RESUMEN
INTRODUCTION: The historical separation between medicine and dentistry has resulted in the creation of separate health records, which have the potential to negatively impact patient care and safety. Of particular importance, errors or omissions in medication lists in separate electronic health records (EHRs) may lead to medical errors and serious adverse outcomes. OBJECTIVE: This study aimed to compare medication lists reported in the EHRs of active patients treated by both the University of Michigan School of Dentistry and Michigan Medicine to determine if differences exist. METHODS: In this cohort study, EHRs of a population of 159,733 patients that the University of Michigan medical and dental clinics share in common were investigated for agreement in the reporting of 16 medications. After exclusion of minors and patients not seen in the last 5 y, records of 27,277 patients were examined. RESULTS: The maximum percentage of agreement in medications reported in both records was 52% for levothyroxine, and the minimum was 7% for sildenafil. The medical record had a significantly higher number of unique medications than the dental record, suggesting higher underreporting in the dental setting. CONCLUSION: The lack of agreement in the report of medications with serious dental and medical implications argues in favor of unification of records and use of available technology to increase accurate medication reporting. KNOWLEDGE TRANSFER STATEMENT: The results demonstrate a lack of agreement between medications reported in medical and dental records, which can have serious implications to patients' health. A unified health record, employing available technology to increase accurate medication reporting, would mitigate this problem.
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Registros Electrónicos de Salud , Atención al Paciente , Estudios de Cohortes , Humanos , MichiganRESUMEN
Vitamin D regulates calcium and immune function. While vitamin D deficiency has been associated with periodontitis, little information exists regarding its effect on wound healing and periodontal surgery outcomes. This longitudinal clinical trial assessed outcomes of periodontal surgery and teriparatide administration in vitamin-D-sufficient and -insufficient individuals. Forty individuals with severe chronic periodontitis received periodontal surgery, daily calcium and vitamin D supplements, and self-administered teriparatide or placebo for 6 wks to correspond with osseous healing time. Serum 25(OH)D was evaluated at baseline, 6 wks, and 6 mos post-surgery. Clinical and radiographic outcomes were evaluated over 1 yr. Placebo patients with baseline vitamin D deficiency [serum 25(OH)D, 16-19 ng/mL] had significantly less clinical attachment loss (CAL) gain (-0.43 mm vs. 0.92 mm, p < 0.01) and probing depth (PPD) reduction (0.43 mm vs. 1.83 mm, p < 0.01) than vitamin-D-sufficient individuals. Vitamin D levels had no significant impact on CAL and PPD improvements in teriparatide patients at 1 yr, but infrabony defect resolution was greater in teriparatide-treated vitamin-D-sufficient vs. -deficient individuals (2.05 mm vs. 0.87 mm, p = 0.03). Vitamin D deficiency at the time of periodontal surgery negatively affects treatment outcomes for up to 1 yr. Analysis of these data suggests that vitamin D status may be critical for post-surgical healing. (ClinicalTrials.gov number, CT00277706).
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Periodontitis Crónica/metabolismo , Periodontitis Crónica/cirugía , Deficiencia de Vitamina D/metabolismo , Vitamina D/farmacología , Vitaminas/farmacología , Cicatrización de Heridas/efectos de los fármacos , 24,25-Dihidroxivitamina D 3/sangre , Adulto , Anciano , Conservadores de la Densidad Ósea/farmacología , Femenino , Humanos , Modelos Lineales , Estudios Longitudinales , Masculino , Persona de Mediana Edad , Teriparatido/farmacología , Resultado del Tratamiento , Vitamina D/metabolismo , Vitaminas/metabolismoRESUMEN
The model of explosion pressure build up in enclosures with inertial vent covers and the CINDY code implementing the model are validated against experiments by Hochst and Leuckel (1998) in a 50 m3 vessel with a pair of ceiling-mounted upwards-opening hinged doors in a 'butterfly' configuration with surface densities of 73 and 124 kg/m2 under conditions of initially quiescent and turbulent mixtures. The model and the code are further validated against an experiment by Zalosh (1978) in a 33.5 m3 room-like enclosure with a pair of wall-mounted rectangular doors, in a parallel configuration, each hinged at its bottom edge with a surface density of 23.1 kg/m2 and initially quiescent mixture. A formula for the torque acting upon a rotating venting door is derived under conditions of vent cover jet formation. The vent cover jet effect decreases the torque three times compared to an elementary approach valid at the start of vent cover movement. It is demonstrated that, similar to translating vent covers, the vent cover jet effect is crucial for prediction of interdependent vent cover displacement in time and pressure transients.
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Explosiones , Modelos Teóricos , Predicción , Gases , Presión , Medición de Riesgo , VentilaciónRESUMEN
BACKGROUND: Gingival crevicular fluid (GCF) biomarkers associated with bone resorption may be useful to determine periodontal disease status and response to therapy. The pyridinoline cross-linked carboxy-terminal telopeptide of type I collagen (ICTP), a bone-specific degradation product, and interleukin 1-beta (IL-1), a potent bone-resorptive cytokine, have both been associated with periodontal disease activity. Minocycline is a tetracycline derivative possessing antimicrobial effects on periodontal pathogens and inhibitory properties on matrix metalloproteinases (MMPs) associated with tissue destruction. The aim of this study was to evaluate the effect of periodontal treatment in the form of scaling and root planing (SRP) and locally administered minocycline microspheres on the GCF levels of ICTP and IL-1. METHODS: Forty-eight chronic periodontitis patients were randomly assigned to 2 groups (SRP plus subgingival application of vehicle control [SRP + V], or SRP plus subgingival application of minocycline microspheres [SRP + M]) and monitored at 8 sites per subject at baseline and 1, 3, and 6 months. Four shallow (PD < or = 3 mm) and 4 deep (PD > or = 5 mm) sites were evaluated for both marker levels and for probing depth (PD), clinical attachment level (CAL), and bleeding on probing (BOP). Eight periodontally healthy control subjects with no probing depths >3 mm and no loss of attachment were also monitored at the same time intervals. GCF levels of ICTP and IL-1 were determined using radioimmunoassay and enzyme-linked immunosorbent assay techniques, respectively. RESULTS: Significant differences (P<0.001) in GCF levels of ICTP and IL-1 were found between deep and shallow sites at all time points in both treatment groups. In addition, healthy subjects demonstrated significantly reduced levels of both markers compared to both shallow and deep sites in periodontitis patients (P <0.001). Only the SRP + M treated patients exhibited significant reductions (P <0.05) in both ICTP and IL-1 levels 1 month after treatment. Furthermore, the SRP + M group demonstrated significantly lower IL-1 levels (P <0.02) at 1 month compared to the SRP + V group. CONCLUSIONS: Results of this study indicate that GCF levels of ICTP and IL-1 correlate with clinical measures of periodontal disease and may aid in assessing disease status and response to periodontal therapy. Furthermore, local administration of minocycline microspheres led to a potent short-term reduction in GCF IL-1 levels. Additional studies are needed to address whether repeated administration of scaling and root planing along with minocycline microspheres will achieve long-term reductions in GCF ICTP and IL-1 levels.
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Antibacterianos/uso terapéutico , Resorción Ósea/terapia , Colágeno/análisis , Interleucina-1/análisis , Minociclina/uso terapéutico , Péptidos/análisis , Periodontitis/terapia , Administración Tópica , Adulto , Anciano , Análisis de Varianza , Antibacterianos/administración & dosificación , Biomarcadores/análisis , Resorción Ósea/tratamiento farmacológico , Enfermedad Crónica , Colágeno/efectos de los fármacos , Colágeno Tipo I , Raspado Dental , Femenino , Estudios de Seguimiento , Líquido del Surco Gingival/química , Hemorragia Gingival/tratamiento farmacológico , Hemorragia Gingival/terapia , Humanos , Masculino , Análisis por Apareamiento , Microesferas , Persona de Mediana Edad , Minociclina/administración & dosificación , Péptidos/efectos de los fármacos , Pérdida de la Inserción Periodontal/tratamiento farmacológico , Pérdida de la Inserción Periodontal/terapia , Bolsa Periodontal/tratamiento farmacológico , Bolsa Periodontal/terapia , Periodontitis/tratamiento farmacológico , Aplanamiento de la Raíz , Método Simple Ciego , Estadística como AsuntoRESUMEN
BACKGROUND: Biochemical markers harvested from gingival crevicular fluid (GCF) may be useful to identify and predict periodontal disease progression and to monitor the response to treatment. C-telopeptide pyridinoline cross-links (ICTP), a host-derived breakdown product specific for bone, and interleukin-1beta (IL-1), a potent bone-resorptive cytokine, have been associated with periodontal tissue destruction. The aim of this study was to examine the effect of non-surgical periodontal therapy on GCF levels of ICTP and IL-1. METHODS: Twenty-five chronic periodontitis subjects were monitored at 8 sites per subject at baseline prior to scaling and root planing and 1, 3, and 6 months after therapy. Four shallow (probing depths < 4 mm) and 4 deep (probing depths > or = 5 mm) sites were monitored for both marker levels and clinical parameters. GCF was collected for 30 seconds on paper strips, and levels of ICTP and IL-1 were determined using radioimmunoassay (RIA) and enzyme-linked immunosorbent assay (ELISA) techniques, respectively. Clinical measurements included probing depth (PD), clinical attachment level (CAL), and bleeding on probing (BOP). RESULTS: Deep sites exhibited significantly (P<0.001) higher ICTP and IL-1 levels compared to shallow sites at all time intervals. ICTP demonstrated a stronger association to clinical parameters than IL-1 including a modest correlation (r = 0.40, P<0.001) between ICTP and attachment loss. Significant improvements in PD, CAL, and BOP were observed at 1, 3, and 6 months in all sites (P<0.01). However, non-surgical mechanical therapy did not significantly reduce ICTP and IL-1 levels over the 6-month period. Further examination of subjects based on smoking status revealed that ICTP levels were significantly reduced at 3 and 6 months and IL-1 levels reduced at 3 months among non-smokers only. CONCLUSIONS: A single episode of non-surgical mechanical therapy did not significantly reduce biochemical markers associated with bone resorption in patients exhibiting chronic periodontitis. Future longitudinal studies are warranted to specifically evaluate the relationship between C-telopeptide pyridinoline cross-links and periodontal disease progression.
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Colágeno/metabolismo , Raspado Dental , Líquido del Surco Gingival/metabolismo , Interleucina-1/metabolismo , Péptidos/metabolismo , Periodontitis/metabolismo , Periodontitis/terapia , Adulto , Anciano , Pérdida de Hueso Alveolar/metabolismo , Biomarcadores , Enfermedad Crónica , Colágeno/análisis , Colágeno Tipo I , Progresión de la Enfermedad , Ensayo de Inmunoadsorción Enzimática , Femenino , Líquido del Surco Gingival/química , Humanos , Interleucina-1/análisis , Masculino , Persona de Mediana Edad , Péptidos/análisis , Índice Periodontal , Valor Predictivo de las Pruebas , Radioinmunoensayo , FumarRESUMEN
BACKGROUND: The authors previously suggested that an adjunctive, controlled-release chlorhexidine, or CHX, chip may reduce periodontal surgical needs at little additional cost. This article presents an economic analysis of the CHX chip in general dental practice. METHODS: In a one-year prospective clinical trial, 484 chronic periodontitis patients in 52 general practices across the United States were treated with either scaling and root planing, or SRP, plus any therapy prescribed by treating, unblinded dentists; or SRP plus other therapy as above but including the CHX chip. Economic data were collected from bills, case report forms and 12-month treatment recommendations from blinded periodontist evaluators. RESULTS: Total dental charges were higher for SRP + CHX chip patients vs. SRP patients when CHX chip costs were included (P = .027) but lower when CHX chip costs were excluded (P = .012). About one-half of the CHX chip acquisition cost was offset by savings in other charges. SRP + CHX chip patients were about 50 percent less likely to undergo surgical procedures than were SRP patients (P = .021). At the end of the trial, periodontist evaluators recommended similar additional procedures for both groups: SRP, about 46 percent; maintenance, about 37 percent; surgery, 56 percent for SRP alone and 63 percent for SRP + CHX chip. CONCLUSIONS: Adjunctive CHX chip use for general-practice patients with periodontitis increased costs but reduced surgeries over one year. At study's end, periodontists recommended similar additional surgical treatment for both groups. CLINICAL IMPLICATIONS: In general practice, routine use of the CHX chip suggests that costs will be partially offset by reduced surgery over at least one year.
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Antiinfecciosos Locales/economía , Clorhexidina/economía , Preparaciones de Acción Retardada/economía , Periodontitis/economía , Periodontitis/terapia , Adulto , Anciano , Análisis de Varianza , Antiinfecciosos Locales/administración & dosificación , Clorhexidina/administración & dosificación , Enfermedad Crónica , Raspado Dental/economía , Femenino , Humanos , Formulario de Reclamación de Seguro , Modelos Lineales , Masculino , Persona de Mediana Edad , Oportunidad Relativa , Estudios Prospectivos , Método Simple CiegoRESUMEN
This study evaluated the use OF bioactive glass (BG) for repairing/regenerating periodontal intrabony defects. Fourteen systemically healthy patients participated. Each patient had 2 contralateral sites with > or = 6 mm clinical probing depth and radiographic evidence of an intrabony defect. One defect was treated with flap debridement plus BG (test) and the other with flap debridement alone (control). Baseline measurements included gingival index (GI), plaque index (PI), position of the free gingival margin (S/FGM), clinical attachment level (CAL), probing depth (PD), and mobility. At the time of surgery and at surgical reentry (9 to 13 months later), hard tissue measurements included: stent to defect base, bone crest to defect base, and defect width at the bone crest. One-way repeated ANOVA was used to analyze the treatment effect. Friedman's test was used to detect any significant changes of GI, PI and mobility at different time periods (baseline, 3 months, 6 months, and reentry). For multivariate analysis, the random coefficients mixed effect model was applied to adjust the intra-correlation effect. Both treatments resulted in decreased PD and gain of CAL. These changes were only significant (P < 0.05) for the BG treated sites (PD reduction = 1.24+/-0.43 mm, CAL gain = 0.87+/-0.38 mm) from baseline. Defect fill was significant for test (1.1+/-0.4 mm) and control (1.4+/-0.4 mm) alike (P < or = 0.01). Although BG treated sites had more PD reduction and CAL gain than debridement only controls, there were no statistically significant differences between groups for any parameter measured. Further studies are required to clarify the beneficial effects, if any, of BG alloplast in treating periodontal intrabony defects.
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Pérdida de Hueso Alveolar/cirugía , Sustitutos de Huesos/uso terapéutico , Cerámica/uso terapéutico , Adulto , Anciano , Análisis de Varianza , Desbridamiento , Índice de Placa Dental , Estudios de Evaluación como Asunto , Femenino , Estudios de Seguimiento , Recesión Gingival/cirugía , Regeneración Tisular Guiada Periodontal/métodos , Humanos , Masculino , Persona de Mediana Edad , Análisis Multivariante , Pérdida de la Inserción Periodontal/cirugía , Índice Periodontal , Bolsa Periodontal/cirugía , Colgajos Quirúrgicos , Movilidad Dentaria/cirugíaRESUMEN
In vitro cytotoxicity studies of periodontal dressings have not generally produced a result consistent with in vivo observations. These prior in vitro studies have not used human intraoral cell lines. We tested the effects of two eugenol containing and two non-eugenol periodontal dressings on cultured human gingival fibroblasts (HGF) (ATCC #1292). Replicate HGF cultures grown in microtiter plates were exposed to stock, 1:4 and 1:16 dilutions of extracts made from each of the four periodontal dressings. The HGF cultures were pulse labelled with tritiated thymidine (3HTdR) after 24, 48, and 72 hours. Incorporations of the labelled thymidine were measured using liquid scintillation counting and expressed as counts per minute. The results showed that undiluted extracts from all four periodontal dressings totally inhibited 3HTdR uptake (P less than 0.05). The 1:4 dilution of eugenol dressings inhibited 3HTdR uptake significantly more than non-eugenol dressings (P less than 0.05). Interestingly, at 72 hours the 1:16 dilution of the non-eugenol dressings caused significantly increased 3HTdR uptake which was not observed with the eugenol dressings. The present results suggest that the use of a human fibroblastic cell line for testing the effects of periodontal dressings may provide information about the relative biological effects of these dressings. Using this cell line, we have found that eugenol dressings inhibit fibroblast proliferation to a greater extent than non-eugenol dressings.