diode laser. Plaque index, gingival index, bleeding on probing, probing depth, and clinical attachment level were measured at baseline and at one, three, and six months after treatment.

The gingival crevicular fluid levels of interleukin-1 beta (IL-1β), interleukin-6 (IL-6), interleukin-8 (IL-8), matrix metalloproteinase-1 (MMP-1), matrix metalloproteinase-8 (MMP-8), and tissue inhibitor matrix metalloproteinase-1 (TIMP-1) were analyzed by enzyme-linked immunosorbent assay.

Here are some of the key results:

•The test group showed a significantly better outcome compared with the control group in full-mouth clinical parameters.

•MMP-1, MMP-8, and TIMP-1 showed significant differences between groups after treatment compared with baseline. The total amount of IL-1β, IL-6, MMP-1, MMP-8, and TIMP-1 decreased and IL-8 increased after treatment in both test and control groups.

•The diode laser provided significant improvements in clinical parameters, and MMP-8 was significantly impacted by the adjunctive laser treatment at the first month.

Conclusion:
Correct selection of the dental laser device, modes of irradiation, application time, the diameter of the laser fiber tip, and frequency of application may help the clinicians to get better results in treating periodontal disease, he added.

"We observed satisfactory results by using diode laser," Saglam concluded. "But there is no guarantee to achieve satisfactory results in every time. We need more evidence to use dental lasers effectively in the treatment of periodontitis."

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Posted by: Suzanne AT 08:05 am   |  Permalink   |  0 Comments  |  Email
 

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