Bone Loss in Furcation-involved Mandibular Molars: A Retrospective Analysis.

Purpose: The purpose of this retrospective study was to determine whether teeth with furcation involvement lose significantly more bone in furcation sites over time than interproximal sites of the same tooth.Methods: Existing radiographs were analyzed to compare the rate of bone loss between furcation and interproximal sites of the same tooth. Selection criteria included mandibular molars with furcation involvement and a minimum follow-up of 5 years. Using ImageJ software, anatomical landmarks were located and measured corono-apically.Results: Bone level change over time averaged 4.22 % ± 2.49 for interproximal sites and 4.55% ± 2.84 for furcation sites. Significant difference in bone loss was noted in furcation sites between compliant (a minimum of one periodontal maintenance appointments per year) and non-compliant (fewer than one periodontal maintenance appointments per year) sub-groups. No other sub-group variables were associated with significant bone loss.Conclusion: There were no significant differences in bone loss between furcation sites and interproximal sites of the same tooth. Compliant patients lost significantly less bone in furcation sites than non-compliant patients. Periodontal maintenance therapy may provide more effective debridement for mandibular molars that exhibit radiographic furcation bone loss than previously thought. Clinicians are encouraged to expand and explore a non-surgical approach for maintaining multi-rooted teeth with furcation involvement.

Sodium hypochlorite (dilute chlorine bleach) oral rinse in patient self-care.

Sodium hypochlorite (NaOCl), commonly known as "bleach," is widely accepted as being a safe and effective antiseptic against bacteria, fungi, and viruses. For over a century, bleach has been used to control or overcome infection in homes, hospitals, and even on battlefields, and in endodontics for disinfection of root canals. This paper reviews clinical studies on the efficacy of sodium hypochlorite oral rinse to combat dental plaque and gingival inflammation. Sodium hypochlorite is readily available as inexpensive household bleach, and we suggest that oral rinsing twice weekly with dilute bleach (0.25% sodium hypochlorite) constitutes a valuable adjunct to current methods of plaque removal.

Triple jump examination evaluation of faculty examiners by dental student examinees.

The triple jump examination (TJE) is an oral examination that poses challenges for objective assessment. Student satisfaction levels with faculty assessment can provide information on quality of teaching and students' perceptions of the learning environment. The purpose of this study was to determine scale and interrater reliability of an instrument used by approximately 576 first-year dental students at one U.S. dental school for assessment of their faculty evaluators following midterm and final TJEs over a three-year period. One hundred and one faculty members served as administrators of the TJE with a range of one to 187 times (mean=44.10, median=29, mode=11). The grand mean for six items on a six-point Likert scale was 5.39 with a pooled standard deviation of 1.01. Results indicate positive agreement toward performance of examiners with strong interrater reliability (Average Measures ICC=0.936, Single Measures ICC=0.708) (F5,23475 = 51.564, p<0.001) and consistency across all items (Cronbach's α=0.936). The a priori assumption that students would rate faculty higher as they gained experience over time was rejected (r=0.018, p=0.429). Indications are that faculty members, who are relatively inexperienced with TJE examining, can perform acceptable assessment from the students' perspective. Overall, these students expressed a high level of satisfaction with TJE faculty performance.

The rationale for and implementation of learner-centered education: experiences at the Ostrow School of Dentistry of the University of Southern California.

This report describes the design, implementation, and function of integrated, learner-centered education at the Ostrow School of Dentistry of the University of Southern California. The 190 required courses of the previous curriculum have been condensed to forty-four courses. Four courses, presented for each of eleven trimesters of the four-year D.D.S. program, are entitled Human Structure, Human Function, Human Behavior, and Human Clinical Dentistry. An integrated biomedical sciences curriculum is supported by small-group, facilitator-based, problem-based learning (PBL) and an electronic PBL case library. Modules, rotations, and preclinical and clinical sessions make up remaining instructional units of the curriculum. Selected assessment outcomes measuring student knowledge, behavior, and skill development are discussed. As an external measure, first-attempt pass rates on the National Board Dental Examination (NBDE) Part I show a range of 87-96 percent over a ten-year period (for Classes 2005-14). First-attempt pass rates on the NBDE Part II for Classes 2005-12 ranged from 74 percent to 93 percent. Perceived barriers and opportunities for better performance on the NBDE Part II are addressed. Additionally, an exit survey, administered over the past four years, indicates a high level of student satisfaction with "depth and breadth" of their education (82-93 percent) and that graduates feel well prepared to enter the practice of dentistry (94-97 percent).

Triple jump examinations for dental student assessment.

The triple jump examination (TJE) attempts to assess a higher level of learning with demand for analysis, critical thinking, and resolution of problems presented by written scenarios based on patient care situations. The purpose of this study was to examine the internal consistency, scale reliability, and interrater reliability of the TJE used at the Ostrow School of Dentistry, University of Southern California. On the sample of 2,227 examinations administered by seventy-seven raters across a three-year time period, the Cronbach's coefficient alpha for internal consistency of the overall TJE was found to be good (a=0.869). The internal consistency of the three subscales was found to be acceptable (a=0.731), good (a=0.820), and good (a=0.820). Average and single measures intraclass correlation coefficients (ICC) for scale reliability were significant at p<0.001, indicating strong interrater reliability. There were no statistically significant differences (p≤0.05) in the mean scores assigned on the TJE between rater groups defined by rater experience level with the TJE. A very high level of agreement among rater pairs was also observed. Across the entire three-year study period, with over 19,152 ratings, the seventy-seven raters were in general agreement 99.5 percent of the time and in exact agreement 77.2 percent of the time.

Risk of prion disease transmission through bovine-derived bone substitutes: a systematic review.

BACKGROUND: Despite the causal association between variant Creutzfeldt - Jakob disease and bovine spongiform encephalopathy (BSE), bovine origin graft materials are widely used during dental surgical procedures. The aim of this study was to assess the risk of BSE transmission through anorganic bovine bone substitutes. METHODS: Electronic database of MEDLINE was searched to identify relevant studies regarding our focused questions, presence of BSE prion infectivity in raw bovine bone, BSE prion inactivation by bone substitute manufacturing process, protein contents in anorganic bovine bone substitutes, and validity of current BSE diagnostic methods. Search terms yielded 1,704 titles. After title/abstract screening and duplicates removal, 36 full-text articles were screened for inclusion. RESULTS: A total of 16 studies were included in the final analysis. No eligible studies were identified regarding the efficacy of BSE prion inactivation by the treatments used for anorganic bovine bone manufacturing. BSE infectivity and PrP(Sc) , pathological prion, were detected in bovine bone marrow and serum samples. Proteins were detected in Tutoplast® (bovine), Bio-Oss®, and tibia samples treated at the similar condition for Bio-Oss deproteinization. Inconsistent results of different BSE diagnostic tests were not unusual findings (Iwata et al. 2006; Arnold et al. 2007; Murayama et al. 2010), and a study by Balkema-Buschmann and colleagues showed an apparent discrepancy between BSE infectivity and detection of PrP(27-30), the current surrogate marker for prion disease infectivity. CONCLUSION: This review indicates that bovine-derived graft biomaterials may carry a risk of prion transmission to patients.

Cone beam computed tomographic measurement of maxillary central incisors to determine prevalence of facial alveolar bone width ≥2 mm.

BACKGROUND: The initial thickness of maxillary bone has significant impact on the responding level of facial bone and soft tissue after extraction and immediate implant placement. A prevailing notion is that following implant placement in fresh extraction sites, at least 2 mm of facial bone is needed to prevent soft tissue recession, fenestration, and dehiscence. PURPOSE: The purpose of this study was to use cone beam computed tomography (CBCT) to measure horizontal width of facial alveolar bone overlying healthy maxillary central incisors and to determine prevalence of bone thickness ≥2 mm. MATERIALS AND METHODS: Tomographic data from 101 randomly selected patients were evaluated by two independent observers. Assessments were made of facial bone width at levels 1.0 to 10.0 mm apical to the bone crest. RESULTS: Healthy maxillary central incisors (n= 202) were measured from 101 patient scans. The percent of teeth with facial bone ≥2 mm at levels 1, 2, 3, 4, and 5 mm from the bone crest was 0, 1.5, 2.0, 3.0, and 2.5%, respectively. Overall mean thickness of the bone was 1.05 mm for right and left central incisors combined. The range of individual measurements for all levels was 0 to 5.1 mm. The occurrence of ≥ 2 mm thickness bone measurements increased with increasing depth. However, mean widths observed at levels 6 to 10 mm from the crest ranged only 1.0 to 1.3 mm because of apparent fenestration occurrence (0 mm bone) in approximately 12% of teeth. Overall, no significant differences in bone thickness were found between ethnic, gender, age, or scan groups. CONCLUSIONS: Using CBCT, occurrences of ≥2 mm maxillary facial alveolar bone were found on no more than 3% of root surfaces 1.0 to 5.0 mm apical to the bone crest in this sample of maxillary central incisors. The study evidenced prevalence of a thin facial alveolar bone (<2 mm) that may contribute to risk of facial bone fenestration, dehiscence, and soft tissue recession after immediate implant therapy.

The profile of inflammatory cytokines in gingival crevicular fluid around healthy osseointegrated implants.

OBJECTIVE: Regardless of gingival health and subgingival microbiology, production of cytokines within peri-implant tissues may be different from that of teeth. The objective of this study was to describe the peri-implant levels of pro-inflammatory cytokines and subgingival microbiology in clinically healthy sites. MATERIALS AND METHODS: Subgingival plaque and gingival crevicular fluid (GCF) were obtained from 28 clinically healthy implants and 26 teeth selected from 24 individuals. Microbial composition was determined by selective anaerobic culture techniques. Pro-inflammatory cytokines were quantified by flow cytometry analysis of GCF. The concentration of cytokines between implants and teeth were compared with the independent t-test. RESULTS: The concentration of cytokines was higher in GCF from healthy implants than in teeth. The profile of cytokines was characteristic of an innate immune response. A more frequent detection of periodontopathic bacteria was observed in teeth than implants. Cultivable levels of periodontopathic bacteria were similar between implants and teeth. CONCLUSIONS: Despite gingival tissue health and scarce plaque accumulation, the profile of inflammatory cytokines in implant crevicular fluid was distinctive of an innate immune response and in higher concentration than in teeth. Other than bacterial stimulus, intrinsic factors related to implants may account for more cytokine production than teeth.

The impact of early-in-life periodontal infection on the smiles of children: a worldwide view.

Little attention has been directed toward evidence that an early-in-life oral infection with the potential to reach epidemic proportions is threatening the health of youths throughout world. Health professionals and the public seem unaware that the silent disease process of early-in-life periodontal infection is targeting thousands of children and young adults, their smiles, and, consequently, their emotional and psychologic lives. Yet, the literature is replete with reports that many periodontopathic microorganisms are multiplying at an alarming rate with a serious impact on youths in many cities, towns, and villages throughout the globe. However, clinical measurement of reported periodontal disease has been fraught with problems that have confused and clouded messages to policymakers in government and health professionals in treatment settings. The aim of this article is to help raise the level of awareness so that those who have the power and knowledge can appropriately address the suffering of the youngest members of societies.

The impact of systemic disease-associated gingival enlargement on pediatric patients.

This article provides an analysis of pediatric systemic disease and the corresponding prescribed medications for selected physical and mental health conditions. The focus is on pediatric oral health, specifically the drug-associated side effect of gingival enlargement. A simple and logical analysis of current pediatric health trends reveals that gingival overgrowth is evident in societies worldwide as a serious epidemic. This article describes the morbidity and risks that are related to drug-associated gingival overgrowth, and proposes a framework of action for treating the side effects of chronic diseases and conditions in pediatric patients.

Microbiology and cytokine levels around healthy dental implants and teeth.

BACKGROUND: Elicitation of the relationship of periodontopathogens and pro-inflammatory cytokines to bone resorption and formation is significant to a growing body of research known as osteoimmunology. It is essential that clinically healthy peri-implant and periodontal sites are studied to contribute comparison data for investigations that are addressing diseased sites. PURPOSE: The purpose of this study was to describe levels of selected pro-inflammatory cytokines in clinically healthy peri-implant and periodontal sites, and to examine whether cytokine levels may be related to specific bacterial/viral pathogens. MATERIALS AND METHODS: Eleven subjects (mean age 56.2 +/- 10) participated in the study. Subgingival microbial samples were cultured for periodontopathic bacteria. Gingival crevicular fluid samples were analyzed by nested polymerase chain reaction for Cytomegalovirus (HCMV) and were tested for the quantification of Interleukin (IL)-8, IL-1beta, IL-6, IL-10, Tumor Necrosis Factor (TNF)-alpha, and IL-12p70 using flow cytometry (FACS). Findings for microbiota composition and cytokine levels were compared between implants and teeth (chi square, Kruskall-Wallis, Mann-Whitney; p < or = .05). RESULTS: Both the frequency (%) and levels (%) of periodontopathic bacteria were higher around teeth than implants. The concentration (picogram per milliliter) of cytokines was more prominent around implants than teeth, reaching nearly twofold differences in some instances. Cytokine levels were higher when the sites analyzed were positive for any bacteria tested. HCMV was not detected. CONCLUSIONS: Pro-inflammatory cytokine production was unrelated to heavy bacterial challenge. Nevertheless, when periodontopathic bacteria were detected by culture, cytokine levels were increased around both implants and teeth. Studies are needed to investigate the pro-inflammatory cytokines (especially IL-1beta and TNF-alpha) produced in spite of minimal bacterial accumulation.

Immunology, microbiology, and virology following placement of NobelPerfect scalloped dental implants: analysis of a case series.

BACKGROUND: Cytokine-microbiology-virology monitoring after implant placement may help to develop profiles of variables that can help to explain interaction between the immune system and alveolar bone. Descriptive information at the molecular and cellular levels after implant placement is important in the emerging field of osteoimmunology and may help to formulate hypotheses and intervention strategies in periodontology and implantology. PURPOSE: The purpose of this study was to determine the presence or absence of selected cytokines in association with periodontopathogens and human cytomegalovirus (HCMV) after placement of dental implants. MATERIALS AND METHODS: Charts of seven consecutive patients with 19 NobelPerfect (Nobel Biocare, Yorba Linda, CA, USA) implants were reviewed for crevicular fluid sample outcomes. Anaerobic culture determined periodontopathogens 2 to 5 days, 3 and 6 months postimplant insertion. At 3, 6, and 12 months, real-time reverse transcriptase-polymerase chain reaction (RT-PCR) was performed to detect active HCMV, interleukin-1beta (IL-1beta), tumor necrosis factor-alpha (TNF-alpha), and interferon-gamma (INF-gamma). RESULTS: Four of five, and six of seven patients harbored no periodontopathogens at 3- or 6-month intervals, respectively. In spite of absence of a bacterial challenge, IL-1beta and TNF-alpha activity was significant. INF-gamma was not detected, and HCMV was present at one time interval only. CONCLUSIONS: TNF-alpha is produced mainly in the early stages of acute inflammation, and high levels of this cytokine at 3 and 6 months postimplant placement may be related to a repetitive acute-phase inflammatory response. Lack of INF-gamma and a high cytokine presence without significant corresponding periopathogens or viruses raise a concern that inflammation and, thus, inflammatory bone destruction, is possible outside of these variables. Inflammation and bone loss around this same group of scalloped implants, reported by our previous study, may have been initiated by local factors, such as particular implant design features.

Problem-based learning versus a traditional educational methodology: a comparison of preclinical and clinical periodontics performance.

To evaluate efficacy of a problem-based learning (PBL) pedagogy in preclinical and clinical teaching, test scores of 234 undergraduate dental students from the conventionally taught classes of 2003 and 2004 were compared with scores of 274 dental students from the PBL classes of 2005 and 2006. Although the groups' means were close together, t-test analysis of scores revealed that PBL students performed significantly better than traditional (TRAD) students on midterm (p=.0001) and final (p=.015) examinations taken on student partner/mock patients. ANOVA comparing the classes with each other showed significant differences for the midterm and final, but not for the clinical examination. Further multiple comparison tests (Tukey HSD) for the midterm and final revealed that differences specifically reflected superior performance of PBL classes against one of the TRAD classes (2004). There was no difference in performance between PBL (n=134) and TRAD (n=233) students on examinations taken with actual clinical patients who were undergoing nonsurgical periodontal treatment. Over a two-year period, PBL students rated their program instructors at a mean of 4.41 on a Likert-type scale of 1 (not helpful) to 5 (outstanding). The program provides a PBL model for teaching preclinical and clinical skills supported by a four-year evaluation of manual skills outcomes.