Risk factors for osteonecrosis of the jaws: a case-control study from the CONDOR Dental PBRN.

Case reports and cohort studies have linked bisphosphonate therapy and osteonecrosis of the jaws (ONJ), but neither causality nor specific risks for lesion development have been clearly established. We conducted a 1:3 case-control study with 3 dental practice-based research networks, using dentist questionnaires and patient interviews for collection of data on bisphosphonate therapy, demographics, co-morbidities, and dental and medical treatments. Multivariable logistic regression analyses tested associations between bisphosphonate use and other risk factors with ONJ. We enrolled 191 ONJ cases and 573 controls in 119 dental practices. Bisphosphonate use was strongly associated with ONJ (odds ratios [OR] 299.5 {95% CI 70.0-1282.7} for intravenous [IV] use and OR = 12.2 {4.3-35.0} for oral use). Risk markers included local suppuration (OR = 7.8 {1.8-34.1}), dental extraction (OR = 7.6 {2.4-24.7}), and radiation therapy (OR = 24.1 {4.9-118.4}). When cancer patients (n = 143) were excluded, bisphosphonate use (OR = 7.2 {2.1-24.7}), suppuration (OR = 11.9 {2.0-69.5}), and extractions (OR = 6.6 {1.6-26.6}) remained associated with ONJ. Higher risk of ONJ began within 2 years of bisphosphonate initiation and increased 4-fold after 2 years. Both IV and oral bisphosphonate use were strongly associated with ONJ. Duration of treatment >2 years; suppuration and dental extractions were independent risk factors for ONJ.

Aging effects on oropharyngeal swallow and the role of dental care in oropharyngeal dysphagia.

Difficulty with oropharyngeal swallow requires careful diagnosis and treatment from a team of professionals including the patients' physicians and the speech-language pathologist specializing in dysphagia. The dentist can be a critical team member in prevention, early identification, and management of oropharyngeal dysphagia. This manuscript reviews the physiology of normal oropharyngeal swallow and the effects of normal aging on this physiology. Typical etiologies for oropharyngeal dysphagia are defined as is the most commonly used physiologic diagnostic procedure, the modified barium swallow (MBS). The critical role of the dentist in identifying risk of oropharyngeal dysphagia, making appropriate referrals, and improving oral hygiene to prevent aspiration pneumonia in the elderly is discussed.

The PBRN initiative: transforming new technologies to improve patient care.

The NIDCR-supported Practice-based Research Network initiative presents dentistry with an unprecedented opportunity by providing a pathway for modifying and advancing the profession. It encourages practitioner participation in the transfer of science into practice for the improvement of patient care. PBRNs vary in infrastructure and design, and sustaining themselves in the long term may involve clinical trial validation by regulatory agencies. This paper discusses the PBRN concept in general and uses the New York University College of Dentistry's Practitioners Engaged in Applied Research and Learning (PEARL) Network as a model to improve patient outcomes. The PEARL Network is structured to ensure generalizability of results, data integrity, and to provide an infrastructure in which scientists can address clinical practitioner research interests. PEARL evaluates new technologies, conducts comparative effectiveness research, participates in multidisciplinary clinical studies, helps evaluate alternative models of healthcare, educates and trains future clinical faculty for academic positions, expands continuing education to include "benchmarking" as a form of continuous feedback to practitioners, adds value to dental schools' educational programs, and collaborates with the oral health care and pharmaceutical industries and medical PBRNs to advance the dental profession and further the integration of dental research and practice into contemporary healthcare (NCT00867997, NCT01268605).

An assessment of the perceived benefits and challenges of participating in a practice-based research network.

BACKGROUND: A survey was conducted to describe the benefits of and challenges to practitioner participation in the Practitioners Engaged in Applied Research and Learning (PEARL) Network, a dental practice-based research network (PBRN). The results were compared with results from medical PBRNs across different tiers of participation (based on practitioner-investigators previous involvement with PEARL research protocols). METHODS: A 39-item web-based survey addressed the benefits of PBRN participation on three levels: individual/practitioner, practice (office), and community/professional. Participants were also asked to rate challenges to participation. RESULTS: A total of 153 of 216 PEARL practitioner-investigators participated, a response rate of 71%. The majority (70%) was male, with a median of 23 years in private practice. 'Means to stay informed of new developments in my profession' was considered a 'very important' benefit for nearly three-quarters of the sample (71%). 'Opportunity to improve clinical procedures' was considered as 'very important' by 73% of respondents. In terms of benefits related to the community and profession, 65% of respondents reported 'means to directly contribute to the evidence base of dental practice' as being 'very important'. 'Disruption in practice routine/clinical practice' was considered the most important challenge to participation. CONCLUSIONS: The benefits of and challenges to participation identified did not differ across tiers of participation and were similar to benefits identified by participants in medical PBRNs. The results of this study will help facilitate the design of future PBRN protocols to encourage greater participation by the profession. Results suggest that practitioners with similar interests could be recruited to collaborative studies between medicine and dentistry.

Risk factors for osteonecrosis of the jaws: a case-control study from the CONDOR dental PBRN.

Case reports and cohort studies have linked bisphosphonate therapy and osteonecrosis of the jaws (ONJ), but neither causality nor specific risks for lesion development have been clearly established. We conducted a 1:3 case-control study with three dental Practice-based Research Networks, using dentist questionnaires and patient interviews for collection of data on bisphosphonate therapy, demographics, co-morbidities, and dental and medical treatments. Multivariable logistic regression analyses tested associations between bisphosphonate use and other risk factors with ONJ. We enrolled 191 ONJ cases and 573 controls in 119 dental practices. Bisphosphonate use was strongly associated with ONJ (odds ratios [OR] 299.5 {95%CI 70.0-1282.7} for intravenous [IV] use and OR = 12.2 {4.3-35.0} for oral use). Risk markers included local suppuration (OR = 7.8 {1.8-34.1}), dental extraction (OR = 7.6 {2.4-24.7}), and radiation therapy (OR = 24.1 {4.9-118.4}). When cancer patients (n = 143) were excluded, bisphosphonate use (OR = 7.2 {2.1-24.7}), suppuration (OR = 11.9 {2.0-69.5}), and extractions (OR = 6.6 {1.6-26.6}) remained associated with ONJ. Higher risk of ONJ began within 2 years of bisphosphonate initiation and increased four-fold after 2 years. Both IV and oral bisphosphonate use were strongly associated with ONJ. Duration of treatment > 2 years; suppuration and dental extractions were independent risk factors for ONJ.

Clinical evaluation of ferric oxalate in relieving dentine hypersensitivity.

Previous in vitro permeability and scanning electron microscopic (SEM) studies have demonstrated the effectiveness of the oxalate ion in dentine permeability reduction and effective tubule occlusion. The aim of this randomized double-blind, split mouth 4-week clinical study, therefore was to determine whether a 1-min application of ferric oxalate (Sensodyne Sealant) on exposed root dentine was effective in reducing dentine hypersensitivity (DH). Thirteen subjects [8F:5M, mean age 46.2 (s.d. 4.15) years] completed the study. The subjective response was evaluated by tactile, thermal and evaporative methods of assessment. Data were collected at baseline and post-application at +5 min and 4 weeks. Analysis was based on paired t-test (P=0.05) and Wilcoxon-Mann-Whitney tests. No statistically significant differences were noted between ferric oxalate and placebo preparations at +5 min and 4 weeks for any of the test stimuli. There was, however, a clear trend towards immediate reduction (+5 min) in DH reverting back to baseline values at 4 weeks with the exception of the Biomat Thermal Probe mean values, which maintained the reductions in DH compared with placebo. The results of the present study demonstrated that a 1-min application of ferric oxalate is both rapid and effective in reducing DH although its long-term effectiveness still needs to be determined.

Amlexanox oral paste: a novel treatment that accelerates the healing of aphthous ulcers.

Five percent Amlexanox oral paste is a novel treatment for aphthous ulcers. In 3 controlled clinical studies that evaluated 1,124 immunocompetent patients with mild to moderate aphthous ulcers, 5% Amlexanox oral paste (Aphthasol) was shown to accelerate healing of these ulcers. Treatment with Aphthasol reduced the median time to ulcer healing and to complete pain resolution in a statistically significant manner. This was true both when treatment with 5% Amlexanox oral paste was compared to treatment with a vehicle and when treatment with the Amlexanox paste was compared to no treatment. Study results after 3 days comparing treatment with the paste and no treatment indicated complete healing of ulcers for 21% and 8% of patients, respectively. Complete resolution of pain after 3 days was reported for 44% and 20% of patients, respectively.

Desensitizing effect of a potassium chloride dentifrice.

Sensodyne F is a potassium chloride (KCl) and sodium monofluorphosphate (MFP) containing dentifrice currently marketed in the United Kingdom and Germany was compared to a KCl only dentifrice and to a placebo dentifrice for effectiveness in alleviating dentin hypersensitivity. This 3-cell, randomized, double-blind, parallel clinical study utilized 62 subjects for an 8-week duration of product use. The degree of hypersensitivity of the affected teeth was assessed by tactile stimulation, cold air stimulation and overall subjective patient response. The results from these three methods of assessment indicated that a KCl containing dentifrice either alone or in combination with sodium MFP were significantly more effective than the placebo dentifrice in reducing dentin hypersensitivity. The therapeutic response to the KCl dentifrices as measured by air sensitivity and tactile sensitivity was statistically significant when compared to the placebo dentifrice within 4 weeks of use. Significant improvement was seen for all parameters at the conclusion of the 8-week clinical study period. Plaque reduction was significantly reduced at 8 weeks. The results indicate that KCl is an efficacious molecule in reducing dentin hypersensitivity when used either alone or in combination with sodium MFP as measured by improved overall patient comfort.

Caries prevalence in xerostomic individuals.

Saliva, via its lubricating, cleansing, remineralizing, antibacterial, and buffering actions, is an important protective factor for both dentition and soft tissue. Xerostomia is commonly found in older individuals due to the use of medications or medical conditions, such as Sjögren's, which directly affect salivary gland function. A xerostomic subgroup (n = 60), mean age = 60, 66 per cent female) of the Nutrition and Oral Health Study (n = 370) was reexamined for caries. Unstimulated and two-per-cent citric-acid stimulated parotid and submandibular/sublingual salivary flow rates were determined. This group was matched for number of teeth, age, sex, and alcohol and smoking habits with a medication-free subgroup (n = 60). Active root and coronal caries were found to be significantly higher in the xerostomic subgroup than in a matched subgroup of medication-free individuals. The mean DFS for the xerostomic subgroup was 45.4 +/- 21.7 for coronal caries and 5.3 +/- 5.8 for root caries. The mean number of teeth was 21.8. The mean DFS in the medication-free subgroup was 36.5 +/- 22.1 for coronal caries and 3.2 +/- 3.2 for root caries. The mean DFS in the xerostomic subgroup for coronal and root caries was statistically significantly higher (p < 0.05). The odds ratio was 2.89 for coronal caries and 3.27 for root caries in the xerostomic versus the medication-free subgroup. Caries varied inversely with salivary flow rate. The difference in flow rates for those in the lowest and highest quartile for coronal caries experience (DFS) in the xerostomic subgroup was found to be statistically significant (p < 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

Clinical effectiveness of a dentifrice containing potassium chloride as a desensitizing agent.

Sensodyne F, a dentifrice currently marketed in the United Kingdom, containing potassium chloride (KCl) and sodium monofluorophosphate (MFP) was compared to a placebo dentifrice for effectiveness in alleviating dentinal hypersensitivity. This randomized, double-blind, parallel clinical study covered 12 weeks of product use by 41 subjects. Hypersensitivity levels of the affected teeth were assessed by tactile stimulation, cold air stimulation and overall subjective patient response. The results from these three methods of assessment demonstrated that the KCl/MFP dentifrice was significantly more effective than the placebo dentifrice in reducing dentinal hypersensitivity. The therapeutic response to the KCl/MFP dentifrice as measured by air sensitivity and overall subjective evaluation was statistically significant when compared to the placebo dentifrice within 4 weeks of use. Significant improvement was observed for all parameters at the conclusion of the 12-week clinical study period. Plaque reduction was significantly reduced at week 8 and continued to improve by week 12. The results indicate that KCl with sodium MFP significantly reduced dentinal hypersensitivity and improved overall patient comfort.

Bioavailability of aspirin and salicylamide following oral co-administration in human volunteers.

BC powder (I) is a commercially available analgesic containing the active ingredients aspirin and salicylamide. The kinetics of I, BC powder minus aspirin (II), and BC powder minus salicylamide (III) were evaluated in 13 volunteers. Ten minutes after administration of I, aspirin reached a maximum concentration of 12.9 micrograms/mL, while salicylamide concentration reached a peak value of 3.4 micrograms/mL. However, when III was administered, aspirin was not detected at 10 min and only reached a concentration of 0.4 microgram/mL at 2 and 6 h. Furthermore, the area under the plasma concentration versus time curve for aspirin when III was administered was sixfold less compared with treatment with I. The area under the curve for aspirin metabolites was significantly different in I versus III. After treatment with II, a delay in salicylamide peak concentration was observed. Gentisamide was not detected throughout the study. This study demonstrates that salicylamide significantly enhances plasma levels of aspirin with potential therapeutic implications.

The effect of thromboxane on contraction of canine mesenteric and lingual arteries.

Thromboxane A2 (TXA2), a potent vasoconstrictor agent, is released from platelets and smooth muscle during inflammation and trauma. TXA2 may cause lingual artery (LA) contraction, leading to lingual paresthesia. The effects of U-46619, a TxA2 mimetic, on isolated rings of canine LA and mesenteric artery (MA) were examined. U-46619 (1 nmol/L to 1 mumol/L) caused a triphasic contraction of LA and MA; a rapid, phasic contraction; a slow, sustained contraction; and, upon washout of U-46619, a maintained contraction. The MA relaxed slowly, but the LA remained contracted for at least three h after washout. Decreasing extracellular calcium ion (Ca2+o) to less than 0.1 mumol/L with 2 mmol/L EGTA relaxed MA, but not LA. EGTA (4 mmol/L) partially relaxed the maintained contraction of LA. Inhibition of protein kinase C with amphotericin B or staurosporine inhibited the phasic and sustained contractions of LA, but did not affect the maintained contraction in the presence or absence of EGTA. Thus, CA2+o was required for the initial contraction of the LA by U-46619, but did not appear to be required for the maintained contraction following washout of U-46619. The data support the conclusion that following a brief exposure to U-46619, maintained contraction of LA persists by a unique mechanism that may be independent of Ca2+ and protein kinase C. Sustained LA contraction after exposure to endogenous TXA2 during inflammation and trauma may contribute to impaired lingual blood flow and orofacial tissue injury.

Effect of vitamin E gel, placebo gel and chlorhexidine on periodontal disease.

The purpose of this study was to compare the effects of a topical 5% vitamin E gel, a placebo gel and chlorhexidine on established and developing plaque and periodontal disease in 48 adult subjects. Baseline data included Plaque Index, Gingival Index and periodontal probing depth. All data were collected by a single calibrated examiner using a double-blind methodology. One group of subjects applied 12 mL of a vitamin E-containing gel delivering 800 mg of alpha-tocopherol, another applied 12 mL of a placebo gel, and the final group rinsed with 0.5 oz of 0.12% chlorhexidine gluconate. After two weeks, the clinical data were again recorded, and two quadrants were randomly selected and treated by root planing and scaling, with data collection repeated after both 4 and 6 weeks. Our results indicated that no significant effects upon plaque or gingivitis were obtainable in either the placebo or the vitamin E groups. However, use of 0.12% chlorhexidine significantly reduced plaque. These results do not support the use of vitamin E as a topical chemotherapeutic agent for the control of gingivitis or periodontal disease.

Tooth hypersensitivity in the spectrum of pain.

Dentinal hypersensitivity satisfies all the criteria to be classified as a true pain syndrome that can be acute, but for our purposes is a chronic condition with acute episodes without the disabling characteristics and severe dysfunction of a chronic pain syndrome. It is estimated that the frequency of dentinal hypersensitivity affects one of six people, and one or more teeth can be affected. The incidence of dentinal hypersensitivity appears to peak around the third decade of life and may appear as root sensitivity in the fifth decade of life as root sensitivity particularly in patients undergoing periodontal surgery. The relationship of dentinal hypersensitivity to acute and chronic pain is shown in Table 1. Dentists' ability to soothe or stop pain has always been their greatest asset in establishing patient rapport. The experience of pain is so subjective that none of us can ever be sure another person is having it. Physicians, dentists, and especially those affiliated with pain centers and clinics have resolved this dilemma in a commonsensical way. They simply treat the pain as if it were real, and their track record in confronting this inscrutable condition has contributed to their high regard as professionals.

Toothbrush bristle density: relationship to plaque removal.

A double-blind, parallel, controlled study was conducted to determine the effect of toothbrush bristle density (total number of bristles divided by the brush head area) in removing plaque from tooth surfaces. Ninety subjects (29 males, 61 females), aged 18-65, were randomly assigned to one of three groups using the Sensodyne Search 4-Rowa toothbrush modified to have the following bristle densities: A (4.5 bristles per mm2); B (8.3 bristles per mm2); or C (11.8 bristles per mm2). The average trim height of the bristles was 10.77 mm. Subjects brushed without any dentifrice once a day for 7 days in order for adherent deposits (salivary pellicle and plaque remnants) to accumulate on their teeth. On the eight day, examinations for stained deposits were performed according to the Global Scoring Index before and after one minute of brushing with a commercially available toothpaste. Percent reductions in deposits were highly significant for the eighty-seven subjects who completed the study. A paired t-test between the pre- and post-treatment scores (p = 0.005) demonstrated the following: Toothbrushes A, B and C had reductions in plaque of 45.5%, 51.9% and 56.8%, respectively. On an overall basis, the intergroup percent reductions were significantly different using ANOVA (p = 0.001), and demonstrated a relationship in terms of data clustering for percent plaque removal of toothbrushes with varied bristle densities.