HIV screening in the dental setting in New York State.

While primary care providers in New York State (NYS) are mandated to offer all patients a HIV test, still many NYS residents miss the HIV screening opportunity. To fill the gap, and as the CDC recommends, this study aimed to examine the feasibility of implementing HIV screening in dental setting, identify patient characteristics associated with acceptance of HIV rapid testing, and discuss best practices of HIV screening in dental setting. New York State Department of Health (NYSDOH) collaborated with the Northeast/Caribbean AIDS Education and Training Center (NECA AETC) and three dental schools in New York State to offer free HIV screening tests as a component of routine dental care between February 2016 and March 2018. Ten clinics in upstate New York and Long Island participated in the study. HIV screening was performed using the OraQuick™ In-Home HIV Test. 14,887 dental patients were offered HIV screening tests; 9,057 (60.8%) were screened; and one patient (0.011%) was confirmed HIV positive and linked to medical care. Of all dental patients, 33% had never been screened for HIV; and 56% had not had a primary care visit or had not been offered an HIV screening test by primary care providers in the previous 12 months. Multi-level generalized linear modeling analysis indicated that test acceptance was significantly associated with patient's age, race/ethnicity, gender, country of origin, primary payer (or insurance), past primary care visits, past HIV testing experiences, and the poverty level of patient's community. HIV screening is well accepted by dental patients and can be effectively integrated into routine dental care. HIV screening in the dental setting can be a good option for first-time testers, those who have not seen a primary care provider in the last 12 months, and those who have not been offered HIV screening at their last primary care visit.

Excessive postextraction bleeding associated with Cordyceps sinensis: a case report and review of select traditional medicines used by Vietnamese people living in the United States.

Many older people who have emigrated from Vietnam to the United States continue to use the traditional medicines that they used in their country of origin. Clinicians trained in the West may not be familiar with these products. We reviewed 6 Asian traditional medicines that are popular among older Vietnamese people living in the United States. Each medicine has significant side effects that can lead to complications in patients undergoing surgery. Here, we present the case of a patient who used Cordyceps sinensis daily as a tonic and experienced prolonged bleeding after dental surgery.

Populating Physician Biographical Pages Based on EMR Data.

The physicians' biographical pages are essential in providing information about physicians' specialties. However, physicians may not have biographical pages or the current pages are not comprehensive. We hypothesize that physicians' specialty information can be mined from Electronic Medical Records (EMRs) of their patients. We proposed an automated physician specialty populating (PSP) system that analyzes physician-ascertained diagnoses in EMRs, aggregates them to an appropriate granularity based on the current biographical pages, and populates the biographical pages accordingly. In this study, we applied the system using EMR data from Mayo Clinic and evaluated the system using the current biographical pages regarding various ranking strategies. Preliminary results demonstrated that using EMR data is a scalable and systematic way to populate physicians' biographical pages.

Blood pressure and blood sugar assessment by recent dental school graduates.

OBJECTIVE: Recent dental school graduates' willingness to assess blood pressure and blood sugar in practice is positively influenced by having a workplace policy fostering these assessments. Negative influences toward these assessments include practice culture issues and time management concerns. The aim of this study was to determine whether 2010-2014 graduates of the School of Dental Medicine at Buffalo, NY (UB-SDM) continue to assess blood pressure and capillary blood sugar after graduation. STUDY DESIGN: Starting in 2010, UB-SDM predoctoral students were required to assess blood pressure (BP) on all patients and capillary blood sugar (CBS) on all patients with diabetes at every clinic appointment. UB-SDM graduates from 2010-2014 were sent an anonymous survey consisting of 34 questions to determine whether these assessments continue after graduation. The survey consisted of BP and CBS assessment parameters, including benefits and barriers to assessments. RESULTS: Although UB-SDM graduates generally assessed BP (77%) and CBS (23%), most did not follow the school's strict educational policies when providing these services. Dental practice policies mandating BP and CBS assessments were positively correlated with UB-SDM graduates' actually providing these services. Lack of time and poor practice support were cited as negative factors toward BP and CBS assessments. CONCLUSIONS: Disparities between UB-SDM educational efforts and entrenched dental practice cultures must be addressed in order for our graduates to fully embrace BP and CBS assessments in practice.

Effects of Two Diode Lasers With and Without Photosensitization on Contaminated Implant Surfaces: An Ex Vivo Study.

OBJECTIVE: The aim of this ex vivo study is to assess decontamination potential of two different diode laser wavelengths, with or without the aid of photodynamic therapy, on dental implant surfaces and to evaluate the harmful potential of temperature increase during laser irradiation. MATERIALS AND METHODS: One hundred thirty-two machined sterile implants were placed into sterile porcine bone blocks with standardized coronal angular bony defects and inoculated with Streptococcus sanguinis. Four different treatment protocols were used: 810 or 980 nm laser, with or without photosensitization. Two nontreated control groups were used, one with samples coated with indocyanine green dye. Samples were rinsed and plated on agar plates for subsequent colony count. Irradiation was repeated without contamination at room temperature and in a 37°C water bath monitoring the temperature variation. RESULTS: There is a statistically significant decontamination effect when the laser is used. Both wavelengths minimize contamination. There was modest improvement given by the photosensitization being more marked in the 810 nm groups, but was not statistically significant compared to laser only. A critical temperature increase was never observed when the sample was in a 37°C water bath. CONCLUSIONS: The use of both diode laser wavelengths in implant surface decontamination was efficacious regardless of the use of photosensitization and without dangerous increase of temperature.

Thermodynamic Effects of 3 Different Diode Lasers on an Implant-Bone Interface: An Ex-Vivo Study With Review of the Literature.

The aim of this study is to assess the increase of temperature following laser irradiation with 810 nm, 980 nm, and 1064 nm diode laser wavelengths, of an implant under conditions that more closely replicate those of the human body. A 4 × 14 mm machined surface implant was placed in a porcine rib to replicate the conductivity of heat given by the bone. A peri-implant vertical defect was made that was 2 mm wide and 2 mm deep to simulate bone resorption. Two thermocouples were positioned crestally and apically on the implant surface. The tip of the laser was kept 3 mm away from the surface and continuously moved in an up-and-down and side-to-side fashion, inside the defect for 60 seconds. Initial temperatures and the time needed to reach an increase of 10°C were recorded. The experiment was repeated at room temperature and in a 37°C water bath with the following settings: 0.6 W, 0.8 W, 1 W continuous and repeated in pulsed. A critical increase of temperature of more than 10°C is reached with all lasers at 0.8 W and 1 W in continuous mode at room temperature. Only the 1064 nm diode laser reached the critical increase at 0.8 W in pulsed mode. No critical increase of temperature was registered with other settings and when the bone block was placed in a 37°C water bath. The results of this study suggest that use of these diode lasers does not cause a harmful increase in temperature when used under conditions similar to those of the human body.

Prevention of Alveolar Osteitis. A Case Report and Review of Literature.

Alveolar osteitis (aka, "dry socket") is a frustrating complication of exodontia, especially in the posterior mandible. We describe a novel technique for its possible prevention. The method involves administration of doxycycline dispersed in a local anesthetic solution, along with the use of a Gelfoam carrier. The senior author has used this technique as a routine element of care for several decades without complication.

Using Standardized Patients to Teach Interprofessional Competencies to Dental Students.

The aims of this study were to develop, implement, and evaluate a novel interprofessional standardized patient exercise (ISPE) with oral-systemic and interprofessional collaborative practice (IPCP) components. Dental students and doctor of nursing practice (DNP) students at one U.S. university participated in the simulation, which was primarily designed to test their teamwork skills. In spring 2014, DNP students worked in the dental clinics with dental students under the supervision of nursing and dental faculty members. To test the teamwork outcomes for both groups of students, a standardized patient (SP) scenario was designed to include multiple chronic medical diagnoses and an oral-systemic component. The exercise was filmed for later review. Outcomes measures included SP and student self-evaluations and faculty evaluation of student documentation. The primary outcome of interest from a dental standpoint was faculty evaluation of IPCP competencies derived from the Core Competencies of Interprofessional Collaborative Practice and were deemed to be observable by faculty when viewing the videotaped scenario. Eight teams of students participated with an SP trained in the scenario. Each team consisted of a DNP student, a fourth-year dental student, and a second-year dental student. All eligible students in the DNP class (n=20) and eight students from each dental class (approximately 110 each) participated. The results showed that the teams scored highest on the role/responsibilities subscale, indicating students were respectful of each other's roles and expertise and effectively engaged each other to develop strategies to meet the patient's needs. Scores on the three other subscales (values/ethics, interprofessional communication, and teams/teamwork) were also high. These findings appeared to support IPCP as a method to foster knowledge and respect for other roles and responsibilities, improve appreciation of teamwork, and encourage better communication among health care providers. The ISPE scenario provided an effective way to evaluate IPCP competencies.

An unusual affliction of the tongue.

A dramatic presentation of a large ulcer on the dorsal tongue of a recently hospitalized patient is presented. The lesion was found to be nosocomial in origin, and consistent with traumatic ulcerative granuloma with stromal eosinophilia (TUGSE). A review of the current pathogenic mechanisms, differential diagnosis and management of TUGSE is included.

Attitudes toward monitoring blood pressure and blood sugar at a New York State dental school.

The aim of this retrospective study was to assess dental patient, physician and dental student attitudes toward blood pressure and glycemic monitoring within a dental school environment. The responses of these cohort groups were analyzed by using an Institutional Review Board-approved survey. Physicians and dental students viewed blood pressure monitoring positively, while patients were less enthusiastic. All three groups viewed measuring blood sugar on diabetic patients prior to dental surgery as important, but not on a routine basis.

Acquired tufted angioma of upper lip: case report and review of the literature.

Acquired tufted angioma is a rare, cutaneous and slow growing benign vascular neoplasm that usually affects pediatric populations. Only six cases of oral mucosal acquired tufted angioma have been reported in the English language literature. We present in this report the seventh case and discuss its clinical and pathological features.

Treatment of severe sinus infection after sinus lift procedure: a case report.

UNLABELLED: Maxillary sinus floor augmentation may have a variety of postoperative complications including infection, sequestration of bone, and maxillary sinusitis. Complications can also occur due to a preexisting sinus condition called ostium stenosis. This case report presents a complication after sinus lift and grafting procedure due to an unrecognized ostium stenosis. CASE REPORT: A 50-year-old male patient had sinus augmentation on his right side. However, postoperatively, his symptoms were protracted. A CT scan showed thickening of the Schneiderian membrane and scattered graft material. Management included endoscopic nasal examination and ostium enlargement, antibiotic coverage, and full enucleation of the graft and diseased tissue. CONCLUSION: Patency of the sinus ostium should be carefully evaluated before sinus lift/grafting procedure using CT technology. Radiology and otolaryngology consultations may be necessary to rule out ostium stenosis before surgery.

The nature and frequency of medical emergencies among patients in a dental school setting.

As health care improves and life expectancy increases, dentists and dental students are treating a growing number of elderly and medically compromised patients, increasing the likelihood of a medical emergency during treatment. Previous studies examining emergencies in a dental setting have relied upon self-reports and are therefore subject to biases in reporting. The purpose of this study was to examine data generated from documentation of CODE-5 medical emergency events at the University at Buffalo School of Dental Medicine over an eight-and-a-half-year period. The incidence of emergencies was found to be 164 events per million patient visits, which is lower than reported in previous studies. Most emergencies involved suspected cardiovascular events, syncope, complications related to local anesthesia, and hypoglycemia. Twenty percent of emergencies involved people who were in the building for reasons other than to receive dental care, underscoring the need for an operational CODE-5 system whenever a building is occupied. We suggest strategies to reduce the incidence of medical emergencies and increase ability to manage those that do occur.

Multiple suppurative cystic lesions of the lips and buccal mucosa: a case of suppurative stomatitis glandularis.

Cheilitis glandularis (CG) is a rare inflammatory salivary gland disease that usually affects the lips. Although the etiology of CG is still unknown, it is believed to be a hereditary disease with an autosomal dominant pattern of inheritance. Three clinical presentations of CG are described in the literature: simple, superficial suppurative, and deep suppurative. A case of deep suppurative CG that extended to the buccal mucosa has been previously reported as suppurative stomatitis glandularis (SSG). Here we report a case of SSG in a 64-year-old white female with a history of bilateral renal transplants for adult polycystic kidney disease, who presented with painful swollen lips and bilateral buccal mucosal lesions. The diagnosis and management of the case is discussed. To the best of our knowledge, this is the second report of SSG, a rare condition affecting the minor salivary glands in the oral cavity.

Identification of a signaling network in lateral nucleus of amygdala important for inhibiting memory specifically related to learned fear.

We identified the Grp gene, encoding gastrin-releasing peptide, as being highly expressed both in the lateral nucleus of the amygdala, the nucleus where associations for Pavlovian learned fear are formed, and in the regions that convey fearful auditory information to the lateral nucleus. Moreover, we found that GRP receptor (GRPR) is expressed in GABAergic interneurons of the lateral nucleus. GRP excites these interneurons and increases their inhibition of principal neurons. GRPR-deficient mice showed decreased inhibition of principal neurons by the interneurons, enhanced long-term potentiation (LTP), and greater and more persistent long-term fear memory. By contrast, these mice performed normally in hippocampus-dependent Morris maze. These experiments provide genetic evidence that GRP and its neural circuitry operate as a negative feedback regulating fear and establish a causal relationship between Grpr gene expression, LTP, and amygdala-dependent memory for fear.