Effect of being overweight and obese on periodontal treatment costs.

BACKGROUND: Obesity can increase a person's risk of developing periodontal disease, and patients with obesity have greater health care costs. However, the effect of obesity on periodontal treatment costs has not been examined. METHODS: This retrospective cohort study used data from the electronic dental records of adult patients examined from July 1, 2010, through July 31, 2019 at a US dental school. Primary exposure was body mass index, which was categorized as obese, overweight, or normal. Periodontal disease was categorized using clinical probing measures. Fee schedules and procedure codes were used to compute the primary outcome, which was total periodontal treatment costs. A generalized linear model with gamma distribution was used to examine the relationship between body mass index and periodontal costs after controlling for initial periodontal disease severity and other confounding variables. Parameter coefficients and mean ratios with 95% CIs were estimated. RESULTS: The study sample included 3,443 adults, of whom 39% were normal weight, 37% were overweight, and 24% were obese. Mean (SD) total periodontal treatment costs for patients who were obese were considerably higher ($420 [$719]) than those for patients who were overweight ($402 [$761]) and patients who were normal weight ($268 [$601]). After controlling for covariates and disease severity, patients who were obese had 27% higher periodontal treatment costs than patients who were normal weight. The additional periodontal treatment costs attributable to obesity were greater than those attributable to either diabetes or smoking. CONCLUSIONS: The study results suggest that among patients at a dental school, those who were obese incurred substantially higher periodontal treatment costs than patients who were normal weight, independent of initial periodontal disease severity. PRACTICAL IMPLICATIONS: The study findings have important implications for clinical guidelines and dental benefit design and coverage policies.

Response to commentary: See Original Article here.

This letter is a response to commentary by Dr. Smith on 'Examining the association between cancer history in early life and dental care utilization'. We provided additional information and clarification regarding our analysis and results in response to Dr. Smith's questions and comments. Despite the limitations and weaknesses of our study, we still believe that it provides important information and further research questions.

The association of sedentary behaviour and physical activity with periodontal disease in NHANES 2011-2012.

AIM: Periodontal disease is one of the most prevalent oral pathologies and a major chronic disease worldwide. Lifestyle habits such as poor nutrition and smoking have been established to contribute to the development of periodontal disease, but limited research has investigated whether physical activity and sedentary lifestyle play a role. The purpose of this study is to evaluate the association between physical activity, sedentary behaviour, and periodontal disease. MATERIALS AND METHODS: We used a nationally representative data set from the National Health and Nutrition Examination Survey (NHANES) 2011-2012. We examined the association between physical activity and sedentary behaviour and periodontal disease using multivariable logistic regression models and reported odds ratios (ORs). RESULTS: Individuals with higher total physical activity, higher leisure time physical activity, and lower amount of total sedentary behaviour had lower periodontal disease prevalence. Adjusted multivariable regression models showed that higher sedentary behaviour (more than 7.5 h/day) was associated with higher odds of periodontal disease (OR = 1.17; 95% confidence interval = 1.00-1.36; p = .045). CONCLUSIONS: The findings showed that higher sedentary behaviour is associated with higher odds of periodontal disease. Future prospective longitudinal studies and strategies are needed to investigate implications further and define the magnitude of the association between physical activity and periodontal disease.

Examining the association between cancer history in early life and dental care utilization.

OBJECTIVES: This study aims to examine associations between cancer history in early life (diagnosed at 20 years of age or younger) and utilization of dental care. METHODS: We analysed data of 10,185 participants, aged ≥20 years, from the National Health and Nutrition Examination Survey cycles 2015-2018. The main predictor was self-reported past history of any type of cancer diagnosed at 20 years of age or younger (yes/no). The outcome variables were having a dental visit within the past year, treatment or preventative visit, urgent need for care, and unmet dental need. Covariates included gender, age, race, marital status, education, and income. Bivariate and multiple logistic regression were conducted, accounting for the complex sampling design. RESULTS: There was no difference between early life cancer survivors in regards to dental visit within the past year (OR: 0.7; 95% CI: 0.3-1.6), visit for dental treatment (OR: 0.6; 95% CI: 0.3-1.6), urgent need for care (OR: 0.8; 95% CI: 0.3-2.0), or unmet dental need (OR: 0.6; 95% CI: 0.2-1.6) compared to cancer-free participants. CONCLUSIONS: Cancer history in early life doesn't impact dental care visits, type of last dental visit, dental care recommendation, or unmet dental need. Future cohort studies are needed to confirm this association.

The Healthy Eating Index and coronal dental caries in US adults: National Health and Nutrition Examination Survey 2011-2014.

BACKGROUND: The purpose of this cross-sectional study was to determine if Healthy Eating Index (HEI-2015) scores are associated with coronal caries and the odds of untreated coronal caries in adults 20 years and older. METHODS: Data on decayed, missing, and filled teeth (DMFT), untreated coronal caries, and HEI-2015 scores were obtained from 7,751 adults who completed a dental examination and two 24-hour dietary recalls in National Health and Nutrition Examination Survey cycles 2011-2012 and 2013-2014. HEI-2015 scores were categorized into quintiles, with HEI-2015 quintile 1 scores indicating the least compliance with 2015-2020 Dietary Guidelines for Americans. The authors used multivariable linear regression to assess associations of HEI-2015 with DMFT and logistic regression for associations with untreated coronal caries. All regression models were controlled for age, sex, race or ethnicity, current cigarette use, family income to poverty threshold ratio, last dental visit, education, and whether participants were ever told they had a heart attack. RESULTS: Relative to HEI-2015 quintile 1, the adjusted odds of any untreated coronal caries were quintile 5 (odds ratio [OR], 0.61; 95% confidence interval [CI], 0.46 to 0.80), quintile 4 (OR, 0.66; 95% CI, 0.53 to 0.84), quintile 3 (OR, 0.76; 95% CI, 0.56 to 1.04), and quintile 2 (OR, 0.93; 95% CI, 0.66 to 1.31). Participants who met the recommendations for the total fruits, whole fruits, greens and beans, and added sugars components of the HEI-2015 score were less likely to have untreated coronal caries than those who did not meet the recommendations. Overall, mean coronal DMFT also decreased as HEI-2015 scores increased, but trends were not consistent in all racial or ethnic groups. CONCLUSIONS AND PRACTICAL IMPLICATIONS: Greater compliance with the Dietary Guidelines for Americans is associated with lower prevalence and the odds of untreated caries in adults. Dietary counseling for caries prevention by dental professionals should incorporate comprehensive dietary guidelines that are consistent with those intended for enhancing overall health and reducing the risk of developing common systemic diseases.

Marginal analysis of ordinal clustered longitudinal data with informative cluster size.

The issue of informative cluster size (ICS) often arises in the analysis of dental data. ICS describes a situation where the outcome of interest is related to cluster size. Much of the work on modeling marginal inference in longitudinal studies with potential ICS has focused on continuous outcomes. However, periodontal disease outcomes, including clinical attachment loss, are often assessed using ordinal scoring systems. In addition, participants may lose teeth over the course of the study due to advancing disease status. Here we develop longitudinal cluster-weighted generalized estimating equations (CWGEE) to model the association of ordinal clustered longitudinal outcomes with participant-level health-related covariates, including metabolic syndrome and smoking status, and potentially decreasing cluster size due to tooth-loss, by fitting a proportional odds logistic regression model. The within-teeth correlation coefficient over time is estimated using the two-stage quasi-least squares method. The motivation for our work stems from the Department of Veterans Affairs Dental Longitudinal Study in which participants regularly received general and oral health examinations. In an extensive simulation study, we compare results obtained from CWGEE with various working correlation structures to those obtained from conventional GEE which does not account for ICS. Our proposed method yields results with very low bias and excellent coverage probability in contrast to a conventional generalized estimating equations approach.

Influence of Obesity on Periodontitis Progression Is Conditional on Interleukin-1 Inflammatory Genetic Variation.

BACKGROUND: This study evaluates whether specific patterns of interleukin (IL)-1 gene variants, known to affect periodontitis severity, influence the previously reported association between obesity and subsequent periodontitis progression in a longitudinal database. The study population included 292 men (aged 29 to 64 years at entry) from the Veterans Affairs Dental Longitudinal Study from whom DNA and dental and anthropometric endpoints were collected during multiple examinations (approximately every 3 years for up to 27 years). METHODS: Key variables assessed included: 1) periodontitis; 2) body mass index; 3) waist circumference to height (WHTR) ratio for central adiposity; 4) age; 5) smoking; 6) glucose tolerance; and 7) two previously reported versions of IL-1 genetic patterns associated with periodontitis severity and progression. Disease progression was determined using predefined criteria that used a combination of change in classification of disease severity based on alveolar bone loss and tooth loss during follow-up. Extended Cox regression analyses were used to estimate hazards of experiencing periodontal disease progression with or without adjustments for appropriate covariates. RESULTS: In hazard ratio analyses, men with WHTR >50% at baseline and positive for either IL-1 genotype version were at significantly higher risk (two-fold) for disease progression (P for interaction = 0.04). Participants positive for IL-1 genotype version 2 exhibited earlier progression (fewer years from baseline to first incidence of progression) than those who were negative (P = 0.02, adjusted for age and smoking). CONCLUSION: In this longitudinally monitored male population, observed effect of baseline central adiposity on future periodontitis progression is conditional on proinflammatory IL-1 genetic variations.

The Dietary Approaches to Stop Hypertension Diet and New and Recurrent Root Caries Events in Men.

OBJECTIVES: To examine the effect of overall dietary quality on number of teeth with new or recurrent root caries events during follow-up (root caries increment). DESIGN: Prospective study with dental examinations approximately every 3 years over 20 years. SETTING: Veterans Affairs Dental Longitudinal Study in greater Boston, Massachusetts, area. PARTICIPANTS: Men aged 47 to 90 (N = 533). MEASUREMENTS: A single calibrated examiner assessed root caries and restorations, calculus, probing pocket depth, and attachment loss on each tooth at each examination. The adjusted root caries increment (root-ADJCI) was computed from new and recurrent root caries events on teeth with recession of 2 mm or more. Dietary information was obtained from food frequency questionnaires. An adherence score was computed by comparing consumption frequency of 10 food groups (fruits, vegetables, total dairy, low-fat dairy, meat, total grains, high-fiber grains, legumes, fats, sweets) from the Dietary Approaches to Stop Hypertension (DASH) diet guidelines. Mean root-ADJCIs were compared according to DASH adherence score quartile using generalized linear negative binomial regression models, controlling for age, number of teeth at risk of root caries, time at risk of root caries, calculus, presence of removable denture, history of dental prophylaxis, body mass index, and smoking status. RESULTS: Men with DASH adherence scores in the highest quartile had a 30% lower mean root-ADJCI (1.86 teeth) than those in the lowest quartile (2.68 teeth) (P = .03). Root-ADJCI was lower with greater adherence to recommendations for vegetables and total grains and greater with greater sugar-sweetened carbonated beverage consumption. Root caries incidence rate did not vary significantly between quartiles. CONCLUSION: A higher-quality diet may reduce root caries risk in older men.

Coffee consumption and periodontal disease in males.

BACKGROUND: Coffee is a major dietary source of antioxidants as well as of other anti-inflammatory factors. Given the beneficial role of such factors in periodontal disease, whether coffee intake is associated with periodontal disease in adult males was explored. METHODS: Existing data collected by a prospective, closed-panel cohort study of aging and oral health in adult males was used. Participants included the 1,152 dentate males in the Veterans Affairs (VA) Dental Longitudinal Study who presented for comprehensive medical and dental examinations from 1968 to 1998. Mean age at baseline was 48 years; males were followed for up to 30 years. Participants are not VA patients; rather, they receive their medical and dental care in the private sector. Periodontal status was assessed by probing depth (PD), bleeding on probing, and radiographic alveolar bone loss (ABL), measured on intraoral periapical radiographs with a modified Schei ruler method. Moderate-to-severe periodontal disease was defined as cumulative numbers of teeth exhibiting PD ≥4 mm or ABL ≥40%. Coffee intake was obtained from participant self-reports using the Cornell Medical Index and food frequency questionnaires. Multivariate repeated-measures generalized linear models estimated mean number of teeth with moderate-to-severe disease at each examination by coffee intake level. RESULTS: It was found that higher coffee consumption was associated with a small but significant reduction in number of teeth with periodontal bone loss. No evidence was found that coffee consumption was harmful to periodontal health. CONCLUSION: Coffee consumption may be protective against periodontal bone loss in adult males.

High-fiber foods reduce periodontal disease progression in men aged 65 and older: the Veterans Affairs normative aging study/Dental Longitudinal Study.

OBJECTIVES: To determine whether foods that are good to excellent sources of fiber reduce periodontal disease progression in men. DESIGN: Prospective, observational study. SETTING: Greater Boston, Massachusetts, metropolitan area. PARTICIPANTS: Six hundred twenty-five community-dwelling men participating in the Department of Veterans Affairs Dental Longitudinal Study. MEASUREMENTS: Dental and physical examinations were conducted every 3 to 5 years. Diet was assessed using food frequency questionnaires (FFQs). Mean follow-up was 15 years (range: 2-24 years). Periodontal disease progression on each tooth was defined as alveolar bone loss (ABL) advancement of 40% or more, probing pocket depth (PPD) of 2 mm or more, or tooth loss. Good and excellent fiber sources provided 2.5 g or more of fiber per serving. Multivariate proportional hazards regression estimated hazard ratios (HRs) and 95% confidence intervals (CIs) of periodontal disease progression and tooth loss in relation to fiber sources, stratified according to age younger than 65 versus 65 and older, and controlled for smoking, body mass index, calculus, baseline periodontal disease level, caries, education, exercise, carotene, thiamin and caffeine intake, and tooth brushing. RESULTS: In men aged 65 and older, each serving of good to excellent sources of total fiber was associated with lower risk of ABL progression (HR = 0.76, 95% CI = 0.60-0.95) and tooth loss (HR = 0.72, 95% CI = 0.53-0.97). Of the different food groups, only fruits that were good to excellent sources of fiber were associated with lower risk of progression of ABL (HR = 0.86 per serving, 95% CI = 0.78-0.95), PPD (HR = 0.95, 95% CI = 0.91-0.99), and tooth loss (HR = 0.88, 95% CI = 0.78-0.99). No significant associations were seen in men younger than 65. CONCLUSION: Benefits of higher intake of high-fiber foods, especially fruits, on slowing periodontal disease progression are most evident in men aged 65 and older.

Does double-row rotator cuff repair improve functional outcome of patients compared with single-row technique? A systematic review.

BACKGROUND: The advantage of single-row versus double-row arthroscopic rotator cuff repair techniques has been a controversial issue in sports medicine and shoulder surgery. There is biomechanical evidence that double-row techniques are superior to single-row techniques; however, there is no clinical evidence that the double-row technique provides an improved functional outcome. HYPOTHESIS: When compared with single-row rotator cuff repair, double-row fixation, although biomechanically superior, has no clinical benefit with respect to retear rate or improved functional outcome. STUDY DESIGN: Systematic review. METHODS: The authors reviewed prospective studies of level I or II clinical evidence that compared the efficacy of single- and double-row rotator cuff repairs. Functional outcome scores included the American Shoulder and Elbow Surgeons (ASES) shoulder scale, the Constant shoulder score, and the University of California, Los Angeles (UCLA) shoulder rating scale. Radiographic failures and complications were also analyzed. A test of heterogeneity for patient demographics was also performed to determine if there were differences in the patient profiles across the included studies. RESULTS: Seven studies fulfilled our inclusion criteria. The test of heterogeneity across these studies showed no differences. The functional ASES, Constant, and UCLA outcome scores revealed no difference between single- and double-row rotator cuff repairs. The total retear rate, which included both complete and partial retears, was 43.1% for the single-row repair and 27.2% for the double-row repair (P = .057), representing a trend toward higher failures in the single-row group. CONCLUSION: Through a comprehensive literature search and meta-analysis of current arthroscopic rotator cuff repairs, we found that the single-row repairs did not differ from the double-row repairs in functional outcome scores. The double-row repairs revealed a trend toward a lower radiographic proven retear rate, although the data did not reach statistical significance. There may be a concerning trend toward higher retear rates in patients undergoing a single-row repair, but further studies are required.

Overweight and obesity predict time to periodontal disease progression in men.

AIMS: To examine whether overweight and obesity indicators - body mass index (BMI), waist circumference (WC), and WC-to-height ratio - predict progression of periodontal disease in men. MATERIAL AND METHODS: Participants were 1038 medically healthy, non-Hispanic, white males in the VA Dental Longitudinal Study who were monitored with triennial oral and medical examinations between 1969 and 1996. Periodontal disease progression in an individual was defined as having two or more teeth advance to levels of alveolar bone loss ≥40%, probing pocket depth ≥5 mm, or clinical attachment loss ≥5 mm after baseline. Extended Cox regression analyses estimated hazards of experiencing periodontal disease progression events due to overweight/obesity status, controlling for age, smoking, education, diabetes, recent periodontal treatment, recent prophylaxis, and number of filled/decayed surfaces. RESULTS: Body mass index and WC-to-height ratio were significantly associated with hazards of experiencing periodontal disease progression events regardless of periodontal disease indicator. Adjusted hazard ratios for periodontal disease progression were 41-72% higher in obese men (BMI ≥30 kg/m(2)) relative to men with both normal weight and WC-to-height ratio (≤50%). CONCLUSION: Both overall obesity and central adiposity are associated with an increased hazards of periodontal disease progression events in men.

Association of endodontic involvement with tooth loss in the Veterans Affairs Dental Longitudinal Study.

INTRODUCTION: The effect of endodontic involvement on tooth loss has not been quantified, so the present study aimed to assess this relationship after controlling for other relevant risk factors for tooth loss. METHODS: We analyzed data from 791 participants (18,798 teeth) in the Veterans Affairs Dental Longitudinal Study. Potential tooth-level and person-level covariates were fitted into marginal proportional hazards models, including both apical radiolucencies (AR) and root canal therapy (RCT) status as time-dependent variables. Survival curves were plotted for teeth according to their AR and RCT status. RESULTS: Both current AR and RCT status were associated with increased risk of tooth loss (P < .01), after controlling for baseline levels of periodontal disease, caries, tooth type, number of proximal contacts, number of teeth, age, education, and smoking history. Root canal filled (RCF) teeth seemed to have better survival than non-RCF teeth among teeth with AR but worse survival than non-RCF teeth among teeth without AR. CONCLUSIONS: Endodontic involvement was associated with tooth loss, controlling for other potential risk factors. Additional prospective studies are needed to provide better evidence as to the impact of endodontic involvement on tooth loss.

Does the graft source really matter in the outcome of patients undergoing anterior cruciate ligament reconstruction? An evaluation of autograft versus allograft reconstruction results: a systematic review.

BACKGROUND: Despite the large number of anterior cruciate ligament reconstructions performed each year, there remains a significant controversy regarding the effect of the graft source on the functional outcome of patients. HYPOTHESIS: There is no difference in outcomes of autograft versus allograft anterior cruciate ligament reconstructions. STUDY DESIGN: Systematic review. METHODS: The authors systematically identified prospective studies (Oxford level of evidence I or II only) that included autograft patients, allograft patients, or both. Objective outcomes that were reported were meta-analyzed; this included pivot-shift results, KT-1000 arthrometer results, International Knee Documentation Committee (IKDC) scores, Lysholm Scores, graft failures, and postoperative complications. Two statistical analyses were performed. First a primary statistical analysis was performed comparing pooled autograft data (bone-patellar-tendon bone and hamstrings combined) and pooled allograft data (bone-patellar-tendon bone and hamstrings combined). To have a more comprehensive understanding of the differences between each specific graft source, a secondary analysis was performed without pooling the data; this directly compared the 4 types of graft sources that were studied. RESULTS: Over 400 scientific manuscripts were initially reviewed; 31 manuscripts fulfilled all of the search criteria. There were very few statistically significant differences between autograft and allograft tissue. The KT-1000 arthrometer laxity testing revealed a mean of 1.4 +/- 0.2 mm (weighted mean +/- standard error of the mean) for the allograft group compared with 1.8 +/- 0.1 mm for the autograft group (t = 2.40; P <.02). However, this difference was only for the mean score; there was no statistical significance when considering KT-1000 arthrometer measurements of greater than 3 or 5 mm. The percentage of patients receiving a final IKDC score of "A" (normal knee) was statistically significant for allograft tissue (43.9% +/- 5.5%) versus autograft tissue (28.2% +/- 1.0%) reconstructions. There was no statistically significant difference between the percentages of IKDC scores of A or B for patients receiving pooled allograft (82.9% +/- 4.2%) versus pooled autograft (87.2% +/- 0.9%) anterior cruciate ligament reconstruction (t = 1.01; P > .1). The graft failure rate was 4.7 +/- 0.5 per 100 for autograft reconstructions and 8.2 +/- 2.1 per 100 allograft reconstructions; although this may represent a trend, it is not statistically significant (t = 1.49; P > .1). The complication rate was slightly higher for autograft reconstructions at 3.5 +/- 0.4 complications per 100 autograft reconstructions compared with 2.4 +/- 1.1 complications per 100 allograft reconstructions, but not significant (t = 1.41; P > .1). CONCLUSION: After a comprehensive examination and statistical analysis of the modern literature, the authors could not identify an individual graft source that was clearly superior to the other graft sources. This led them to believe that, with currently available data, the graft source has a minimal effect on the outcome of patients undergoing anterior cruciate ligament reconstruction.

Arthroscopic versus open acromioplasty: a meta-analysis.

BACKGROUND: To address persisting controversy in the literature concerning the efficacy of arthroscopic compared to open acromioplasty, a meta-analysis was performed to evaluate the treatment effect after both approaches. HYPOTHESIS: The final clinical outcomes will be the same after both open and arthroscopic acromioplasty. However, the arthroscopic technique results in faster recovery and less postoperative morbidity as reflected by faster return to work and decreased hospital stays. STUDY DESIGN: Meta-analysis; Level of evidence, 3. METHODS: We performed our search of published English language literature using PubMed. We also searched the proceedings from 4 major orthopaedic meetings convened from 2000 to 2007. Furthermore, the reference sections of all relevant articles were reviewed for pertinent studies and presentations. Nine studies met the inclusion criteria that directly compared arthroscopic versus open acromioplasty with minimum follow-up of 1 year. The analysis focused on 1-year clinical outcome and included comparison of the objective 100-point score, hospital stay, time until return to work, operative time, and complications. RESULTS: No significant differences were found in clinical outcomes or complications for the 2 groups. However, open acromioplasty was associated with longer hospital stays (2.3 days, P = .05) and a greater length in time until return to work (65.1 days) compared with the arthroscopic technique (48.6 days) (P < .05). CONCLUSION: Arthroscopic and open acromioplasty have equivalent ultimate clinical outcomes, operative times, and low complication rates. However, arthroscopic acromioplasty results in faster return to work and fewer hospital inpatient days compared with the open technique.

Intakes of (n-3) fatty acids and fatty fish are not associated with cognitive performance and 6-year cognitive change in men participating in the Veterans Affairs Normative Aging Study.

High intake of fish and (n-3) PUFA may protect against age-related cognitive decline. However, results are inconsistent and limited data exist regarding changes in multiple cognitive functions over a longer period of time. In this study, we assessed the association between fatty fish intake as well as (n-3) PUFA intake with cognitive performance and cognitive change over 6 y in 1025 elderly men. Participants were from the Veterans Affairs Normative Aging Study. Cognitive function was assessed with a battery of cognitive tests focusing on factors representing memory/language, speed, and visuospatial/attention. Dietary intakes were assessed with a validated FFQ. We used general linear models to assess cross-sectional associations and mixed models to assess the associations over time. Models were adjusted for age, education, BMI, smoking, diabetes, and intake of alcohol, saturated fat, vitamin C, and vitamin E. The mean age of participating men was 68 y at baseline. Median fish consumption ranged from 0.2 to 4.2 servings/wk across quartiles. Cross-sectional analyses showed no association between fatty fish or (n-3) PUFA intake and cognitive performance. Longitudinal analyses, over 6 y of follow-up, also did not show any significant associations between fatty fish or (n-3) PUFA intake and cognitive change. In this population of elderly men, intake of neither fatty fish nor (n-3) PUFA was associated with cognitive performance.

Arthroscopic versus mini-open rotator cuff repair: a comprehensive review and meta-analysis.

BACKGROUND: Controversy remains regarding the results of all arthroscopic rotator cuff repairs compared with the mini-open approach. The purpose of this study was to perform a comprehensive literature search and meta-analysis of clinical trials comparing the results of arthroscopic rotator cuff repairs and mini-open rotator cuff repairs. HYPOTHESIS: There is no difference between the clinical results obtained from all arthroscopic rotator cuff repairs compared with mini-open repairs. STUDY DESIGN: Meta-analysis. METHODS: A computerized search of articles published between 1966 and July 2006 was performed using MEDLINE and PubMed. Additionally, a search of abstracts from 4 major annual meetings each held between 2000 and 2005 was performed to identify Level I to III studies comparing the results of arthroscopic rotator cuff repair and mini-open repair. Studies that included follow-up of an average of over 2 years and a minimum of 1 year and included the use of 1 of 4 validated functional outcome scores used to study shoulder injuries were included in the present meta-analysis. All outcome scores were converted to a 100-point scale to allow for outcome comparison. RESULTS: Five studies that met the inclusion criteria were identified. There was no difference in functional outcome scores or complications between the arthroscopic and mini-open repair groups. CONCLUSION: Based on current literature, there was no difference in outcomes between the arthroscopic and mini-open rotator cuff repair techniques.

Age-dependent associations between chronic periodontitis/edentulism and risk of coronary heart disease.

BACKGROUND: Several epidemiological studies have suggested periodontitis as a risk factor for coronary heart disease (CHD), but results have been inconsistent. METHODS AND RESULTS: We evaluated the association between clinical and radiographic measures of periodontitis, edentulism, and incident CHD (angina, myocardial infarction, or fatal CHD) among 1203 men in the VA Normative Aging and Dental Longitudinal Studies who were followed up with triennial comprehensive medical and dental examinations up to 35 years (median 24 years). Cox proportional hazards models with time-varying effects of exposure and potential confounders were fit. We found a significant dose-dependent association between periodontitis and CHD incidence among men < 60 years of age (hazard ratio 2.12, 95% confidence interval 1.26 to 3.60 comparing highest versus lowest category of radiographic bone loss, P for trend=0.02), independent of age, body mass index, smoking, alcohol intake, diabetes mellitus, fasting glucose, total cholesterol, high-density lipoprotein cholesterol, triglycerides, hypertension, systolic and diastolic blood pressure, education, marital status, income, and occupation. No association was found among men > 60 years of age. Similar results were found when the sum of probing pocket depths was used as a measure of periodontitis. Among men > or = 60 years of age, edentulous men tended to have a higher risk of CHD than dentate men in the lowest bone loss (hazard ratio 1.61, 95% confidence interval 0.95 to 2.73) and lowest pocket depth (hazard ratio 1.72, 95% confidence interval 1.03 to 2.85) categories, independent of confounders. CONCLUSIONS: Chronic periodontitis is associated with incidence of CHD among younger men, independent of established cardiovascular risk factors.