Postmenopausal women with HIV have increased tooth loss.

BACKGROUND: With effective antiretroviral therapy, people with HIV (PWH) are living longer and aging; the majority of PWH in the United States are now over the age of 50 and in women have gone through the menopause transition. Menopause potentiates skeletal bone loss at the spine, hip, and radius in PWH. The alveolar bone which surronds the teeth is different than long bones because it is derived from the neural crest. However, few studies have assessed the oral health and alveolar bone in middle aged and older women with HIV. Therefore, the objective of this study was to evaluate periodontal disease and alveolar bone microarchitecture in postmenopausal women with HIV. METHODS: 135 self-reported postmenopausal women were recruited (59 HIV-, 76 HIV + on combination antiretroviral therapy with virological suppression) from a single academic center. The following parameters were measured: cytokine levels (IFN-γ, TNF-α, IL-1ß, IL-2, IL-5, IL-6, IL-7, IL-8, IL-10, IL-12p70, IL-13, IL-17 A, OPG, and RANKL) in gingival crevicular fluid, bleeding on probing, probing depth, clinical attachment loss, number of teeth present, alveolar crestal height, and alveolar bone microarchitecture. RESULTS: The mean age of participants was 57.04+/-6.25 years and a greater proportion of women with HIV were black/African American (HIV + 68.42%, HIV- 23.73%; p < 0.001). There was no significant difference in bleeding on probing (p = 0.17) and attachment loss (p = 0.39) between women who were HIV infected vs. HIV uninfected. Women with HIV had significantly higher RANKL expression in Gingival Crevicular Fluid (HIV + 3.80+/-3.19 pg/ul, HIV- 1.29+/-2.14 pg/ul ; p < 0.001), fewer teeth present (HIV + 17.75+/-7.62, HIV- 22.79+/-5.70; p < 0.001), ), lower trabecular number (HIV + 0.08+/-0.01, HIV- 0.09+/-0.02; p = 0.004) and greater trabecular separation (HIV + 9.23+/-3.11, HIV- 7.99+/-3.23; p = 0.04) compared to women without HIV that remained significant in multivariate logistic regression analysis in a sub-cohort after adjusting for age, race/ethnicity, smoking status, and diabetes. CONCLUSION: Postmenopausal women with HIV have deterioration of the alveolar trabecular bone microarchitecture that may contribute to greater tooth loss.

The utility of a formative one-station objective structured clinical examination for Substance use disorders in a dental curriculum.

Substance use disorders (SUD) are chronic relapsing medical conditions characterised by compulsive substance seeking and use. They constitute a substantial disease burden globally. Labelling of persons with SUD has created barriers to treatment but there are effective management strategies. The dental profession has embraced reforms designed to address the SUD epidemic by promoting continuing education for practitioners and initiating curriculum changes in dental schools. Screening, Brief Intervention and Referral to Treatment (SBIRT) is an evidence-based model for managing patients with SUD. The use of a formative 1-station Objective Structured Clinical Examination (OSCE) for learning and assessment in SBIRT, operationalised with the MD3 rating scale is presented in this study. In 3 years of implementation, the SBIRT OSCE successfully integrated into the curriculum of the College of Dental Medicine, Columbia University. Mean score of total adherent behaviours was 11.80 (SD =4.23) (range: 2 - 24) and Cronbach's coefficient alpha for across-items reliability in adherent behaviours was 0.66. Adherent behaviours correlated with the global ratings (r = 0.66). Mean of global rating scores were 2.90 (SD =1.01) for collaboration and 2.97 (SD =1.00) for empathy and the global rating scores correlated with each other (r = 0.85). Histograms of global rating scores resembled normal distribution. The 1-station OSCE is a good model for learning about SBIRT. Psychometric analysis was useful in understanding the underlying construct of the MD3 rating scale and supported its reliability, validity and utility in dental education.

A novel treatment of gingival recession using a botanical topical gingival patch and mouthrinse.

BACKGROUND AND AIM: Current treatment of gingival recession (GR) is limited to surgical procedures. We describe a case series of 18 patients with GR who were treated with a botanical patch and rinse following standard conservative therapy. CASE SERIES DESCRIPTION: A total of 22 sites with GR > 1 mm were studied. Following scaling and root planing (SRP) and oral hygiene instruction, patients received two courses of patch treatment (3 days each) and botanical rinse administered twice daily throughout the treatment period. Outcome measures (GR, gingival index (GI) and gingival thickness (GT) were taken at baseline; at 1 to 2 weeks; 2 to 4 weeks; and at 6 to 8 weeks. Miller classifcation and plaque index (PI) were measured at baseline and at 6 to 8 weeks. At the end of the treatment period, mean GR decreased from 4.18 ± 1.74 mm to 3.31 ± 1.51 mm (20.8%); Miller grade from 1.86 ± 0.56 to 1.06 ± 0.43; GI scores from 1.45 ± 0.63 to 0.17 ± 0.38 (88.3%); and PI scores from 1.33 ± 0.59 to 0.78 ± 0.94. GT increased from 0.74 mm ± 0.40 to 1.21 ± 0.39 (63.5%). No adverse effects were reported with either the patch or rinse treatments. CONCLUSION: We observed a decrease in GR and GI scores in 18 patients (22 sites) treated with the study patch and rinse, with increased GT. CLINICAL SIGNIFICANCE: A combined botanical patch-rinse treatment may be effective as adjuvant treatment to standard conservative care for GR. Further research is needed to verify these fndings.

Effect of an herbal mouth rinse in preventing periodontal inflammation in an experimental gingivitis model: a pilot study.

BACKGROUND: Gingivitis is a chronic inflammatory condition, resulting from gingival bacteria and bacterial byproducts. Antiplaque oral rinses reduce inflammation by removing or inhibiting plaque formation. The purpose of this pilot study was to examine the anti-inflammatory effects of HM-302, a mouth rinse based on natural products, on gingival inflammation. METHODS: A prospective, double-blinded, randomized parallel-group controlled trial involving 62 patients was conducted to assess efficacy and safety. During a 2-week period with no dental hygiene, subjects were randomized to receive either the study rinse (HM-302); a cetylpyridinium chloride (CPC) rinse; an essential oils (EO) rinse; or a water-only preparation. The gingival index (GI), plaque index (PI), and number of bleeding sites were measured at baseline and at the end of the study period. RESULTS: Progression of gingival inflammation resulting from lack of dental hygiene was lowest in patients treated with the HM-302 rinse, and was significantly less marked than in patients treated with the water-only preparation. When compared to the CPC and EO treatments, HM-302 was the only mouth rinse that was significantlybetter than the control, with respect to both the change in absolute GI scores (p = .006) and to the percent increase in GI scores (p = .012). No serious adverse effects were noted in any of the study groups. CONCLUSION: HM-302 is a safe and effective treatment for preventing the development of gingival inflammation in an experimental gingivitis model. Further research is needed to evaluate its long-term effects.

Innovations in pre-doctoral dental education: Influencing attitudes and opinions about patients with substance use disorder.

Screening, Brief Intervention, and Referral to Treatment (SBIRT) is an evidence-based model for managing patients with substance use disorders (SUD). Historically, SUD were seen as a criminal issue and access to treatment was limited, but that paradigm is shifting and substance abuse is now being recognized as a disease state and the management of patients with SUD is increasingly within the healthcare system starting with primary healthcare settings including dental facilities. In a new training initiative, first-year dental students (DDS1) attended a 90-minute SBIRT training. An Attitudes and Opinion Survey (AOS) consisting of 8 questions that separately assesses DDS1 attitudes toward alcohol and drug use disorders was utilized to evaluate the training. Assenting DDS1 anonymously completed the AOS before and following the training. Over 3 years, we analyzed changes in the AOS of 230 DDS1 using Chi-squared test for bivariate comparison. We then applied a Bonferroni correction to the P-values. Response rate was 95.5%. The SBIRT training improved DDS1 attitudes and opinions toward patients with SUD with respect to all AOS questions. There was a statistically significant improvement (P < 0.003) in DDS1 attitudes and opinions with respect to whether other patients care suffers because of time and resources spent on patients with SUD and whether the SBIRT training provided adequate education to prepare DDS1 to manage patients with SUD. SBIRT training is relevant to dental education. It fills an important educational gap and is a suitable model for other dental schools.

Completeness of Electronic Dental Records in a Student Clinic: Retrospective Analysis.

BACKGROUND: A well-designed, adequately documented, and properly maintained patient record is an important tool for quality assurance and care continuity. Good clinical documentation skills are supposed to be a fundamental part of dental student training. OBJECTIVE: The goal of this study was to assess the completeness of electronic patient records in a student clinic. METHODS: Completeness of patient records was assessed using comparative review of validated cases of alveolar osteitis treated between August 2011 and May 2017 in a student clinic at Columbia University College of Dental Medicine, New York, USA. Based on a literature review, population-based prevalence of nine most frequently mentioned symptoms, signs, and treatment procedures of alveolar osteitis was identified. Completeness of alveolar osteitis records was assessed by comparison of population-based prevalence and frequency of corresponding items in the student documentation. To obtain all alveolar osteitis cases, we ran a query on the electronic dental record, which included all cases with diagnostic code Z1820 or any variation of the phrases "dry socket" and "alveolar osteitis" in the notes. The resulting records were manually reviewed to definitively confirm alveolar osteitis and to extract all index items. RESULTS: Overall, 296 definitive cases of alveolar osteitis were identified. Only 22% (64/296) of cases contained a diagnostic code. Comparison of the frequency of the nine index categories in the validated alveolar osteitis cases between the student clinic and the population showed the following results: severe pain: 94% (279/296) vs 100% (430/430); bare bone/missing blood clot: 27% (80/296) vs 74% (35/47) to 100% (329/329); malodor: 7% (22/296) vs 33%-50% (18/54); radiating pain to the ear: 8% (24/296) vs 56% (30/54); lymphadenopathy: 1% (3/296) vs 9% (5/54); inflammation: 14% (42/296) vs 50% (27/54); debris: 12% (36/296) vs 87% (47/54); alveolar osteitis site noted: 96% (283/296) vs 100% (430/430; accepted documentation requirement); and anesthesia during debridement: 77% (20/24) vs 100% (430/430; standard of anesthetization prior to debridement). CONCLUSIONS: There was a significant discrepancy between the index category frequency in alveolar osteitis cases documented by dental students and in the population (reported in peer-reviewed literature). More attention to clinical documentation skills is warranted in dental student training.

Invasive Oral Procedures and Events in Postmenopausal Women With Osteoporosis Treated With Denosumab for Up to 10 Years.

CONTEXT: Antiresorptive therapy has been associated with osteonecrosis of the jaw (ONJ), an infrequent but potentially serious adverse event. OBJECTIVE: To assess information on invasive oral procedures and events (OPEs)-dental implants, tooth extraction, natural tooth loss, scaling/root planing, and jaw surgery-during the 7-year Fracture REduction Evaluation of Denosumab in Osteoporosis every 6 Months (FREEDOM) Extension study and to present details of positively adjudicated ONJ cases. DESIGN: Randomized, double-blind, placebo-controlled, 3-year trial (FREEDOM) followed by 7 years of open-label denosumab (FREEDOM Extension). At Extension Year 3, women were asked to record their history of invasive OPEs since the start of the Extension to Year 2.5 and oral events in the prior 6 months. The questionnaire was then administered every 6 months until the end of the Extension. SETTING: Multicenter, multinational clinical trial. PATIENTS: Postmenopausal women with osteoporosis. INTERVENTIONS: Subcutaneous denosumab 60 mg or placebo every 6 months for 3 years, then 7 years of open-label denosumab. MAIN OUTCOME MEASURES: Self-reports of OPEs and adjudicated cases of ONJ. RESULTS: Of respondents, 45.1% reported at least one invasive OPE. The exposure-adjusted ONJ rate in FREEDOM Extension was 5.2 per 10,000 person-years. ONJ incidence was higher in those reporting an OPE (0.68%) than not (0.05%). CONCLUSIONS: Although invasive OPEs were common in these denosumab-treated women and were associated with an increased ONJ incidence, the overall rate of ONJ was low, and all cases with complete follow-up resolved with treatment.

Incidence of osteonecrosis of the jaw in women with postmenopausal osteoporosis in the health outcomes and reduced incidence with zoledronic acid once yearly pivotal fracture trial.

BACKGROUND: The authors determined incidence of osteonecrosis of the jaw (ONJ) in a large, prospective three-year clinical trial of zoledronic acid in women with postmenopausal osteoporosis (PMO). METHODS: A total of 7,714 women with PMO received intravenous zoledronic acid 5 mg or a placebo. No spontaneous reports of ONJ were received. An independent, blinded adjudication committee searched the trial's adverse event database by using 60 terms. On an ongoing basis, the committee reviewed the identified events, and it defined ONJ as exposed bone in the maxillofacial area with delayed healing for more than six weeks despite appropriate care. RESULTS: One participant who received a placebo and one participant who received zoledronic acid experienced delayed healing associated with infection. Both conditions resolved after antibiotic therapy, débridement or both. CONCLUSION: The occurrence of ONJ is rare in a PMO population, and delayed healing of lesions can occur with and without bisphosphonate use over three years. CLINICAL IMPLICATIONS: The low incidence of ONJ must be assessed in the context of the clinical benefit of zoledronic acid therapy in reducing hip, vertebral and nonvertebral fractures in this at-risk population. There is no evidence to suggest that healthy patients with osteoporosis who are receiving bisphosphonates require any special treatment beyond routine dental care or to support altering standard treatment practices.

Relationship Between Dental Students' Pre-Admission Record and Performance on the Comprehensive Basic Science Examination.

The Comprehensive Basic Science Examination (CBSE) is the entrance examination for oral and maxillofacial surgery, but its implementation among dental students is a relatively recent and unintended use. The aim of this study was to examine the relationship between pre-admission data and performance on the CBSE for dental students at the Columbia University College of Dental Medicine (CDM). This study followed a retrospective cohort, examining data for the CDM Classes of 2014-19. Data collected were Dental Admission Test (DAT) and CBSE scores and undergraduate GPAs for 49 CDM students who took the CBSE from September 2013 to July 2016. The results showed that the full regression model did not demonstrate significant predictive capability (F[8,40]=1.70, p=0.13). Following stepwise regression, only the DAT Perceptual Ability score remained in the final model (F[1,47]=7.97, p<0.01). Variations in DAT Perceptual Ability scores explained 15% of the variability in CBSE scores (R2=0.15). This study found that, among these students, pre-admission data were poor predictors of CBSE performance.

Bisphosphonate-associated osteonecrosis of the jaw: conclusions based on an analysis of case series.

ONJ appears to be associated with BPs; however, the pathophysiology, incidence, and co-morbidities require further investigation. The major risk factors identified to date appear to be cancer (or chemotherapy for cancer) and dental procedures or oral trauma. A clear definition of ONJ is critical to understanding this disease entity. Although recommendations regarding the prevention and management of ONJ exist, clinical studies are needed to establish more definitive guidelines for the management of ONJ. The use of intensive hyperbaric oxygen therapy may be beneficial to patients with ONJ.

Beta-glucuronidase activity in saliva: relationship to clinical periodontal parameters.

BACKGROUND: Beta-glucuronidase (betaG) in gingival crevicular fluid (GCF), a marker of neutrophil influx into the crevicular environment, has previously been shown to be correlated with periodontal clinical parameters at individual sites (probing depth and clinical attachment level). Furthermore, elevated levels of betaG were found to be a risk factor for periodontal attachment loss. Analysis of betaG in saliva may be a measure of crevicular neutrophil influx for the whole mouth. The purpose of this cross-sectional study was to evaluate the relationship between betaG activity in saliva and periodontal clinical parameters in subjects demonstrating various levels of periodontal disease. METHODS: The study population consisted of 380 subjects (108 males and 272 females). A sample of unstimulated whole saliva and a venous blood sample were obtained from each subject, and a periodontal examination, which included measurement of probing depth (PD), attachment level (AL), and gingival index (GI) was performed. The unmodified saliva samples were frozen at -20 degrees C and analyzed for betaG activity. The blood samples were analyzed for number of white blood cells, neutrophils, monocytes, lymphocytes, and platelets. Statistical analysis was conducted to determine the association between salivary betaG activity and the whole-mouth clinical periodontal parameters, complete blood count, smoking status, and age. RESULTS: Highly significant correlations between salivary betaG activity and mean probing depth (MPD), mean gingival index (MGI), and the number of sites with probing depth > or = 5 mm were found. When subjects were divided into tertiles based on their MPD and MGI, elevated salivary betaG activity was detected in subjects in the 2 upper tertiles. Logistic regression modeling was used to determine which of the clinical or laboratory parameters were able to identify patients with at least 4 sites with PD > or = 5 mm. Salivary betaG activity > or = 100 produced an odds ratio (OR) of 3.77. In comparison, current and former smokers had an OR of 3.15 and 2.29, respectively. CONLCUSIONS: The results suggest that a significant association exists between periodontal clinical parameters and salivary betaG activity. Due to the non-invasive and simple nature of saliva collection, this association should be studied to determine its usefulness as a screening test for periodontitis, and a means of monitoring the response to treatment.

Gingival crevicular fluid levels of interleukin-1beta and glycemic control in patients with chronic periodontitis and type 2 diabetes.

BACKGROUND: Patients with diabetes have increased incidence and severity of periodontal disease not accounted for by differences in the subgingival microbial infection. Poor glycemic control has been consistently associated with periodontal disease severity. Also, recent evidence suggests that hyperglycemia may induce inflammatory cytokine production. Few studies, however, have examined local biochemical measures of periodontal inflammation in patients with type 2 diabetes. The aim of this study was to determine whether glycemic control was related to gingival crevicular fluid (GCF) levels of interleukin-1beta (IL-1beta). METHODS: GCF samples were collected from 45 patients with type 2 diabetes and untreated chronic periodontitis. Plaque index (PI), bleeding on probing (BOP), probing depth (PD), and attachment level (AL) were recorded at six sites per tooth. IL-1beta levels were determined from individual GCF samples by enzyme-linked immunoabsorbent assay (ELISA). Individual site and mean patient values were calculated. Glycated hemoglobin (HbA1c) levels were measured from anticoagulated whole blood using an automated affinity chromatography system. Serum glucose was also determined. RESULTS: Clinical periodontal measures (PD, AL, BOP) and measures of glycemic control (HbA1c, random glucose) were significantly correlated with GCF IL-1beta. Patients with greater than 8% HbA1c had significantly higher mean GCF IL-1beta levels than patients with less than 8% HbA1c. In a multivariate model adjusting for age, gender, PD, AL, BOP, and PI, HbA1c and random glucose were independent predictors of high GCF IL-1beta. CONCLUSIONS: Poor glycemic control is associated with elevated GCF IL-1beta. These data are consistent with the hypothesis that hyperglycemia contributes to an heightened inflammatory response, and suggests a mechanism to account for the association between poor glycemic control and periodontal destruction.

Origin of galactose-deficient immunoglobulin g in gingival crevicular fluid in periodontitis.

BACKGROUND: Periodontitis is a chronic inflammatory disease initiated by a synergistic and dysbiotic microbial community that elicits a gingival inflammatory response leading to tissue breakdown. Periodontitis shares many characteristics with other chronic inflammatory diseases, including abnormal glycosylation of immunoglobulin (Ig)G. The current authors have previously demonstrated that IgG from gingival crevicular fluid (GCF) of patients with chronic periodontitis contains galactose (Gal)-deficient IgG. METHODS: The origin of the aberrantly glycosylated IgG was determined by measuring levels of Gal-deficient IgG in GCF and serum from patients with periodontitis and non-periodontitis controls using lectin enzyme-linked immunosorbent assay. The Ig-producing cells and the proportion of cells producing Gal-deficient IgG were immunohistochemically determined in gingival tissues from patients with periodontitis by fluorescence microscopy. The results were statistically evaluated and correlated with clinical data. RESULTS: The results indicate that GCF of patients with periodontitis had higher levels of Gal-deficient IgG compared with controls (P = 0.002). In gingival tissues, IgG was the dominant isotype among Ig-producing cells, and 60% of IgG-positive cells produced Gal-deficient IgG. Moreover, the proportion of Gal-deficient IgG-producing cells directly correlated with clinical parameters of probing depth and clinical attachment loss (AL). CONCLUSION: These results suggest that the presence of Gal-deficient IgG is associated with gingival inflammation and may play a role in the worsening of clinical parameters of periodontitis, such as AL.

The incidence of osteonecrosis of the jaw in patients receiving 5 milligrams of zoledronic acid: data from the health outcomes and reduced incidence with zoledronic acid once yearly clinical trials program.

BACKGROUND: The Health Outcomes and Reduced Incidence with Zoledronic Acid Once Yearly-Pivotal Fracture Trial found one case of osteonecrosis of the jaw (ONJ) in a patient with postmenopausal osteoporosis (OP) treated with 5 milligrams of zoledronic acid (ZOL) once yearly and one case in a patient receiving a placebo. The authors examined ONJ incidence in four additional clinical trials involving patients with osteopenia or OP who were treated with ZOL, and they analyzed levels of the bone resorption marker serum ß C-telopeptide (S-CTx) to assess its usefulness in predicting the risk of developing ONJ. METHODS: To determine ONJ prevalence, an independent committee conducted a masked review of the clinical trials' adverse events databases for cases meeting predefined criteria for ONJ. The committee collected S-CTx level data for subsets of patients from these trials. RESULTS: The results of the four additional clinical trials revealed no further cases of ONJ. The S-CTx levels commonly were lower than 0.15 nanograms per milliliter, with no correlation to the incidence of ONJ. CONCLUSIONS: In the clinically diverse group of 5,903 patients who received ZOL in five clinical trials, ONJ incidence was less than one in 14,200 patient treatment-years. Data from four clinical trials indicated that S-CTx levels lower than 0.15 ng/mL were common among patients receiving ZOL for treatment of OP and were not associated with ONJ. CLINICAL IMPLICATIONS: Occurrences of ONJ have been rare in patients with OP who are receiving ZOL. Whereas low S-CTx values may be common in patients receiving bisphosphonates for OP therapy, they are not associated necessarily with an increased risk of developing ONJ.

Usefulness of self-reported periodontal disease to identify individuals with elevated inflammatory markers at risk of cardiovascular disease.

Periodontal disease has been associated with cardiovascular disease (CVD), and inflammation may represent a common pathophysiology. Oral health screening in the context of CVD risk assessment represents a potential opportunity to identify individuals at risk for CVD. The purposes of this study were to determine if self-reported oral health status is independently associated with inflammatory markers and if oral health assessment as part of CVD risk screening can identify at-risk individuals without traditional CVD risk factors. A baseline analysis was conducted among participants in the National Heart, Lung, and Blood Institute's Family Intervention Trial for Heart Health (FIT Heart; n = 421, mean age 48 +/- 13.5 years, 36% nonwhite) without CVD or diabetes who underwent standardized assessment of oral health, lifestyle, CVD risk factors, and the inflammatory markers high-sensitivity C-reactive protein and lipoprotein-associated phospholipase A(2). Statistical associations between oral health, risk factors, and inflammatory markers were assessed, and logistic regression was used to adjust for effects of lifestyle and potential confounders. Periodontal disease was independently associated with being in the top quartile of lipoprotein-associated phospholipase A(2) compared with the lower 3 quartiles (odds ratio 1.9, 95% confidence interval 1.1 to 3.2) after adjustment for lifestyle and risk factors. Histories of periodontal disease were reported by 24% of non-overweight, non-hypertensive, non-hypercholesterolemic participants, and of these participants, 37% had elevated high-sensitivity C-reactive protein (> or =3 mg/L) or lipoprotein-associated phospholipase A(2) (> or =215 ng/ml) levels. In conclusion, self-reported periodontal disease is independently associated with inflammation and common in individuals without traditional CVD risk factors.

The influence of diabetes on gingival crevicular fluid beta-glucuronidase and interleukin-8.

OBJECTIVES: Polymorphonuclear neutrophil (PMN) dysfunction is associated with diabetes. We examined the gingival crevicular fluid (GCF) beta-glucuronidase (BG) and interleukin-8 (IL-8) levels of periodontitis patients with and without type 2 diabetes mellitus (DM). MATERIAL AND METHODS: Forty five adults with type 2 DM and 32 adults without DM, both with chronic periodontitis were enrolled. GCF was collected from eight posterior sites in each quadrant, and periodontal parameters were recorded. GCF was assayed for IL-8 by ELISA and BG by a fluorometric assay. RESULTS: GCF IL-8 was positively correlated with probing depth (PD), and GCF BG but not clinical attachment level (CAL), bleeding on probing (BOP), or plaque index (PI). In contrast, GCF BG was strongly correlated with each of the clinical measures of periodontal disease. Subjects with DM significantly lower levels of both BG (73.0+/-44.8 versus 121.9+/-84.6 pg/sample; p=0.002) and IL-8 (32.1+/-33.1 versus 90.8+/-83.2 pg/sample; p<0.0001) even after adjustments for age, gender, PD, CAL, BOP, and PI. Neither BG nor IL-8 was correlated with HbA1c levels in subjects with DM. CONCLUSION: These data suggest that an inadequate local response by PMN, partially explained by an altered chemokine gradient, may contribute to periodontal disease in patients with type 2 DM.

In practice evaluation of a denture adhesive using a gnathometer.

PURPOSE: This study measured the extent to which the performance of a maxillary complete denture can be improved with the use of a denture adhesive. This in-practice evaluation assessed both a quantitative measure (force until dislodgement), without and with the adhesive, and patients' perception regarding the use of adhesive. MATERIALS AND METHODS: A total of 194 patients (77 men, 117 women) who wore maxillary complete dentures were tested for denture performance both without and with denture adhesive. A simple gnathometer was used. Patient perceptions were also assessed by a questionnaire and analyzed for denture performance as well as the effects on speaking and chewing, fit and comfort, and perceived confidence. RESULTS: There was a 63.4% improvement in bite force dislodgement with the use of a denture adhesive. A total of 79.2% of the patients perceived better denture performance (bite force dislodgement) with adhesive use. A total of 55.7% perceived an improvement in speaking and chewing. A total of 56.2% noticed the fit and comfort were better. A total of 63.9% responded that they had improved confidence. CONCLUSIONS: Use of a denture adhesive can improve the incisal (or protrusive) biting force for patients who wear a maxillary complete denture. Subjectively, the patients reported an improved perception of denture performance and that the use of adhesive provided greater confidence when using the prosthesis.

GCF IL-1beta profiles in periodontal disease.

OBJECTIVES: Studies suggest a genetic influence on levels of interleukin-1beta (IL-1beta) in gingival crevicular fluid (GCF). Levels of IL-1beta in GCF, however, are also dependent upon the clinical parameters at the site of collection, including probing depth (PD) and level of attachment (AL). To examine this issue, IL-1beta in GCF was evaluated from patients with varying degrees of periodontal disease. The influence of both the status of the patient and the probing depth at the sampled sites were considered in the analysis. MATERIAL AND METHODS: GCF IL-1beta was determined by ELISA at 6-8 molar sites from 29 non-smoking adults with mild, moderate, or severe periodontal disease at baseline, 2 weeks, and 24 weeks following scaling and root planing. For later analysis, patients were dichotomized on the basis of disease severity (mild/moderate vs severe). Sampled sites were classified at baseline by PD as, shallow (<4 mm), intermediate (4-6 mm), or deep (>6 mm). RESULTS: PD and AL were each strongly correlated with IL-1beta levels at baseline. However, patients with severe disease had higher levels of IL-1beta in each PD category than those with mild/moderate disease. As compared to patients with mild/moderate disease, IL-1beta levels in shallow sites from patients with severe disease was elevated nearly 2 fold (p<0.001). IL-1beta levels were reduced in all groups at 2 weeks and were still significantly reduced in patients with mild/moderate disease at 24 weeks. At 24 weeks IL-1beta returned to near baseline levels in patients with severe disease. CONCLUSION: While PD and AL are each associated with increased GCF IL-1beta, patients with severe disease show higher IL-1beta GCF levels in shallow sites, suggesting that high GCF IL-1beta expression is in part a host trait, and not strictly a function of clinical parameters.