The Effect of Hypothyroidism on Bone Loss at Dental Implants.

Hypothyroidism (HT) is an endocrine disorder characterized by abnormally reduced thyroid gland activity and is most commonly of autoimmune etiology. HT is associated with alterations in bone metabolism, and HT patients typically experience decreased bone resorption. The objective of this study was to use dental implants as standardized reference markers to compare the extent of alveolar bone loss in implant patients with and without HT. We examined medical and dental history records and radiographic data from 635 patients receiving 1480 implants during 2000-2017. The rate of bone loss was calculated from differences in radiographic bone levels over time, corrected for radiographic distortion. Peri-implant bone loss from patients with HT was significantly lower than for those without HT (t1252= -3.42; 95% confidence interval= 0.47-1.73; P < .001; M = 0.53 and 1.63 mm/yr, respectively). A similar relationship persisted after excluding smokers and diabetics and after additionally excluding those on systemic steroids, hormone replacement therapy, hormone medications, or autoimmune diseases other than HT. Our data suggest that patients with HT have a decreased rate of bone loss around dental implants and may not be at increased risk for dental implant failure. The decreased bone metabolic rate among patients with HT might contribute to those findings.

Effect of Proton Pump Inhibitors on Bone Loss at Dental Implants.

PURPOSE: Proton pump inhibitors (PPIs) are prescribed for the treatment of gastric reflux disease, but such medications might also influence bone metabolism. Therefore, the primary goal of this study was to determine if bone loss severity at dental implants could be associated with PPI use. MATERIALS AND METHODS: Dental, medical, and radiographic history records of patients receiving dental implants at the University at Buffalo, School of Dental Medicine from 2000 to 2017 were reviewed in this retrospective clinical study. Bone loss around each implant was evaluated radiographically by direct measurement of crestal bone loss and by counting the number of radiographically evident exposed threads. PPI use was confirmed by medical record examination. The effects of systemic factors were assessed. Confidence intervals (CI) and P values of mean differences between PPI and non-PPI groups were computed via IBM SPSS Statistics v.25. RESULTS: A total of 1,480 implants from 635 patients were used in this study. Greater crestal implant bone loss was associated with patients with a history of PPI medication use. Mean crestal bone loss of 1.60 mm was noted at implants from PPI patients, in contrast to 1.01 mm of crestal implant bone loss at implants from the non-PPI group (group difference = 0.59 mm, 58.40% increase, P = .024, CI [95%] = 0.08 to 1.09 mm). Following adjustment for systemic factors, those effects persisted, with crestal implant bone loss of 1.87 mm from PPI patients, in contrast to 1.04 mm from non-PPI patients (group difference = 0.83 mm, 79.80% increase, P = .028, CI [95%] = 0.09 to 1.56 mm). Similarly, 0.63 exposed threads per implant were found in the PPI group, in contrast to 0.38 supracrestal implant threads in the non-PPI patient group (mean difference = 0.25 exposed threads, 65.8% increase, P = .039, CI [95%] = 0.01 to 0.50 mm). After excluding systemic factors, a similar pattern was observed with 0.79 vs 0.36 threads exposed from subjects taking PPIs, compared with those not taking PPIs, respectively (mean difference = 0.43 exposed threads, 119.4% increase, P = .014, CI [95%] = 0.09 to 0.77 mm). CONCLUSION: The data suggest that PPI medications are related to more loss of crestal bone at implant sites. Patients receiving implant therapy might require more frequent periodontal maintenance.

Relationship between hypothyroidism and periodontitis: A scoping review.

AIM: The objective of this study was to assess the existing literature to determine if a relationship exists between hypothyroidism and periodontitis. METHODS: We used a modified approach to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses by searching five databases in addition to the gray literature. Keywords in the title and abstract fields, as well as subject headings for both periodontal disease and hypothyroidism, were used to search the existing literature for publications relevant to evaluation of the thyroid-periodontitis relationship. RESULTS: The authors screened 847 unique publications which, after applying inclusion and exclusion criteria, yielded 29 publications, which were further analyzed for relevance and applicability. Most of the included papers were cross-sectional studies and retrospective chart reviews. Following critical analysis, four publications, including one abstract, were used to further assess the hypothyroid-periodontitis relationship. CONCLUSIONS: There are very few high-quality studies describing the potential association between hypothyroidism and periodontitis. In general, and among the included papers with the fewest confounding factors, a positive relationship between hypothyroidism and periodontitis was found. Further well-controlled, prospective clinical and immunologic studies will be required to confirm that relationship.

Patient Satisfaction Measurement in Occupational and Environmental Medicine Practice.

: High patient satisfaction is a desirable goal in medical care. Patient satisfaction measures are increasingly used to evaluate and improve quality in all types of medical practices. However, the unique aspects of occupational and environmental medicine (OEM) practice require development of OEM-specific measures and thoughtful interpretation of results. The American College of Occupational and Environmental Medicine has developed and recommends a set of specific questions to measure patient satisfaction in OEM, designed to meet anticipated regulatory requirements, facilitate quality improvement of participating OEM practices, facilitate case-management review, and offer fair and accurate assessment of OEM physicians.

The salivary mucin MG1 (MUC5B) carries a repertoire of unique oligosaccharides that is large and diverse.

The high-molecular-mass salivary mucin MG1, one of two major mucins produced by human salivary glands, plays an important role in oral health by coating the tooth surface and by acting as a bacterial receptor. Here this mucin was purified from the submandibular/sublingual saliva of a blood group O individual. The presence of MUC5B as the major mucin in this preparation was confirmed by amino acid analysis and its reactivity with the monoclonal antibody PAN H2. To structurally characterize MG1 carbohydrates the O-glycans were released by reductive beta-elimination. Nuclear magnetic resonance spectroscopy of the nonfractionated mixture showed that (1) fucose was present in blood group H, Le(a), Le(x), Le(b), and Le(y) epitopes; (2) NeuAc was mainly linked alpha 2-3 to Gal or alpha 2-6 to GalNAcol; and (3) the major internal structures were core 1 and core 2 sequences. After this preliminary analysis the released oligosaccharides were separated into neutral (56%), sialylated (26%), and sulfated (19%) fractions, with an average length of 13, 17, and 41 sugar residues, respectively. Gas chromatography-mass spectrometry and matrix-assisted laser desorption/ionization time-of-flight mass spectrometry of mixtures of neutral and sialylated oligosaccharides revealed at least 62 neutral and 25 sialylated oligosaccharides consisting of up to 20 monosaccharide residues. These results showed that the MG1-derived oligosaccharides were much longer than those of MG2, and only a few species were found on both molecules. Thus, these two mucins create an enormous repertoire of potential binding sites for microorganisms at one of the major portals where infectious organisms enter the body.