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BackgroundGingivitis is a non-specific inflammatory lesion in response to the accumulation of oral biofilm and is a necessary precursor to periodontitis. Enhanced oral hygiene practices, including utilization of a dentifrice that could significantly improve plaque accumulation and gingival inflammation, is desirable to prevent and treat gingivitis and potentially prevent progression to periodontitis. This clinical study aimed to investigate the effect of a new stannous fluoride-containing dentifrice with 2.6% ethylenediamine tetra acetic acid (EDTA) as an anti-tartar agent to reduce plaque index and gingival index over a 3-month study period compared to other commercially-available fluoride-containing dentifrices.MethodsThis double-blind, randomized controlled clinical study evaluated plaque, gingival inflammation, and sulcular bleeding in patients using one of five commercially available fluoride-containing dentifrices The dentifrices tested contained: 0.454% stannous fluoride and 2.6% EDTA (D1), 0.24% sodium fluoride (C), and 0.454% stannous fluoride (D2-D4). One hundred fifty subjects participated over a 3-month period. Co-primary endpoints were improvements in plaque index (PI) and modified gingival index (mGI) from baseline values. No professional cleaning was performed during the study period.ResultsAll subjects in the study demonstrated statistically significant improvements in all measures of oral hygiene over the 3-month study period. Subjects using dentifrice 1 (D1) showed statistically significantly greater reductions in PI, mGI, and modified sulcular bleeding index (mSBI) compared with all other commercially-available dentifrices tested (p

BackgroundCompliance to periodontal maintenance therapy (PMT) is essential for long-term periodontal health. Between PMT visits, patients must maintain good oral hygiene. A dentifrice with demonstrable clinical benefits for use between PMT visits would be highly desirable. The aim of this clinical study was to investigate the effect of a novel dental gel on probing depths (PD) and inflammation when used as a home care dentifrice in Stage I and II periodontitis patients.MethodsThis double-blind clinical study randomized 65 subjects with Stage I and II periodontitis to the novel dental gel containing 2.6% EDTA, and a commercially available anti-gingivitis dentifrice with 0.454% stannous fluoride. Primary endpoint was PD at 6 months for those sites with baseline PD ≥ 4 mm and secondary endpoints included whole mouth mean scores of modified gingival index (MGI), modified sulcus bleeding index (mSBI) and plaque index (PI). No SRP was performed at baseline.ResultsSubjects using the novel dentifrice showed significant PD reductions of 1.18 mm (from 4.27 mm at baseline to 3.09 mm at 6 months) compared to 0.93 mm (from 4.23 mm at baseline to 3.30 mm at 6 months) shown for those using the positive control dentifrice. Difference between treatments at 6 months was 0.21 mm with P-value = 0.0126. Significant improvements in MGI (P = 0.0000), mSBI (P = 0.0000), and PI (P = 0.0102) were also observed in 6 months.ConclusionThe novel dentifrice showed significant reductions in PD and gingival inflammation over 6 months solely as a home care dentifrice without baseline SRP in Stage I and II periodontitis maintenance patients.

Background: Extensive reviews on the role of scaling and root planing (SRP) in the treatment of periodontitis have been previously published. This commentary will address the importance of subgingival calculus in the progression and treatment of periodontitis and addresses factors that make the execution of a "definitive" SRP a critical part of therapy.Methods: A search for articles, using keywords relevant to the subject , (e.g., periodontitis, dental scaling, root planing, dental calculus, biofilm, inflammation) was conducted using PubMed, Ovid Medline, Cochrane Reviews and the ADA Center for Evidence Based Dentistry data bases. Additionally, references cited in relevant articles were also considered.Results: Surfaces of subgingival calculus are covered with a biofilm of metabolically active bacteria. Periodontal inflammation is clearly related to the presence of calculus and biofilm. The primary goal of SRP is removal of subgingival calculus and biofilm deposits to create a biologically compatible root surface and reduce the inflammatory burden. Current evidence suggests that inflammation associated with periodontal infections affects both the immediate oral environment and the patient's systemic health.Conclusion: SRP is still critical to the treatment of periodontitis. SRP involving deep probing depths (≥ 5 mm) and root surfaces with anatomical and surface irregularities, regardless of the type of instrumentation, requires time, exceptional skill and perseverance, and patient compliance with periodontal maintenance. Sites with persistent nonresponding probing depths and signs of inflammation following a definitive SRP, should be considered for surgical intervention. [ABSTRACT FROM AUTHOR]

The article discusses the American Academy of Periodontology's (AAP's) use of a best evidence consensus (BEC) model for defining periodontal phenotype modification therapy (PhMT) for purposes of dental restoration and orthodontic therapy. Topics, including gingival recession and phenotypes, peri-implantitis, disease classification, dental prostheses and keratinized mucosa, are discussed.

Despite a quarter of a century of laser research, there is a persistent debate regarding the efficacy of dental lasers in the treatment of periodontitis or periodontal maintenance therapy. There are many claims and much hyperbole surrounding the use of lasers, either as a monotherapy or adjunctive to scaling and root planing, to treat periodontitis. There is little evidence that using a diode or neodymium:yttrium-aluminum-garnet laser adds clinical value over and above conventional non-surgical or surgical periodontal treatment. There is a significant need for better designed human clinical trials. Data from such trials should be analyzed according to initial probing depth and characteristics of the treated sites, such as non-molar, molar flat surfaces, and molar furcations, and evaluated for long-term post-treatment results. [ABSTRACT FROM AUTHOR]

Twenty-five years of research focused on various aspects of laser-mediated periodontal therapy have yielded a significant amount of conflicting evidence and a considerable amount of controversy. Despite the inconsistencies and the polemics, the use of lasers, either as a monotherapy or adjunctive to traditional therapy, is still promoted by some expert clinicians, key opinion leaders, and commercial entities. This article is protected by copyright. All rights reserved. [ABSTRACT FROM AUTHOR]

Background: Historically, periodontal regeneration has focused predominantly on bone substitutes and/or barrier membrane application to provide for defect fill and/or selected cell repopulation of the lesion. More recently, a number of technologies have evolved that can be viewed as emerging therapeutic approaches for periodontal regeneration, and these technologies were considered in the review paper and by the consensus group. The goal of this consensus report on emerging regenerative approaches for periodontal hard and soft tissue reconstruction was to develop a consensus document based on the accompanying review paper and on additional materials submitted before and at the consensus group session. Methods: The review paper was sent to all the consensus group participants in advance of the consensus conference. In addition and also before the conference, individual consensus group members submitted additional material for consideration by the group. At the conference, each consensus group participant introduced themselves and provided disclosure of any potential conflicts of interest. The review paper was briefly presented by two of the authors and discussed by the consensus group. A discussion of each of the following topics then occurred based on the content of the review: a general summary of the topic, implications for patient-reported outcomes, and suggested research priorities for the future. As each topic was discussed based on the review article, supplemental information was then added that the consensus group agreed on. Last, an updated reference list was created. Results: The application of protein and peptide therapy, cell-based therapy, genetic therapy, application of scaffolds, bone anabolics, and lasers were found to be emerging technologies for periodontal regeneration. Other approaches included the following: 1) therapies directed at the resolution of inflammation; 2) therapies that took into account the influence of the microbiome; 3) therapies involving the local regulation of phosphate and py-rophosphate metabolism; and 4) approaches directed at harnessing current therapies used for other purposes. The results indicate that, with most emerging technologies, the specific mechanisms of action are not well understood nor are the specific target cells identified. Patient-related outcomes were typically not addressed in the literature. Numerous recommendations can be made for future research priorities for both basic science and clinical application of emerging therapies. The need to emphasize the importance of regeneration of a functional periodontal organ system was noted. The predictability and efficacy of outcomes, as well as safety concerns and the cost-to-benefit ratio were also identified as key factors for emerging technologies. Conclusions: A number of technologies appear viable as emerging regenerative approaches for periodontal hard and soft tissue regeneration and are expanding the potential of reconstructing the entire periodontal organ system. The cost-to-benefit ratio and safety issues are important considerations for any new emerging therapies. Clinical Recommendation: At this time, there is insufficient evidence on emerging periodontal regenerative technologies to warrant definitive clinical recommendations. [ABSTRACT FROM AUTHOR]

Background: The treatment of periodontitis frequently begins with a non-surgical phase that includes scaling and root planing (SRP) and, on occasion, the use of systemic antibiotics. The goal of this review is to systematically evaluate the data concerning the effect of the concomitant administration of amoxicillin and metronidazole adjunctive to SRP in adults who are otherwise healthy. Methods: The PubMed-MEDLINE, Cochrane-Central, and EMBASE databases were searched to April 1, 2012, to identify appropriate studies. Probing depth (PD), clinical attachment level (CAL), bleeding on probing, and plaque index were selected as outcome variables. Based on the extracted mean values and number of individuals, changes in weighted means were calculated and a meta-analysis conducted. Results: The search yielded 526 unique titles and abstracts. Ultimately, 35 studies were selected, describing 28 clinical trials meeting the eligibility criteria. The full-mouth weighted mean change for PD showed an improvement of 1.41 mm. The full-mouth weighted mean change for CAL showed a gain of 0.94 mm. Conclusion: Systemic antimicrobial therapy using a combination of amoxicillin and metronidazole as an adjunct to SRP can enhance the clinical benefits of non-surgical periodontal therapy in adults who are otherwise healthy. [ABSTRACT FROM AUTHOR]

Background: Excellent patient compliance to periodontal maintenance is absolutely necessary for successful long-term therapy. However, absolute (100%) compliance is rare, having been reported as low as 16%. Although social, behavioral, cultural, and economic factors have been implicated as determinants in patterns of compliance, the influence of personality characteristics on attitudes remains to be carefully explored. This focused review of the literature explores current research addressing psychologic factors associated with compliance to periodontal maintenance therapy. Methods: A literature search of PubMed electronic database was conducted, inclusive of the years 1990 to 2011. The search used MeSH terminology such as periodontal maintenance, emotional intelligence, personality, patient compliance, etc. In addition, searches were conducted of reference lists from original research and review articles. Studies were assessed with respect to methodology and design, statistical analysis, and psychologic measurements. Results: Non-compliant patients appear to have a higher frequency of stressful life events. Studies suggest that initial patient response to periodontal therapy may be related to emotional intelligence. Regarding personality factors, high neuroticism and low conscientiousness are most widely associated with non-compliance. As such, increased knowledge of the "Big Five" personality factors (i.e., neuroticism, extraversion, openness to experience, agreeableness, and conscientiousness) could assist clinicians in potentially increasing compliance among patients. Clinicians could also incorporate a working knowledge of the Health Belief Model and Theory of Planned Behavior to develop individualized treatment strategies for patient compliance. Conclusion: Non-compliance to periodontal maintenance cannot be solely explained by one determinant but rather may involve an individual's health beliefs, emotional intelligence, psychologic stressors, and personality traits. [ABSTRACT FROM AUTHOR]

Background: It was previously reported that dentin matrix protein 1-null mice, which are the hypophosphatemic rickets animal model, postnatally developed severe periodontal defects. However, to the best of our knowledge, it was not documented whether similar periodontal defects were present in human patients with hypophosphatemic rickets. The aim of this study is to evaluate the periodontal status of adult patients with hypophosphatemic rickets. Methods: This case-series study evaluates the periodontal condition of adults with genetic hypophosphatemic rickets and compared their periodontal status with similar data from several cycles of the National Health and Nutrition Examination Survey (NHANES). Information regarding medical histories, dental histories, intraoral photos, probing depths (PD), calculated clinical attachment loss (AL), the presence of gingival recession, bleeding on probing, and full-mouth radio-graphic surveys were acquired. Descriptive statistics were used for comparison to NHANES data. Results: A total of 10 adult patients with hypophosphatemic rickets (two males and eight females) were evaluated. The definition of periodontitis used in this study is as follows: "A periodontitis case was defined as a person who had ≥ 3 sites with clinical AL ≥ 4 mm and ≥ 2 sites with PD ≥ 3 mm." According to this definition, the patients exhibited periodontal bone loss at a much higher prevalence (60%) compared to the reported national periodontitis prevalence (3.6% to 7.3%). Conclusion: The preliminary data from our study suggests that patients with hypophosphatemic rickets are more prone to periodontal bone loss than the general population and may require a more careful examination by dental care providers. [ABSTRACT FROM AUTHOR]

Background: Mounting evidence supports a connection between periodontal disease and coronary heart disease, ischemic stroke, and diabetes. This theoretically grounded study examines the knowledge, attitudes, and screening and referral behaviors of primary care nurse practitioners (NPs) in relation to the periodontal disease-systemic link. Methods: A questionnaire based on the theory of planned behavior was administered to 200 primary medical care providers, mostly NPs, to determine their practice behaviors, attitudes, opinions, and knowledge regarding the periodontal disease-systemic link. A total of 137 partially and fully complete questionnaires were used for data analyses. Data were analyzed for the reported frequency of screening for periodontal disease and the knowledge of the relationship between periodontal and systemic disease. Oblimin rotation was used to explore the underlying factor structure of 10 practice-behavior items. Bivariate analyses were conducted to determine which factor subscales and demographic characteristics were significantly associated with screening and referral behaviors. Results: Twenty-two percent of the respondents reported that they always or routinely screened patients for periodontal disease. When providers felt good about their training and continuing education (attitude), they were significantly more likely to screen patients for periodontal disease. If providers believed it was within their scope of practice (social norm) to screen for periodontal disease, and they had control over the establishment of office protocols (control), the likelihood of screening for periodontal disease increased. Conclusions: Professional and social norms, the perceived control over one's practice site, and reimbursement were significantly related to NPs engaging in periodontal screening and the subsequent referral for care. These results support the importance of interprofessional and collaborative education between medicine/nursing and dentistry. [ABSTRACT FROM AUTHOR]

Background: Third generation carbon dioxide (3-CO2) lasers have handpieces that accommodate a periodontal insert that permits irradiation directly into the periodontal pocket/sulcus. The purpose of this pilot study was to evaluate, by scanning electron microscopy (SEM), the surface effects of 3-CO2 laser treatment on the root surfaces and soft tissues and to investigate the effects of 3-CO2 laser on periodontal pathogenic bacteria compared to negative controls. Methods: Five patients with chronic periodontitis and treatment planned for a maxillary immediate denture were included in the study. Periodontal pockets with a mean probing depth of 5.5 ± 0.8 mm were irradiated one time by CO2 laser (wavelength of 10,600 nm) at a power of 2.2 W, 50 Hz, an 80-millisecond pulse length, and an exposure rate of 1 mm per 5 seconds. DNA analysis of eight periodontal bacteria was performed on samples collected from laser-treated and control sites prior to and immediately following treatment and was compared between groups. In addition, block biopsies, including soft tissue, were harvested for SEM examination. Results: SEM examination of test group specimens showed heat damage on the soft tissues in three of 17 specimens (17.6%). In addition, 11.7% (two of 17) of the 3-CO2-treated teeth exhibited localized slight damage to root surfaces. Microbiologic results of the control sites indicated that 90.6% of the bacterial counts remained the same, 6% increased, and 3% decreased. In the test group, 71.25% of the bacterial count analyses for the eight different periodontal microbes remained the same, 12.50% increased, and 16.25% decreased. Conclusion: A one-time use of the 3-CO2 laser in periodontal pockets did not sterilize or substantially reduce subgingival bacterial populations compared to negative controls. [ABSTRACT FROM AUTHOR]

A response by Charles M. Cobb to a letter to the editor about his article "Lasers in Periodontics: A Review of the Literature" in the 2006 issue is presented.

Background: According to a recent study, the severity of periodontal disease of individuals referred for periodontal care is greater now than in 1980. Variability in the standard of periodontal care in general dental practices may result in less than desirable outcomes and consequences of poorer periodontal health. Methods: A sample of 100 newly referred dental patients from three separate periodontal practices in the greater Kansas City, Missouri area participated in this study. Data were collected from three sources; 1) a clinical chart audit, 2) current periodontal disease status as determined by clinical examination, and 3) a patient response questionnaire on past professional care and personal oral care habits. Bivariate analyses were performed using a statistical package. Results: Of the 100 subjects, 74 were diagnosed as periodontal case type IV at the point of referral, of which 29.8% were treatment planned by the periodontist for two or more extractions. Teeth treatment planned for extraction were significant as a function of disease severity (P=0.0001). Periodontal treatment provided in general dental practices did not vary because of disease severity. The incidence of deep cleanings (scaling and root planing) was reported slightly higher (32.4%) for case type IV than for case type III (26.9%), but this difference was not statistically significant. The average number of cleanings received in the general dental office was less than the standard of care according to the severity of the disease. Conclusion: If one assumes that the data obtained in the Kansas City practices are representative of a larger geographic area, it indicates that dentistry may be failing to address issues of the timely diagnosis of periodontal disease, appropriate treatment, and/or timely referral for treatment. [ABSTRACT FROM AUTHOR]

Background: Maxillary tuberosities have been widely used as a source of autogenous bone for a variety of oral surgical procedures How ever, no previous studies have actually demonstrated the histalogic and histomorphometric characteristics of this anatomical region in detail. The aim of this study was to evaluate maxillary tuberosities in cadavers histologically and histomorphometrically. Methods: A block section, including the overlying alveolar mucosa, was obtained from a randomly assigned maxillary tuberosity of 20 cadavers (nine females and 11 males). All cadavers were edentulous distal to the second bicuspid teeth, and 14 out of 20 were edentulous distal to the cuspids. A minimum of 35 serial sections were obtained from each cadaver. Description analysis was performed for the presence of either a fibrotic or fatty infiltration of the marrow spaces and thickness and continuity of alveolar bone. Computer-based histomorphometric image analysis of the percentage surface area of bone was also carried out in three sections of each cadaver. Statistical analysis was performed to establish possible differences between genders. The analysis did not control for nutritional status and/or possible systemic or skeletal diseases. Results: Little variation existed between specimens, regardless of gender, with respect to thickness of oral mucosa overlying the tuberosity. Descriptive bone analysis revealed thin cortical bone and sparse cancellous bone patterns. In addition, the block specimens exhibited no evidence of osteoid or active bone formation, but large marrow spaces infiltrated with loosely organized fibrous connective tissue and/or lipid cells. Histomorphometric analysis demonstrated a mean percentage of vital bone of 24.23% ± 5.2%. Stratification of the data revealed statistically significant differences in mean percentage of vital bone between genders (27.15% ± 4.7% for males versus 20.66% ± 3.4% for females; P = 0.003). Conclusions: Within the limitations of this study, maxillary tuberosities seem to mainly consist of marrow spaces, adipose tissue, and a low vital bone profile. Females demonstrated a statistically significant lower amount of vital bone than males. The results suggest that this specific area may not be an ideal source of autogenous bone for grafting pub poses in older individuals. However, it is imperative to note that this investigation did not control for nutritional imbalances and skeletal disorders. Further studies are necessary to control all confounding factors. [ABSTRACT FROM AUTHOR]

Background: Despite the large number of publications, there is still controversy among clinicians regarding the application of dental lasers to the treatment of chronic periodontitis. The purpose of this review is to analyze the peer reviewed research literature to determine the state of the science concerning the application of lasers to common oral soft tissue problems, root surface detoxification, and the treatment of chronic periodontitis. Methods: A comprehensive computer based search combined the following databases into one search: Medline, Current Contents, and the Cumulated Index of Nursing and Allied Health. This search also used key words. In addition, hand searches were done for several journals not cataloged in the databases, and the reference lists from published articles were checked. All articles were considered individually to eliminate non-peer-reviewed articles, those dealing with commercial laser technology, and those considered by the author to be purely opinion articles, leaving 278 possible articles. Results: There is a considerable conflict in results for both laboratory studies and clinical trials, even when using the same laser wavelength. A meaningful comparison between various clinical studies or between laser and conventional therapy is difficult at best and likely impossible at the present. Reasons for this dilemma are several, such as different laser wavelengths; wide variations in laser parameters; insufficient reporting of parameters that, in turn, does not allow calculation of energy density; differences in experimental design, lack of proper controls, and differences in severity of disease and treatment protocols; and measurement of different clinical endpoints. Conclusions: Based on this review of the literature, there is a great need to develop an evidence based approach to the use of lasers for the treatment of chronic periodontitis. Simply put, there is insufficient evidence to suggest that any specific wavelength of laser is superior to the traditional modalities of therapy. Current evidence does suggest that use of the Nd:YAG or Er:YAG wavelengths for treatment of chronic periodontitis may be equivalent to scaling and root planing (SRP) with respect to reduction in probing depth and subgingival bacterial populations. However, if gain in clinical attachment level is considered the gold standard for non-surgical periodontal therapy, then the evidence supporting laser-mediated periodontal treatment over traditional therapy is minimal at best. Lastly, there is limited evidence suggesting that lasers used in an adjunctive capacity to SRP may provide some additional benefit. [ABSTRACT FROM AUTHOR]

Background: Currently, there is limited knowledge concerning the specific genus and species of bacteria that may colonize internal surfaces of the implant-abutment interface (IAI) of two-stage dental implants. The purpose of this study was to use DNA probe analysis to identify those periodontopathic bacteria that may inhabit the internal surfaces and healing abutment screw-threads of the IAI of dental implants in situ. Methods: Following osseointegration, bacterial samples for DNA probe analysis were obtained from 54 two-stage hydroxyapatite plasma spray-coated implants in 32 patients. Using sterile paper points, samples were obtained from the IAI of 43 implants and the screw-threads of healing abutments in the other 11 implants. DNA probes were available to detect the following microbes: Actinobacillus actinomycetemcomitans, Tannerella forsythensis, Campylobacter rectus, Eikenella corrodens, Fusobacterium nucleatum, Porphyromonas gingivalis, Prevotella intermedia, and Treponema denticola. Results: All samples taken from healing abutment screw-threads were negative for all target microbes. The aggregate percentage of positive results for each target microbe for samples from internal surfaces of the IAI were: 41.9%, A. actinomycetemcomitans; 60.5%, T. forsythensis; 44.2%, C. rectus, 60.5%, E. corrodens; 48.8%, F. nucleatum; 46.5%, P. gingivalis; 55.8%, P. intermedia; and 51.2%, T. denticola. In addition, no significant differences were noted between colonization of individual microbial species when comparing anterior to posterior and maxillary to mandibular implant sites. Conclusions: Moderate to high levels of eight different periodontopathic microbes inhabiting the internal surfaces of the IAI of 43 two-stage implants in partially edentulous patients were identified by DNA probe analysis. The microbes colonized these surfaces within 25 days following the second stage surgery and placement of the hearing abutment. In contrast, all samples obtained from screw-threads of 11 healing abutments were DNA probe negative. These findings appear to support those of other investigations demonstrating the translocation of bacteria from residual dentition to implants. [ABSTRACT FROM AUTHOR]

Background: It has been speculated that periodontal probes can transmit periodontal pathogens from site to site. The purpose of this study was to evaluate the potential for bacterial transmission as a function of periodontal probe design. Methods: Four different periodontal probes were used to measure probing depths ranging from 0 to 3 mm and ≥4 mm. Following measurement of each pocket, probes were transported to a laboratory and cultured on blood agar, and colony forming units (CFUs) were determined for total aerobic, anaerobic, and dark-pigmented colonies (DPCs). Eight randomly selected probe tips. representing each probe type and probing depth category, were selected for examination by scanning electron microscopy (SEM) to determine distribution and morphotypes of adhering microbes. Results: Results showed no statistically significant main effect for probes with respect to CFUs. However, there was a statistically significant increase in CFUs for deeper pockets when compared to pockets 0 to 3 mm. SEM observations were consistent among groups, regardless of probe design or probing depth. All probes exhibited a rough surface texture. Microbes were observed as single organisms or in aggregates and were adherent along the entire length of the probe up to the maximum probing depth. Conclusions: There was no difference in CFUs obtained as a function of periodontal probes. The rough surfaces of the probes used in this study likely promoted bacteria] adherence through two different mechanisms: through scraping of the pocket walls by the roughened surfaces of the probe and by the high surface-free energy of the metal probes, facilitating bacterial adherence. [ABSTRACT FROM AUTHOR]

Background: In AIDS patients who present with an oral neoplasm, Kaposi sarcoma is the tumor most frequently encountered, comprising 50% to 80% of all tumor occurrences. However, oral Kaposi sarcoma associated with erosion of underlying bone is a relatively rare finding. This report and review of the literature documents a case of AIDS-related oral Kaposi sarcoma exhibiting severe bilateral erosion of the maxillary alveolar ridges. Methods: An HIV-seropositive male with extensive maxillary Kaposi sarcoma and associated bilateral alveolar bone erosion presented for dental evaluation subsequent to radiation therapy. Clinical and radiographic examinations were performed. Medical and dental histories were procured and supplemented with consultations from the patient's primary physician and radiation oncologist. Maxillary edentulation with surgical revision for primary closure was the treatment of choice for management of the dentoalveolar pathology. A maxillary immediate treatment denture was designed to obturate anticipated antral communications with the maxillary sinus. Results: Surgical and prosthetic treatments were completed, but complicated by an oral-antral perforation that subsequently healed without complication. Soft tissue biopsies obtained during surgery revealed no evidence of residual Kaposi sarcoma. Conclusions: Although AIDS-related oral Kaposi sarcoma is a relatively common finding, erosion of subjacent alveolar bone is uncommon. Treatment of the tumor with subsequent dental reconstruction can be complicated by the severe lack of bone, surgical perforation of the maxillary sinus, and tack of stable teeth to serve as abutments. Significant advances in understanding the pathogenesis of AIDS-related Kaposi sarcoma have occurred in the last decade. HHV-8 and various inflammatory cytokines have been implicated in the pathogenesis and are likely to become the primary targets for therapeutic intervention. [ABSTRACT FROM AUTHOR]

Background: A review of the periodontal literature offers little information concerning trends in referral patterns of patients for periodontal therapy. Over the last 2 decades, there has been a significant increase in the knowledge base concerning inflammatory periodontal disease. It might be assumed that the collective advances in knowledge have impacted periodontal referral patterns. Thus, the purpose of this study was to examine the differences in periodontal referral patterns in the same offices separated by a 20-year interval (i.e., 1980 and 2000). Methods: A retrospective chart analysis was conducted on a total of 782 patient charts from three conveniently selected periodontal practices. Charts were randomly selected from two time periods: 1980-1981 and 2000-2001. The following information was obtained from each patient record: gender, age at time of initial examination, tobacco smoking status at time of initial examination, periodontal case type, number of missing teeth at initial examination (not including third molars), and number of teeth scheduled for extraction per periodontal treatment plan. Descriptive data were analyzed using frequency distributions, measures of central tendency, and measures of dispersion. Non-parametric statistics were used to examine the relationship of disease severity as a function of site, time period, and patient age. Results: The following trends were noted: 1) an increase in the average age of patients at the time of the initial examination; 2) a decrease in the percentage of patients using tobacco at the time of the initial interview; 3) an increase in the percentage of periodontal Case Type IV patients with a concomitant decrease in the number of periodontal Case Type III patients; 4) an increase in the average number of missing teeth per patient at the initial examination; and 5) an increase in the average number of teeth scheduled for extraction per periodontal treatment plan. Conclusions: Characteristics of patients referred in 1980 compared to those referred in the year 2000 indicate that, although fewer patients used tobacco, there were several noteworthy trends. At referral, patients exhibited a greater loss of teeth, had more severe disease, and required extraction of a greater number of teeth in 2000 compared to 1980. Possible reasons for these trends are discussed. [ABSTRACT FROM AUTHOR]

Background: Stress and anxiety alter respiratory rate and thereby alter oxygen saturation in the blood. Management of psychological stress in the dental office may help maintain blood gas homeostasis. One method of stress management is through the use of preoperative oral sedation. Methods: The study population consisted of 13 patients scheduled to receive two quadrants of periodontal surgery at two different appointments. A randomized split-mouth crossover design was used with one quadrant of surgery involving preoperative oral sedation (diazepam) and local anesthetic, and the second using local anesthetic only. Oxygen saturation was monitored by pulse oximetry, which recorded the number of times saturation dropped below 95% in a given time period. Data were recorded at 5 time periods: 1) baseline; 2) from time of anesthetic administration to 20 minutes into surgery; 3) 21 to 40 minutes; 4) 41 to 60 minutes; and 5) 61 to 80 minutes into the surgery. Data were analyzed by a two-factor repeated measures ANOVA. The two within-group factors were treatment group and time. Results: Results indicated no significant interaction between time and treatment (P >.05). However, data for groups overtime suggested a trend supporting an interaction. The η² value of 0.124 suggested a moderate effect favoring the diazepam treatment. No significant difference was noted for the main effect of treatment and time. However, the η² value of 0.24 for treatment effect (diazepam versus no diazepam) suggested a meaningful difference between groups. Similarly the η² value of 0.135 for time suggested a moderate effect over time within-subjects. Conclusions: This study indicates that diazepam given orally in adult dosages does not cause significant respiratory depression, and is generally safe for those healthy patients who may require slight to mild sedation during periodontal surgery. [ABSTRACT FROM AUTHOR]

Background: The purpose of this study was to determine the total root surface area of extracted teeth by computerized image analysis and the amount of remaining attachment area assuming various amounts of bone loss due to periodontal disease. Methods: One hundred fifty extracted mandibular teeth were evaluated, and measured from cusp tip to the cemento-enamel junction (CEJ), CEJ to root apex, and cusp tip to root apex. The fulcrum point of the tooth was also measured, along with the total root surface area of attachment and total surface area of attachment remaining following simulation of attachment loss in 2 mm increments. Measurements were made on 80 teeth on one proximal surface and either the buccal or lingual surface and multiplied by a factor of 2. Measurements on 70 teeth were made on all 4 root surfaces to predict the accuracy of measuring only 2 surfaces to determine root surface area. Images of the tooth surfaces were obtained by video camera and converted to computer image with measurement of the surface areas. Results: The total root surface area for the mandibular cuspids and first and second bicuspids was 275,88 mm², 251.45 mm², and 271.81 mm², respectively. The 2-sided and 4-sided measurements for the mandibular first bicuspid were 252.55 mm² and 247.02 mm², respectively (P >0.05). Conclusions: This study found the total root surface area to be greater than that in most previous studies. Increasing attachment loss is related to decreasing root surface area; however, this relationship is not directly proportional. No statistical difference was found between measuring 4 surfaces versus only 2 surfaces. [ABSTRACT FROM AUTHOR]

Background: Relative few reports exist concerning healing of laser created osteotomies over an extended period of time. The purpose of this study was to evaluate long-term healing, from 21 to 63 days, of osteotomy defects in the rat tibia created with the Nd:YAG and CO2 in the presence of a surface cooling spray of air/water. Methods: The experimental model consisted of 15 large Sprague-Dawley rats. Six treatment modalities were randomly distributed among 6 tibia] recipient sites: 1) a negative control (no treatment); 2) a positive control (bur osteotomy); 3) CO2 laser at 5 W (860 J/cm²); 4) CO2 laser at 6 W (1032 J/cm²); 5) Nd:YAG laser at 5 W (714 J/cm²); and 6) Nd:YAG laser at 7 W (1000 J/cm²). All laser irradiation was delivered in the presence of a surface coolant consisting of air (15 psi) and sterile water. Five animals were sacrificed at each of 3 time intervals: 21, 35, and 63 days post-treatment. Multiple histologic sections from each treatment site were examined by light microscopy using hematoxylin and eosin Goldner's trichrome stains, and polarized light and evaluated for presence of a char layer, heat induced cracking, heat related alterations in cells or tissue matrix, and osseous regeneration. Results: Healing was severely delayed in all laser treated sites compared to positive control sites. Of the laser treated sites, those irradiated by CO2 laser at 5 W (780 J/cm²) exhibited the greater amount of bone regeneration. At best, however, only a small percentage of sections from any of the laser treated specimens showed evidence of bone regeneration within the ablation defect regardless of the post-treatment time interval. Conclusions: Under the conditions of this study, the osseous healing response was severely delayed by CO2 and Nd:YAG laser irradiation of bone, even in the presence of a surface cooling spray of air/water. [ABSTRACT FROM AUTHOR]

Background: Dental patients routinely complete a medical questionnaire and have an oral interview during their initial visit, but may have undiagnosed systemic problems which can affect their dental treatment. Methods: Thirty-nine consecutive patients referred for a periodontal evaluation completed a medical questionnaire and an oral interview. They were referred to a hospital laboratory for an urinalysis, complete blood count, and a standard blood chemistry panel. Results: The self-reported medical history responses were compared with the laboratory data and several abnormalities were noted. Abnormal levels were found with cholesterol, (26/39 patients, 67%); triglycerides, (13/39, 33%); glucose, (6/39, 15%); eosinophils, (18/39, 46%); and monocytes, (10/39, 26%). Smokers (17/39, 44%) had a higher number of abnormal levels or percentages of cholesterol, triglycerides, basophils, lymphocytes, in elevated triglyceride levels, abnormal aspartate aminotransferase (AST) and alanine aminotransferase (ALT), and self-reported cardiovascular disease. Conclusions: This study demonstrated that many patients are unaware of their current medical status and a significant number had undiagnosed abnormalities. [ABSTRACT FROM AUTHOR]

Background: Currently, the most commonly used lasers for dental procedures are the Nd:YAG and CO2. Studies comparing healing of osteotomy defects prepared with rotary burs to those created by laser irradiation have reported conflicting results. The purpose of this study was to evaluate and compare the histologic healing of bone in rat tibial osteotomy defects created either by a dental bur, CO2 laser with and without removal of the char layer, and Nd:YAG laser with char layer removed and with and without use of an air/water surface cooling spray. Methods: Tibial osteotomy defects were created in 4 groups of 6 rats each using the following: 1) #6 round bur with simultaneous saline irrigation; 2) CO2 laser with char layer intact; 3) CO2 laser with char layer removed; 4} Nd:YAG laser with air/water surface cooling, and char layer intact; 5) Nd:YAG laser with air/water surface cooling, and char layer removed; and 6) Nd:YAG laser without air/water surface cooling, and char layer removed. Both laser types were used at energy densities typically utilized for oral soft tissue surgery. Results: Progressive healing from day 0 through day 21 post-treatment was observed in all treatment groups. However, compared 10 controls treated by rotary dental bur, those specimens treated by laser, regardless of laser type, energy density, or other parameters, exhibited a delay in healing that appeared to be related to the presence of residual char in the osseous defect. Specimens treated with the Nd:YAG laser using an air/water surface coolant exhibited a decreased thickness and continuity of the char layer and yielded the only specimens with new bone formation at the surface of the laser ablation defect. In addition, the normal pattern of bone remodeling in the rat tibia appeared to have been altered by laser irradiation. Conclusions: In this animal model, laser-induced osteotomy defects, when compared to those prepared by rotary bur, exhibited a delayed healing response that appeared to be related to the presence of residual char in the osseous defect. [ABSTRACT FROM AUTHOR]

Background: Collateral thermal damage and residual char formation have severely limited the use of conventional lasers in the surgical preparation of bony tissue. Thermal damage from lasers can be minimized by selecting a wavelength that is strongly absorbed and by reducing the laser pulse duration. In contrast to the fixed wavelengths and microsecond pulse intervals of conventional lasers, the Vanderbilt free electron laser (FEL) can be set at wavelengths ranging from 2.1 to 9.8 µm, and the pulse duration can be reduced to a series of 1 to 2 picosecond (ps) micropulses delivered in succession over intervals of 4 microsecond macropulses. The purpose of this study was to compare the morphologic and chemical changes induced in the near-surface region of bone following exposure to the FEL at 3.0, 6.1. and 6.45 µm wavelengths. The selected wavelengths coincide with the vibrational modes of proteins and water within bone. Methods: Under general anesthesia, laser incisions were made in the tibias of 14 skeletally mature rabbits. Laser parameters included 22.5 ± 2.5 mJ/pulse delivered in individual 4 microsecond macropulses at a repetition rate of 30 Hz, focused to 200 µm and 500 µm spot sizes. Laser incisions were made using a computer-assisted surgical program, and control incisions were created with a bone saw. Rabbits were euthanized after the final incision, tibias recovered, and non-decalcified specimens processed for light microscopy. Separate samples were prepared for FTIR (Fourier transform infrared) photoacoustic spectroscopic analysis. Results: The light microscopy sections of the ablation defects created at the differing wavelengths showed similar features, i.e., 2 zones of collateral damage, a zone generally <10mm of extensive thermal damage, and a wider zone of empty lacunae, in comparing treated and untreated surfaces, the spectral differences were limited to a relative decrease in intensity of the amide II and III absorption peaks in all laser-treated surfaces. Conclusions: Spectroscopic and histologic results indicated minimal thermal damage to bone ablated at 3.0, 6.1, and 6.45 µm wavelengths using the FEL (Fourier transform infrared) at the specified parameters. The FTIR photoacoustic spectroscopic results suggest that the char layer is limited to an area less than approximately 6 um from the surface. [ABSTRACT FROM AUTHOR]

IN TISSUES THAT CLOSELY APPROXIMATE bone, sufficient heat may he transferred to the bone during laser surgery to cause damage and/or necrosis. To date, there have been few studies examining the temperatures elicited at the bone surface as a result of laser application to the overlying soft tissues. The purpose of this investigation was to determine, under in vitro conditions, temperature changes at the bone/soft tissue interface during laser ablation with CO2 and Nd:YAG lasers used with and without (w/wo) air/water coolant. Experimental specimens consisted of 5 mandibles from freshly sacrificed hogs; laser treatment sites were the buccal and lingual attached gingival of the molars and the lingual keratinized mucosa of the incisor region. CO2 and Nd:YAG lasers were used two coolant at power settings of 4 to 8 W and 5 to 9 W, Respectively. Temperature changes were measured with a copper constant thermocouple contained within a 21 gauge hypodermic needle. In comparing the lasers at comparable energy densities w/wo coolant, temperature increases at the bone/soft tissue interface ranged from 8.0 to 11.1°C with the Nd:YAG and 1.4 to 2.1°C with the CO2. Similarly, in comparing the times required for the interface to return to baseline temperature following removal of the laser, values ranged from ~143 to 205 and ~119 to 139 seconds for the Nd:YAG and CO2, respectively. Results from this study suggest that, at energy densities equal or above those reported here, the increase in temperature at the bone surface as a result of periodontal soft tissue surgery with the Nd:YAG laser could be damaging, especially if the exposure is prolonged. [ABSTRACT FROM AUTHOR]