Racial and ethnic disparities in periodontal health among adults seeking dental care in rural North Carolina communities: A retrospective study.

BACKGROUND: Population studies consistently demonstrate a greater prevalence of chronic diseases, including oral diseases, among underrepresented minorities. This retrospective study aimed to measure and describe the prevalence and extent of periodontitis among adults seeking dental care within an academic practice-based network in rural North Carolina. METHODS: This study used de-identified electronic health record (EHR) data from 2011 to 2017 of adult dentate patients (aged ≥30 years) seeking dental care who received a comprehensive periodontal examination at one of nine networked clinical centers. Periodontitis prevalence was calculated using CDC/AAP case definitions, along with extent (%) scores for periodontal parameters. Comparisons focused on age, sex, race, ethnicity, tobacco use, diabetes status, payer or insurance status, plaque scores, and the number of teeth. RESULTS: EHR data for 10,544 adult patients (60.5% female) indicated 79.8% had some form of periodontitis. This patient population was diverse: 22.6% Black, 4.4% American Indian, and 53.8% White, with 4.8% self-identified as Hispanic. Patients 50 years and older showed greater mean extent scores for clinical attachment levels relative to patients 30 to 49 years. Males exhibited greater periodontitis than females (p = 0.001). Blacks showed significantly (p < 0.001) greater periodontitis prevalence relative to Whites. Hispanics also showed a greater prevalence of periodontitis (p < 0.001) relative to non-Hispanics. Significantly greater periodontitis was also noted for tobacco users (p < 0.001) but not for diabetes or payer status. A multiple logistic regression analysis of periodontitis prevalence confirmed significant associations for periodontitis for age, sex, race, ethnicity, tobacco use, high plaque scores, and the number of teeth (p < 0.001), but not diabetes or payer status. CONCLUSIONS: The data document that racial and ethnic inequalities in periodontal health occur within the population of adults residing in rural communities in North Carolina and seeking dental care.

Randomized Clinical Trial of a Topical Botanical Patch for the Adjunctive Management of Periodontitis.

PURPOSE: This randomized, controlled clinical trial aimed to evaluate the clinical, adjunctive effects of an approved botanical barrier device or patch on probing parameters in patients with periodontitis. MATERIALS AND METHODS: Eighty patients with periodontitis were recruited for this single-blinded trial. Patient demographic data, including gender, age, self-reported smoking status, and history of diabetes or cardiovascular disease, were collected. At baseline, all patients received a full-mouth probing examination followed by scaling and root planing (SRP). Thereafter, patients were randomized to receive either adjunctive botanical patch applications (i.e. at 2-4 treatment sites with baseline pocket depth PD ≥6 mm) or no additional therapy (SRP alone, control). Patients applied botanical patch devices per randomization to treatment sites three times on day 0 and once daily on days 1-6. Study devices were spontaneously shed or removed by the patient at 2-2.5 h after each application. Patients were recalled for probing reexaminations at 1, 2 and 3 months. Statistical analyses focused on intergroup differences in probing parameters and included ANOVA for baseline measures and ANCOVA controlling for baseline measures at 1, 2 and 3 months in the overall population and in subpopulations (e.g. smokers vs nonsmokers). RESULTS: Randomized patient groups were balanced with respect to baseline periodontal status (mean and extent PD) but not smoking, with statistically significantly more smokers clustering in the control group (p = 0.002). For the overall population and the non-smoking subpopulation, statistically significantly improved PD and clinical attachment levels (CAL) were observed with adjunctive botanical patch therapy vs control at 1 and 2 months (p < 0.05) but not 3 months (p = 0.08 for PD). For smokers, no statistically significant intergroup differences in PD or CAL were detected with botanical patch treatment. CONCLUSIONS: The data from this trial indicate short-term improvements in probing parameters with the botanical patch device when used adjunctively with SRP, especially with non-smoking periodontitis patients.

Alcohol intake and periodontitis in adults aged ≥30 years: NHANES 2009-2012.

BACKGROUND: Whether an association between alcohol consumption and periodontitis exists is still unclear. This study aimed to assess the association between alcohol consumption and periodontitis. METHODS: 7062 adults 30 years or older who participated in 2009-2010 and 2011-2012 cycles of the National Health and Nutrition Examination Survey (NHANES) were included. Alcohol consumption measurement included self-reported average number of alcoholic drinks per week over the previous 12 months and was categorized into four groups (0, < 1, 1- < 8, and ≥8 drinks per week). Participants were categorized using surveillance case definitions for periodontitis that included both clinical attachment level (CAL) and periodontal probing depth (PD) measurements. The association between alcohol consumption and chronic periodontitis was evaluated by multivariable regression analyses adjusting for age, gender, race/ethnicity, education level, income-to-poverty ratio, smoking, self-rated overall oral health, and HbA1c . RESULTS: The odds ratio (95% confidence interval) of having severe periodontitis was 1.9 (1.2-3) among participants who reported alcohol consumption of ≥8 drinks compared to participants consuming some alcohol but < 1 drink per week on average. Participants who consumed 1- < 8, and ≥8 drinks per week, on average, also had higher mean PD, percentage of sites with PD ≥4 mm, mean CAL, and percentage of sites with CAL ≥3 mm compared to participants reporting consumption of < 1 drink per week. Meanwhile, the odds of having periodontitis, mean PD, extent PD ≥4 mm, mean CAL, and extent CAL ≥3 mm were not significantly different for nondrinkers than for participants who consumed some alcohol but < 1 drink per week on average. CONCLUSIONS: Alcohol consumption was associated with an increase in the likelihood of having periodontitis, particularly severe periodontitis. Consumption of some alcohol, < 1 drink per week on average, was associated with similar odds of having periodontitis compared to consumption of no alcohol.

Dentists' knowledge and opinions of oral-systemic disease relationships: relevance to patient care and education.

Population studies consistently support associations between poor oral (periodontal) health and systemic diseases such as cardiovascular disease (CVD) and diabetes. The aim of this study was to assess the knowledge of dentists and document their opinions regarding the evidence on oral-systemic disease relationships. A survey consisting of 39 items was developed and mailed to 1,350 licensed dentists in North Carolina. After three mailings, 667 dentists (49%) meeting inclusion criteria responded. The respondents were predominantly male (76.3%), in solo practice (59.5%), and in non-rural settings (74%). More than 75% of these dentists correctly identified risk factors like diet, genetics, smoking, obesity, and physical inactivity for CVD and diabetes. The majority rated the evidence linking periodontal disease with CVD and diabetes as strong (71% and 67%, respectively). These dentists were most comfortable inquiring about patients' tobacco habits (93%), treating patients with diabetes (89%) or CVD (84%) and concurrent periodontal disease, and discussing diabetes-periodontal disease risks with patients (88%). Fewer respondents were comfortable asking patients about alcohol consumption (54%) or providing alcohol counseling (49%). Most agreed that dentists should be trained to identify risk factors (96%) or actively manage systemically diseased patients (74%). Over 90% agreed that medical and dental professionals should be taught to practice more collaboratively. These data indicate that these dentists were knowledgeable about oral-systemic health associations, had mixed comfort levels translating the evidence into clinical practice, but expressed support for interprofessional education to improve their readiness to actively participate in their patients' overall health management.

Adjunctive Treatment of Periodontal Disease with Self-Adhesive Hydrogel Wound Dressing: Case Series.

UNLABELLED: Periodontal disease (periodontitis) is a common inflammatory condition affecting the deep, supporting tissues around teeth. While specific bacteria in plaque biofilm initiate the disease process, host immuno-inflammatory responses are responsible for the majority of tissue destruction. Conventional methods for controlling periodontitis include mechanical removal of the biofilm-with or without surgical access-and the adjunctive use of chemotherapeutics (antimicrobials or host modulators). PerioPatch™ is an approved device product that has been developed as an oral adhesive barrier for promoting healing in inflamed oral/gingival tissues and reducing pain, irritation, and the symptoms of inflammation. In this case series, which documented the adjunctive benefits of PerioPatch therapy in patients with chronic periodontitis, 9 patients who presented with generalized moderate to severe chronic periodontitis were treated with scaling and root planing plus adjunctive PerioPatch devices. Patients applied the devices to identified areas with periodontal pocketing (≥ 6 mm at baseline) twice daily at Day 1, then once daily for Days 2 to 7. Three of the patients additionally applied devices to the treatment sites on Days 15 to 21. Patients were evaluated for changes in probing parameters at 4 to 6 weeks. RESULTS: Clinical examinations performed at baseline and post-treatment indicated consistent pocket depth reductions (mean 2.8 mm) and resolution of bleeding on probing (94%). Patients complied with the application schedule and reported no adverse effects. The authors conclude that within the confines of this case series, the PerioPatch is a novel but simple device that can be used adjunctively with scaling and root planing for the management of chronic periodontitis.

Factors associated with the clinical response to nonsurgical periodontal therapy in people with type 2 diabetes mellitus.

BACKGROUND: Type 2 diabetes mellitus (T2DM) is a growing health problem worldwide. People with T2DM are at risk of experiencing periodontitis and likely require treatment. Using data from the national multicenter Diabetes and Periodontal Therapy Trial (DPTT), the authors assessed patient-based characteristics associated with the clinical response to nonsurgical therapy. METHODS: The DPTT investigators randomly assigned adults with T2DM (hemoglobin A1c [HbA1c] ≥ 7 percent and < 9 percent) and moderate to advanced periodontitis to receive immediate or delayed therapy (scaling and root planing, oral hygiene instruction, chlorhexidine rinse). The investigators assessed probing depth (PD), clinical attachment level (CAL), bleeding on probing (BOP), and medical conditions at baseline, three months and six months. Six-month changes in mean PD, CAL and BOP defined the treatment response. Complete data were available for 473 of 514 DPTT participants. The authors used multiple regression models to evaluate participant-level factors associated with the response. RESULTS: More severe baseline PD, CAL and BOP were associated with greater improvements in these same measurements (P < .0001). Hispanic participants experienced greater improvements in PD and CAL than did non-Hispanic participants (P < .0001). Obese participants (those with a body mass index > 30 kilograms per square meter) experienced greater reductions in PD and BOP than did participants who were not obese (P < .001). Age, sex, HbA1c values, diabetes duration, and smoking were not associated with change in any outcome (P > .1). CONCLUSIONS: In patients with T2DM, baseline disease severity was associated with the clinical response to nonsurgical periodontal therapy. Body mass index and Hispanic ethnicity-but not glycemic control, diabetes duration or smoking-also may be useful in predicting clinical changes in this population.

Dentists' practice behaviors and perceived barriers regarding oral-systemic evidence: implications for education.

Observational studies consistently support a relationship between poor oral health and systemic diseases like cardiovascular disease and diabetes mellitus. The purpose of this study was to identify current practices and perceived barriers among North Carolina dentists regarding the incorporation of oral-systemic evidence into the delivery of patient care. A survey questionnaire was developed, pilot tested, revised, and mailed to 1,350 licensed dentists in North Carolina. The response rate was 49 percent. Bivariate analysis was used to compare practice behaviors and barriers among age, gender, practice type, and setting categorizations using the chi-square test. Respondents were predominantly male (77 percent), in solo practice (59.4 percent), and in urban or suburban settings (74 percent). Half (50 percent) reported updating medical histories at every patient visit. Younger dentists were significantly (p<0.05) more likely to inquire about patient blood glucose levels and utilize blood pressure guidelines. Perceived patient objections to additional fees and lack of patient acceptance were reported as significant barriers, especially among younger dentists. Significantly more rural dentists reported lack of appropriate referral options as a barrier (p<0.05). In the multivariate analysis, gender and type of practice but not age were statistically significant predictors of respondents' perceptions of patients' objection to additional fees. Dental schools need to prepare dental students for future roles in the assessment, management, and interprofessional collaboration that will be needed in the future.

The effect of nonsurgical periodontal therapy on hemoglobin A1c levels in persons with type 2 diabetes and chronic periodontitis: a randomized clinical trial.

IMPORTANCE: Chronic periodontitis, a destructive inflammatory disorder of the supporting structures of the teeth, is prevalent in patients with diabetes. Limited evidence suggests that periodontal therapy may improve glycemic control. OBJECTIVE: To determine if nonsurgical periodontal treatment reduces levels of glycated hemoglobin (HbA1c) in persons with type 2 diabetes and moderate to advanced chronic periodontitis. DESIGN, SETTING, AND PARTICIPANTS: The Diabetes and Periodontal Therapy Trial (DPTT), a 6-month, single-masked, multicenter, randomized clinical trial. Participants had type 2 diabetes, were taking stable doses of medications, had HbA1c levels between 7% and less than 9%, and untreated chronic periodontitis. Five hundred fourteen participants were enrolled between November 2009 and March 2012 from diabetes and dental clinics and communities affiliated with 5 academic medical centers. INTERVENTIONS: The treatment group (n = 257) received scaling and root planing plus chlorhexidine oral rinse at baseline and supportive periodontal therapy at 3 and 6 months. The control group (n = 257) received no treatment for 6 months. MAIN OUTCOMES AND MEASURES: Difference in change in HbA1c level from baseline between groups at 6 months. Secondary outcomes included changes in probing pocket depths, clinical attachment loss, bleeding on probing, gingival index, fasting glucose level, and Homeostasis Model Assessment (HOMA2) score. RESULTS: Enrollment was stopped early because of futility. At 6 months, mean HbA1c levels in the periodontal therapy group increased 0.17% (SD, 1.0), compared with 0.11% (SD, 1.0) in the control group, with no significant difference between groups based on a linear regression model adjusting for clinical site (mean difference, -0.05% [95% CI, -0.23% to 0.12%]; P = .55). Periodontal measures improved in the treatment group compared with the control group at 6 months, with adjusted between-group differences of 0.28 mm (95% CI, 0.18 to 0.37) for probing depth, 0.25 mm (95% CI, 0.14 to 0.36) for clinical attachment loss, 13.1% (95% CI, 8.1% to 18.1%) for bleeding on probing, and 0.27 (95% CI, 0.17 to 0.37) for gingival index (P < .001 for all). CONCLUSIONS AND RELEVANCE: Nonsurgical periodontal therapy did not improve glycemic control in patients with type 2 diabetes and moderate to advanced chronic periodontitis. These findings do not support the use of nonsurgical periodontal treatment in patients with diabetes for the purpose of lowering levels of HbA1c. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT00997178.

Dental hygienists' knowledge and opinions of oral-systemic connections: implications for education.

Although associations between periodontal and systemic health have been well established, there is little evidence regarding dental hygienists' knowledge of the oral-systemic connection. The purpose of this study was to determine the knowledge levels of North Carolina dental hygienists regarding oral-systemic connections and their attitudes and confidence about incorporating this knowledge into clinical practice. A survey was developed, pilot tested, revised, and mailed to 1,665 licensed dental hygienists in North Carolina. After three mailings, the response rate was 62 percent, with 52 percent (N=859) meeting the inclusion criteria. The majority (>80 percent) of the respondents correctly identified risk factors for diabetes and cardiovascular disease (CVD), but were less knowledgeable about risk factors for osteoporosis and adverse pregnancy outcomes. Most knew that there is strong evidence linking periodontal disease with CVD (77 percent) and diabetes (70 percent). The majority felt that dental hygienists should be trained to identify risk factors for oral-systemic disease (94 percent) and to actively manage patients with systemic disease (78 percent). Eighty-eight percent felt that dental and medical professionals should be taught to practice collaboratively. These dental hygienists had a high level of knowledge in some areas of oral-systemic disease but could improve their confidence levels and knowledge through expanded content in their educational programs and continuing education. Inter-professional education and collaboration would also assist in integration of knowledge into clinical practice.

Incorporating oral-systemic evidence into patient care: practice behaviors and barriers of North Carolina dental hygienists.

PURPOSE: Current research has reported associations between periodontal and systemic health, however, there is little data regarding how dental hygienists are incorporating this evidence into the dental hygiene practice. The purpose of this survey research was to determine what practice behaviors are prevalent among North Carolina dental hygienists regarding the incorporation of oral-systemic evidence into practice as well as perceived barriers to implementation. METHODS: A questionnaire was developed, pilot tested, revised and mailed to 1,665 licensed dental hygienists in North Carolina. After 3 mailings the response rate was 62%, with 52% (n=859) of respondents meeting inclusion criteria. Survey data was analyzed using descriptive statistics and Chi-square analysis. RESULTS: Respondents were predominately female (99%) with a 2 year degree (84%). While a minority of dental hygienists (20%) reported measuring blood pressure routinely on all patients, a majority (62%) measure blood pressure in select patients. Oral cancer screenings were performed by 89% of respondents. Eight percent record blood sugar levels, but only 3% record HbA1c values. Fifty percent of dental hygienists are extremely likely to refer patients to a medical provider for follow up assessments. Conditions dental hygienists are likely to discuss with patients include tobacco use (89%), pregnancy (84%) and genetics (79%). Significant barriers to implementing oral-systemic evidence include lack of time (52%), concern over legal risks (44%) and lack of education (27%). CONCLUSION: North Carolina dental hygienists are implementing some aspects of oral-systemic evidence into practice, but could take a more active role if they had more allotted time, education and training.

Interferon-gamma promoter hypomethylation and increased expression in chronic periodontitis.

AIM: The goal of this investigation was to determine whether epigenetic modifications in the IFNG promoter are associated with an increase of IFNG transcription in different stages of periodontal diseases. MATERIALS AND METHODS: DNA was extracted from gingival biopsy samples collected from 47 total sites from 47 different subjects: 23 periodontally healthy sites, 12 experimentally induced gingivitis sites and 12 chronic periodontitis sites. Levels of DNA methylation within the IFNG promoter containing six CpG dinucleotides were determined using pyrosequencing technology. Interferon gamma mRNA expression was analysed by quantitative polymerase chain reactions using isolated RNA from part of the biological samples mentioned above. RESULTS: The methylation level of all six analysed CpG sites within the IFNG promoter region in the periodontitis biopsies {52% [interquartile range, IQR (43.8%, 63%)]} was significantly lower than periodontally healthy samples {62% [IQR (51.3%, 74%)], p=0.007} and gingivitis biopsies {63% [IQR (55%, 74%)], p=0.02}. The transcriptional level of IFNG in periodontitis biopsies was 1.96-fold and significantly higher than tissues with periodontal health (p=0.04). Although the mRNA level from experimental gingivitis samples exhibited an 8.5-fold increase as compared with periodontally healthy samples, no significant methylation difference was observed in experimental gingivitis sample. CONCLUSIONS: A hypomethylation profile within IFNG promoter region is related to an increase of IFNG transcription present in the chronic periodontitis biopsies, while such an increase of IFNG in experimentally induced gingivitis seems independent of promoter methylation alteration.

Gingival transcriptome patterns during induction and resolution of experimental gingivitis in humans.

BACKGROUND: To our knowledge, changes in the patterns of whole-transcriptome gene expression that occur during the induction and resolution of experimental gingivitis in humans were not previously explored using bioinformatic tools. METHODS: Gingival biopsy samples collected from 14 subjects during a 28-day stent-induced experimental gingivitis model, followed by treatment, and resolution at days 28 through 35 were analyzed using gene-expression arrays. Biopsy samples were collected at different sites within each subject at baseline (day 0), at the peak of gingivitis (day 28), and at resolution (day 35) and processed using whole-transcriptome gene-expression arrays. Gene-expression data were analyzed to identify biologic themes and pathways associated with changes in gene-expression profiles that occur during the induction and resolution of experimental gingivitis using bioinformatic tools. RESULTS: During disease induction and resolution, the dominant expression pathway was the immune response, with 131 immune response genes significantly up- or downregulated during induction, during resolution, or during both at P <0.05. During induction, there was significant transient increase in the expression of inflammatory and oxidative stress mediators, including interleukin (IL)-1 alpha (IL1A), IL-1 beta (IL1B), IL8, RANTES, colony stimulating factor 3 (CSF3), and superoxide dismutase 2 (SOD2), and a decreased expression of IP10, interferon inducible T-cell alpha chemoattractant (ITAC), matrix metalloproteinase 10 (MMP10), and beta 4 defensin (DEFB4). These genes reversed expression patterns upon resolution in parallel with the reversal of gingival inflammation. CONCLUSIONS: A relatively small subset (11.9%) of the immune response genes analyzed by array was transiently activated in response to biofilm overgrowth, suggesting a degree of specificity in the transcriptome-expression response. The fact that this same subset demonstrates a reversal in expression patterns during clinical resolution implicates these genes as being critical for maintaining tissue homeostasis at the biofilm-gingival interface. In addition to the immune response pathway as the dominant response theme, new candidate genes and pathways were identified as being selectively modulated in experimental gingivitis, including neural processes, epithelial defenses, angiogenesis, and wound healing.

Interproximal tissue dimensions in relation to adjacent implants in the anterior maxilla: clinical observations and patient aesthetic evaluation.

OBJECTIVES: This clinical study aimed to assess (i) interproximal tissue dimensions between adjacent implants in the anterior maxilla, (ii) factors that may influence interimplant papilla dimensions, and (iii) patient aesthetic satisfaction. MATERIAL AND METHODS: Fifteen adults, who had two or more adjacent implants (total of 35) in the anterior maxilla, participated in the study. The study design involved data collection from treatment records, clinical and radiographic assessment, and a questionnaire evaluating aesthetic satisfaction. RESULTS: The median vertical dimension of interimplant papillae, i.e., distance from tip of the papilla to the bone crest, was 4.2 mm. Missing papilla height (PH) at interimplant sites was on average 1.8 mm. Median proximal biologic width at interimplant sites was 7 mm. The most coronal bone-to-implant contact at implant-implant sites was located on average 4.6 mm apical to the bone crest at comparable neighbouring implant-tooth sites. The tip of the papilla between adjacent implants was placed on average 2 mm more apically compared with implant-tooth sites. The contact point between adjacent implant restorations extended more apically by 1 mm on average compared with implant-tooth sites. Median missing PH was 1 mm when an immediate provisionalization protocol had been followed, whereas in the case of a removable temporary it was 2 mm. Split group analysis showed that for missing PH

Locally administered antimicrobials for the management of periodontal infection.

Residual or persistent periodontal inflammation is associated with periodontal disease progression and tooth loss. Hence, resolving periodontal inflammation remains an important goal of periodontal treatment. Clinical trials consistently demonstrate that LAAs combined with SRP effectively reduce tissue inflammation in patients with chronic periodontitis. These changes are clinically relevant, and preliminary data suggest that this approach to periodontal treatment may be associated with improvements in systemic outcomes.

Results from the Periodontitis and Vascular Events (PAVE) Study: a pilot multicentered, randomized, controlled trial to study effects of periodontal therapy in a secondary prevention model of cardiovascular disease.

BACKGROUND: In the Periodontitis and Vascular Events (PAVE) pilot study, periodontal therapy was provided as an intervention in a secondary cardiac event prevention model through five coordinated cardiac-dental centers. METHODS: Subjects were randomized to either community care or protocol provided scaling and root planing to evaluate effects on periodontal status and systemic levels of high-sensitivity C-reactive protein (hs-CRP). RESULTS: After 6 months, there was a significant reduction in mean probing depth and extent of 4- or 5-mm pockets. However, there were no significant differences in attachment levels, bleeding upon probing, or extent of subgingival calculus comparing subjects assigned to protocol therapy (n = 151) to those assigned to community care (n = 152). Using intent-to-treat analyses, there was no significant effect on serum hs-CRP levels at 6 months. However, 48% of the subjects randomized to community care received preventive or periodontal treatments. Secondary analyses demonstrated that consideration of any preventive or periodontal care (i.e., any treatment) compared to no treatment showed a significant reduction in the percentage of people with elevated hs-CRP (values >3 mg/l) at 6 months. However, obesity nullified the periodontal treatment effects on hs-CRP reduction. The adjusted odds ratio for hs-CRP levels >3 mg/l at 6 months for any treatment versus no treatment among non-obese individuals was 0.26 (95% confidence interval: 0.09 to 0.72), adjusting for smoking, marital status, and gender. CONCLUSION: This pilot study demonstrated the critical role of considering obesity as well as rigorous preventive and periodontal care in trials designed to reduce cardiovascular risk.

Long-term follow-up and tomographic assessment of an intrabony defect treated with enamel matrix derivative.

BACKGROUND: Enamel matrix derivative (EMD) has an extensive documentation of use in the treatment of periodontal defects. Digital volume tomography (DVT) has been in use in dental medicine since the late 1990s, with a major advantage of decreased radiation and cost-effectiveness compared to conventional computed tomography (CT). To the best of our knowledge, there is no peer-reviewed report documenting long-term tomographic assessment of an intrabony defect treated with EMD alone. METHODS: In this case report, we document the long-term response of an isolated intrabony defect treated with flap surgery plus EMD and monitored for 30 months with a DVT scan. We also compare clinical and radiographic findings for the defect at 7 and 30 months postoperatively. RESULTS: With regenerative treatment, significant improvements in probing depth (PD), clinical attachment level (CAL), and bleeding on probing (BOP) were observed both short and long term. No recession occurred, and papillary heights were maintained throughout the monitoring period. Although intraoral radiography suggested bone fill at the defect site at 7 months, DVT confirmed that the intrabony defect was eliminated at 30 months. CONCLUSIONS: Treatment of an intrabony defect with surgery plus EMD demonstrated excellent bone fill as assessed with conventional radiographic and tomographic examinations performed over 30 months. Larger studies are needed to further assess the use of DVT imaging as an appropriate adjunctive diagnostic tool for evaluating the responses of intrabony defects to regenerative techniques.

Realigning biomedical science instruction in predoctoral curricula: a proposal for change.

Currently in North America, there is an active dialogue going on about the state of predoctoral dental education and the need for curriculum change, innovation, and the adoption of contemporary, competency-based educational models. At the institutional level, curriculum committees struggle with requests from faculty to add new content to an overburdened didactic and clinic schedule. This article will describe potential solutions centering on the role and scope of the biomedical sciences in predoctoral dental education. The authors propose that dental educators and institutions reconsider the current admission prerequisites and curriculum content of the biomedical sciences in predoctoral programs. The proposed changes are intended to eliminate content redundancy between undergraduate and predoctoral dental education by integration of the biomedical sciences--in particular, biochemistry, microbiology, and physiology--into other clinically oriented coursework and learning experiences in the curriculum based on a pathophysiology model that fosters students' comprehension of the etiology of oral and systemic diseases encountered by the general dental practitioner. The authors explore how changes in the biomedical science prerequisites for dental school matriculation and associated modifications in curriculum focus and content would impact admissions testing, composition of national board exams, and strategies for teaching and learning within dental schools.

Locally delivered antimicrobials: clinical evidence and relevance.

Periodontitis is a common oral infection and inflammatory condition. Following treatment, residual or persistent periodontal inflammation is associated with disease progression and tooth loss. Cumulative evidence from clinical trials and meta-analyses support a complementary medical-mechanical model that combines locally delivered antimicrobials with scaling and root planing for the treatment of chronic periodontitis. Accordingly, greater pocket depth reductions and/or attachment level gains occur in patients treated with adjunctive locally administered antimicrobials (eg, tetracycline, chlorhexidine, doxycycline, and minocycline). These responses are clinically relevant because they are accompanied by a higher probability of patient maintenance or pocket resolution. Recent trials also indicate that locally administered antimicrobials may enhance the effects of periodontal surgical therapy and may reduce the signs of peri-implantitis. The consistency of these findings supports the use of locally administered antimicrobials for managing dental patients with chronic periodontitis.