The integration of diet and nutrition lifestyle management strategies into the dental office visit for diabetes risk reduction and management

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1. Maura Bruno, RD, CDE, DCN

+Author Affiliations

1. Dr. Bruno is an adjunct assistant professor, Department of Nutritional Sciences, School of Health Related Professions, University of Medicine and Dentistry of New Jersey, Newark. She also is a certified diabetes educator. Address reprint requests to Dr. Bruno at Department of Nutritional Sciences, School of Health Related Professions, University of Medicine and Dentistry of New Jersey, 65 Bergen St., Room 157, Newark, N.J. 07107-3001, e-mail brunoms@umdnj.edu.

Abstract

Background. The incidence of diabetes and prediabetes in the United States continues to increase. Oral health care professionals (OHCPs) play a role in diabetes screening and education.

Methods. The author presents and explores diet and lifestyle management strategies OHCPs can provide to patients who have prediabetes and type 2 diabetes mellitus (T2DM).

Results. Modest weight loss (7 percent of body weight) and regular physical activity (150 minutes per week) are important in the prevention and treatment of prediabetes and T2DM. Following a carbohydrate-controlled diet that is limited in fat and cholesterol will help patients with T2DM achieve normoglycemia and reduce their risk of developing diabetes complications.

Conclusions. The importance of using these strategies can be reinforced by OHCPs during office visits. OHCPs can collaborate with registered dietitians to improve the outcome of oral health through diabetes prevention, education and management.

Clinical Implications. Being familiar with risk factors for T2DM and recommendations for lifestyle modification strategies to prevent T2DM may help OHCPs educate patients and refer them for appropriate treatment and therapy.

1. The Journal of the American Dental Association December 1, 2012 vol. 143 no. 12 1320-1323

The limitations of the clinical oral examination in detecting dysplastic oral lesions and oral squamous cell carcinoma

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1. Joel B. Epstein, DMD, MSD, FRCD(C), FDS RCS(Edin)

1. Dr. Epstein is an adjunct professor and the director of oral medicine, City of Hope National Medical Center, Duarte, Calif., and a staff member, Cedars Sinai Medical Center, Los Angeles.

1. Pelin Güneri, DDS, PhD

1. Dr. Güneri is a professor, Department of Maxillofacial Radiology, School of Dentistry, Ege University, Bornova, Izmir 35100, Turkey, e-mail peleen_2000@yahoo.com. Address reprint requests to Dr. Güneri.

1. Hayal Boyacioglu, PhD

1. Dr. Boyacioḡlu is a lecturer, Department of Statistics, Faculty of Science, Ege University, Izmir, Turkey.

1. Elliot Abt, DDS, MS, MSc

+Author Affiliations

1. Dr. Abt is an attending staff member, Department of Dentistry, Advocate Illinois Masonic Medical Center, Chicago.

Abstract

Background. The clinical oral examination (COE) is the criterion standard for the initial detection of oral lesions that harbor dysplasia or oral squamous cell carcinoma (OSCC) at an early stage when they are most treatable. The authors conducted a systematic review to assess the effectiveness of the COE in predicting histologic diagnosis of dysplasia or OSCC.

Methods. The authors conducted automated searches of PubMed, Web of Knowledge and the Cochrane Library from 1966 through 2010 for randomized controlled trials and observational studies that included the terms “oral mucosal lesion screening” and “oral lesions.” They determined the quality (sensitivity, specificity, positive predictive value, negative predictive value and diagnostic odds ratio) of selected studies by using the Quality Assessment of Diagnostic Accuracy Studies tool.

Results. The overall diagnostic odds ratio was 6.1 (95 percent confidence interval, 2.1–17.6); therefore, the COE was considered to have poor overall performance as a diagnostic method for predicting dysplasia and OSCC.

Clinical Implications. On the basis of the available literature, the authors determined that a COE of mucosal lesions generally is not predictive of histologic diagnosis. The fact that OSCCs often are diagnosed at an advanced stage of disease indicates the need for improving the COE and for developing adjuncts to help detect and diagnose oral mucosal lesions.

1. The Journal of the American Dental Association December 1, 2012 vol. 143 no. 12 1332-1342

Tooth sensitivity and bleaching effectiveness associated with use of a calcium-containing in-office bleaching gel

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1. Stella Kossatz, DDS, MS, PhD

1. Dr. Kossatz is an associate professor, School of Dentistry, University Estadual de Ponta Grossa, Rua Carlos Cavalcanti, 4748, Bloco M, Sala 64-A, Uvaranas, Ponta Grossa, Paraná, Brazil 84030-900, e-mail stellakp@gmail.com. Address reprint requests to Dr. Kossatz.

1. Gislaine Martins, DDS, MS

1. Dr. Martins is a doctoral student, School of Dentistry, University Estadual de Ponta Grossa, Ponta Grossa, Paraná, Brazil.

1. Alessandro Dourado Loguercio, DDS, MS, PhD

1. Dr. Loguercio is an adjunct professor, School of Dentistry, University Estadual de Ponta Grossa, Ponta Grossa, Paraná, Brazil.

1. Alessandra Reis, DDS, PhD

+Author Affiliations

1. Dr. Reis is an adjunct professor, School of Dentistry, University Estadual de Ponta Grossa, Ponta Grossa, Paraná, Brazil.

Abstract

Background. The authors conducted a study to evaluate tooth sensitivity (TS) and the bleaching effectiveness associated with use of a calcium-containing (CC) in-office bleaching gel.

Methods. The authors used a 35 percent calcium-free (CF) hydrogen peroxide gel and a 35 percent CC hydrogen peroxide gel according to the manufacturer’s instructions in 40 caries-free participants 18 years or older. They performed two bleaching sessions with a one-week interval between sessions. The authors registered the color at baseline and after the first and second bleaching sessions by using a shade guide and by gauging the participant’s perception of TS as registered on a scale from 0 (none) to 4 (severe). The authors evaluated the bleaching effectiveness at each week’s recall visit by means of the Friedman test, and they compared the groups at each assessment point by means of the Mann-Whitney test. They evaluated the percentage of participants with TS and the intensity of the TS by using the Fisher exact and Mann-Whitney tests.

Results. Both groups demonstrated equivalent and significant tooth color enhancement compared with color values at baseline (P < .05), with an average bleaching of 7 to 8 shade guide units. Most of the participants from the CF group (80 percent) experienced sensitivity while undergoing the bleaching regimen, whereas only 40 percent of participants from the CC group reported experiencing TS (P = .02). The intensity of TS was significantly higher (P < .01) for the CF group during in-office dental bleaching.

Conclusions. The CC 35 percent hydrogen peroxide gel reduced the TS during in-office dental bleaching without jeopardizing the bleaching effectiveness.

Clinical Implications. The results of this study support the findings that a CC 35 percent hydrogen peroxide gel can reduce TS during in-office dental bleaching.

1. The Journal of the American Dental Association December 1, 2012 vol. 143 no. 12 e81-e87

Results from the Xylitol for Adult Caries Trial (X-ACT)

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1. James D. Bader, DDS, MPH⇓, 
2. William M. Vollmer, PhD, 
3. Daniel A. Shugars, DDS, PhD, MPH, 
4. Gregg H. Gilbert, DDS, MBA, 
5. Bennett T. Amaechi, BDS, MS, PhD,
6. John P. Brown, BDS, MS, PhD, 
7. Reesa L. Laws, BS, 
8. Kimberly A. Funkhouser, BS,
9. Sonia K. Makhija, DDS, MPH, 
10. André V. Ritter, DDS, MS and 
11. Michael C. Leo, PhD
    Group for the X-ACT Collaborative Research

+Author Affiliations

1. Dr. Bader is a research professor, Department of Operative Dentistry, School of Dentistry, University of North Carolina at Chapel Hill. He also is the associate editor for evidence-based dentistry for The Journal of the American Dental Association.
2. Dr. Vollmer is a senior investigator, Kaiser Permanente Center for Health Research, Portland, Ore.
3. Dr. Shugars is a professor, Department of Operative Dentistry, School of Dentistry, University of North Carolina at Chapel Hill.
4. Dr. Gilbert is a professor and the chair, Department of Clinical and Community Sciences, School of Dentistry, University of Alabama at Birmingham.
5. Dr. Amaechi is an associate professor and the director of cariology, Department of Comprehensive Dentistry, Dental School, University of Texas Health Science Center at San Antonio.
6. Dr. Brown is a professor emeritus, Department of Comprehensive Dentistry, Dental School, University of Texas Health Science Center at San Antonio.
7. Ms. Laws is a coordinating centers manager, Kaiser Permanente Center for Health Research, Portland, Ore.
8. Ms. Funkhouser is a data manager, Kaiser Permanente Center for Health Research, Portland, Ore.
9. Dr. Makhija is an associate professor, Department of Clinical and Community Sciences, School of Dentistry, University of Alabama at Birmingham.
10. Dr. Ritter is a professor and the graduate program director, School of Dentistry, University of North Carolina at Chapel Hill.
11. Dr. Leo is an investigator, Kaiser Permanente Center for Health Research, Portland, Ore.

1. Address reprint requests to Dr. Bader at School of Dentistry, University of North Carolina at Chapel Hill, CB#7450, Chapel Hill, N.C. 27599-7450, e-mailjim_bader@unc.edu.

Abstract

Background Although caries is prevalent in adults, investigators have tested few preventive therapies in adult populations. In a randomized controlled trial, the authors evaluated the effectiveness of xylitol lozenges in preventing caries in adults at elevated risk of developing caries.

Methods The Xylitol for Adult Caries Trial (X-ACT) was a three-site placebo-controlled randomized trial. Participants (n = 691) aged 21 through 80 years consumed five 1.0-gram xylitol or placebo lozenges daily for 33 months. They underwent clinical examinations at baseline and at 12, 24 and 33 months.

Results Xylitol lozenges reduced the caries increment 10 percent. This reduction, which represented less than one-third of a surface per year, was not statistically significant. There was no indication of a dose-response effect.

Conclusions Daily use of xylitol lozenges did not result in a statistically or clinically significant reduction in 33-month caries increment among adults at an elevated risk of developing caries.

Clinical Implications. These results suggest that xylitol used as a supplement in adults does not reduce their caries experience significantly.

1. The Journal of the American Dental Association January 1, 2013 vol. 144 no. 1 21-30

Breastfeeding An overview of oral and general health benefits

1. Lindsey Rennick Salone, DDS, 
2. William F. Vann Jr., DMD, PhD⇓ and
3. Deborah L. Dee, PhD, MPH

1. At the time this study was conducted, Dr. Salone was a dental student at the University of North Carolina at Chapel Hill and a general practice resident at the University of North Carolina Hospitals, Chapel Hill. She now is in private practice in Charlotte, N.C
2. Dr. Vann is a research professor of pediatric dentistry, School of Dentistry, University of North Carolina at Chapel Hill, CB# 7450, 228 Brauer Hall, Chapel Hill, N.C. 27599-7450, e-mail bill_vann@dentistry.unc.edu
3. At the time this study was conducted, Dr. Dee was affiliated with the Nutrition Branch, Division of Nutrition, Physical Activity, and Obesity, Centers for Disease Control and Prevention, Atlanta. She now is the senior scientist, Applied Sciences Branch, Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Preventio

Abstract

Background Breastfeeding is the reference against which alternative infant feeding models must be measured with regard to growth, development and other health outcomes. Although not a systematic review, this report provides an update for dental professionals, including an overview of general and oral health–related benefits associated with breastfeeding.

Types of Studies Reviewed The authors examined the literature regarding general health protections that breastfeeding confers to infants and mothers and explored associations between breastfeeding, occlusion in the primary dentition and early childhood caries. To accomplish these goals, they reviewed systematic reviews when available and supplemented them with comparative studies and with statements and reports from major nongovernmental and governmental organizations.

Results When compared with health outcomes among formula-fed children, the health advantages associated with breastfeeding include a lower risk of acute otitis media, gastroenteritis and diarrhea, severe lower respiratory infections, asthma, sudden infant death syndrome, obesity and other childhood diseases and conditions. Evidence also suggests that breastfed children may develop a more favorable occlusion in the primary dentition. The results of a systematic review in which researchers examined the relationship between breastfeeding and early childhood caries were inconclusive.

Conclusions and Clinical Implications The American Academy of Pediatric Dentistry, Chicago, suggests that parents gently clean infants' gums and teeth after breastfeeding. The American Academy of Pediatrics, Elk Grove Village, Ill., recommends that breastfeeding should be exclusive for about the first six months of life and should continue, with the introduction of appropriate complementary foods, to at least age 12 months or beyond, as desired by mother and child. Dentists and staff members can take steps to ensure they are familiar with the evidence and guidelines pertaining to breastfeeding and to oral health. They are encouraged to follow the surgeon general's recommendations to promote and support optimal breastfeeding and oral health practices among their patients.

1. The Journal of the American Dental Association February 1, 2013 vol. 144 no. 2 143-151

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