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OBJECTIVE: This study compared the efficacy of transmucosal anaesthetic patches containing lidocaine (46.1 mg/2 cm(2)) to placebo for local anaesthesia during quadrant scaling and root planing using periodontal clinical indices and patient perception of pain. MATERIAL AND METHODS: Forty healthy adults with moderate periodontal disease and moderate subgingival calculus were scaled at weekly intervals, two quadrants randomized to treatment patches and two quadrants randomized to placebo patches. Bleeding, probing depths and attachment levels were evaluated prior to treatment and 1 month after quadrant scaling was completed. Subjects completed 100 mm visual analogue pain scales 15 min. after patch placement and at the end of treatment, and were asked for verbal assessment of perceived pain. RESULTS: Subjects' verbal ratings demonstrated consistently greater pain relief with active patches than placebo (p<0.0001). Visual analogue scales demonstrated significantly greater pain relief with the treatment patches after 15 min. (p=0.0003) and at the end of treatment (p=0.0149). Efficacy of periodontal therapy was equivalent for treatment and control groups. No adverse events were observed; localized minimal gingival irritation was noted in three subjects. CONCLUSION: Transmucosal lidocaine patches provided sufficient anaesthesia for therapeutic quadrant scaling and root planing procedures. [ABSTRACT FROM AUTHOR]

The diversity of criteria used in the diagnosis of periodontitis in pregnant women makes it difficult to define and compare the disease. Using a systematic review, this study evaluated the accuracy of criteria for diagnosing periodontitis in pregnant women. Searches were carried out in the databases: Medline/PubMed, Embase, Scopus, Web of Science, SciELO, Lilacs, ProQuest, and CINAHL. Validation studies of the criteria used for diagnosing periodontitis met the inclusion criteria. The study steps were performed by three independent reviewers. A qualitative synthesis of the included articles was carried out and the quality methodological analysis using the QUADAS-2 instrument. The assessment of the quality of the evidence was obtained through the GRADE tool. A total of 592 records were identified, of which only 6 made up this systematic review. The included studies analyzed different criteria for diagnosing periodontitis, evaluating 3,005 pregnant women. The criteria selected as a test presented results equivalent to the performance of those recognized as the gold standard. The self-reported criteria were of lower diagnostic accuracy. A major limitation of this review was the small number of primary studies that evaluated clinical diagnosis of periodontitis in pregnant women, which was highly heterogeneous, making it impossible to carry out accuracy meta-analysis and additional analyzes. There is a lack of consensus on the criteria for the diagnosis of periodontitis, with great variability in the accuracy and prevalence of the disease in pregnant women., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Conceição et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background: Excess weight (EW), especially in women of childbearing age, those who are pregnant, as well as postpartum, is a problem worldwide. Fat accumulation deregulates the inflammatory response, contributing to the development of health problems, such as periodontitis. This study investigated the association between EW and periodontitis during pregnancy., Methods: A cross-sectional, multicenter study involved 1745 postpartum women in Brazil. Socioeconomic-demographic data, gestational history, lifestyle behavior, and general and oral health conditions were obtained. Pre-pregnancy body mass index (BMI) was collected from medical records with EW being the exposure. Both tooth loss and clinical attachment level (CAL) were evaluated, and the presence of periodontitis was the outcome. Logistic regression, odds ratio (OR) and 95% confidence interval (95% CI), and quantile regression, beta coefficient and 95% CI, estimated the association between EW (BMI) and periodontitis and its combined effect with tooth loss ≥3, as dichotomous and continuous variables (CAL and tooth loss), with 5% significance level., Results: The EW was 27.7% prevalent and periodontitis was 11.7%. There was a positive association between EW and periodontitis: OR adjusted :1.39; 95% CI:1.01;1.92 and between EW and periodontitis combined with tooth loss ≥3: OR adjusted :1.73; 95% CI:1.36;2.20. The adjusted association between EW and periodontitis as continuous variables was also positive, showing that for each unit of increased BMI, there was an elevation in the mean CAL (p = 0.04) and tooth loss (p < 0.01), with statistical significance., Conclusions: There was a moderate association between EW and periodontitis during pregnancy, with an even greater association of pregnant women with EW presenting periodontitis combined with tooth loss., (© 2024 American Academy of Periodontology.)

Background: The treatment of leprosy reactions (LRs) involves thalidomide, corticosteroids, and other immunomodulatory medications. This study evaluated the effect of these treatments on the association between periodontitis and LRs, as well as factors associated with LRs., Methods: This case-control study was conducted on 283 individuals followed at a leprosy outpatient clinic in Brazil. The case group was comprised of 158 individuals presenting type 1 or type 2 LRs, and the control group of 125 leprosy individuals without reactions. A complete oral examination was performed to diagnose periodontitis, the independent variable. Antireaction medication used was collected from medical records, and participants were classified according to the use of prednisone and/or thalidomide, time of use, or non-use of medication. Socioeconomic-demographic, clinical, and lifestyle covariables were collected by interview. Unconditional logistic regression analysis by subgroups evaluated the effect of antireaction medication on the association between periodontitis and LRs, estimating the odds ratio with a 95% confidence interval (OR; 95% CI)., Results: A relationship between periodontitis and LRs was observed only in the subgroup using the association prednisone and thalidomide: OR adjusted  = 0.32; 95% CI = 0.11-0.95. Conversely, more severe periodontal clinical parameters were observed in cases versus controls. Several socioeconomic, health conditions, and lifestyle factors were associated with the presence of LRs., Conclusions: Although periodontal disease indicators were worse among the cases, the findings showed a negative relationship between periodontitis and LRs in individuals receiving associated prednisone and thalidomide. These medications appear to influence the inflammatory cascade between diseases, modifying and masking the manifestations of periodontitis., (© 2024 American Academy of Periodontology.)

Background: Dyslipidemia, a silent multifactorial condition, is characterized by changes in blood lipid levels, affecting all socioeconomic strata, increasing the risk for atherosclerotic diseases. This study investigated whether there is an association between dyslipidemia and the combined exposure of periodontitis plus the number of remaining teeth, gingival bleeding, or caries., Methods: A two-center cross-sectional study was conducted involving 1270 individuals, with a minimum age of 18 years. Socioeconomic and demographic data, health conditions, lifestyle parameters, and anthropometric, biochemical, and oral clinical examinations were performed. The exposures considered were the presence of periodontitis, dental caries, number of remaining teeth, and gingival bleeding. The outcome was dyslipidemia as defined by the Brazilian Guidelines on Dyslipidemia and Prevention of Atherosclerosis. The combined associations between periodontitis plus other oral health conditions and dyslipidemia were estimated using confounder-adjusted prevalence ratios (PR single , PR multiple , for single and multiple covariable adjustments) with 95% confidence intervals (95% CIs), in a Poisson regression model with robust variance., Results: The occurrence of dyslipidemia was 70.1% and periodontitis was 84.1%. A positive association between periodontitis and dyslipidemia existed: PR single  = 1.13; 95% CI: 1.01-1.26. Combined exposure of periodontitis plus <11 remaining teeth (PR multiple  = 1.23; 95% CI: 1.05-1.43), as well as combined exposure of periodontitis plus ≥10% gingival bleeding and <11 remaining teeth (PR multiple  = 1.22; 95% CI: 1.03-1.44), represented greater probabilities of 23% and 22% of individuals having a diagnosis of dyslipidemia., Conclusion: Periodontitis combined with fewer than 11 teeth doubled the likelihood of being diagnosed with dyslipidemia., (© 2023 American Academy of Periodontology.)

The objective of this study was to investigate the association between periodontitis severity and metabolic syndrome (MetS) through systematic review, registered in PROSPERO: CRD42021232120. Selected articles were independently chosen by three reviewers from six databases, including using article reference lists, up until March 2022. Eligible studies were observational, without language limitation, and in subjects aged at least 18 years. The methodological quality of selected studies was assessed using the Newcastle-Ottawa Scale. Random effects models calculated summary measurements (odds ratio-OR, 95% confidence interval, 95%CI). The I 2 test evaluated the statistical heterogeneity of the data. Sensitivity, subgroup, and meta-regression analyses were performed. For the reliability of evidence, the Grading of Recommendations, Assessment, Development, and Evaluations tool was used. A total of 2133 records were identified, and 14 studies were included comprising 24,567 participants. The summary odds ratio showed a positive association between individuals with moderate (OR adjusted  = 1.26; 95%CI = 2.10-5.37; I 2  = 45.85%), and severe periodontitis (OR adjusted  = 1.50; 95%CI:1.28-1.71; I 2  = 56.46%), and MetS. Subgroup and meta-regression analyses showed that study effect size was influenced by year of publication, study design, and MetS diagnostic criteria, contributing to inter-study variability. The findings showed that moderate and severe levels of periodontitis are associated with MetS, suggesting a possible dose-response effect., (© 2022 Wiley Periodicals LLC.)

Background: Mental disorders represent a major public health challenge worldwide, affecting 80% of people living in low- and middle-income countries. Depression, a mental disorder, is a chronic disease of long duration that causes changes in the brain, resulting from a combination of genetic, physiologic, environmental, and behavioral factors. The aim of this study was to investigate possible factors associated with depression in Brazilian adults., Methods: A population-based, cross-sectional study was carried out using the public domain database of the 2019 National Health Survey, conducted in Brazil. Depression was considered the dependent variable, and through hierarchical analysis, predictor variables were investigated such as, at the distal level-socioeconomic variables, at the intermediate level-variables related to lifestyle behavior, health condition, and history, and at the proximal level-demographic variables. Logistic regression analysis was used to obtain the adjusted Odds Ratio and the respective 95% confidence interval to identify possible factors associated with depression., Results: The study included 88,531 participant records with 10.27% diagnosed with depression. The adjusted association measurements, after selecting the independent variables in the hierarchical analysis, showed the following factors associated with depression with differing magnitudes: age, brown and white race/skin color, female sex, poor, very poor, or regular self-reported health condition, diagnosis of cardiovascular disease, work-related musculoskeletal disorder, history of smoking habit, and macroeconomic region., Conclusions: An effective strategy for preventing and managing depression in Brazilian adults must include the control of health status and lifestyle behavior factors, with actions and programs to reduce people's exposure to these factors, understanding that socioeconomic-demographic differences of each population can potentially reduce the disease burden., (© 2023. BioMed Central Ltd., part of Springer Nature.)

Objectives: Dental caries and periodontal diseases are significant health concerns in developing nations. This study assessed the impact of a comprehensive oral health education program on adolescent girls in rural Kenya., Methods: Eighty-seven girls aged 13-18 years attending school in rural Nanyuki, Kenya, were enrolled in the study. The comprehensive program included personalized oral hygiene training, education and health advocacy coaching. Dental caries, gingival inflammation and dental plaque biofilm were assessed at baseline, 1- and 2.5-year post-implementation., Results: The intervention was highly effective in arresting pre-existing carious lesions and preventing the formation of new ones in this population. The data revealed that there was a significant remineralization of incipient caries lesion, as shown by decreases in modified ICCMS™ scores from baseline to 1-year post-implementation. From baseline to the 2.5-year post-implementation assessment, only six new carious lesions developed. Dental plaque biofilm was reduced by 83.6%, and gingival inflammation was reduced by 81.6%., Conclusion: A comprehensive oral health program, which included behavioural awareness and educational approaches, resulted in significant positive oral health outcomes in caries, dental plaque biofilm and gingival inflammation., (© 2023 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Objective: This cross-sectional study was performed to investigate the association between excess body weight and periodontitis in adults, stratified by sex and age, and using different criteria for obesity., Material and Methods: Enrolled in the study were 345 individuals with a minimum age of 18 years who had attended the Public Health Service in the city of Salvador, Bahia, Brazil. All individuals underwent a complete periodontal examination and anthropometric measurements and answered a questionnaire regarding their socioeconomic, demographic, health, and lifestyle conditions. Excess body weight (exposure factor) was defined using body mass index (BMI) and waist circumference (WC). Prevalence ratios (PRs) and 95% confidence intervals (95%CI) were obtained by Poisson regression analysis with robust variance., Results: Periodontitis was found in 74.2% of study participants, with the disease being more prevalent among those individuals with increased WC. The occurrence of overweight was 44.4% and that of obesity ranged from 29.9 to 70.8%, dependent upon the specific definition of obesity that was used. There was a positive association between obesity (WC > 88 cm) and periodontitis only among women, after adjustment for age, smoking habit, education level, diabetes, and family income (PR adjusted : 1.20; 95%CI: [1.01-1.44]). The magnitude of this positive association was higher among women aged 18 to 49 years when the outcome was severe periodontitis, and the exposure was obesity defined by WC., Conclusions: The findings draw attention to the high frequency of the diseases investigated: overweight, obesity and periodontitis. Moreover, obesity was positively associated with periodontitis in women and younger individuals, demonstrating that among those with obesity, there is a higher probability of having periodontitis. The smaller number study of men in the may have influenced the non-statistically significant association found in that group., Clinical Relevance: Obese females and younger people are more likely to also have periodontitis. Periodontal evaluation and clinical management of individuals with obesity is recommended., (© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Purpose/objectives: The School of Dentistry at The University of Texas Health Science Center at San Antonio (UTHSA-SoD) implemented an SoD Emerging Leaders Program (SoDELP) in 2020-2021. This case report describes the leadership training needs of junior faculty that stimulated SoDELP development, the inter-institutional collaboration that facilitated program implementation, SoDELP curriculum content, and outcomes of formative assessment for two pilot cohorts of the SoDELP., Methods: The 32-h curriculum was comprised of readings, reflection exercises, seminars by the Center for Professional Excellence at the University of Texas at San Antonio, case discussion, analysis of leadership dilemmas, and self-assessments. For a capstone project, participants created a case depicting a challenging leadership situation they experienced as a team leader or member. The SoDELP commenced in a face-to-face format but was completed online due to COVID 19. Formative evaluation included participants' pre- and post-training perceptions elicited by the Leadership Attitudes, Confidence and Concerns Inventory (LACCI) and qualitative appraisal of program components obtained by surveys and focus groups., Results: All 18 participants completed SoDELP and provided positive evaluations of program content, organization, teaching quality, and value. Analysis of pre- and post-assessments indicated that participants' confidence in performing an array of leadership tasks was significantly enhanced, and participants' concerns about assuming leadership roles, such as not being ready for the job, impact on friendships, or concerns about ethical challenges, were significantly reduced. The LACCI displayed promising reliability in assessing participants' confidence, attitudes and concerns, demonstrating the potential to serve as a measurement tool to appraise outcomes of leadership training in the health professions., Conclusion: Outcomes suggest that SoDELP enhances faculty members' sense of readiness for leadership roles, and the LACCI may be a useful assessment tool for leadership training., (© 2022 American Dental Education Association.)

Background: Maternal hyperglycemia, periodontitis, and adverse gestational outcomes are important health problems. The present study investigated the hypothesis that periodontitis and the glycemic level of mothers may have opposing influences on birth weight (BW). This study evaluated the effect of high glycemic levels, albeit within the normal range, on the association between periodontitis and low birth weight (LBW)., Methods: A total of 732 women took part in this case-control study; 172 were mothers of children with LBW <2,500 g, and 560 were mothers of children with BW ≥2,500 g. The BW of newborns was obtained from medical records, and information on socioeconomic-demographic, lifestyle behavior were obtained through interviews. Glycated hemoglobin (HbA1c) levels were evaluated, and full-mouth periodontal examination was carried out within 7 days postpartum. Hierarchical and logistic regression analysis evaluated the effect of glycemic levels on the association between periodontitis and LBW by subgroups, estimating odds ratios (OR) with 95% confidence intervals (95% CI)., Results: In the group with HbA1c levels <5.6%, a statistically significant relationship existed between periodontitis and LBW. Using the Centre for Disease Control/American Academy of Periodontics criteria, the OR adjusted was 1.55; 95% CI: 1.04 to 2.31; using the Gomes-Filho et al. criteria the OR adjusted was 1.91; 95% CI, 1.06 to 3.45. In the group with higher HbA1c levels but still within the normal range (≥5.6% and <6.5%), the findings showed no association between periodontitis and LBW., Conclusion: Higher maternal glycemic levels within the normal range, inferior to those indicative of gestational diabetes, diabetes mellitus, or hyperglycemia, and periodontitis have opposing effects on BW, altering the association magnitude., (© 2021 American Academy of Periodontology.)

Objective: To investigate the association between the severity of periodontitis (exposure) and dyslipidemia (outcome)., Methods: This was a cross-sectional study of users of public health services. Periodontitis was defined using the Center for Disease Prevention and Control and the American Academy of Periodontology criteria. Lipid evaluation used data on systemic biomarkers. Dyslipidemia diagnosis was based on the Guidelines of total cardiovascular risk of the World Health Organization. Weight, height, waist circumference, and blood pressure were measured, and socioeconomic-demographic, lifestyle behavior factors, general and oral health conditions of the participants were collected. Hierarchical and logistic regression analyzes were used to determine the association between the exposures and the outcome. Odds Ratios, unadjusted and adjusted, and 95% confidence intervals were estimated., Results: Of 1,011 individuals examined, 75.17% had dyslipidemia, and 84.17% had periodontitis, 0.2% with mild, 48.56% moderate, and 35.41% severe disease. The association between periodontitis and dyslipidemia was maintained through hierarchical analysis and in the multiple regression modeling, showing that the occurrences of dyslipidemia in the group with periodontitis, and its moderate and severe levels, were, respectively, 14%, 30%, and 16% higher compared with those without periodontitis., Conclusions: The results showed a positive association between moderate and severe periodontitis and dyslipidemia., (© 2021 Wiley Periodicals LLC.)

Objectives: The purpose of this study was to evaluate the COVID-19 vaccination experience among United States-based dental professionals and students: to understand their beliefs, concerns, safety and confidence levels, and side effects experienced after vaccination; striving to boost vaccination acceptability to curtail the pandemic., Methods: An observational survey study approved by The University of Texas Health San Antonio Institutional Review Board was distributed to members of the School of Dentistry community using Qualtrics XM software. The survey was completed anonymously. Data were analyzed using R statistical computing software, χ2 test and Fisher's Exact test., Results: Over 80% of all participants felt moderately to very safe working after the COVID-19 vaccine was made available, and more than 75% were moderately to very confident that the vaccine can protect them during the pandemic. At least 35% were moderately to very concerned about immediate and long-term side effects of the vaccine; despite the concerns, 94% received the vaccine. Side effects were more common after the second dose of the vaccine. Most common side effects were injection site pain, and general side effects of fatigue/tiredness, headache, muscle/body ache, and chills/fever. 74% reported no effect of the vaccine on daily activities, and the severity of side effects no worse than mild (about 60%)., Conclusions: Majority of the participants felt safe and confident that the vaccine would protect them against COVID-19 infection. Sharing these findings and reliable information that the vaccine is safe and effective is paramount to fostering the vaccine uptake and curtailing the pandemic., Practical Implications: Findings of this study demonstrated the confidence of the UT Health San Antonio, School of Dentistry community that the benefits of the vaccines greatly outweigh the risks; boosting the vaccination acceptance while creating a COVID-19 free environment both for the academic dental setting and the community it serves., Competing Interests: The authors have declared that no competing interests exist.

Background: The purpose of this study was to evaluate the multifaceted impact of the COVID-19 pandemic on dental practices and their readiness to resume dental practice during arduous circumstances., Methods: The authors distributed an observational survey study approved by The University of Texas Health Science Center at San Antonio Institutional Review Board to dental care practitioners and their office staff members using Qualtrics XM software. The survey was completed anonymously. The authors analyzed the data using R statistical computing software, χ 2 test, and Wilcoxon rank sum test., Results: Nearly all participants (98%) felt prepared to resume dental practice and were confident of the safety precautions (96%). Only 21% of dentists felt the COVID-19 pandemic changed their dental treatment protocols, with at least two-thirds agreeing that precautions would influence their efficiency adversely. Although most participants were satisfied with the resources their dental practice provided for support during the pandemic (95%), most were concerned about the impact on their general health and safety (77%) and to their dental practice (90%), found working during the pandemic difficult (≈ 60%), and agreed there are challenges and long-term impacts on the dental profession (> 75%)., Conclusions: Dental care professionals, although affected by the COVID-19 pandemic and at high risk of developing COVID-19, were prepared to resume dental practice during most challenging circumstances., Practical Implications: The pandemic has affected dental care practitioners substantially; thus, there is need to formulate psychological interventions and safety precautions to mitigate its impact. Further research should evaluate the long-term effects on dentistry and oral health and interceptive measures for better communication and programming around future challenges., (Copyright © 2022 American Dental Association. Published by Elsevier Inc. All rights reserved.)

Purpose: The aim of this study was to evaluate the effects of locally delivered 1% alendronate (ALN) gel used as an adjunct to non-invasive periodontal therapy., Methods: Ligature-induced periodontitis was performed in 96 rats. The ligature was tied in the cervical area of the mandibular left first molar. The animals were randomly divided into 4 groups: 1) NT, no treatment; 2) SRP, scaling and root planning; 3) SRP/PLA, SRP followed by filling the periodontal pocket with placebo gel (PLA); and 4) SRP/ALN, SRP followed by filling the periodontal pockets with 1% ALN gel. Histomorphometric (percentage of bone in the furcation region [PBF]) and immunohistochemical (receptor activator of nuclear factor-κB ligand, osteoprotegerin, and tartrate-resistant acid phosphatase) analyses were performed. Data were statistically analyzed, with the threshold of statistical significance set at P≤ 0.05., Results: The SRP, SRP/PLA, and SRP/ALN groups presented a higher PBF than the NT group ( P ≤0.01) at 7, 15, and 30 days. The SRP/ALN group presented a higher PBF than the SRP/PLA group in all experimental periods, as well as a higher PBF than the SRP group at 15 and 30 days. No differences were observed in the immunohistochemical analyses ( P >0.05 for all)., Conclusions: Locally delivered 1% ALN gel used as an adjunct to SRP enhanced bone regeneration in the furcation region in a rat model of experimental periodontitis., Competing Interests: No potential conflict of interest relevant to this article was reported., (Copyright © 2021. Korean Academy of Periodontology.)

Background: Periodontitis and the Triglyceride/High Density Lipoprotein Cholesterol (TG/HDL-C) ratio have both been associated with cardiovascular disease, metabolic syndrome, and obesity. Additionally, the ratio is a possible substitute for predicting insulin resistance. This study investigated the association between periodontitis, its severity levels (exposures), and the TG/HDL-C ratio (outcome)., Methods: A cross-sectional study of public health service users in Brazil considered socioeconomic-demographic characteristics, lifestyle behavior, and general and oral health conditions. Anthropometric measurements and blood pressure were also measured. Systemic biomarker data were obtained, as well as assessment of periodontal diagnosis and its severity. The TG/HDL-C ratio was calculated using the serum triglyceride level over HDL cholesterol and the cut-off point, TG/HDL-C ≥2.3 serving as the cutoff indicting dyslipidemia. Logistic and linear regressions were used to statistically analyze the data., Results: A total of 1011 participants were included, with 84.17% having periodontitis and 49.85% having a TG/HDL-C ratio ≥2.3. For individuals with periodontitis, the odds of TG/HDL-C ratio ≥2.3 were 1.47 times greater than in those without periodontitis (OR Adjusted  = 1.47, 95% CI: 1.02-2.14). Similar results were found for those with moderate and severe periodontitis, with a slight increase in the measurement magnitude with disease severity., Conclusion: A positive relationship between periodontitis and the TG/HDL-C ratio ≥2.3 was found, suggesting a possible association with periodontal disease severity., (© 2021 American Academy of Periodontology.)

Background: There exists a diverse range of criteria used in epidemiological studies for the diagnosis of periodontitis. The results from these studies should be evaluated with consideration to the diagnostic criteria used, and this may account for differences between studies especially in some population groups such as pregnant females. The objective is to evaluate the diagnostic criteria used in a variety of epidemiologic studies of periodontitis in pregnant females., Methods: An accuracy study with cross-sectional design was performed out from a database of 671 pregnant females, using six different sets of criteria for the diagnosis of periodontitis. Women were classified for periodontitis, as follows: Center for Disease Control and Prevention/American Academy of Periodontology (CDC/AAP, 2012 criterion), the gold standard, Gomes-Filho et al.(2018) criterion, Albandar et al.(2007) criterion, Bassani et al.(2007) criterion, López et al.(2002) criterion, and Nesse et al.(2008) criterion. For comparison amongst the gold standard and the other criteria, sensitivity, specificity, predictive values, and likelihood ratio were determined., Results: The frequency of periodontitis ranged from 25.0% to 90.2%. The Bassani et al. (2007) criterion was found to be more sensitive among the studies, and thus more suitable for diagnostic screening studies. Gomes-Filho et al.(2018), Albandar et al. (2007), López et al. (2002), and Nesse et al. (2008) criteria were considered more specific, which makes them more useful for studies of periodontitis with the aim of using diagnosis for confirmation of disease., Conclusions: A variation in the occurrence of periodontitis was observed. The criterion must be chosen according to the research aims and population characteristics., (© 2020 American Academy of Periodontology.)

Objective: This study investigated the association between periodontitis severity (exposure) and metabolic syndrome (MetS - outcome), using two criteria for diagnosis of the outcome, since this relationship remains unexplored., Materials and Methods: A case-control study was conducted with 870 individuals: 408 with first MetS diagnosis (cases) and 462 without MetS (controls). Participants' general information was obtained using a questionnaire and laboratory data was collected from medical records. Periodontitis severity criteria followed the Center for Disease Control and Prevention: none, mild, moderate, and severe. Odds ratios (OR) and 95% confidence intervals (95% CI) were determined by logistic regression analysis., Results: Findings showed a positive association between moderate and severe periodontitis and MetS: OR adjusted = 1.64 (95% CI: 1.01 to 2.68) and OR adjusted = 1.94 (95% CI: 1.19 to 3.16), respectively, after adjustment for age, sex, schooling level, smoking habit, and cardiovascular disease. The adjusted measurements showed that among individuals with moderate or severe periodontitis, the probability of having MetS was around two times greater than among those without periodontitis, and that the chance was greater among participants with severe periodontitis than those with moderate periodontitis., Conclusion: An association between the severity of periodontal status and MetS was found, suggesting a possible relationship between the two diseases., Clinical Relevance: MetS influences the etiology of cardiovascular diseases, one of the leading causes of mortality worldwide. The findings suggest that the greater the severity of periodontitis, the greater is the association magnitude with MetS. The health professional needs to recognize that the importance of periodontal disease may play in MetS.

In humans, the composition of microbial communities differs among body sites and between habitats within a single site. Patterns of variation in the distribution of organisms across time and space are referred to as "biogeography." The human oral cavity is a critical observatory for exploring microbial biogeography because it is spatially structured, easily accessible, and its microbiota has been linked to the promotion of both health and disease. The biogeographic features of microbial communities residing in spatially distinct, but ecologically similar, environments on the human body, including the subgingival crevice, have not yet been adequately explored. The purpose of this paper is twofold. First, we seek to provide the dental community with a primer on biogeographic theory, highlighting its relevance to the study of the human oral cavity. We summarize what is known about the biogeographic variation of dental caries and periodontitis and postulate that disease occurrence reflects spatial patterning in the composition and structure of oral microbial communities. Second, we present a number of methods that investigators can use to test specific hypotheses using biogeographic theory. To anchor our discussion, we apply each method to a case study and examine the spatial variation of the human subgingival microbiota in 2 individuals. Our case study suggests that the composition of subgingival communities may conform to an anterior-to-posterior gradient within the oral cavity. The gradient appears to be structured by both deterministic and nondeterministic processes, although additional work is needed to confirm these findings. A better understanding of biogeographic patterns and processes will lead to improved efficacy of dental interventions targeting the oral microbiota., (© 2019 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Objective: The objective of this study was to investigate an association between obesity (exposure) and periodontitis (outcome) in pregnant women., Background: This association was investigated and only five studies were identified as showing a positive association. However, some of these studies had limitations such as reduced sample sizes, inadequate exposure criteria and outcome measures, which question the internal validity of these investigations., Methods: A cross-sectional study was carried out with a sample of 644 pregnant women of the public health service of the municipality of Santo Antônio de Jesus, Bahia, Brazil. Data were obtained by collecting of socioeconomic-demographic information, health behavior, health conditions, and reproductive history through an interview. Obesity was evaluated using body mass index adjusted for gestational age and expected weight gain. The diagnosis of periodontitis followed two criteria: (a) Center for Disease Prevention and Control and American Academy of Periodontology (CDC/AAP); (b) Gomes-Filho et al (2018) using criterion that also evaluated bleeding upon probing; Prevalence ratios and respective 95% confidence intervals were obtained by Poisson regression analysis., Results: In accordance with the outcome diagnostic criterion, the frequency of periodontitis was 17.24% (Gomes-Filho et al) and 66.92% (CDC/AAP). The participants were classified as low weight (19.72%), adequate weight (42.39%), overweight (24.84%), and obesity (13.04%), based on the exposure diagnostic criterion. The low weight and overweight groups were excluded from the data analysis, giving a final sample of 357 pregnant women. The association between obesity in pregnant women and periodontitis was not statistically significant, after adjusting for confounders such as age, schooling level, alcoholic beverage consumption, alimentary and nutritional orientation, urinary infection, and dental flossing., Conclusions: The findings showed a high frequency of periodontitis, obesity, and overweight in the studied population but no association between obesity and periodontitis in pregnant women was found., (© 2019 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Background: Studies suggest that when children do not achieve the emotional satiety and adequate stimulus provided by breast-feeding, they exhibit sucking behaviors. This study aimed to estimate the association from 4 through 6 months of exclusive breast-feeding (EB) postpartum and pacifier-sucking behavior at 12 months of life., Methods: A cohort study was conducted with 1,037 infants, born alive and monitored up to 12 months. At 4 and 6 months after birth, the children were classified according to the type of breast-feeding they had received: exclusive, predominant, complementary, or none. The prevalence of pacifier-sucking behavior was calculated, and the association between the 2 events was estimated. Mothers' socioeconomic-demographic characteristics, delivery features, and prenatal care, as well as the biological characteristics of the children, were determined. Relative risk (RR) and 95% confidence intervals (95% CI) were calculated., Results: In comparison with EB infants, the RR of pacifier-sucking behavior at 12 months of life was higher in children receiving complementary breast-feeding or no breast-feeding for both 4 months (RR adjusted , 1.68 [95% CI, 1.39 to 2.02] and RR adjusted , 2.67 [95% CI, 2.24 to 3.17], respectively) and 6 months (RR adjusted , 1.43 [95% CI, 1.03 to 2.00] and RR adjusted , 3.30 [95% CI, 2.40 to 4.54], respectively)., Conclusions and Practical Implications: EB for 6 months postpartum is associated with reduced pacifier-sucking behavior, adjusted for maternal color, number of prenatal consultations, and family income. Promotion of EB may reduce the use of pacifiers and their potential deleterious effects on oral health. Dental health care professionals should consider discussing the importance of breast-feeding with their patients with regard to the possible development of sucking habits in their children., (Copyright © 2019 American Dental Association. Published by Elsevier Inc. All rights reserved.)

Introduction: The purpose of this case report was to evaluate clinical and radiographic outcomes of periodontally accelerated osteogenic orthodontics (PAOO) combined with soft tissue enhancement in a patient with thin biotype and lack of buccal plate., Case Presentation: A 46-year-old female was referred for periodontal risk assessment prior to orthodontic treatment. Following a comprehensive examination, including taking a cone beam computerized tomography (CBCT) the patient was identified as high risk for soft tissue recession because of prominent roots, lack of buccal plates, and thin soft tissue. The treatment was PAOO combined with soft tissue enhancement to improve hard and soft tissue support of anterior mandibular teeth., Conclusions: Clinical and radiographic evaluation after one year revealed significant improvements in hard and soft tissue phenotype. In conclusion, combination of PAOO and soft tissue grafting could be a promising treatment to improve hard and soft tissue support for orthodontic patients., (© 2018 American Academy of Periodontology.)

Spatial and temporal patterns in microbial communities provide insights into the forces that shape them, their functions and roles in health and disease. Here, we used spatial and ecological statistics to analyze the role that saliva plays in structuring bacterial communities of the human mouth using >9000 dental and mucosal samples. We show that regardless of tissue type (teeth, alveolar mucosa, keratinized gingiva, or buccal mucosa), surface-associated bacterial communities vary along an ecological gradient from the front to the back of the mouth, and that on exposed tooth surfaces, the gradient is pronounced on lingual compared to buccal surfaces. Furthermore, our data suggest that this gradient is attenuated in individuals with low salivary flow due to Sjögren's syndrome. Taken together, our findings imply that salivary flow influences the spatial organization of microbial communities and that biogeographical patterns may be useful for understanding host physiological processes and for predicting disease.

Bioactive glasses release ions, those enhance osteoblast collagen matrix synthesis and osteogenic marker expression during bone healing. Collagen matrix density and osteogenic marker expression depend on osteogenic transcription factors, (e.g., Osterix (OSX)). We hypothesize that enhanced expression and formation of collagen by Si(4+) depends on enhanced expression of OSX transcription. Experimental bioactive glass (6P53-b) and commercial Bioglass(TM) (45S5) were dissolved in basal medium to make glass conditioned medium (GCM). ICP-MS analysis was used to measure bioactive glass ion release rates. MC3T3-E1 cells were cultured for 20 days, and gene expression and extracellular matrix collagen formation was analyzed. In a separate study, siRNA was used to determine the effect of OSX knockdown on impacting the effect of Si(4+) on osteogenic markers and matrix collagen formation. Each bioactive glass exhibited similar ion release rates for all ions, except Mg(2+) released by 6P53-b. Gene expression results showed that GCM markedly enhanced many osteogenic markers, and 45S5 GCM showed higher levels of expression and collagen matrix fiber bundle density than 6P53-b GCM. Upon knockdown of OSX transcription, collagen type 5, alkaline phosphatase, and matrix density were not enhanced as compared to wild type cells. This study illustrates that the enhancement of elongated collagen fiber matrix formation by Si(±) depends on OSX transcription. © 2016 Wiley Periodicals, Inc. J Biomed Mater Res Part A: 104A: 2604-2615, 2016., (© 2016 Wiley Periodicals, Inc.)

Several systematic reviews have shown that maxillary sinus augmentation is a predictable and effective procedure for augmentation of an atrophic posterior maxilla. However, we know of no reviews that have covered all the clinical aspects. We searched the PubMed, EMBASE, Cinhal, and Cochrane databases up to January 2015 to select relevant studies that cover the different objectives of this review, including the anatomy of the maxillary sinus, surgical techniques, biomaterials used in the sinus augmentation, and potential complications., (Copyright © 2016 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.)

The Lancet Commission on Education of Health Professionals for the 21(st) Century calls for enhancing health education for the needs and challenges of the 21st century to improve health status globally. To complement the Lancet report, this article makes recommendations for including core global health competencies in the education of health care professionals and specific groups of the public who are relevant to oral health in a global context in order to tackle the burden of oral diseases. Experts from various professional backgrounds developed global oral health competencies for four target groups: Group 1 was defined as dental students, residents/trainee specialists (or equivalent), and dentists; Group 2 was community health workers, dental hygienists, and dental therapists (or the equivalent); Group 3 was health professionals such as physicians, physician assistants, nurses, nurse practitioners, and pharmacists; and Group 4 was non-health professionals in the public arena such as parents, teachers, decision makers, key opinion leaders, and health and consumer advocates. Key competencies for members of each of the four target groups are presented in a matrix. The suggested competency matrix shows that many other health professions and groups in society have potentially crucial roles in the prevention, control, and management of oral diseases globally. Workforce models including a wider range of professionals working together as a team will be needed to tackle the burden of oral diseases in an integrated way in the broader context of non-communicable diseases. Further discussion and research should be conducted to validate or improve the competencies proposed here with regard to their relevance, appropriateness, and completeness.

Background: The use of systemic antibiotics in conjunction with scaling and root planing (SRP) may improve the clinical outcome and even could be essential for a successful treatment of periodontitis. However, the effectiveness and clinical safety of this combination of therapy remain unclear. The authors of this study reviewed the available literature related to this hypothesis, evaluating the effectiveness of the use of systemic antimicrobials in combination with SRP versus SRP alone in the treatment of chronic periodontitis (CP) or aggressive periodontitis (AgP)., Methods: The authors used 3 electronic databases and hand searched articles published from April 2001 through October 2013 in selected journals. The authors selected clinical trials with a minimum of 6 months follow-up during which patients with either CP or AgP had been treated with systemic antibiotics plus SRP in comparison with SRP alone or with placebo. The authors analyzed the gain in clinical attachment level (CAL), reduction in probing pocket depth (PPD), reduction in bleeding on probing (BOP), and patient-related variables (that is, adverse effects)., Results: After the selection process, the authors included 23 clinical trials in this review. Assessment of the quality of the studies revealed the risk of bias as a common finding. Overall, there was a tendency toward improvement of the measured outcomes, CAL, PPD, and BOP in studies for which systemic antibiotics were used as adjunctive therapy with SRP., Conclusion: Owing to the high level of heterogeneity of the studies included in this review, the authors could not establish definitive conclusions and guidelines regarding the use of adjunctive systemic antibiotics. However, within the limitations of this review, the use of systemic antibiotics with SRP may be beneficial for specific populations. Standardized clinical disease diagnostic criteria and additional randomized controlled clinical trials are necessary to verify the effectiveness of the use of adjunctive systemic antimicrobials with SRP., Practical Implications: Owing to methodological differences and biases among clinical trials evaluating systemic antibiotics adjunctive to SRP, clinicians should base their decisions to prescribe on the results of weighing both benefits and risks for each patient., (Copyright © 2015 American Dental Association. Published by Elsevier Inc. All rights reserved.)

Osteocalcin (OCN) expression is an essential osteogenic marker of successful bone regeneration therapies. This study hypothesizes that Si(4+) and Ca(2+) combinatorial released by bioactive glass enhance osteoblast biomineralization through up-regulation of OCN expression; and Mg(2+) release delays such enhancement. Osteoblasts (MC3T3-E1) were treated with ionic products of bioactive glass dissolution (6P53-b experimental bioactive glass and 45S5 commercial Bioglass™). Results showed that gene expressions, including OCN and its up-stream transcription factors (Runx2, ATF4, MSX1, SP7/OSX), growth factors and signaling proteins (BMP2, BMP6, SMAD3), were enhanced in both 45S5 and 6P53-b glass conditioned mediums (GCMs). This up-regulation led to enhanced mineral formation by 45S5 glass conditioned mediums ([GCM], Si(4+)+Ca(2+)) after 20 days, and by 45S5 GCM and 6P53-b GCM (Si(4+)+Ca(2+)+Mg(2+)) after 30 days. In examining the extracellular matrix generated by cells when exposed to each GCM, it was found that 45S5 GCM had slightly elevated levels of mineral content within ECM as compared to 6P53-b GCM after 30 days while control treatments exhibited no mineral content. The formation of well-defined mineralized nodules (distinct PO4(3-) [960 cm(-1)] and CO3(2-) [1072 cm(-1)] peaks from Raman Spectra) was observed for each GCM as the soluble glass content increased. In examining the individual and combined ion effects between Si(4+), Ca(2+), and Mg(2+), it was found Mg(2+) down-regulates OCN expression. Thus, ions released from both 45S5 and 6P53-b bioactive glasses up-regulate OCN expression and biomineralization while 6P53-b GCM Mg(2+) release down-regulated OCN expression and delayed osteoblast biomineralization. These results indicate that Si(4+), Ca(2+), and Mg(2+) combinatorially regulate osteoblast OCN expression and biomineralization., (Copyright © 2013 Elsevier B.V. All rights reserved.)

This study tests the hypothesis that silicon and calcium ions combinatorially target gene expression during osteoblast differentiation. MC3T3-E1 subclone 4 osteoblast progenitors (transformed mouse calvarial osteoblasts) were exposed to Si(4+) (from Na(2)SiO(3)) and Ca(2+) (from CaCl(2):H(2)O) ion treatments both individually (0.4 mM each + control treatment) and combinatorially (0.4 mM Si(4+) + 0.4 mM Ca(2+) + control treatment) and compared to control treated (α-minimum essential medium, 10% fetal bovine serum, and 1% penicillin-streptomycin) cells. Cell proliferation studies showed no significant increase in cell density between treatments over 5 days of culture. Cellular differentiation studies involved addition of ascorbic acid (50 mg/L) for all treatments. Relative gene expression was determined for collagen type 1 (Col(I)α1/Col(I)α2), core-binding factor a (cbfa1/Runx2), and osteocalcin (OCN), which indicated osteoblast progenitor differentiation into a mineralizing phenotype. Increased Si(4+) or Ca(2+) ion treatments enhanced Col(I)α1, Col(I)α2, Runx2, and OCN expression, while increased Si(4+) + Ca(2+) ion treatments enhanced OCN expression. Moreover, it was found that a Si(4+)/Ca(2+) ratio of unity was optimal for maximal expression of OCN. Collagen fiber bundles were dense, elongated, and thick within extracellular matrices (ECM) exposed to Si(4+) and Si(4+) + Ca(2+) treatments, while collagen fiber bundles were sparse, short, and thin within Ca(2+) and control treated ECM. These results indicated that individual ions enhance multiple osteogenic gene expression, while combined ion treatments enhance individual gene expression. In addition, these results indicated that Si(4+) enhanced osteoblast gene expression and ECM formation at higher levels than Ca(2+). These results support the larger concept that ions (possibly released from bioactive glasses) could control bone formation by targeting osteoblast marker expression.

From 2008 to 2011, the School of Dentistry at Muhimbili University of Health and Allied Sciences in Tanzania revised and then initiated implementation of a curriculum to improve the educational process for, and competence of, its graduates. As an increasing body of research demonstrates the detrimental effects of oral diseases on health and the interrelationships between oral and systemic diseases (including HIV and diabetes), the importance of dentistry education grows. We describe the population oral health problems in Tanzania, the need to enhance the dental workforce, and the process of curricular reform to meet these needs. This reform included transition to a competency-based curriculum featuring teaching methods that will enhance the effectiveness of the education and performance of graduates in traditional and new roles. We conclude with lessons for Tanzania and for health professions educational institutions elsewhere, as well as for public health-care planners concerned about linking health professions education to improving population health in resource-poor countries.

This study resulted in enhanced collagen type 1 and osteocalcin expression in human periodontal ligament fibroblasts (hPDLF) when exposed to bioactive glass conditioned media that subsequently may promote early mineralized tissue development. Commercial Bioglass™ (45S5) and experimental bioactive coating glass (6P53-b), were used to make a glass conditioned media (GCM) for comparison to control medium. ICP-MS analysis showed increased concentrations of Ca(2+), PO(4) (3-), Si(4+), and Na(+), for 45S5 GCM and Mg(2+), K(+), Ca(2+), PO(4)(3-), Si(4+), and Na(+) for 6P53-b GCM (relative to control medium). Differentiating hPDLF cultures exposed to 45S5 and 6P53-b GCM showed enhanced expression of collagen type 1 (Col1α1, Col1α2), osteocalcin, and alkaline phosphatase gene expression. These GCM also enhanced osteocalcin protein expression. After 16 d of culture, 45S5 and 6P53-b GCM treated cells showed regions of deep red Alizarin staining, indicating increased Ca within their respective extracellular matrices (ECM), while control-treated cells did not exhibit these features. SEM analysis showed more developed ECM in GCM treated cultures, indicated by multiple tissue layering and abundant collagen fiber bundle formation, while control treated cells did not exhibit these features. SEM analysis showed polygonal structures suggestive of CaP in 45S5 GCM treated cultures. These results indicate the osteogenic potential of bioactive coating glass in periodontal bone defect filling applications., (Copyright © 2011 Wiley Periodicals, Inc.)

This study tested the hypothesis that bioactive coating glass (SiO(2)-CaO-P(2)O(5)-MgO-K(2)O-Na(2)O system), used for implant coatings, enhanced the induction of collagen type 1 synthesis and in turn enhanced the expression of downstream markers alkaline phosphatase, Runx2 and osteocalcin during osteoblast differentiation. The ions from experimental bioactive glass (6P53-b) and commercial Bioglass(TM) (45S5) were added to osteoblast-like MC3T3-E1 subclone 4 cultures as a supplemented ion extract (glass conditioned medium (GCM)). Ion extracts contained significantly higher concentrations of Si and Ca (Si, 47.9+/-10.4 ppm; Ca, 69.8+/-14.0 for 45S5; Si, 33.4+/-3.8 ppm; Ca, 57.1+/-2.8 ppm for 6P53-b) compared with the control extract (Si<0.1 ppm, Ca 49.0 ppm in alpha-MEM) (ANOVA, p<0.05). Cell proliferation rate was enhanced (1.5x control) within the first 3 days after adding 45S5 and 6P53-b GCM. MC3T3-E1 subclone 4 cultures were then studied for their response to the addition of test media (GCM and control medium along with ascorbic acid (AA; 50 ppm)). Each GCM+AA treatment enhanced collagen type 1 synthesis as observed in both gene expression results (day 1, Col1alpha1, 45S5 GCM+AA: 3x control+AA; 6P53-b GCM+AA: 4x control+AA; day 5, Col1alpha2, 45S5 GCM+AA: 3.15x control+AA; 6P53-b GCM+AA: 2.35x control+AA) and in histological studies (Picrosirius stain) throughout the time course of early differentiation. Continued addition of each GCM and AA treatment led to enhanced expression of alkaline phosphatase (1.4x control+AA after 5 days, 2x control+AA after 10 days), Runx2 (2x control+AA after 7 days) and osteocalcin gene (day 3, 45S5 GCM+AA: 14x control+AA; day 5, 6P53-b GCM+AA: 19x control+AA) and protein expression (40x-70x control+AA after 6 days). These results indicated the enhanced effect of bioactive glass ions on key osteogenic markers important for the bone healing process.

Objective: To investigate the effect of hypoxia on isolated human periodontal ligament stem cells (hPDLSC) in vitro., Methods: hPDLSC were exposed to normoxia (20% O(2)) and hypoxia (1.5% - 2% O(2)). Total cellular RNA and protein were collected on day 1, 2, 4 and 6 after culture. Western analysis and semi-quantitative RT-PCR were used to analyze osteogenic differentiation of hPDLSC, including alkaline phosphatase (ALP), osteocalcin (OCN), secreted protein acidic and rich in cysteine (SPARC) and bone morphogenetic protein-2 (BMP-2)., Results: In the first two days hypoxia slightly increased the growth of hPDLSC [A value was 0.697(hypoxia) vs 0.617 (nomoxia)] and after the third day hypoxia dramatically decreased the growth of the hPDLSC [A value was 0.870(hypoxia) vs 1.242 (nomoxia)]. Up to 90% reduction of ALP activity was observed in hPDLSC after 5 days of hypoxia [A value was 0.004(hypoxia) vs 0.049(nomoxia)]. Hypoxia decreased SPARC expression at protein level and down-regulated ALP, OCN and BMP-2 expression at mRNA level in comparison with nomoxia., Conclusions: Hypoxia inhibited proliferation of hPDLSC and down-regulated BMP-2 mRNA expression, then down-regulated their target genes such as ALP, OCN, and SPARC, thus inhibiting critical steps in osteogenic differentiation of hPDLSC.

Background: A landmark report from the U.S. surgeon general identified disparities in oral health care as an urgent and high-priority problem. A parallel development in the dental education community is the growing consensus that significant curriculum reform is long overdue., Methods: The authors performed a literature review and conducted a series of structured interviews with key institutional and community stakeholders from seven geographical regions of the United States. They investigated a wide range of partnerships between community-based dental clinics and academic dental institutions., Results: On the basis of their interviews and literature review, the authors identified common themes and made recommendations to the dental community to improve access to care while enhancing the dental curriculum., Conclusions: Reducing disparities in access to oral health care and the need for reform of the dental curriculum may be addressed, in part, by a common solution: strategic partnerships between academic dental institutions and communities. Practice Implications. Organized dentistry and individual practitioners, along with other major stakeholders, can play a significant role in supporting reform of the dental curriculum and improving access to care.

Background: The authors conducted a study to compare administration of local anesthetic using a computer-controlled delivery device with an aspirating syringe for therapeutic scaling and root planing. The anterior middle superior alveolar, or AMSA, injection was compared with other maxillary injections., Methods: Twenty healthy adults with moderate periodontal disease participated in this single-blind crossover study. Subjects were evaluated by a trained examiner and were treated by experienced dental hygienists. Subjects provided written and verbal pain ratings via a visual analog scale, or VAS, and a verbal rating scale, or VRS. AMSA injections were compared with syringe-delivered injections--greater palatine, or GP, and nasopalatine, or NP, blocks, and anterior superior alveolar and middle superior alveolar injections--in maxillary quadrants. Bleeding and changes in attachment were evaluated after one month., Results: VAS and VRS scores for AMSA were significantly lower for computer-controlled delivery when compared with NP injections and combined maxillary injections (VAS scores) and with GP and combined maxillary injections (VRS scores). Mean injection times were similar for both groups. Mean gains in attachment were equal, 0.19 millimeters for quadrants anesthetized using computer-controlled injections and 0.22 mm for syringe injections., Conclusions: Subjects reported having less pain with GP and NP injections delivered using the computer-controlled device, and total injection time was similar to that required for syringe injections. Both techniques provided adequate anesthesia for therapeutic scaling and root planing. Clinical Implications. The two anesthetic delivery techniques were therapeutically equivalent for mandibular injections, and the AMSA injection has clinically significant advantages for maxillary injections.

A variety of microbiological diagnostic tests are available for clinicians to use for evaluation of patients with periodontal disease. Each one has its own unique set of advantages and disadvantages, and probably the most useful information for the clinician can be obtained using a combination of the various analytic methods. The tests appear to have their greatest utility when used on patients with chronic or aggressive periodontitis who do not respond favorable to conventional mechanical therapy. The major limitation of all microbiological tests is that the information obtained is relevant to the site sampled, and may not be representative of the microflora of the entire dentition. However, since it is often only specific sites that do not respond to initial therapy, knowing the constituents of the microflora that populate these sites is clinically relevant.

Background: Our understanding of the complexity of the oral microbiota continues to improve as new technologies, such as the analysis of 16S rRNA bacterial genes, are utilized. Despite the difficult of cataloguing all microorganisms and determining their pathogenic potential, some species, mostly members of the resident oral microbiota, have been identified as likely periodontal pathogens. However, for microbial diagnosis to be of value, it needs to affect disease diagnosis and/or treatment planning as well as result in superior treatment outcomes and/or provide an economic benefit to the patient., Rationale: The purposes of this systematic review were to determine if microbial identification influences periodontal patient management and whether treatment outcomes are better compared to patients whose treatment plans are developed without this information., Focused Question: In patients with periodontal diseases, does microbial identification influence patient management compared to treatment prescribed without this information?, Search Protocol: The MEDLINE database was searched for clinical studies in English from 1991 through 2002 by 2 investigators. Hand searches were performed on the Journal of Clinical Periodontology, Journal of Periodontology, Journal of Periodontal Research, Oral Microbiology and Immunology, and Periodontology 2000. In addition, directors of diagnostic laboratories were contacted about unpublished data., Inclusion Criteria: Articles in which bacterial identification influenced patient treatment were preferred as were those reporting longitudinal data demonstrating a direct relationship between the presence or absence of certain bacteria and subsequent alterations in clinical variables. Because of the limited number of studies, all articles, including case reports, were considered., Exclusion Criteria: Review articles without original data were excluded, although references were examined for possible inclusion. Articles reporting data showing associations between certain microorganisms and disease or health that did not affect treatment were excluded. Clinical trials testing antibacterial agents for their ability to enhance mechanical debridement were not included since bacterial identification had little effect on drug selection or experimental group assignment. Articles dealing with implants rather than natural teeth were omitted. DATA ANALYSIS AND COLLECTION: The heterogeneity of the published data precludes any meaningful pooling of data or meta-analysis. The pertinent literature, including relevant variables of plaque, gingivitis, and bleeding on probing scores; probing depth; clinical attachment level; number of lost teeth; and microbial changes; and patient-centered outcomes including decrease in morbidity, reduced need for surgery, and duration and cost of treatment are summarized., Main Results: 1. There was a lack of articles with a high evidence rating; most pertinent articles were either case reports or case series without controls. 2. Because reports were heterogeneous regarding study design, patient selection, and data collection, meta-analysis was not feasible and results are summarized in tabular format. 3. This report is based on a total of 24 studies, representing a total patient population of approximately 835. 4. Thirteen studies reported on microbiological identification as an aid in treatment planning. 5. Eleven studies reported a differential clinical response depending on the detection or lack of detection of specific organisms., Reviewers' Conclusions: 1. The published material suggests that microbiological monitoring may be useful in management of selected patients who do not respond to standard therapy. 2. Some practitioners consider microbial identification a valuable adjunct to managing patients with certain forms of periodontitis, although there is a lack of strong evidence to this effect. 3. Additional research is needed to address this issue.

Exposure to microgravity has been associated with several physiological changes in astronauts and cosmonauts, including an osteoporosis-like loss of bone mass. In-flight measures used to counteract this, including intensive daily exercise regimens, have been only partially successful in reducing the bone loss and in the process have consumed valuable work time. If this bone loss is to be minimized or, preferably, prevented, more effective treatment strategies are required. This, however, requires a greater understanding of the mechanisms through which bone metabolism is affected by microgravity. Various research strategies have been used to examine this problem, including in vitro studies using bone cells and in vivo studies on humans and rats. These have been conducted both in flight and on the ground, by strategies that produce weightlessness to mimic the effects of microgravity. Overall, the majority of the studies have found that marked decreases in gravitation loading result in the loss of bone mass. The processes of bone formation and bone resorption become uncoupled, with an initial transitory increase in resorption accompanied by a prolonged decrease in formation. Loss of bone mass is not uniform throughout the skeleton, but varies at different sites depending on the type of bone and on the mechanical load received. It appears that the skeletal response is a physiologic adaptation to the space environment which, after long space flights or repeated shorter ones, could eventually lead to significant reductions in the ability of the skeletal tissues to withstand the forces of gravity and increased susceptibility to fracture.

This study was undertaken to determine the direct effects of extracts derived from Porphyromonas gingivalis on bone formation and mineral resorption in an osteogenic/osteoclastic cell in vitro co-culture model. Osteogenic bone marrow derived stromal cells were isolated from 18-day old embryonic chickens, while osteoclastic cells were isolated from laying white Leghorn hens on calcium deficient diets. Osteoclastic cells (5 x 10(5)) were seeded onto mineral thin films and suspended above osteogenic cells (1 x 10(4)) already plated on the bottoms of tissue culture plate wells. Sonicated P. gingivalis 2561 extracts were prepared from whole bacterial cells and added in varying proportions (0 to 2 microg/ml) to the co-culture growth medium. These co-cultures, and appropriate mono-culture controls, were incubated for a further 4 days. Parameters of bone forming cell activity including alkaline phosphatase activity, calcium and inorganic phosphate accumulation were performed on the osteogenic cells. Mineral substrate resorption by osteoclastic cells was assessed morphometrically. In their respective mono-cultures, the addition of P. gingivalis sonicate to the culture medium had no effect on osteoclastic mineral resorption, but significantly inhibited osteogenesis (up to 45%; P <0.05). In co-cultures, however, the sonicate induced significant increases in mineral resorption (up to 70%; P <0.05), whereas bone forming cell activity was still inhibited, although to a significantly lesser extent than in mono-cultures (up to 25%; P <0.05). These results suggest that P. gingivalis sonicate induced up-regulation of mineral resorption may be mediated via osteogenic cells.

The processes involved in the regulation of bone cell metabolism are complex, including those implicated in bone cell coupling. This study was undertaken to develop a model that would permit real-time interaction between osteoclastic cells and osteoblasts in vitro. Osteogenic bone marrow stromal cells were isolated from 18-day-old embryonic chickens, while osteoclastic cells were isolated from laying White Leghorn hens on calcium-deficient diets. Osteoclastic cells (5x10(5)) were seeded onto mineral thin films and suspended above osteogenic cells (1x10(4)) already plated on the bottoms of tissue culture plate wells. The data showed that after 4 days of incubation there was up to a fivefold (P<0.05) reduction in all measured parameters of osteogenesis (mineralization, alkaline phosphatase activity and type I collagen production) in osteogenic cultures grown in the presence of osteoclastic cells. Similarly, osteoclastic cell-induced mineral resorption was reduced up to threefold (P<0.05). Co-culture effects on cellular responses could be manipulated by known antiresorptive agents (e.g., pamidronate) altering either the source or the age of osteoclastic cells. The results indicate that the co-culture model may be useful in the study of bone cell interactions.

By using an in vitro bone-forming culture system, the chick periosteal osteogenesis (CPO) model, the direct effects on osteogenesis of sonicated extracts derived from oral bacteria were examined. Both extracts from bacterial species having strong associations with periodontal diseases (Porphyromonas gingivalis, Actinobacillus actinomycetemcomitans, and Prevotella intermedia, hereinafter referred to as suspected periodontopathogens) and extracts from species not correlated with periodontal disease (Streptococcus sanguis, Veillonella atypica, and Prevotella denticola, hereinafter referred to as nonpathogenic bacteria) were tested. All bacterial cultures were grown under standard anaerobic culture conditions. Sonicated bacterial extracts were prepared from the bacterial pellet. These were added in various proportions to the CPO cultures. Parameters of osteogenesis, including alkaline phosphatase activity, calcium and P(i) accumulation, and collagen synthesis, were measured in 6-day-old cultures. Compared with controls grown in the absence of bacterial products, osteogenesis was inhibited significantly in cultures treated with extracts derived from the suspected periodontopathogens. No osteogenic inhibition was observed in cultures treated with extracts from the nonpathogenic bacteria. These results suggest that the ability to inhibit osteogenesis in vitro may be a pathogenic property shared by a limited group of species. Further characterization of the P. gingivalis extracts revealed that both proteinaceous and nonproteinaceous products, including lipopolysaccharide, were able to inhibit osteogenesis. P. gingivalis extract-mediated inhibition of osteogenesis in CPO cultures was blocked by indomethacin, implicating prostaglandins in the regulation of the bacterial effects. The bacterial extracts had either reversible or irreversible inhibitory effects on osteogenesis when added after differentiation or before/during differentiation of bone cells, respectively.

It is well documented that oral microorganisms play a significant role in the initiation and progression of periodontal disease. By using various in vitro models, it has been shown that some bacteria considered periodontal pathogens or their products can stimulate bone resorption and some other parameters of osteoblast-like cell activity. However, the effects of these organisms and their products on osteogenesis itself are not known. This study was undertaken to determine the direct effects of metabolic products and sonicated extracts of Porphyromonas gingivalis on bone formation in the chick periosteal osteogenesis model. Cultures of P. gingivalis 2561 were grown under standard anaerobic culture conditions. The spent medium was collected, and following centrifugation, sonicated bacterial extracts were prepared from the bacterial pellet. These were added in various proportions to the chick periosteal osteogenesis cultures. Sonicated extracts were further fractionated into five molecular-size ranges and similarly tested. Parameters of osteogenesis, including alkaline phosphatase activity, calcium and Pi accumulation, and collagen synthesis, were measured on 6-day-old cultures. Compared with controls devoid of bacterial products, osteogenesis was inhibited significantly in cultures treated with either conditioned medium or extracts obtained from P. gingivalis. Various amounts of inhibitory activity were observed in the different ultrafiltration molecular-size fractions, with very profound inhibitory effects observed in the < 5-kDa range. Histological observations indicated the presence of cells, some bone, and/or new fibrous connective tissue at all concentrations, indicating that toxicity was not a factor. These results suggest that periodontal pathogens such as P. gingivalis might contribute to the bone loss in periodontal diseases not only by stimulating resorption but, possibly, by inhibiting bone formation directly.