Gingival tissue human beta-defensin levels in relation to infection and inflammation.

AIM: To profile gingival tissue levels of human beta-defensin (hBD)-2 and hBD-3 in relation to gingival inflammation, Th17-related cytokine concentrations, Porphyromonas gingivalis counts, and gingipain and total protease activities. MATERIALS AND METHODS: Gingival tissue and subgingival plaque samples were collected from 21 periodontitis patients including 48 periodontal pocket sites with marginal, mild, or moderate to severe inflammation. hBD levels were determined by immunodetection, P. gingivalis counts with real-time polymerase chain reaction, protease activities with fluorogenic substrates, and cytokine concentrations with Luminex technique. Data were statistically analysed using Kruskal-Wallis and Mann-Whitney U tests and Spearman correlation coefficients. RESULTS: Subgingival plaque counts of P. gingivalis (p = .001) and gingipain activity (p < .001), as well as interleukin (IL)-1ß (p = .012), IL-10 (p = .024), IL-17A (p = .002), IL-17F (p = .006), and IL-23 (p = .036) concentrations were elevated in severely inflamed sites, whereas no change was observed in hBD-2 and hBD-3 levels. Negative correlations were found between protease activity and hBD-2 (p = .033) and hBD-3(p = .003) levels. CONCLUSIONS: Shift in gingival inflammation from marginal to mild stage is related to elevations in subgingival plaque P. gingivalis counts and gingipain activity, but not to tissue hBD levels. Negative correlations between hBDs and total protease activity suggest the degradation of these antimicrobial peptides in progressed inflammation.

Implant-Site Related and Patient-Based Factors With the Potential to Impact Patients' Satisfaction, Quality of Life Measures and Perceptions Toward Dental Implant Treatment.

OBJECTIVES: The present study aimed at evaluating both the implant site-related and patient-based factors with the potential to affect the extent of patients' satisfaction and also their perceptions regarding dental implant treatment. Potential differences between the esthetic evaluations of dental patients and dental specialists were also considered. MATERIALS AND METHODS: Implant-supported fixed prosthesis (n = 164) in 264 anterior esthetic implant sites were included. Patients' satisfaction, esthetic considerations, and perceptions toward dental implants, were evaluated by both Oral Health Impact Profile-14 (OHIP-14) questionnaire and visual analog scale. Pink Esthetic Score/White Esthetic Score were used for the professional esthetic evaluations of dental specialists. RESULTS: Overall patient satisfaction was high (87.42 ± 11.86). Compared with implant supported single-tooth restorations, patients with implant-supported bridges had lower OHIP scores (P = 0.001) and were relatively less satisfied with particular aspects of dental implant treatment (eg, cleanability, phonetics, surgical discomfort, and pretreatment information). Generally, type of prosthesis, history of soft/hard tissue augmentation, and reason for tooth loss had a clear impact on the extent of patients' satisfaction, esthetic considerations regarding treatment outcome, and their perceptions toward dental implant treatment (P < 0.05). CONCLUSIONS: Fixed implant-supported restorations generally provide with high levels of satisfaction and oral health-related quality of life.

Practical Implementation of Evidence-Based Dentistry Into Daily Dental Practice Through a Short Time Dependent Searching Method.

INTRODUCTION: Despite the fact that the benefits of implementation of Evidence-Based Dentistry (EBD) into clinical practice is increasingly being highlighted, there are still clear limitations in its implementation into daily dental practice. One potentially important barrier to effective implementation into practice is the perception of EBD as a time-consuming process. The aim of the present study is to increase the familiarity of dental practitioners with the benefits of different time-dependent 'practical' search strategies important to EBD using a clinical question from the field of dental implantology as an example. MATERIALS AND METHODS: The PICO (population, intervention, comparison, outcome) question used in this study was: "In young adults with anterior single-tooth implant what is the effect of immediate or delayed loading on success?" A bibliographic search according to the Haynes 5S pyramid, together with 3 different time-dependent strategies (5-min, 30-min and more than 60-min), were applied. RESULTS: Both the Haynes 5S Pyramid and time-dependent search strategies revealed promising results for enhancing decision-making for determining the feasibility of immediate or conventional loading of anterior single dental implants. Results clearly showed that selection of the loading protocol would be case (patient)-specific and also indicated high primary implant stability and bone quality as the most important prerequisites for a successful immediate/early loading. From among the 3 different time-dependent strategies (5 min, 30 min and more than 60 min), the 60+ min search results were quite comparable with the Haynes pyramid search results. CONCLUSION: It is likely that the different time-dependent search strategies may have the potential to support the clinical decision making process and may improve the implementation of EBD into daily dental practice. Increased time spent searching naturally seems to increase the extent of this support. However, even with short time-dependent searches, busy dental clinicians may get an improved idea/opinion regarding a clinical question.

Implementation of evidence-based dentistry into practice: analysis of awareness, perceptions and attitudes of dentists in the World Dental Federation-European Regional Organization zone.

Based on evidence-based dentistry (EBD) being a relatively new concept in dentistry, the attitudes, perceptions and level of awareness of dentists regarding EBD, and perceived barriers to its implementation into daily practice, were comparatively analysed in six countries of the FDI (World Dental Federation-Federation Dentaire Internationale)-European Regional Organization (ERO) zone (France, Georgia, Poland, Portugal, Slovakia and Turkey). For this purpose, a questionnaire, 'The Relationship Between Dental Practitioners and Universities', was developed by the FDI-ERO Working Group and applied by National Dental Associations (NDAs). A total of 850 valid responses were received, and cumulative data, comparisons between countries and potential impact of demographic variables were analysed. Regarding EBD, similar percentages of respondents reported that they 'know what it is' (32.8%) and 'they practice' (32.1%). Most respondents believed that 'EBD is beneficial' (89.1%); however, they had different thoughts regarding 'who actually benefited from EBD'. Of the participants, 60% believed that 'dentists experience difficulties in implementing EBD'. Although lack of time, lack of education and limited availability of evidence-based clinical guidelines were among the major barriers, there were differences among countries (P<0.05). Significant differences were also observed between countries regarding certain questions such as 'where EBD needed to be taught' (P<0.05), as both undergraduate and continuing education were suggested to be suitable. Age, practice mode and years of practice significantly affected many of the responses (P<0.05). There was a general, positive attitude toward EBD; however, there was also a clear demand for more information and support to enhance dentists' knowledge and use of EBD in everyday practice and a specific role for the NDAs.

Oral health workforce planning part 2: figures, determinants and trends in a sample of World Dental Federation member countries.

BACKGROUND AND AIM: A range of factors needs to be taken into account for an ideal oral health workforce plan. The figures related to dentists, specialists, auxiliaries, practice patterns, undergraduate and continuing dental education, laws/regulations, the attitudes of oral health-care providers and the general trends affecting the practice patterns, work conditions and preferences of oral health-care providers are among such determinants. Thus, the aim of the present study was to gather such information from a sample of World Dental Federation (FDI) member countries with different characteristics. METHODS: A cross-sectional survey study was carried out among a sample of FDI member countries between March 2, 2012 and March 27, 2012. A questionnaire was developed addressing some main determinants of oral health workforce, such as its structure, involvement of the public/private sector to provide oral health-care services, specialty services, dental schools, trends in workforce and compliance with oral health needs, and a descriptive analysis was performed. The countries were classified as developed and developing countries and Mann-Whitney U-tests and chi-square tests were used to identify potential significant differences (P > 0.05) between developed and developing countries. All data were processed in SPSS v.19. RESULTS: In the18 questionnaires processed, the median number of dentists (P = 0.005), dental practices (P = 0.002), hygienists (P = 0.005), technicians (P = 0.013) and graduates per year (P = 0.037) was higher in developed countries. Only 12.5% of developed and 22.2% of developing countries reported having optimal number of graduates per year. It was noted that 66.7% of developing countries had more regions lacking enough dentists to meet the demand (P = 0.050) and 77.8% lacked the necessary specialist care (P = 0.015). Although developing countries reported mostly an oversupply of dentists, regardless of the level of development most countries did not report an oversupply of specialists. Most developed countries did not feel that their regulations (87.5%) complied with the needs and demands of the population and most developing countries did not feel that their undergraduate dental education (62.5%) complied. Migrating to other countries was a trend seen in developing countries, while, despite increased numbers of dentists, underserved areas and communities were reported. DISCUSSION: The cross-sectional survey study suggests that figures related to optimum or ideal oral health workforce and fair distribution of the available workforce does not seem to be achieved in many parts of the world. Further attention also needs to be dedicated to general trends that have the capacity to affect future oral health workforce.

Analysis of the attitudes and needs/demands of dental practitioners in the field of patient safety and risk management.

Patient safety is a relatively new discipline aimed at improving the quality of care, minimising treatment errors and improving the safety of patients. Although health professions always have a specific concern for patient safety, few practitioners have a clear understanding of the broad context and not all health-care providers practice it. This might well be because of limited availability of information and materials as well as a lack of national or international laws and regulations. Thus, through member National Dental Associations (NDAs) of FDI (World Dental Federation), the present study aimed at analysing the attitudes of dental practitioners to the issues of patient safety and risk management, and the availability of materials and laws and regulations. Determination of their specific needs and demands in these fields was also attempted. For this purpose, an online questionnaire was developed for the member NDAs to respond. Questions mainly focused on the awareness regarding patient safety, availability of materials and regulations and the particular topics for which dentists needed further knowledge and information. A total of 40 responses were received. While some countries lack any documents, patient safety documents and materials were available in some countries but they were mostly limited to infection control and radiation protection and did not address other important aspects of patient safety. The NDAs clearly demanded more information. A significant number of countries also lacked national laws and/or regulations regarding patient safety. Although dentistry always has a genuine concern for patient safety, the findings of the survey suggest that yet more efforts are needed to improve the knowledge, understanding and awareness of dental practitioners regarding its broad context and the relatively 'new' patient safety culture. NDAs, dental educators, national, regional and international dental organisations and health authorities all can play significant roles to achieve these goals.

Oral health workforce planning. Part 1: Data available in a sample of FDI member countries.

BACKGROUND & AIM: Workforce planning is a resource to measure and compare current versus future workforce. Organised dentistry needs to focus on the benefits and the determinants and various systems of workforce planning together with the challenges, new trends and threats. The aim of the study was to identify data sources from countries relating to a selection of oral health indicators in a sample of FDI member countries. The potential for differences between developed and developing countries was also examined. METHODS: A cross-sectional survey study was carried out among FDI member countries classified in developed and developing countries between October 2011 and January/February 2012. A questionnaire was developed addressing the availability of 40 selected indicators distributed in four domains. Mann-Whitney U-tests to identify differences between developed and developing countries and chi-square tests for the degree of information regularly available were carried out. RESULTS: There is an important lack of information about indicators relevant to oral health between FDI participating countries regardless of their level of economic development. Although not significant, the availability of indicators for developing countries showed higher variability and minimum values of zero for all domains. Surveys were the source of information more frequently reported. DISCUSSION: Standardised and reliable methodologies are needed to gather information for successful workforce planning. It is of utmost importance to increase the awareness and understanding of the member National Dental Associations regarding the role, basic elements, benefits, challenges, models and critical elements of an ideal workforce planning system.

Analysis of the extent and efficiency of the partnership and collaboration between the dental faculties and National Dental Associations within the FDI-ERO zone: a dental faculties' perspective.

BACKGROUND AND AIM: As National Dental Associations and dental faculties can be considered as the two major institutions representing national organised dentistry, their further extended collaboration is crucial in responding to the many global oral health matters and issues. The main aim of the present study is to analyse the nature and extent of the partnership between the dental faculties and NDAs. METHODS: A questionnaire was developed focusing on the relationship between National Dental Associations and the dental faculties within the World Dental Federation-European Regional Organisation zone regarding their major professional activities such as dental education, workforce issues, improvement of national oral health, science and knowledge transfer. The questionnaire was sent to 173 dental faculties within the countries in the European Regional Organisation zone. RESULTS: Response rate was 62/173 (35.8%). Major activities of dental faculties were listed as implementation of new technologies into practice (72%), followed by improvement of national oral health (65%), while the least involved activity was dental workforce issues (42%). The dental faculties perceived their relationship with the National Dental Associations as quite satisfactory in the field of continuing education and science and knowledge transfer. However, their relationship was suggested to need significant improvement when dealing with undergraduate dental education curriculum, dental workforce issues and negotiations with the authorities regarding professional matters/issues. DISCUSSION AND CONCLUSIONS: Despite the fact that there are differences between the perceived competences and responsibilities of the two bodies, the presence of so many potential areas of collaboration, the increasing expectations from the individual dentists/dental profession and the new challenges of the dental profession give this relationship significant importance. Communication, regular contacts, more joint activities and improved collaboration is needed between dental faculties and National Dental Associations to overcome such professional matters and issues.

Effect of inflammation on cytokine levels and bone remodelling markers in peri-implant sulcus fluid: a preliminary report.

OBJECTIVES: Since ingredients of peri-implant sulcus fluid (PISF) may be related to the bony structure surrounding dental implants, analyze of specific markers related to bone resorption in PISF seems to be suitable for long term monitoring of peri-implant health. It is suggested that analysis of PISF may serve for detection of inflammation. The aim of this study is to analyze PISF interleukin-1 beta (IL-1ß), IL-10, osteoprotegerin (OPG), receptor activator of nuclear factor-kappa B ligand (RANKL) levels to determine whether the diagnostic value of PISF can be used to evaluate early changes around implants. MATERIALS AND METHODS: A total of 47 dental implants either healthy/non-inflamed (n=20) (Group I), or gingivitis/inflamed (n=27) (Group II), were classified. Peri-implant status has been evaluated by clinical evaluation (plaque index, gingival index, probing depth and gingival bleeding time index) were recorded and PISF samples were also obtained. PISF IL-1ß, IL-10, RANKL, and OPG levels were measured by enzyme-linked immunosorbent assay. Potential volumetric changes in PISF were also evaluated. RESULTS: All clinical parameters and volume of PISF were higher in Group II and these differences were statistically significant except volume values. IL-1ß, IL-10 and OPG levels in PISF were significantly higher in Group II. Although the PISF RANKL level in Group II was higher than the level of Group I, the difference between groups did not reach the statistically significant level. CONCLUSIONS: These data suggest that a balance of inflammatory- and osteoclastogenesis related molecules locally produced may play an important role in the development of inflammatory peri-implant lesions.

Patient safety and dentistry: what do we need to know? Fundamentals of patient safety, the safety culture and implementation of patient safety measures in dental practice.

Although concern for patient safety is inherent to the practice of the health care professions, its transformation into a specific body of knowledge is relatively recent and thus patient safety may be considered as a comparatively 'new' discipline. Its main objectives are to avoid the occurrence of preventable adverse events (accidents, errors and complications) associated with health care and to limit the impact of inevitable adverse events. Despite these simple definitions, patient safety is multifaceted, quite complex in nature and includes many key elements. Thus, it cannot be simply defined as the provision of safe health care or the protection of patients from harm by health care providers because there are economic, fiscal, social, cultural and organisational aspects of a patient safety climate. It is essential for all health care practitioners and health care organisations to become more familiar with the general context of patient safety, to actively participate in efforts to implement patient safety measures in daily practice and to establish a patient safety culture.

Comparative analysis of gingival wetness at natural teeth and dental implant sites.

BACKGROUND: "Gingival Wetness (GW)," which is the thickness of residual saliva on gingiva, functions as a moisture retainer and a protective barrier for microbial colonization. Whether dental implant (DI) treatment affects GW scores and whether gingival inflammation has the capacity to alter GW remains unknown. Thus, this study was designed to evaluate the potential impact of DI treatment on GW. METHODS: A total of 118 DIs and natural teeth (NT) sites were comparatively analyzed. Clinical periodontal and periimplant status were determined. Sites were classified into 2 subgroups based on the clinical inflammatory status as inflamed or noninflamed. GW was measured by standardized paper strips and quantified by micromoisture meter. RESULTS: Gingival index, clinical attachment loss, plaque index, and gingival bleeding time index scores were generally lower at DI sites. Significant differences were seen in clinical attachment loss, plaque index, and gingival bleeding time index in inflamed sites, presenting higher scores for NT. Comparable values were observed for DI and NT regarding GW for all sites. No differences were noticed in GW scores between the noninflamed NT and DI sites and also wheninflamed sites were concerned. CONCLUSIONS: DI treatment does not seem to result in any apparent reduction in GW. Thus, it can be speculated that similar protective processes may occur at dental implant and NT sites. Furthermore, GW does not seem to depend on the local inflammatory status of the soft tissues.

Collaboration between dental faculties and National Dental Associations (NDAs) within the World Dental Federation-European Regional Organization zone: an NDAs perspective.

Although improvements in certain oral health measures have been achieved, many global oral health matters and challenges exist. Collaborations and partnerships among various institutions are crucial in solving such problems. The main aim of the present study was to analyse the nature and extent of the partnership between dental faculties and National Dental Associations (NDAs). A questionnaire was developed, focusing on the relationship between NDAs and dental faculties within the World Dental Federation-European Regional Organization (FDI-ERO) zone with regard to major professional activities, such as dental education (both undergraduate and continuing education), workforce issues, improvement of national oral health, and science and knowledge transfer. The questionnaire was sent to all member NDAs within the ERO zone. The response rate was 21/41 (53.65%). The major activities in which NDAs were found to be involved were improvement of national oral health (100%), followed by continuing education activities (90%), whereas the activity which received least involvement was the development of an undergraduate dental curriculum (52%). The NDAs perceived their relationship with dental faculties to be quite satisfactory in the fields of continuing education, science and knowledge transfer, and the implementation of new technologies into daily dental practice. However, it was suggested that their relationship needed significant improvement with regard to the development of an undergraduate dental education curriculum, dental workforce issues and negotiations with the authorities regarding professional matters/issues. As the two important elements of organised dentistry, NDAs and dental faculties have a significant role to play in the improvement of oral health and in finding solutions to global oral health challenges; therefore, their collaboration and partnership are crucial for this purpose. On the basis of the perceptions of NDAs regarding their relationship with dental faculties, it can be concluded that their partnership can and should be further improved.

Unmet need for education by professionals and inconsistency in knowledge and behavior of dental patients.

In order to identify what knowledge dental patients have of oral health and to analyze the potential relationship between knowledge, behavior and oral health status, 250 randomly selected patients were asked to complete a self-administered questionnaire. Responses were analyzed based on the age, gender and educational status of participants. It was determined that oral health-related behavior and knowledge were generally inadequate. Although knowledge had some influence on behavior, this was not constantly observed. The unmet need of patients with regard to getting information from professional resources emphasizes the need for dental professionals to dedicate more time to prevention and the promotion of oral health through efficient strategies.

Eleven Basic Procedures/Practices for Dental Patient Safety.

OBJECTIVES: This study aimed to help alleviate the shortage of reliable information on clinical care issues; the Spanish Observatory of Dental Patient Safety (OESPO) has resorted to the study of legal claims by patients and searched those which produced clinical problems. METHODS: Based on OESPO data, this article proposes 11 basic procedures/practices for dental patient safety to help mitigate most preventable adverse events. RESULTS: The sample of the OESPO is large (415 adverse events studied), but it has the bias of a judicial source. However, the results provide an interesting approach to clinical safety in dentistry. When studying in detail the causes that led to preventable adverse events, it can be seen that most of these (and most severe) events have been caused by a small number of erroneous behaviors. CONCLUSIONS: Most preventable adverse events during the dental health care are produced by a relatively small number of causes. Therefore, a few basic safety procedures can reduce significantly these preventable adverse events.

A 12-month evaluation of nitrite oxide metabolism around immediate and conventionally loaded dental implants.

BACKGROUND: During bone remodeling, alignment of bone is affected by loading direction. Considerable amount of data also suggest nitric oxide (NO) to be involved in bone metabolism. This study was conducted to evaluate the potential changes in NO metabolism in relation to the loading style of dental implants by analyzing the nitrite content of peri-implant sulcus fluid. METHODS: Dental implants were placed in 12 patients who had first molar loss bilaterally in the mandibular area. One site of the patient determined as immediately loaded and the other side were conventionally loaded. Clinical parameters were recorded and peri-implant sulcus fluid samples were obtained. Peri-implant sulcus fluid nitrite levels were spectrophoto-metrically determined. Clinical measurements and nitrite analysis were repeated at 1, 3, 6, 9, and 12 months. RESULTS: In both groups, there was a reduction between baseline and 12 months in all clinical parameters, except probing depth. Although, steady decrease was noticed in total nitrite levels during the whole experimental period in immediately loaded implants, more fluctuations were observed in conventionally loaded ones. CONCLUSIONS: The findings of this 12-month follow-up study support the association of NO in the bone metabolism around dental implants and further suggest the impact of different loading regimens on NO metabolism.

The impact of prosthetic design on the stability, marginal bone loss, peri-implant sulcus fluid volume, and nitric oxide metabolism of conventionally loaded endosseous dental implants: a 12-month clinical study.

BACKGROUND: Further clarification of the early and late response of peri-implant tissues to surgical insertion and loading of dental implants and the potential associations among the various implant-related measures are likely to improve the evaluation/monitoring of implant sites. Thus, analyses were made of the volume and nitric oxide (NO) profile of peri-implant sulcus fluid (PISF), implant stability, and marginal bone level in relation to different prosthetic designs. METHODS: Seven totally edentulous subjects and 11 partially edentulous subjects were included. Resonance frequency analysis (RFA), marginal bone level measurements, PISF volume, and spectrophotometrically determined nitrite levels were analyzed comparatively at conventionally loaded (CL) implant sites and at implants with removable prostheses (RP; N = 14) and fixed prostheses (FP; N = 11) for a period of 12 months. RESULTS: At implant sites with RP, PISF volume decreased gradually and its lowest level occurred at the end of the experimental period. The PISF nitrite content increased until 6 months and was followed by a significant decrease at 12 months. Compared to baseline, RFA values exhibited a significant decrease at 1 and 3 months. Marginal bone level was significantly lower at all follow-up visits compared to baseline. More volumetric fluctuations of PISF was noted at implant sites with FP. The PISF nitrite content had decreased, compared to baseline, at 6, 9, and 12 months. A general stability was observed for RFA. The marginal bone loss observed at 6 months was followed by a gain at 12 months. An inverse relationship was noted between RFA values and marginal bone levels. CONCLUSION: The prosthetic design particularly seems to affect the NO metabolism around CL implants, whereas it does not seem to have any impact on the stability of dental implants.

Myeloperoxidase as a measure of polymorphonuclear leukocyte response in inflammatory status around immediately and delayed loaded dental implants: a randomized controlled clinical trial.

BACKGROUND: As well as gingival crevicular fluid (GCF), peri-implant sulcus fluid (PISF) may have a potential diagnostic value for the early identification of metabolic and destructive processes. PURPOSE: The aim of this study was to analyze the potential impact of inflammation and loading on PISF myeloperoxidase (MPO) levels, in comparison with GCF. MATERIALS AND METHODS: A total of 220 sites, dental implant (immediately [IL] or delayed loaded [DL]), and natural tooth, either healthy/noninflamed or gingivitis/inflamed, were classified. Clinical parameters were recorded, and GCF/PISF samples were obtained. GCF/PISF MPO levels were spectrophotometrically determined. RESULTS: Clinical parameters demonstrated increases with the presence of gingival/peri-implant inflammation. Total MPO levels were higher at inflamed tooth and implant sites compared to noninflamed/healthy sites (p < .05). Although they did not reach a significance level, inflamed IL sites had higher total MPO levels than inflamed DL sites (p = .401). Gingival index and total MPO levels exhibited significant correlations (p < .05). CONCLUSION: Using implants and natural teeth in the same study design, the findings of the present study support the close relationship between MPO production and inflammation, and may speculate a potential for loading of dental implants, contributing to the MPO content of PISF.

Clinical Guidelines and Implementation into Daily Dental Practice.

INTRODUCTION: The purpose of this study is to assess the extent of the familiarity, attitude and perceptions of dental professionals regarding clinical dental guidelines and their implementation into daily dental practice. MATERIAL AND METHODS: For this purpose, a questionnaire which was developed by the members of the World Dental Federation, European Regional Organization Working Group - 'Relation Between Dental Practitioner and Universities', was implemented by the National Dental Associations of six European Regional Organization-zone countries (Georgian Stomatological Association - Georgia, Associazione Nazionale Dentisti Italiani - Italy, Portuguese Dental Association - Portugal, Russian Dental Association - Russia, Swiss Dental Association - Switzerland, and Turkish Dental Association - Turkey. The questionnaire was filled by a total of 910 dental professionals who are members of one of these national dental associations and who voluntarily wanted to participate to this survey. RESULTS: Most of the survey participants were familiar with clinical dental guidelines (68%), claimed that they implemented them into daily practice (61.7%), and generally acknowledged their benefits (81.8%). Many participants believed that clinical dental guidelines could help to improve the clinical treatment plan (50.6 %) and the accuracy of diagnosis (39.4%); which increased with age and years of practice (p < 0.05). The most frequently perceived barrier to the effective implementation of clinical dental guidelines was expressed as 'lack of awareness', while participants suggested a role for national dental associations in spreading clinical dental guidelines. DISCUSSION: A better understanding of the perceptions and attitudes of dentists towards clinical dental guidelines and the potential impact of factors affecting such perceptions and attitudes may be of particular importance for attempts aiming at overcoming the barriers for effective implementation of clinical dental guidelines into daily practice. CONCLUSION: Despite a significant familiarity and a common positive attitude, dental professionals are likely to have different perceptions towards clinical dental guidelines, especially regarding their effective implementation into daily practice, benefits and barriers.

Introdução: Este estudo tem como objetivo avaliar a abrangência da familiaridade, das atitudes e das perceções dos profissionais da área da saúde oral em relação às normas clínicas dentárias e a sua implementação na prática da Medicina Dentária diária. Material e Métodos: Com esta finalidade, desenvolveu-se um questionário pelos membros da Federação Dentária Mundial, pelo Grupo de Trabalho da Organização Regional Europeia - "Relação entre Médicos Dentistas e as Universidades" e, foi implementado pelas Associações de Medicina Dentária/Estomatologia Nacionais de seis países da Organização Regional Europeia (Associação Estomatológica da Geórgia - Geórgia, Associação Nazionale Dentisti Italiani - Itália, Ordem dos Médicos Dentistas - , Associação Dentária Russa - Rússia, Associação Dentária Suíça - Suíça e Associação Dentária Turca - Turquia. O questionário foi preenchido por um total de 910 profissionais da área da saúde oral, membros de uma dessas associações de medicina dentária/estomatologia Nacionais e que, voluntariamente quiseram participar neste inquérito. Resultados: A maioria dos entrevistados estava familiarizada com os normas clínicas dentárias (68%) e implementam-nas na clínica diária (61,7%) reconhecendo os seus benefícios (81,8%). Muitos participantes acreditavam que as normas clínicas dentárias poderiam ajudar a melhorar o plano de tratamento clínico (50,6%) e a precisão do diagnóstico (39,4%); que aumentou com a idade e os anos de prática (p < 0,05). A barreira mais frequentemente percecionada para a implementação efetiva dos normas clínicas dentárias foi expressa como 'falta de conscientização'. Os participantes sugeriram o papel das associações de medicina dentária/estomatologia nacionais na disseminação das normas clínicas dentárias. Discussão: Uma melhor compreensão das atitudes e perceções dos médicos dentistas em relação às normas clínicas dentárias, e do impacto potencial dos fatores que afetam tais atitudes e perceções, pode ser particularmente importante tendo em vista a necessidade de superar as barreiras existentes quando da implementação efetiva das normas clínicas dentárias na clínica diária. Conclusão: Apesar da familiaridade significativa e de uma atitude positiva comum, os profissionais de saúde oral têm perceções diferentes em relação às normas clínicas dentárias, especialmente em relação à sua implementação efetiva na prática diária, benefícios e barreiras.

Impact of the distinct sampling area on volumetric features of gingival crevicular fluid.

BACKGROUND: Volumetric features of gingival crevicular fluid (GCF) are under the influence of many factors, including sampling variables. Standardizing such factors may enable a more precise methodology. Thus, analysis of the possible impact of the clinical periodontal status and the distinct location of sampling sites on fluid volume was performed. METHODS: Clinical parameters were recorded, and fluid samples were obtained from 931 maxillary sites. The potential site-specific volumetric differences among healthy, gingivitis, and periodontitis sites; between multirooted or single-rooted teeth and mesio-buccal or disto-buccal sampling sites; and the correlations between volume and clinical measures were statistically analyzed. RESULTS: Although volume increased in a disease-related pattern (healthy < gingivitis < periodontitis; P <0.05), the distribution range of volume was widespread, with prominent overlaps between the different clinical periodontal conditions. Multirooted teeth presented more fluid volume, and even mesio-buccal or disto-buccal sites exhibited some volumetric differences (P <0.05). Constant correlations between volume and clinical parameters could be observed only at gingivitis sites (P <0.05). CONCLUSIONS: The spectrum of fluid volume is disease related in general. However, the wide range of volumetric distribution, the site-specific nature, and the clear impact of the distinct sampling site on volume are important volumetric features of this biologic fluid. Whenever possible, standardization of the extent of probing depth, degree of gingival inflammation, and distinct sampling area is likely to improve the reliability of GCF methodology.