Management of Dentin Hypersensitivity by National Dental Practice-Based Research Network practitioners: results from a questionnaire administered prior to initiation of a clinical study on this topic.

BACKGROUND: Dentin hypersensitivity (DH) is a common problem encountered in clinical practice. The purpose of this study was to identify the management approaches for DH among United States dentists. METHODS: One hundred eighty five National Dental Practice-Based Research Network clinicians completed a questionnaire regarding their preferred methods to diagnose and manage DH in the practice setting, and their beliefs about DH predisposing factors. RESULTS: Almost all dentists (99%) reported using more than one method to diagnose DH. Most frequently, they reported using spontaneous patient reports coupled with excluding other causes of oral pain by direct clinical examination (48%); followed by applying an air blast (26%), applying cold water (12%), and obtaining patient reports after dentist's query (6%). In managing DH, the most frequent first choice was desensitizing, over-the-counter (OTC), potassium nitrate toothpaste (48%), followed by fluorides (38%), and glutaraldehyde/HEMA (3%). A total of 86% of respondents reported using a combination of products when treating DH, most frequently using fluoride varnish and desensitizing OTC potassium nitrate toothpaste (70%). The most frequent predisposing factor leading to DH, as reported by the practitioners, was recessed gingiva (66%), followed by abrasion, erosion, abfraction/attrition lesions (59%) and bruxism (32%). CONCLUSIONS: The majority of network practitioners use multiple methods to diagnose and manage DH. Desensitizing OTC potassium nitrate toothpaste and fluoride formulations are the most widely used products to manage DH in dental practice setting.

Association between γ' fibrinogen levels and inflammation.

The γ' fibrinogen isoform produces clots that are stiffer and more resistant to breakdown than the more common fibrinogen isoform, γA. Increased levels of γ' fibrinogen are associated with several forms of cardiovascular disease. The purpose of this cross-sectional study was to investigate the relationship between γ' fibrinogen, an emerging risk factor for cardiovascular disease, and inflammatory markers in subjects with a chronic inflammatory state. The 284 subjects for this study came from the Periodontitis And Vascular Events (PAVE) study, and γ' fibrinogen and total fibrinogen in plasma were measured by ELISA. Information on patient demographics and health status, as well as levels of C-reactive protein (CRP), an inflammatory marker, have previously been collected for this study. The mean (SE) γ' fibrinogen level in the subjects was 0.622 (0.017) mg/ml. Levels of γ' fibrinogen were correlated with CRP (p = 0.006), with a one unit increase in CRP associated with a 1.9% increase in γ' fibrinogen, after adjustment for potential confounders. Total fibrinogen was not correlated with γ' fibrinogen in these subjects. The number of dental sites with evidence of tissue inflammation was also significantly associated with γ' fibrinogen levels. These results provide an important step in the evolution of γ' fibrinogen not only as a general risk factor for cardiovascular disease, but as a potentially useful biomarker for assessing a patient's inflammatory state and associated cardiovascular disease risk.

Alterations in HbA1c following minimal or enhanced non-surgical, non-antibiotic treatment of gingivitis or mild periodontitis in type 2 diabetic patients: a pilot trial.

AIM: The purpose of this pilot study was to determine and compare the effects of two protocols aimed at reducing periodontal inflammation, upon the metabolic control of the diabetic condition in subjects with elevated baseline glycosylated hemoglobin (HbA1c). METHODS AND MATERIALS: Forty-two non-smoking type 2 diabetes subjects with mildly elevated HbA1c (>7 but < 9%) and severely elevated (>9%) were randomized to one of two non-surgical periodontal therapy protocols. Patients in the "minimal therapy" (MT) group received scaling, root planning, and oral hygiene instructions on two occasions six months apart. Participants randomized to the "frequent therapy" (FT) protocol received scaling, root planing, and oral hygiene instructions at two-month intervals and were provided a 0.12% chlorhexidine rinse for home use twice daily. Neither systemic nor local antibiotics were provided to either group. Subjects were asked to report any changes in diabetic medications, nutrition, and physical activity. Data analyses (ANOVA, t-test, Mann-Whitney) grouped subjects according to baseline HbA1c (>7 and < 9%, or > 9%), treatment protocol (minimal or frequent), and +/- medication change. RESULTS: In both MT and FT groups the clinical attachment level (CAL) remained unchanged but the other measures [gingival index (GI) and pocket dept (PD)] of periodontal health improved. Mean reductions in plaque showed improvement but calculus was worse in the FT group, likely due to the use of chlorhexidine. At six months, the largest reduction of HbA1c was 3.7; experienced by a subject receiving FT but no changes in diabetic medication. Among the MT and no medication change subjects, the maximum reduction was 1.6. Overall mean reduction in HbA1c of 27 subjects with baseline HbA1c >9.0 and no medication change was 0.6 with no statistical difference between the MT and FT groups. Among the medication-change subjects with baseline HbA1c >9.0, mean reduction of 1.38 was seen with FT compared to 1.10 with MT. CONCLUSION: Overall, modest improvements in HbA1c were detected with a trend towards FT being better than MT. Although this pilot trial was under-powered to detect small between-group differences, the magnitude of our findings (0.6 mean improvement in HbA1c) matches closely findings from the only meta-analysis conducted on this topic to date. Larger scale studies must be undertaken on diabetic patients with periodontal problems. CLINICAL SIGNIFICANCE: Preventive periodontal regimens for diabetic patients should be sufficiently intense and sustained to eliminate periodontal inflammation and should be closely coordinated with the patient's overall clinical diabetic management.

Coming from all directions: protecting girls and women from the impact of substance use.

Dentists may assist in protecting their female (and male) patients from unhealthy substance use conditions. Prevalence is so high that daily, nearly every U.S. health care provider sees patients either at risk themselves or experiencing negative effects of substance use by a friend, family member, or co-worker. Health care practice-based interventions employ simple universal standardized screening, brief advice, and occasional referrals to specialists and/or community resources. Youth prevention strategies reduce risk and build protective factors.

Interdisciplinary benefits in Project MAINSTREAM: a promising health professions educational model to address global substance abuse.

Our purpose was to evaluate the interdisciplinary aspects of Project MAINSTREAM, a faculty development program that trained 39 competitively selected health professional tutors in substance abuse education. Mid-career faculty fellows (tutors) from 14 different health professions across the US dedicated 20% of their academic time for two years to Project MAINSTREAM. Teams of three fellows carried out curricular enhancement and service-learning field project requirements in mentored Interdisciplinary Faculty Learning Groups (IFLGs). Formative and summative evaluations were conducted via written questionnaires and confidential telephone interviews. The importance of interdisciplinary education was rated positively (mean of 3.57 on 1 - 5 scale). Using 18 parameters, fellows preferred interdisciplinary over single disciplinary teaching (means ranged from 3.40 - 4.86), and reported high levels of benefit from their interdisciplinary collaborations (means ranged from 3.53 - 4.56). Fellows reported that interdisciplinary educational collaborations were feasible (3.31) at their home institutions. The majority (63%) said that their trainees, colleagues, supervisors and institutions valued interdisciplinary training either "highly" or "somewhat", but 22% did not value it. The fellows identified scheduling conflicts (3.46), and lack of faculty rewards (3.46) such as pay or credit toward promotion, as two barriers that they encountered.

Initiating tobacco curricula in dental hygiene education: a descriptive report.

Two hours of tobacco instructions were incorporated into the baccalaureate dental hygiene curricula in a university in the Northwestern United States. Prior to graduation, all senior students were invited to complete anonymously a questionnaire surveying attitudes and clinical skills in providing tobacco services to their clinic patients. Twenty students (67%) responded but no data was collected on the non-respondents. Eighteen (90%) reported practicing some of the "5 A's," and a few reported sustained adherence to all "5 A's." Moderately successful clinical outcomes parallelled students' moderate self-rating of their knowledge/skills. When asked to identify barriers to sustained and ongoing full adherence, most students cited "patient resistance/disinterest," and their own "lack of knowledge or confidence in the skills." Our preliminary findings suggest that additional content and training time may be required for dental hygiene graduates to feel highly confident and knowledgeable, and for them to sustain comprehensive tobacco services once in practice.

A clinical study: Melaleuca, Manuka, Calendula and green tea mouth rinse.

A novel mouthrinse (IND 61,164) containing essential oils and extracts from four plant species (Melaleuca alternifolia, Leptospermum scoparium, Calendula officinalis and Camellia sinensis) were tested. This study aimed to evaluate the safety, palatability and preliminary efficacy of the rinse. Fifteen subjects completed the Phase I safety study. Seventeen subjects completed the Phase II randomized placebo-controlled study. Plaque was collected, gingival and plaque indices were recorded (baseline, 6 weeks, and 12 weeks). The relative abundance of two periodontal pathogens (Actinobacillus actinomycetemcomitans, Tanerella forsythensis) was determined utilizing digoxigenin-labeled DNA probes. ANCOVA was used at the p = 0.05 level of significance. Two subjects reported a minor adverse event. One subject withdrew from the study. Several subjects objected to the taste of the test rinse but continued treatment. Differences between gingival index, plaque index or relative abundance of either bacterial species did not reach statistical significance when comparing nine placebo subjects with eight test rinse subjects. Subjects exposed to the test rinse experienced no abnormal oral lesions, altered vital signs, changes in liver, kidney, or bone marrow function. Larger scale studies would be necessary to determine the efficacy and oral health benefits of the test rinse.

Two-dimensional liquid chromatography study of the human whole saliva proteome.

The human whole saliva proteome was investigated using two-dimensional liquid chromatography (2-DLC). The 2-DLC study was able to identify, with high confidence, 102 proteins including most known salivary proteins (35), and a large number of common serum proteins (67). Peptides from proline-rich proteins, abundant in saliva, had unusual cleavage sites and were frequently only partially tryptic. Three proteins not previously observed in human saliva were also detected. Significantly greater numbers of identified proteins, including high molecular weight, low molecular weight, and proline-rich proteins, were found with 2-DLC compared to previously reported two-dimensional gel electrophoresis studies.

Nutrition, infection, and periodontal disease.

Even though nutrition is not recognized as a risk factor for periodontal diseases, nutrition is acknowledged to have a significant impact on optimal functioning of the immune response. Dental professionals need to routinely assess nutritional status and provide basic nutrition counseling to their patients to ensure optimal functioning of the immune system in combating infection and to promote optimal periodontal health.