Sex-related differences in the distance of the mental foramen to the cementoenamel junction in adults: a study using cone beam computed tomography.

Injury to the contents of the mental foramen (MF) can be minimized by using cone beam computed tomography (CBCT) to determine the exact location of the MF prior to surgical procedures. In this retrospective study, variations in the vertical position of the MF between adult men and women older than 18 years were investigated using CBCT. The distance between the superior border of the MF and the most apical aspect of the cementoenamel junction (CEJ) of the mandibular second premolar was measured. Among the randomly accessed CBCT records of 200 patients, 176 MF-CEJ measurements met the inclusion criteria. There was a statistically significant difference (P < 0.001) between the sexes in the location of the MF. The distance in women was shorter by an average of 2.00 mm, irrespective of the side of the mandible. Additionally, a within-sex asymmetry between right and left sides was observed; the asymmetry was significantly greater in men than in women (P < 0.05). Clinicians should be cognizant of the influence of the patient's sex on the vertical position of the MF and the presence of asymmetry in the position of the MF between the right and left sides of the mandible within the sex groups.

Patient awareness of the association between periodontal and systemic diseases in an academic setting.

BACKGROUND: Periodontal diseases (PD) have been increasingly associated with several systemic conditions such as cardiovascular disease (CVD), diabetes mellitus (DM), rheumatoid arthritis (RA), and Alzheimer's disease (AD). This study aimed to gain insight into patients' awareness of the association between PD and systemic diseases. METHODS: A survey was developed to analyze patient awareness of the association between PD and systemic diseases. Descriptive and categorical variables were summarized with counts and percentages. Chi-squared tests were used to evaluate differences between variables. A linear logistical regression model was used to assess the simultaneous, independent association between each variable. RESULTS: Data from 161 completed surveys were analyzed. The majority of the participants (61.49%) reported awareness of symptoms of PD, but only 36.36% identified all its major symptoms. Individuals reporting awareness of the association between PD and systemic diseases was 48.4%, 31.7%, 14.9%, and 9.9% for CVD, DM, RA, and AD, respectively. Patients aged ≥51 years and males were more aware of the association between PD and CVD. Increased awareness of an association between PD and DM was observed among patients who had a higher frequency of dental visits and those with a self-reported history of DM. CONCLUSIONS: This study provides insight that, even with the vast amount of scientific knowledge on the inter-relationships that exist between PD and systemic diseases, most patients are still unaware of these associations. This research identified that improvement of health literacy surrounding PD, their symptoms, and their association with systemic diseases may be warranted.

The PocketPerio application significantly increases the accuracy of diagnosing periodontal conditions in didactic and chairside settings.

The study aimed to determine the accuracy of diagnosing periodontal conditions using the developed web-based PocketPerio application and evaluate the user's perspective on the use of PocketPerio. First, 22 third-year dental students (DS3) diagnosed ten cases without PocketPerio (control) and with PocketPerio (test) during a mock examination. Then, 105 DS3, 13 fourth-year dental students (DS4), and 32 senior second-year International Standing Program students (ISP2) used PocketPerio chairside. Statistical analysis was performed using a non-parametric paired two-tailed test of significance with the Wilcoxon matched-pairs signed rank test. The null hypothesis that PocketPerio did not increase the accuracy of periodontal diagnoses was rejected at α < 0.01. Periodontal diagnoses made using PocketPerio correlated with those made by periodontics faculty ("gold standard") in all cases. During the mock examination, PocketPerio significantly increased the accuracy of periodontal diagnoses compared to the control (52.73 vs. 13.18%, respectively). Chairside, PocketPerio significantly increased the accuracy of primary (100 vs. 40.0%) and secondary (100 vs. 14.25%) periodontal diagnoses compared to the respective controls. Students regardless of their training year felt more confident in diagnosing periodontal conditions using PocketPerio than their current tools, provided positive feedback on its features, and suggested avenues for its further development.

Periodontitis and cardiovascular risk factors in subjects with and without type 1 diabetes: A cross sectional analysis.

AIMS: This cross-sectional analysis explored the relationships between periodontal disease (PD) and subclinical CVD in a cohort of patients with type 1 diabetes and non-diabetic controls. METHODS: Data were collected from adults enrolled in the Coronary Artery Calcification in Type 1 Diabetes (CACTI) study or enrolled through the Barbara Davis Center for Diabetes Adult Clinic. A clinical periodontal exam measured attachment loss and probing depth. Brachial artery distensibility (brachD), carotid intima-media thickness (cIMT), and pulse wave velocity (PWV) were assessed as measures of subclinical cardiovascular structure and function. RESULTS: 144 participants with T1D and 148 non-diabetics were enrolled. Compared to non-diabetic controls, T1D participants had a higher probing depth (2.6 mm vs. 2.5 mm; p = 0.04), higher attachment loss (2.7 mm vs. 2.4 mm; p < 0.01), lower brachD (mean 5.8 vs. 6.4 mmHg; p < 0.01), a higher cIMT (mean 0.68 vs. 0.64 mm; p < 0.01), and a higher PWV (mean 8.3 vs. 7.8 m/s; p < 0.01). There were no significant associations between PD and CVD metrics. CONCLUSIONS: Periodontal and cardiovascular health was worse in participants with T1D compared to non-diabetics. No significant associations between PD measures and CVD were identified.

Oral mucosal breaks trigger anti-citrullinated bacterial and human protein antibody responses in rheumatoid arthritis.

Periodontal disease is more common in individuals with rheumatoid arthritis (RA) who have detectable anti-citrullinated protein antibodies (ACPAs), implicating oral mucosal inflammation in RA pathogenesis. Here, we performed paired analysis of human and bacterial transcriptomics in longitudinal blood samples from RA patients. We found that patients with RA and periodontal disease experienced repeated oral bacteremias associated with transcriptional signatures of ISG15+HLADRhi and CD48highS100A2pos monocytes, recently identified in inflamed RA synovia and blood of those with RA flares. The oral bacteria observed transiently in blood were broadly citrullinated in the mouth, and their in situ citrullinated epitopes were targeted by extensively somatically hypermutated ACPAs encoded by RA blood plasmablasts. Together, these results suggest that (i) periodontal disease results in repeated breaches of the oral mucosa that release citrullinated oral bacteria into circulation, which (ii) activate inflammatory monocyte subsets that are observed in inflamed RA synovia and blood of RA patients with flares and (iii) activate ACPA B cells, thereby promoting affinity maturation and epitope spreading to citrullinated human antigens.

The Surgical Anatomy of the Greater Palatine Artery: A Human Cadaver Study.

Identifying the accurate location of the greater palatine artery (GPA) can be challenging. The purpose of the present cadaver study was to determine the location of the GPA from the cementoenamel junction (CEJ) of the maxillary canine to second molar teeth and to define its relationship with the palatal vault height (PVH) in Caucasian cadavers. Sixty-six sections from fully or partially dentate cadavers were examined. The location of the GPA from the CEJ ranged from a minimum of 8.7 ± 2.1 mm at the canine to 14.5 ± 1.3 mm at the second molar. The minimum distance of the GPA to the CEJ in different PVH ranged from 6 to 12 mm. There was a significant difference between male and female cadavers regarding shallow PVH. Only the PVH as an independent variable had a significant correlation with the GPA location. The present study is the first to identify the different PVHs with customized stents and to correlate them with the distance of the GPA to the CEJ of maxillary teeth.

Opioid abuse/dependence among those hospitalized due to periapical abscess.

AIM: Opioid abuse/dependence (OAD) is an emerging public health crisis in the USA. The aim of the present study was to estimate the nationwide prevalence of OAD in those hospitalized due to periapical abscess in the USA. METHODS: The Nationwide Inpatient Sample for 2012-2014 was used. All patients who were hospitalized due to periapical abscess were selected for analysis. In this cohort, OAD was identified and used as the outcome variable. A mix of patient and geographic factors were used as independent variables. The simultaneous association between outcome and independent variables was examined by a multivariable logistic regression model. Clustering of outcomes within hospitals was adjusted. Odds of OAD were computed for all independent variables. RESULTS: During the study period, 30 040 patients were hospitalized due to periapical abscess; 1.5% of these had OAD. Those aged 18-29 years (odds ratio [OR] = 3.69, 95% confidence interval [CI] = 1.76-7.72, P < 0.01) and 30-44 years (OR = 3.19, 95% CI = 1.77-5.76, P < 0.01) were associated with higher odds for OAD compared to those aged 45-64 years. Blacks were associated with lower odds for OAD compared to whites (OR = 0.52, 95% CI = 0.28-0.95, P = 0.03). Those covered by Medicare (OR = 4.08, 95% CI = 1.458-11.44, P = 0.01), Medicaid (OR = 5.86, 95% CI = 2.22-15.47, P < 0.01), and those who were uninsured (OR = 3.68, 95% CI = 1.30-10.45, P = 0.01) were associated with higher odds for OAD compared to those covered by private insurance. The odds of OAD increased with comorbid burden (OR = 1.66, 95% CI = 1.50-1.84, P < 0.01). CONCLUSIONS: High-risk groups that are likely to have OAD were identified among those hospitalized due to periapical abscess.

Dental Students' Reflections on Quality of Periodontal Care in Dental School Clinics.

The aim of this study was to analyze dental students' descriptions of and reflections on the periodontal care they provided for their patients in dental school clinics. All students enrolled in the final year of the DDS program in 2011-14 at the University of Colorado School of Dental Medicine were required to complete a self-assessment of the periodontal care they provided for patients. Assessments from 263 students were compiled and qualitatively analyzed. The key reasons given for not providing good care were identified and then stratified as student/school-dependent or patient-dependent factors. Among these students, 63.1% reported that the periodontal care they provided for their patients was inadequate. Some of the student/school-dependent factors were multiple providers involved in patient care (22.8%), student oversight (21.3%), licensure and academic requirements (20.9%), limited clinic operator sessions (19.4%), clinical rotations to other sites (18.3%), and students' interest in/emphasis on other areas of dentistry (17.9%). Some of the patient-dependent factors were patient scheduling compliance (61.6%), patient finances (46.4%), medical status (20.5%), urgent dental needs (18.3%), emphasis only on restorative care (17.5%), periodontal care awareness (16.4%), and patients' oral hygiene compliance (11.5%). This analysis of students' attitudes, challenges they faced, and patient-related factors that influenced the delivery of periodontal care helped to facilitate changes in the curriculum and school policies to optimize clinical instruction and patient care in periodontics.

Stimulation of periodontal ligament stem cells by dentin matrix protein 1 activates mitogen-activated protein kinase and osteoblast differentiation.

BACKGROUND: Periodontitis can ultimately result in tooth loss. Many natural and synthetic materials have been tried to achieve periodontal regeneration, but the results remain variable and unpredictable. We hypothesized that exogenous treatment with dentin matrix protein 1 (DMP1) activates specific genes and results in phenotypic and functional changes in human periodontal ligament stem cells (hPDLSCs). METHODS: hPDLSCs were isolated from extracted teeth and cultured in the presence or absence of DMP1. Quantitative polymerase chain reactions were performed to analyze the expression of several genes involved in periodontal regeneration. hPDLSCs were also processed for immunocytochemical and Western blot analysis using phosphorylated extracellular signal-regulated kinase (pERK) and ERK antibodies. Alkaline phosphatase and von Kossa staining were performed to characterize the differentiation of hPDLSCs into osteoblasts. Field emission scanning electron microscopic analysis of the treated and control cell cultures were also performed. RESULTS: Treatment with DMP1 resulted in the upregulation of genes, such as matrix metalloproteinase-2, alkaline phosphatase, and transforming growth factor ß1. Activation of ERK mitogen-activated protein kinase signaling pathway and translocation of pERK from the cytoplasm to the nucleus was observed. Overall, DMP1-treated cells showed increased expression of alkaline phosphatase, increased matrix, and mineralized nodule formation when compared with untreated controls. CONCLUSION: DMP1 can orchestrate a coordinated expression of genes and phenotypic changes in hPDLSCs by activation of the ERK signaling pathway, which may provide a valuable strategy for tissue engineering approaches in periodontal regeneration.