Endoscopic vs. tactile evaluation of subgingival calculus.

PURPOSE: Endoscopic technology has been developed to facilitate imagery for use during diagnostic and therapeutic phases of periodontal care. The purpose of this study was to compare the level of subgingival calculus detection using a periodontal endoscope with that of conventional tactile explorer in periodontitis subjects. METHODS: A convenience sample of 26 subjects with moderate periodontitis in at least 2 quadrants was recruited from the University of Minnesota School of Dentistry to undergo quadrant scaling and root planing. One quadrant from each subject was randomized for tactile calculus detection alone and the other quadrant for tactile detection plus the Perioscope ™ (Perioscopy Inc., Oakland, Cali). A calculus index on a 0 to 3 score was performed at baseline and at 2 post-scaling and root planing visits. Sites where calculus was detected at visit 1 were retreated. T-tests were used to determine within-subject differences between Perioscope™ and tactile measures, and changes in measures between visits. RESULTS: Significantly more calculus was detected using the Perioscope™ vs. tactile explorer for all 3 subject visits (p<0.005). Mean changes (reduction) in calculus detection from baseline to visit 1 were statistically significant for both the Perioscope™ and tactile quadrants (p<0.0001). However, further reductions in calculus detection from visit 1 to visit 2 was only significant for the Perioscope™ quadrant (p<0.025), indicating that this methodology was able to more precisely detect calculus at this visit. CONCLUSION: It was concluded that the addition of a visual component to calculus detection via the Perioscope™ was most helpful in the re-evaluation phase of periodontal therapy.

A pilot study comparing the outcome of scaling/root planing with and without Perioscope™ technology.

PURPOSE: The purpose of this study was to determine if the use of a periodontal endoscope improves periodontal outcomes of scaling/root planing when compared to scaling/root planing alone. METHODS: Thirty subjects with moderate periodontitis were recruited from the University of Minnesota School of Dentistry. Of these, 26 completed the study. A randomized split mouth design was used to evaluate periodontal outcomes at 6 to 8 weeks and 3 month intervals after sites within 2 quadrants of each subject were scaled and root planed with or without the use of the Perioscope™. Paired t-tests were used to test whether there were within-patient differences in improvement between Perioscope™ and non-Perioscope™ sites as measured by periodontal measurements (probing depth, clinical attachment level) and indices of gingival inflammation, including bleeding on probing (BOP) and gingival inflammation (GI). P-values less than 0.05 were declared to be statistically significant. RESULTS: Less BOP and GI were found in the Perioscope™ sites at visit 1 and visit 2. Reduction in pocket depth and clinical attachment loss was achieved for all sites but probing depth and clinical attachment level changes were found to be unrelated to the use of the Perioscope™. Mean probing depth (SD) was reduced from 5.29 mm (0.4) to 3.55 mm (0.8) in the Perioscope™ sites and 5.39 mm (0.5) to 3.83 mm (1.2) in non-Perioscope™ sites from baseline measurements to visit 2. CONCLUSION: The adjunctive use of the periodontal endoscope improved periodontal outcomes with respect to gingival inflammation and bleeding upon probing. The adjunctive use of the Perioscope™ was not found to be superior to traditional scaling and root planing with regard to pocket depth reduction and clinical attachment loss.

WNT5A expression increases during melanoma progression and correlates with outcome.

PURPOSE: Wnt ligands play a major role in development and are important in cancer. Expression microarray analysis correlates one member of this family, WNT5A, to a subclass of melanomas with increased motility and invasion. There are no large studies of clinical samples primarily addressing the importance of WNT5A in melanoma progression or outcome. Therefore, this study aimed to assess the protein expression of WNT5A during melanoma progression and its effect on outcome. EXPERIMENTAL DESIGN: Expression of WNT5A was determined in a series of 59 primary melanomas with matched metastases. To provide a benchmark of progression against which to assess WNT5A, expression of p16(ink4a) was analyzed, as this has been previously well documented in melanoma. The effect of WNT5A protein expression on outcome was assessed in 102 melanomas. RESULTS: Cytoplasmic WNT5A showed a trend of increasing expression with melanoma progression (P = 0.013), whereas there was diminishing p16(ink4a) expression (P = 0.006). Nevi showed relatively strong WNT5A expression. Strong cytoplasmic WNT5A was an independent risk factor for reduced metastasis-free and overall survival in multivariate analysis (P = 0.001 and 0.003, respectively). CONCLUSION: Cytoplasmic WNT5A increases with melanoma progression and strong expression is associated with poor outcome.

A preliminary study of intra-pocket topical versus injected anaesthetic for scaling and root planing.

AIM: Compare the efficacy of topical benzocaine gel to injected lidocaine during scaling and root planing. MATERIALS AND METHODS: In each of 21 participants undergoing root planing, two dental quadrants were randomly assigned to receive topical 20% benzocaine gel delivered subgingivally (TOP) or injection anaesthesia using 2% lidocaine (INJ). Baseline, intra- and immediate post-operative pain was assessed using the Heft-Parker pain scale. Intra-subject differences (INJ-TOP) were analysed using paired t-tests and mixed models. RESULTS: Baseline and post-operative pain did not differ between treatments (p>0.50). The injected anaesthetic, however, was associated with less intra-operative pain than the topical (INJ-TOP=-24.9 mm, p=0.005) Six participants required rescue (injected) anaesthesia during treatment with the topical. Eleven participants (52%) preferred topical over injected anaesthetic. Among these 11, intra-operative pain scores did not differ significantly (TOP=38.6 mm, INJ=28.4 mm, p=0.23). Among those who preferred the injected anaesthetic, intra-operative pain scores differed significantly (TOP=84.7 mm, INJ=43.8 mm, p=0.03). CONCLUSIONS: Intra-pocket benzocaine gel is less effective than injected lidocaine in controlling pain during scaling and planing. Anaesthetic preference was related to the level of pain experienced during treatment with the topical. Larger studies are needed to confirm these findings.

Predictive validity of critical thinking skills for initial clinical dental hygiene performance.

This study collected validity evidence on the utility of critical thinking skills and critical thinking disposition in predicting initial clinical performance. The predictive value of critical thinking skills scores and disposition scores was examined to determine their unique contribution beyond that provided by traditional predictors: grade point average, age, and number of college hours. The study involved three phases: establishing content validity of three outcome measures; assessing students' baseline critical thinking skills and disposition using the California Critical Thinking Skills Test (CCTST) and the California Critical Thinking Dispositions Inventory (CCTDI); and assessing students' initial clinical competence, clinical reasoning, and clinical knowledge. All baccalaureate-level dental hygiene programs in the United States affiliated with a dental school (N=22) were invited to participate; of those, seven volunteered. A convenience sample of 207 first-year dental hygiene students was obtained. A series of hierarchical multiple regression analyses demonstrated that CCTST scores explained a statistically significant (p<.05) proportion of variance in students' initial clinical reasoning scores, acquired knowledge scores, and faculty ratings, above and beyond that explained by other predictor variables. CCTDI scores were not significant predictors of any outcome measure. It was concluded that CCTST is a good predictor of initial student outcomes and may have utility for student selection and retention.