Effect of laser-assisted reconstructive surgical therapy of peri-implantitis on protein biomarkers and bacterial load.

OBJECTIVES: This randomized clinical trial assessed changes in protein biomarker levels and bacterial profiles after surgical reconstructive therapy of peri-implantitis and investigated whether the adjunctive use of Er:YAG laser impacts protein biomarker and microbial outcomes. MATERIALS AND METHODS: Twenty-four patients received surgical reconstructive therapy for peri-implantitis with guided bone regeneration following mechanical debridement with (test) or without (control) the adjunctive irradiation of Er:YAG laser. Bacterial and peri-implant crevicular fluid (PICF) samples were collected over 6 months and analyzed with bacterial qPCR and luminex multiplex assays. RESULTS: Surgical reconstructive treatment significantly affected the concentration of PICF protein biomarkers, including a 50% reduction in IL-1ß between 2 and 4 weeks (p < .0001). Both MMP-9 (p < .001) and VEGF (p < .05) levels steadily decreased after treatment. In the laser group, the peak increase in IL-1ß was attenuated at 2 weeks, followed by significant reduction in MMP-9 (p < .01) and VEGF (p < .05) across all follow-up appointments compared with the control nonlaser group. The total bacterial load was reduced 2 weeks after treatment, especially in the laser group, but recolonized to presurgical levels after 4 weeks in both groups (p < .01). The composition of selective pathogens varied significantly over the follow-up, but recolonization patterns did not differ between groups. CONCLUSIONS: Reconstructive therapy of peri-implantitis significantly altered PICF protein biomarker and microbial levels during the healing process. The adjunctive use of Er:YAG laser significantly modulated the inflammatory response through reduced levels of MMP-9 and VEGF during the postsurgical period. The bacterial load was reduced immediately after therapy, but recolonization was observed by 4 weeks in both groups.

A randomized controlled trial to compare aesthetic outcomes of immediately placed implants with and without immediate provisionalization.

INTRODUCTION: There are mixed results regarding the aesthetic advantage of immediate provisionalization of dental implants. Therefore, this study aimed to compare facial mucosal level of single immediately placed implants with and without immediate provisionalization. METHODS: Single implants were immediately placed to replace a hopeless maxillary anterior or premolar tooth in 40 subjects. Each implant was randomly assigned to receive a non-occluding temporary crown or a healing abutment after implant placement. At 4 months, these implants were permanently restored and followed up for 12 months. Clinical and radiographic parameters were measured and compared. RESULTS: The implant survival rate at 12 months in the test and control group was 90% and 100%, respectively. Mid-facial mucosal marginal level and papilla height changes were minimal within groups, and no significant differences were found between the two groups. The amount of marginal bone remodelling was modest, with no significant difference between the two groups. Radiographic bone changes were not statistically different between the groups, except for the vertical crestal bone resorption. CONCLUSION: Immediate implant placement with or without provisionalization can achieve stable vertical soft tissue level for 12 months as compared to pre-extraction level. However, immediate provisionalization was not able to improve the aesthetic outcome further.

Personalized medicine: an update of salivary biomarkers for periodontal diseases.

This article provides an up-to-date review of the more robust salivary biomarkers, as well as of panels of combinatorial markers and periodontal pathogens, that reveal high sensitivity and specificity for enhancing clinical decision-making in periodontal disease progression, risk and diagnosis. Periodontal diseases are complex and require an inflammatory response to bacterial pathogens in a susceptible host to stimulate tissue destruction. When used alone, traditional clinical assessments provide a diagnosis of periodontitis only after the biologic onset of the disease process, and are unable to substantiate disease activity or future risk. New technologies are becoming available that are capable of measuring combinations of inflammatory cytokines and proteinases for rapid chair-side testing. Utilizing saliva to identify and measure specific phenotypes and host-derived mediators will allow highly individualized diagnosis, prognosis and treatments for periodontal diseases. This personalized medicine approach will strengthen the power of the clinical oral examination and medical history assessments, providing patients with evidence-based, targeted risk care.

Effects of triclosan on host response and microbial biomarkers during experimental gingivitis.

AIM: This exploratory randomized, controlled clinical trial sought to evaluate anti-inflammatory and -microbial effects of triclosan during experimental gingivitis as assessed by host response biomarkers and biofilm microbial pathogens. MATERIALS AND METHODS: Thirty participants were randomized to triclosan or control dentifrice groups who ceased homecare for 21 days in an experimental gingivitis (EG) protocol. Plaque and gingival indices and saliva, plaque, and gingival crevicular fluid (GCF) were assessed/collected at days 0, 14, 21 and 35. Levels and proportions of 40 bacterial species from plaque samples were determined using checkerboard DNA-DNA hybridization. Ten biomarkers associated with inflammation, matrix degradation, and host protection were measured from GCF and saliva and analysed using a multiplex array. Participants were stratified as "high" or "low" responders based on gingival index and GCF biomarkers and bacterial biofilm were combined to generate receiver operating characteristic curves and predict gingivitis susceptibility. RESULTS: No differences in mean PI and GI values were observed between groups and non-significant trends of reduction of host response biomarkers with triclosan treatment. Triclosan significantly reduced levels of A. actinomycetemcomitans and P. gingivalis during induction of gingivitis. CONCLUSIONS: Triclosan reduced microbial levels during gingivitis development (ClinicalTrials.gov NCT01799226).

Crevicular fluid biomarkers and periodontal disease progression.

AIM: Assess the ability of a panel of gingival crevicular fluid (GCF) biomarkers as predictors of periodontal disease progression (PDP). MATERIALS AND METHODS: In this study, 100 individuals participated in a 12-month longitudinal investigation and were categorized into four groups according to their periodontal status. GCF, clinical parameters and saliva were collected bi-monthly. Subgingival plaque and serum were collected bi-annually. For 6 months, no periodontal treatment was provided. At 6 months, patients received periodontal therapy and continued participation from 6 to 12 months. GCF samples were analysed by ELISA for MMP-8, MMP-9, Osteoprotegerin, C-reactive Protein and IL-1ß. Differences in median levels of GCF biomarkers were compared between stable and progressing participants using Wilcoxon Rank Sum test (p = 0.05). Clustering algorithm was used to evaluate the ability of oral biomarkers to classify patients as either stable or progressing. RESULTS: Eighty-three individuals completed the 6-month monitoring phase. With the exception of GCF C-reactive protein, all biomarkers were significantly higher in the PDP group compared to stable patients. Clustering analysis showed highest sensitivity levels when biofilm pathogens and GCF biomarkers were combined with clinical measures, 74% (95% CI = 61, 86). CONCLUSIONS: Signature of GCF fluid-derived biomarkers combined with pathogens and clinical measures provides a sensitive measure for discrimination of PDP (ClinicalTrials.gov NCT00277745).

Clinical, microbiological, and salivary biomarker profiles of dental implant patients with type 2 diabetes.

OBJECTIVE: Regulators of peri-implant bone loss in patients with diabetes appear to involve multiple risk factors that have not been clearly elucidated. This study was conducted to explore putative local etiologic factors on implant bone loss in relation to type 2 diabetes mellitus, including clinical, microbial, salivary biomarker, and psychosocial factors. MATERIALS AND METHODS: Thirty-two subjects (divided into type 2 diabetes mellitus and non-diabetic controls), having at least one functional implant and six teeth, were enrolled in a 1-year longitudinal investigation. Analyses of clinical measurements and standardized intra-oral radiographs, saliva and serum biomarkers (via protein arrays for 20 selected markers), and plaque biofilm (via qPCR for eight periodontal pathogens) were performed at baseline and 1 year. In addition, the subjects were asked to respond to questionnaires to assess behavioral and psychosocial variables. RESULTS: There was a significant increase from baseline to 1 year in the probing depth of implants in the diabetes group (1.95 mm to 2.35 mm, P = 0.015). The average radiographic bone loss during the study period marginally increased at dental implants compared to natural teeth over the study period (0.08 mm vs. 0.05 mm; P = 0.043). The control group harbored higher levels of Treponema denticola at their teeth at baseline (P = 0.046), and the levels of the pathogen increased significantly over time around the implants of the same group (P = 0.003). Salivary osteoprotegerin (OPG) levels were higher in the diabetes group than the control group at baseline only; in addition, the salivary levels of IL-4, IL-10, and OPG associated with host defense were significantly reduced in the diabetes group (P = 0.010, P = 0.019, and P = 0.024), while controls showed an increase in the salivary OPG levels (P = 0.005). For psychosocial factors, there were not many significant changes over the observation period, except for some findings related to coping behaviors at baseline. CONCLUSIONS: The study suggests that the clinical, microbiological, salivary biomarker, and psychosocial profiles of dental implant patients with type 2 diabetes who are under good metabolic control and regular maintenance care are very similar to those of non-diabetic individuals. Future studies are warranted to validate the findings in longer-term and larger clinical trials (ClinicalTrials.gov # NCT00933491).

Teriparatide and osseous regeneration in the oral cavity.

BACKGROUND: Intermittent administration of teriparatide, a drug composed of the first 34 amino acids of parathyroid hormone, has anabolic effects on bone. Although teriparatide has been evaluated for the treatment of osteoporosis and for the healing of fractures, clinical trials evaluating it for the treatment of osseous conditions of the oral cavity in humans are lacking. METHODS: A total of 40 patients with severe, chronic periodontitis underwent periodontal surgery and received daily injections of teriparatide (20 µg) or placebo, along with oral calcium (1000 mg) and vitamin D (800 IU) supplementation, for 6 weeks. The patients were followed for 1 year. The primary outcome was a radiographic linear measurement of alveolar bone level. Secondary outcomes included clinical variables, bone turnover markers in serum and oral fluid, systemic bone mineral density, and quality of life. RESULTS: Radiographic linear resolution of osseous defects was significantly greater after teriparatide therapy than after placebo beginning at 6 months, with a mean linear gain in bone at 1 year of 29% as compared with 3% (P<0.001). Clinical improvement was greater in patients taking teriparatide than in those taking placebo, with a reduction in periodontal probing depth of 33% versus 20% (2.42 mm vs. 1.32 mm) and a gain in clinical attachment level of 22% versus 7% (1.58 mm vs. 0.42 mm) in target lesions at 1 year (P = 0.02 for both comparisons). No serious adverse events were reported; however, the number of patients in the study was small. No significant differences were noted with respect to the other variables that were assessed. CONCLUSIONS: Teriparatide, as compared with placebo, was associated with improved clinical outcomes, greater resolution of alveolar bone defects, and accelerated osseous wound healing in the oral cavity. Teriparatide may offer therapeutic potential for localized bone defects in the jaw. (Funded by the National Institutes of Health and others; ClinicalTrials.gov number, NCT00277706 .).

Dental Hygienists' Familiarity, Utilization, and Barriers to Using Advanced Instruments during Non-Surgical Periodontal Therapy.

Purpose Non-surgical periodontal therapy (NSPT) is considered to be fundamental in the treatment of periodontal disease. Advanced area specific instruments were designed to increase the clinician's ability to effectively access root furcation areas during NSPT. The purpose of this study was to explore clinical dental hygienists' familiarity, utilization, and perceived efficacy of advanced instruments in root furcation areas during NSPT.Methods A randomized sample (n=3,500) of licensed dental hygienists in Michigan was invited to participate in a paper-based, mail survey. The 10-item instrument consisted of demographic, multiple choice, Likert scale, and open-ended questions. Descriptive and inferential statistics were used to analyze the data.Results A total of 1,156 surveys were returned; 858 met the inclusion criteria for a response rate of 24.5%. Respondents who graduated between 2010-2020 than those who graduated between 1990-1999 were more likely to utilize advanced instruments and those who graduated in 1989 or earlier (16.0% and 19.9% respectively). Respondents familiar with advanced instruments were more likely to use them in furcation areas during NSPT than those less familiar with the instruments (95% CI [18.1, 29.6], p<0.001). Respondents who perceived advanced instruments to be effective in furcation areas were more likely to utilize them (95% CI [1.0, 8.0], p<0.05) during NSPT. Most respondents indicated that they became familiar with advanced instruments during their dental hygiene education or through continuing education courses.Conclusion Familiarity with advanced instruments and perceived efficacy of these instruments for accessing root furcations increased the likelihood of clinical dental hygienists utilizing them during NSPT. Dental hygiene education and continuing education programs should continue to provide opportunities for students and practicing clinicians to learn NSPT instrumentation techniques utilizing advanced instruments designed for furcation access.

Career motivation and satisfaction of dental hygiene students in associate versus bachelor degree programs: A national survey.

OBJECTIVES: Entry-level dental hygiene programs give associate (AD) and bachelor degrees (BD). The objectives were to compare how AD versus BD students differ in career-related role models and information sources, career motivations, and satisfaction and to explore the relationships between career motivations and satisfaction. METHODS: Two hundred seventy-one students in AD and 269 students in BD programs responded to a survey. RESULTS: AD students were older than BD students (26.71/23.6; p < 0.001). Both groups were most likely to name a nurse/dental hygienist (37.6%/37.3%) as role models in their families, were likely to have shadowed a dental hygienist (77.6%/75.0%), and had talked to a health professional (27.7%/23.7%) prior to program application. BD students decided earlier to become dental hygienists (17.20/19.97 years; p < 0.001) and were less likely to have been dental assistants before than AD students (28.3%/36.9%; p = 0.034). Both groups agreed strongly that they wanted to become dental hygienists to help patients (5-point scale with 5 = agree strongly: 4.88/4.86), make a difference in the life of patients (4.88/4.86) and because it is a flexible career (4.83/4.80). Open-ended responses showed that 62.4% of AD students compared to 35.3% of BD students choose their career because of lifestyle considerations (p < 0.001), while 47.2% of BD students versus 38.0% of AD students wanted to work in the healthcare field (p < 0.001). Both groups had high job satisfaction (3-point scale: 2.94/2.97). For AD students, job satisfaction correlated with wanting to help patients (r = 0.49; p < 0.01) and with making a difference in the life of patients (r = 0.52; p < 0.001). For BD students, wanting to work in a team (r = 0.34; p < 0.001) and having a dentist in the family (r = 0.32; p < 0.001) correlated with job satisfaction. CONCLUSIONS: Dental hygiene students in AD versus BD programs differ in the factors that are associated with job satisfaction. Dental hygiene educators can utilize these findings when recruiting future students. The findings related to motivational determinants of job satisfaction can guide educational efforts.

Factors Influencing the Professional Identity of Student and Licensed Professional Members of the American Dental Hygienists' Association.

Purpose: Professional identity formation is positively influenced by roles models, mentors, and experiential learning. The purpose of this study was to investigate the role membership in the American Dental Hygienists' Association (ADHA) plays in developing and sustaining professional identity, and to explore whether differences exist between how students and licensed professionals perceive this role.Methods: A 48-item survey consisting of multiple choice, Likert scale, and open-ended items was created, and pilot tested before dissemination to student (SM) and licensed professional members (LM) of the ADHA via an electronic survey platform. Descriptive and inferential statistics were used to analyze the data.Results: Of the 31,479 surveys sent to ADHA members in the database, 1,983 were completed, for a response rate of 6.3%. Most respondents were licensed professionals (86%, n=1,699), female (98%, n=1,940) and White (84%, n=1,668). Over one-third were over 55 years of age (37%, n=727). Continuing Education and Evidence-based Research resources were identified as positively affecting professional identity (4.0 or higher means). Advocacy efforts, the Journal of Dental Hygiene, and Access Magazine had a significantly greater positive influence on LMs professional identity (p<0.05) while SMs reported patient care resources and career support had a greater influence on their professional identity (p< 0.05).Conclusion: Member benefits in the ADHA positively influence the professional identities of students and licensed professionals. Dental hygiene students most value benefits that will support their roles as future health care professionals, while licensed professionals identified evidence-based resources and advocacy efforts as instrumental in sustaining their professional identity.

Laser-assisted regenerative surgical therapy for peri-implantitis: A randomized controlled clinical trial.

BACKGROUND: Different surgical approaches have been proposed to treat peri-implantitis defects with limited effectiveness and predictability. Laser has been proposed as an effective tool to assist in bacterial decontamination and modulating peri-implant tissue inflammation. The aim of this pilot clinical trial was to evaluate the adjunctive benefits of Er:YAG laser irradiation for regenerative surgical therapy of peri-implantitis-associated osseous defects. METHODS: Twenty-four patients diagnosed with peri-implantitis with a radiographic infrabony defect were randomized into two groups. Both test and control groups received the following treatment: open flap mechanical debridement, supracrestal implantoplasty, bone grafting using a mixture of human allograft with demineralized bone matrix human allograft putty, and then covered with acellular dermal matrix membrane. The only difference in the test group was the adjunctive use of Er:YAG laser to modulate and remove inflammatory tissue as well as to decontaminate the implant surface. Clinical assessments, including pocket depth (PD), clinical attachment level (CAL), and gingival index (GI) were performed by calibrated masked examiners for up to 6 months following surgery. Standardized radiographs were also taken to evaluate linear bone gain and defect bone fill. Student t-tests were used to analyze those clinical parameters. RESULTS: Both groups showed significant reductions in PD, GI, and CAL gain overtime. The test group demonstrated significantly higher PD reductions at the site level compared to the control group (2.65 ± 2.14 versus 1.85 ± 1.71 mm; test versus control, P = 0.014). There were no statistical differences found in CAL gain (1.90 ± 2.28 versus 1.47 ± 1.76 mm; test versus control), GI reduction (-1.14 ± 1.15 versus -1.04 ± 0.89; test versus control), radiographic linear bone gain (1.27 ± 1.14 versus 1.08 ± 1.04 mm; test versus control) or proportional defect size reduction (- 24.46 ± 19.00% versus -15.19 ± 23.56%; test versus control). There was a positive trend for test patients on PD reduction and CAL gain found in narrow infrabony defects. Major membrane exposure negatively impaired the overall treatment outcome of CAL gain (2.47 ± 1.84 versus 1.03 ± 1.48 mm; no/minor versus major exposure, P = 0.051) and PD reduction in the test group (-3.63 ± 2.11 versus -1.66 ± 1.26 mm, P = 0.049). CONCLUSION: This pilot study indicated using laser irradiation during peri-implantitis regenerative therapy may aid in better probing PD reduction. Nonetheless, a larger sample size and longer follow-up is needed to confirm if Er:YAG laser irradiation provides additional clinical benefits for peri-implantitis regenerative therapy (Clinicaltrials.gov: NCT03127228).

Perception and Utilization of Oral Screenings and Fluoride Application in Medical Offices Following the Michigan Caries Prevention Program Training.

Purpose: The Michigan Caries Prevention Program (MCPP) aimed to reduce the burden of childhood dental disease in the state of Michigan by offering training programs to implement preventive oral health services during well-child medical visits. The purpose of this study was to elicit feedback from the participants of the MCPP and determine which oral health services were implemented post-training, identify implementation barriers and assess provider comfort levels in performing oral screenings and fluoride applications.Methods: A descriptive electronic survey was utilized for data collection. A 15-item survey consisting of multiple choice and Likert scale questions was sent to medical providers who had participated in the MCPP from 2015-2017 (n=1115). Descriptive statistics were used to analyze the data.Results: A total of 170 surveys were completed for a 15% response rate. The majority of the participants were physicians (82%, n=134). Nearly all participants reported performing oral screenings and fluoride varnish application post-training (93%, n=153). Participants felt more comfortable applying fluoride varnish than performing oral screenings (80%, n=121 vs 70%, n=112), respectively. Barriers included lack of time, understaffed, staff resistance, feeling that procedures were outside of their scope of practice and disinterest from parents or safety concerns. A majority (70%, n=112) reported that the MCPP training did not help to establish new relationships with community dental providers.Conclusion: Medical providers indicate that the MCPP training was beneficial and that they were willing and able to incorporate oral health screenings and fluoride varnish applications in their practice, but that they face challenges in developing relationships with dental care providers. Opportunities for dental hygienists to work in non-traditional medical-dental integration practice settings may help to increase oral health services offered to patients and improve communication between health care providers.

Volumetric facial contour changes of immediately placed implants with and without immediate provisionalization.

BACKGROUND: Whether immediate provisionalization can preserve facial tissue contour remains undetermined. The goal of this 12-month randomized controlled clinical trial was to compare three-dimensional (3D) ridge changes after immediate implant placement with and without immediate provisionalization. METHODS: Forty participants with an unrestorable maxillary anterior or premolar tooth were randomized to receive either a provisional crown (test) or standard healing abutment (control) after immediate implant placement. In each participant, three digital models taken before implant surgery, final crown delivery (4 months), and final follow-up (12 months) were registered to analyze linear deviation in 3D and volume changes of ridge contour at the implant site. RESULTS: The mean value of mid-facial linear 3D spatial resorption ranged from 0.1 to 0.7 mm. Significant difference of linear changes of facial contour was noted over time and not between the groups. Facial volume changes at 12 months remained significantly higher in the control group than in the test group (17.4% versus 11.9%, P = 0.04). CONCLUSIONS: Linear changes of facial soft-tissue resorption at immediately placed implants were independent of immediate provisionalization. However, immediate provisionalization showed better volume preservation at the esthetic concern area (mid-facial margin and 2 to 6 mm above) at the final 12-month follow-up.

Identification of pathogen and host-response markers correlated with periodontal disease.

BACKGROUND: Periodontitis is the major cause of tooth loss in adults and is linked to systemic illnesses, such as cardiovascular disease and stroke. The development of rapid point-of-care (POC) chairside diagnostics has the potential for the early detection of periodontal infection and progression to identify incipient disease and reduce health care costs. However, validation of effective diagnostics requires the identification and verification of biomarkers correlated with disease progression. This clinical study sought to determine the ability of putative host- and microbially derived biomarkers to identify periodontal disease status from whole saliva and plaque biofilm. METHODS: One hundred human subjects were equally recruited into a healthy/gingivitis group or a periodontitis population. Whole saliva was collected from all subjects and analyzed using antibody arrays to measure the levels of multiple proinflammatory cytokines and bone resorptive/turnover markers. RESULTS: Salivary biomarker data were correlated to comprehensive clinical, radiographic, and microbial plaque biofilm levels measured by quantitative polymerase chain reaction (qPCR) for the generation of models for periodontal disease identification. Significantly elevated levels of matrix metalloproteinase (MMP)-8 and -9 were found in subjects with advanced periodontitis with Random Forest importance scores of 7.1 and 5.1, respectively. The generation of receiver operating characteristic curves demonstrated that permutations of salivary biomarkers and pathogen biofilm values augmented the prediction of disease category. Multiple combinations of salivary biomarkers (especially MMP-8 and -9 and osteoprotegerin) combined with red-complex anaerobic periodontal pathogens (such as Porphyromonas gingivalis or Treponema denticola) provided highly accurate predictions of periodontal disease category. Elevated salivary MMP-8 and T. denticola biofilm levels displayed robust combinatorial characteristics in predicting periodontal disease severity (area under the curve = 0.88; odds ratio = 24.6; 95% confidence interval: 5.2 to 116.5). CONCLUSIONS: Using qPCR and sensitive immunoassays, we identified host- and bacterially derived biomarkers correlated with periodontal disease. This approach offers significant potential for the discovery of biomarker signatures useful in the development of rapid POC chairside diagnostics for oral and systemic diseases. Studies are ongoing to apply this approach to the longitudinal predictions of disease activity.

General Dentists' Perceptions of Dental Hygienists' Professional Role: A Survey.

Purpose: Changes in dental hygienists' scope of practice in the United States (U.S.) are not independent of general dentists' attitudes and behavior related to dental hygienists' professional roles. The purpose of this study was to assess perceptions and knowledge of general dentists concerning the legally allowable duties of dental hygienists in their state versus the services they provide in their individual practices; the importance of dental hygienists' contributions to the practice; and how well dental hygienists interact with dentists and patients. The relationships between dentists' attitudes, and dental hygienists' actual behavior, the age of the dentist and the number of dental hygienists and dental assistants employed in the practice were also explored.Methods: Survey data were collected from 292 general dentists in the state of Michigan concerning their attitudes and behavior related to dental hygienists' scope of practice.Results: The average number of services dental hygienists provided in the practices surveyed were lower than the average number of services that dental hygienists are legally permitted to provide in the state of Michigan. The higher the importance dentists placed on dental hygienists' clinical and overall contributions to their practice and their patient management skills, the more diagnostic services and therapies the dental hygienists performed. The older the dentists were, the higher they rated the importance of dental hygienists' clinical contributions, their contributions for the provision of patient care, and the more often dental hygienists performed diagnostic and additional procedures.Conclusions: While dentists did not indicate delegating all of the legally allowable dental hygiene duties in their practices, they did indicate having a very high appreciation of the contributions of dental hygienists to their practice. The perceived value of dental hygienists' contributions correlated positively with the number of diagnostic and adjunctive services dentists delegated dental hygienists to perform in their practices.

Oral fluid-based biomarkers of alveolar bone loss in periodontitis.

Periodontal disease is a bacteria-induced chronic inflammatory disease affecting the soft and hard supporting structures encompassing the teeth. When left untreated, the ultimate outcome is alveolar bone loss and exfoliation of the involved teeth. Traditional periodontal diagnostic methods include assessment of clinical parameters and radiographs. Though efficient, these conventional techniques are inherently limited in that only a historical perspective, not current appraisal, of disease status can be determined. Advances in the use of oral fluids as possible biological samples for objective measures of current disease state, treatment monitoring, and prognostic indicators have boosted saliva and other oral-based fluids to the forefront of technology. Oral fluids contain locally and systemically derived mediators of periodontal disease, including microbial, host-response, and bone-specific resorptive markers. Although most biomarkers in oral fluids represent inflammatory mediators, several specific collagen degradation and bone turnover-related molecules have emerged as possible measures of periodontal disease activity. Pyridinoline cross-linked carboxyterminal telopeptide (ICTP), for example, has been highly correlated with clinical features of the disease and decreases in response to intervention therapies, and has been shown to possess predictive properties for possible future disease activity. One foreseeable benefit of an oral fluid-based periodontal diagnostic would be identification of highly susceptible individuals prior to overt disease. Timely detection and diagnosis of disease may significantly affect the clinical management of periodontal patients by offering earlier, less invasive, and more cost-effective treatment therapies.

Dental Hygiene Students' Perceptions of Importance and Confidence in Applying Motivational Interviewing During Patient Care.

Purpose: Motivational Interviewing (MI) is an evidence-based, patient-centered counseling approach for eliciting behavior change. In 2012, the University of Michigan (U-M) Dental Hygiene Program significantly enhanced their behavior change curriculum by reinforcing and building upon the Motivational Interviewing segment. The purpose of this study was to examine students' perceptions of the importance of MI and their confidence in applying it during patient care.Methods: A convenience sample of 22 U-M Class of 2015 dental hygiene students who had received an enhanced curriculum participated in this study, utilizing a retrospective, pre-test/post-test design.Results: A Wilcoxon signed rank test was used to compare the differences in average ranks between T1 (Retrospective Pre-Test) and T4 (Post-Test 3) for the importance and confidence questions at each time point for the Class of 2015. Students' perceptions of importance increased with statistical significance in five out of eight MI strategies. Perceptions in confidence increased in seven out of eight strategies. Effect size ranged from .00 to .55. Assessment of qualitative data provided additional insight on student experiences.Conclusion: Student perceptions of importance of using MI and their confidence in applying MI increased in a majority of the strategy categories. Successes with patient health behavior change and challenges with time to integrate this in practice were noted. Research on the longitudinal impact and faculty feedback calibration is recommended.

Factors Associated with the Economic Sustainability of the Registered Dental Hygienist in Alternative Practice.

Purpose: The purpose of this study was to investigate key factors associated with the economic sustainability of the Registered Dental Hygienist in Alternative Practice (RDHAP).Methods: An invitation to participate in a 38-question electronic survey was sent via postal mail to 440 RDHAP licentiate addressees obtained through the Dental Hygiene Committee of California (DHCC). Legal restrictions did not allow for obtaining the RDHAP licentiate email addresses from the DHCC. The survey was disseminated via email to the 254 RDHAPs who were members of the California Dental Hygienists' Association. Additional invitations to participate were made via flyer distribution at an RDHAP symposium, and on RDHAP only social media sites.Results: The response rate was an estimated 16%. While 44% of the RDHAPs reported some employment in a traditional dental practice, given the opportunity, 61% of these respondents indicated that they would practice exclusively as an RDHAP. With regard to practice strategic planning and alliances, 31% felt that dentists lacked knowledge of the RDHAP, and 25% indicated dentists were resistant to this workforce model. Regarding RDHAP practice staffing patterns, 75% indicated not having any employees. When asked about business systems, 64% had solo, portable practices and 16% had standalone practices. Economic sustainability challenges included practice business/equipment expenses (29%), insurance/reimbursement issues (21%), patient flow (19%) and RDHAP visibility (14%).Conclusions: RDHAP practices face challenges including the need for strategic planning and intra- and inter-professional alliances, efficient and effective patient flow, optimal staffing patterns and effective business systems. Focus on enhancing RDHAP visibility within the dental and medical communities should be a priority. In addition, further research should explore RDHAPs aligning with community-based clinics, Federally Qualified Health Centers and Dental Support Organizations (DSOs) with a commitment to disease prevention in addition to the financial resources and staff to manage practice business systems.

Effect of Faculty Development Activities on Dental Hygiene Faculty Perceptions of and Teaching About Motivational Interviewing: A Pilot Study.

The aims of this pilot study were to assess dental hygiene faculty members' perceptions of the importance of motivational interviewing (MI) and their confidence in teaching students about MI and to determine the effect of MI training sessions on those perceptions. Participants were a convenience sample of all 16 dental hygiene faculty members who teach in the clinic at the University of Michigan School of Dentistry. Participants' perceptions were assessed prior to a workshop in MI (pretest), immediately after the workshop (posttest 1), and eight months after the workshop, at the end of the academic year (posttest 2). During the same period, some of the workshop participants took part in team grading sessions of audio recordings of student-patient MI interactions. The results showed that the majority of the faculty members perceived it was important to personally embrace the overall spirit of MI during patient care, and they were confident supporting students as well. Their ratings for embracing the spirit of MI increased from pretest to posttest 1, but slightly decreased at posttest 2. This trend was also seen in their assessment of the importance of and their confidence in teaching the eight MI strategies over time. Among the workshop participants, 56% were part of team grading; they reported the most helpful professional development activities overall were team grading (58%) and the workshop (25%). These results suggest the importance of making use of a variety of faculty development activities and of introducing appropriate follow-up to training sessions over time to ensure long-lasting effects. Future research using carefully designed, multi-institution, longitudinal studies is needed to determine the most effective ways to prepare dental hygiene faculty members to educate their students about MI.