Considerations in the diagnosis of oral hairy leukoplakia-an institutional experience.

OBJECTIVE: We report here the 10-year experience with oral hairy leukoplakia (OHL) at the Division of Oral and Maxillofacial Pathology at the University of North Carolina at Chapel Hill, NC, USA. STUDY DESIGN: All the associated hematoxylin and eosin and Epstein-Barr virus encoding region in situ hybridization slides of OHL cases between January 1, 2008, and February 1, 2017, were retrieved and reviewed. Collected demographic characteristics, clinical presentation, medical and social histories were reviewed and reported. RESULTS: Six OHL cases with confirmed in situ hybridization showed predilection for the lateral tongue. The study included 3 females and 3 males (mean age 50.5 years; age range 29-70 years). One patient had known HIV-positive status before biopsy was performed. Three patients had reported a history of heavy smoking. Other medical conditions reported were history of breast cancer, a long history of corticosteroid inhaler use for asthma treatment, high cholesterol, diabetes, and hypertension. CONCLUSIONS: The findings of this study indicate the need to include OHL as a potential entity in the differential diagnosis of leukoplakic tongue lesions, regardless of the patient's HIV status. In addition, the presence of OHL in the patient requires investigation of various explanations for EBV infection, including immunosuppression caused by HIV infection or chronic steroid use.

Molar root-incisor malformation: considerations of diverse developmental and etiologic factors.

OBJECTIVE: The objective of this study was to evaluate the variation in the condition referred to as molar root-incisor malformation (MRIM) and elucidate the distribution of affected teeth. This study further aimed to identify associated environmental stressors. STUDY DESIGN: Individuals were identified through retrospective review of dental radiographs and through referral to the investigators. Histologic evaluation included examination of mineralized and decalcified sections of affected first permanent molar teeth. RESULTS: Thirty cases of MRIM were identified, with all having affected first permanent molars with dysplastic root formation. The primary second molars were affected in 57% of the cases, with permanent anterior teeth being involved in 40% of the cases. A variety of medical conditions were associated with MRIM, the most common being neurologic. Several affected individuals reported no significant past medical history or environmental stressors. CONCLUSIONS: The etiology of MRIM remains unclear, and this unique developmental defect of the first permanent molar roots appears to occur in populations throughout the world. Clinicians identifying the MRIM phenotype should carefully evaluate the permanent incisors for associated developmental defects that could result in pulpal necrosis.

Portuguese Dentists' Attitudes Towards Their Role in Addressing Obesity.

PURPOSE: To determine Portuguese dentists' role in addressing obesity. MATERIALS AND METHODS: For this pilot study, the original version of the Dentists' Role In Addressing Obesity questionnaire was translated from English into Portuguese and validated to ensure that it was culturally adapted for Portuguese dentists. The questionnaire was distributed to a random sample of 400 Portuguese dentists. SPSS Statistics 20 was used to analyse the survey sampling design and assess respondents' attitudes and opinions, outcome expectations and self-efficacy both as ordinal and dichotomised variables. The analysis was a descriptive statistic based on frequencies, without symmetry test. RESULTS: In all, 141 dentists responded. Overall, 22.0% of respondents offered a form of counseling services and 58.9% reported that they were interested in offering obesity-related services. A paucity of trained personnel (58.9%) was cited by the respondents as a major barrier, followed by patients' rejection of weight-loss advice (32.6%) and fears of offending patients (29.1%). 92% of respondents agreed that dentists would be more willing to intervene if obesity were linked to oral disease. CONCLUSION: Healthcare providers must coordinate prevention and interventional efforts for maximum effect. Given the positioning of dentists willing to assist in such an effort, it appears reasonable for experts in obesity intervention in conjunction with dental educators to develop intervention models to be implemented within the scope of the dental practice.

Topical application of a mucoadhesive freeze-dried black raspberry gel induces clinical and histologic regression and reduces loss of heterozygosity events in premalignant oral intraepithelial lesions: results from a multicentered, placebo-controlled clinical trial.

PURPOSE: Approximately 30% higher grade premalignant oral intraepithelial neoplasia (OIN) lesions will progress to oral cancer. Although surgery is the OIN treatment mainstay, many OIN lesions recur, which is highly problematic for both surgeons and patients. This clinical trial assessed the chemopreventive efficacy of a natural product-based bioadhesive gel on OIN lesions. EXPERIMENTAL DESIGN: This placebo-controlled multicenter study investigated the effects of topical application of bioadhesive gels that contained either 10% w/w freeze-dried black raspberries (BRB) or an identical formulation devoid of BRB placebo to biopsy-confirmed OIN lesions (0.5 g × q.i.d., 12 weeks). Baseline evaluative parameters (size, histologic grade, LOH events) were comparable in the randomly assigned BRB (n = 22) and placebo (n = 18) gel cohorts. Evaluative parameters were: histologic grade, clinical size, and LOH. RESULTS: Topical application of the BRB gel to OIN lesions resulted in statistically significant reductions in lesional sizes, histologic grades, and LOH events. In contrast, placebo gel lesions demonstrated a significant increase in lesional size and no significant effects on histologic grade or LOH events. Collectively, these data strongly support BRB's chemopreventive impact. A cohort of very BRB-responsive patients, as demonstrated by high therapeutic efficacy, was identified. Corresponding protein profiling studies, which demonstrated higher pretreatment levels of BRB metabolic and keratinocyte differentiation enzymes in BRB-responsive lesions, reinforce the importance of local metabolism and differentiation competency. CONCLUSIONS: Results from this trial substantiate the LOH reductions identified in the pilot BRB gel study and extend therapeutic effects to significant improvements in histologic grade and lesional size.

Clinical and histological findings of denture stomatitis as related to intraoral colonization patterns of Candida albicans, salivary flow, and dry mouth.

PURPOSE: Multifactorial etiological factors contribute to denture stomatitis (DS), a type of oral candidiasis; however, unlike other oral candidiasis, DS can occur in a healthy person wearing a denture. In this study, we therefore attempt to explore the association between candida, denture, and mucosal tissue using (1) exfoliative cytology, (2) the candidal levels present in saliva, on mucosal tissues and on denture surfaces, and (3) the salivary flow rate and xerostomic symptoms. MATERIALS AND METHODS: A cross-sectional study enrolled 32 edentulous participants, 17 without DS as controls and 15 with DS (Newton's classification type II and III). Participants with systemic or other known oral conditions were excluded. Participants completed a xerostomia questionnaire, and salivary flow rates were measured. Samples of unstimulated whole saliva (UWS) and stimulated whole saliva (SWS) were collected. UWS was used for fungal culturing. Periodic acid-Schiff (PAS) stain and quantitative exfoliative cytology were performed on samples from affected and unaffected mucosa from each participant. Levels of Candida species (albicans and non-albicans) were determined in salivary samples (expressed as colony-forming units, CFU), as well as from swab samples obtained from denture fitting surfaces, in addition to affected and unaffected mucosa. RESULTS: There were no significant differences in salivary flow rates, mucosal wetness, or frequency of reported dry mouth comparing participants with and without DS. Exfoliative cytology of mucosal smears demonstrated significantly higher (p= 0.02) inflammatory cell counts in DS patients, as compared with smears of healthy denture-wearers. Candida albicans was significantly more prevalent in saliva (p= 0.03) and on denture surfaces (p= 0.002) of DS participants, whereas mucosal candidal counts and the presence of cytological hyphae did not show significant difference comparing DS to healthy participants. CONCLUSIONS: In this investigation, we presented a unique group of healthy edentulous patients. This population may reflect the general DS population without systemic or other oral diseases. The prominent etiological factor for DS in this population is the presence of candida in denture and saliva. We found that other factors such as saliva flow/xerostomia, fitting of the denture, and the presence of candida in the mucosa, are less important in this population. Therefore, DS treatments in healthy patients should first focus on sanitization of an existing denture and/or fabrication of a new denture.

A randomized controlled trial of the effect of standardized patient scenarios on dental hygiene students' confidence in providing tobacco dependence counseling.

PURPOSE: Dental hygienists report a lack of confidence in initiating Tobacco Dependence Counseling (TDC) with their patients who smoke. The purpose of this study was to determine if the confidence of dental hygiene students in providing TDC can be increased by Standardized Patient (SP) training, and if that confidence can be sustained over time. METHODS: This 2-parallel group randomized design was used to compare the confidence of students receiving SP training to stu dents with no SP training. After a classroom lecture, all subjects (n=27) received a baseline test of knowledge and confidence. Subjects were randomly assigned to test and control groups with equivalent mean knowledge scores. The test group subjects participated in a SP TDC session. Both groups gained parallel experience to treating patients who were smokers and giving TDC in clinical scenarios during the 6 month time period. One week end-training and 6 month post-training assessments were administered to both groups. ANCOVA compared mean confidence scores. RESULTS: End-training scores at 1 week showed a statistically significant increase (p=0.002) in overall mean confidence following SP training for individuals in the test group. The 6 month follow-up test results showed a slight decline in confidence scores among subjects in the test group and an overall gain in confidence for control group participants. However, overall confidence scores were comparable for the groups. CONCLUSION: SP training improved dental hygiene students' initial confidence in providing TDC and was sustained, but not to a significant degree. Clinical experience alone increased confidence. Further studies may help determine how the initial confidence gained by SP training can be sustained and what the role of clinical experience plays in overall confidence in providing TDC.

US pediatric dentists' counseling practices in addressing childhood obesity.

PURPOSE: Pediatric dentists could be in an excellent position to identify and intervene early for children at high risk for overweight or obesity; however, current practices and attitudes are uncertain. This study's purpose was to explore the practices and attitudes of pediatric dentists regarding weight-and caries-related counseling. METHODS: Data were analyzed from 1,779 pediatric dentists responding to a 2008-09 survey of 4,154 randomly selected pediatric and 3,846 general dentists. Data were weighted to account for unequal probability of selection and nonresponse rates among regions and dentist types. RESULTS: Sixty-five percent of respondents reported increased proportions of overweight/obese pediatric patients since they began practice, and approximately 9% offered weight-related counseling. By contrast, approximately 80% provided caries-related counseling. Major barriers to providing weight-related counseling included fears of offending parents/patients (~54%) and appearing judgmental (~53%), lack of patient acceptance of weight-loss advice from dentists (~47%), not enough trained personnel to provide counseling (~43%), and insufficient time (~28%). Multivariable predictors of providing weight-related counseling included female sex, Hispanic ethnicity, nongroup practice setting, practice ownership, and dentist self-reported normal- or underweight status. CONCLUSIONS: Primary barriers to weight-related counseling cited by pediatric dentists reflect concerns about offending patients and caregivers. Training and counseling addressing these concerns may help boost counseling rates.

Randomized controlled trials: what are they and who needs them?

Dentistry is rapidly entering a new era of evidence-based practice, and society is demanding prevention and treatment that has been proven to be effective in terms of meaningful health outcomes. Practitioners, individual patients and the public need randomized controlled trials because they provide the highest level of scientific evidence to change clinical practice and inform public health policy. Well-designed randomized controlled trials are conceptually simple but deceptively complex to design, implement and translate into clinical practice. Randomized controlled trials are fundamentally different from observational clinical research because they randomly assign volunteers to receive test or control interventions, they are prospective and the success of the test intervention is based on a meaningful clinical outcome that is specified before the trial begins. To be successful, randomized controlled trials must be carefully designed and powered to answer a specific question that will be generalizable to the population under study. Randomized controlled trials can be designed to evaluate efficacy, effectiveness, superiority, equivalence or noninferiority. Prominent issues and challenges in designing and conducting randomized controlled trials include carefully defining enrollment criteria, establishing an organizational infrastructure, use of a data-coordinating center, developing a manual of procedures, obtaining informed consent, recruiting and ensuring the safety of volunteer subjects, ensuring data quality, analysis and publication of trial outcomes, and translating results into clinical practice.

Use of complementary and alternative medicine for work-related pain correlates with career satisfaction among dental hygienists.

PURPOSE: Chronic musculoskeletal pain (CMSP) is associated with work stress and burn-out among registered dental hygienists, with prevalence estimates ranging between 64 to 93%. Complementary and alternative medicine (CAM) therapies can be helpful in managing CMSP. The purpose of this study was to determine if dental hygienists who use CAM have greater career satisfaction compared to conventional therapy (CT) users. METHODS: ADHA members (n=2,431) in North Carolina (n=573) and California (n=1,858) were surveyed. Data were analyzed using univariate and bivariate analyses and logistic regression. RESULTS: A response rate of 25.3% (n=617) was obtained, revealing that 76.5% (n=472) suffered from CMSP. The use of CAM or CT was reported among 80.7% (n=381) of dental hygienists with CMSP. CAM users reported greater overall health (79.3% vs. 54.0%, p<0.001), career satisfaction (59.2% vs. 39.0%, p<0.001) and were able to work the hours they wanted (69.8% vs. 64.0%, p<0.001) compared to CT users. Of those with CMSP, 36.4% (n=172) considered a career change and 13.0% (n=59) reported having left dental hygiene. Those with CMSP were less likely to recall that ergonomics were taught or reinforced during clinical training. CONCLUSION: CAM therapies may improve quality of life, reduce work disruptions and enhance career satisfaction for dental hygienists who suffer from CMSP. Ergonomics education may help reduce the number of hygienists who suffer from CMSP. Increased student awareness of CMSP risk is needed to reduce CMSP in the future by enhancing ergonomics education and incorporating CAM, such as yoga stretches, into the classroom and clinic routine.

Dentists' attitudes about their role in addressing obesity in patients: a national survey.

BACKGROUND: Reducing the incidence of obesity requires coordination among primary health care providers. Because of their frequent contact with patients, dentists are positioned to recognize patients at risk of developing obesity. The authors conducted a study to assess dentists' interest in and barriers to providing obesity counseling to patients. METHODS: The authors surveyed a random sample of 8,000 American Dental Association members by mail, stratified according to census region (West, Midwest, South, Northeast) and dentist type (general, pediatric). The authors weighted respondents' data to account for the unequal probability of selection and nonresponse rates among regions and dentist types. RESULTS: In all, 2,965 dentists responded. Overall, 4.8 percent of respondents offered a form of counseling services and 50.5 percent reported that they were interested in offering obesity-related services. More than one-half of the respondents cited fears of offending patients (53.8 percent) and appearing judgmental (52 percent) as major barriers, followed by a paucity of trained personnel (46.3 percent) and patients' rejection of weight-loss advice (45.7 percent). Eighty-two percent of respondents agreed that dentists would be more willing to intervene if obesity were linked definitively to oral disease. CONCLUSIONS: Given continued increases in obesity in the United States and the willingness of dentists to assist in preventive and interventional efforts, experts in obesity intervention, in conjunction with dental educators, should develop models of intervention within the scope of dental practice. CLINICAL IMPLICATIONS: Educating dentists about obesity and counseling may reduce barriers for those interested in addressing obesity in their practices.

Factors affecting North Carolina dental hygienists' confidence in providing obesity education and counseling.

PURPOSE: Obesity is a major public health issue in the United States. Dental hygienists influence their patients' oral health by providing dietary and behavioral recommendations that encourage good oral health practices. However, it is not known if they are ready to provide behavioral counseling strategies for weight loss. This study investigates whether dental hygienists in North Carolina are confident to counsel patients who are at-risk for obesity. METHODS: A questionnaire was used to survey 246 dental hygienists attending a continuing education (CE) course. It investigated self-reported confidence in providing obesity counseling, educational preparation, outcome expectations and self-efficacy. The primary outcome was confidence in providing weight loss counseling. Mantel Haenszel statistics were used to compare group of interest. RESULTS: Of the dental hygienists surveyed, 43% perceived an increase of overweight patients in their practices. Nearly all (95%) felt that dental hygienists have a role in helping patients improve nutrition. Over half (65%) expressed confidence in discussing obesity-related health risks. On average, the confidence in getting patients to follow weight loss advice was significantly different (p=0.02) for those with a 2 year degree and those with a 4 year degree. CONCLUSIONS: The findings indicate that many North Carolina dental hygienists are willing to discuss obesity with patients.

Practicing dental hygienists' attitudes toward the proposed Advanced Dental Hygiene Practitioner: a pilot study.

PURPOSE: The purpose of this pilot study was to assess the attitudes of active registered dental hygienists toward the proposed Advanced Dental Hygiene Practitioner (ADHP). Factors of support/interest in the ADHP concept, level of practice, and socio-demographics were examined. METHODS: In 2007, a self-administered questionnaire was mailed to 1,562 active registered dental hygienists in Colorado, Kentucky, and North Carolina, states with diverse practice acts. The quantitative analysis included descriptive statistics, Mantel Haenszel for Likert-scaled responses, and chi-square to compare nominal responses. All of the survey questions were qualitatively reviewed. RESULTS: The response rate was 29% (n = 442), with 45% (n=196) of respondents indicating they had not heard of the proposed ADHP prior to receiving this survey. Overall level of support for the proposed ADHP as indicated by both very supportive and somewhat supportive responses was 87% (n=129) in Colorado, 82% (n=64) in Kentucky, and 92% (n=196) in North Carolina. Overall level of interest for the proposed ADHP as indicated by both very interested and somewhat interested responses was 74% (n=109) in Colorado, 71% (n=55) in Kentucky, and 81% (n=170) in North Carolina. A significant difference was found among respondents interested in becoming an ADHP and those not interested (p<0.05). CONCLUSIONS: Among the 3 states, a higher overall level of support for the proposed ADHP was indicated compared to the overall level of interest. Although the state practice acts vary, these findings suggest that the level of support/interest in the proposed ADHP does not differ among respondents.

North Carolina dental hygiene students' opinions about tobacco cessation education and practices in their programs.

Inadequate training in tobacco cessation counseling (TCC) is a recognized, but mutable, barrier to implementation of tobacco cessation education (TCE) and intervention strategies in dental practice. The objective of this study was to identify the opinions and practices of senior dental hygiene (DH) students in North Carolina regarding their didactic training in TCE and integration of TCE into their clinical curricula. A pilot-tested questionnaire designed by the authors was administered to a cross-sectional, non-random convenience sample of 241 graduating senior DH students enrolled in all twelve North Carolina DH educational programs. Response rate was 65 percent (n=156). Of the respondents, 99 percent agreed that hygienists should be trained to provide TCE. Nearly all respondents (99 percent) had one or more patients who smoked, and 81 percent had one or more patients who used spit tobacco. Eighty-nine percent had one or more patients who had expressed a desire to quit. Most students were comfortable providing TCC to both smokers (92 percent) and spit tobacco users (93 percent); however, 26 percent reported that they were not comfortable providing quit messages to patients unwilling to quit. Enhancements to TCE in DH curricula may increase hygienists' incorporation of TCE into their future practice.

Effect of intracanal corticosteroids on healing of replanted dog teeth after extended dry times.

This study investigated the effect of potent intracanal corticosteroids on periodontal healing of replanted avulsed teeth and evaluated the systemic absorption of these corticosteroids. Sixty-seven extracted dog premolar roots were randomly assigned to one of the following groups: groups 1-3 filled with gutta-percha and replanted immediately and after 40 and 60 minutes, respectively; groups 4 and 5 filled with 0.05% clobetasol; and groups 6 and 7 filled with 0.05 % fluocinonide. Groups 4 and 6 were replanted after 40 minutes and groups 5 and 7 after 60 minutes. After 4 months, roots were evaluated histologically for signs of periodontal healing. Roots treated with clobetasol and fluocinonide healed more favorably than roots filled with gutta-percha and were different from each other at 60 minutes. No change in the systemic corticosteroid blood concentration was observed in any group. Corticosteroids were efficacious in the beagle model as intracanal medicaments for promoting favorable postavulsion periodontal healing.

Periapical microsurgery: an in vivo evaluation of endodontic root-end filling materials.

The purpose of this study was to assess the healing of periapical tissues using three different materials (IRM [L.D. Caulk Inc, Dentsply International Inc, Milford, DE], Geristore [Den-Mat, Santa Maria, CA], and MTA [ProRoot MTA; Dentsply Tulsa Dental Specialties, Tulsa, OK]) after endodontic microsurgery in an animal model. Using beagle dogs as a study model, 48 bicuspids were accessed, instrumented, and intentionally infected. The surgical procedures were performed after 30 days following the radiographic confirmation of periapical radiolucencies. The root canals were still infected and had no disinfection procedure carried out. The root ends were resected, retrograde preparations were completed, and the experimental materials were placed under surgical operating microscopy. After a period of 6 months, digital radiographic images of the periradicular areas were taken. The samples were prepared for histologic evaluation. Although Geristore showed no radiographic difference when compared with the other groups, it showed the least favorable healing in the histologic evaluation. Our histologic and radiographic results showed no statistical difference between MTA and IRM.