The Inflammatory Origins of Periodontal Disease and Diabetes

http://www.ineedce.com/coursereview.aspx?url=2363%2fPDF%2f1210cei_sibner_web.pdf&scid=14915

The Inflammatory Origins of Periodontal Disease and Diabetes: A Framework for Understanding Clinical Outcomes.   A Peer-Reviewed Publication  Written by Jeffrey A. Sibner, D.M.D.

Saliva and the Clinical Laboratory: CE Course

Saliva and the Clinical Laboratory: A Data Driven Model for Periodontics and Implant Dentistry
A Peer-Reviewed Publication
Written by Thomas W. Nabors, DDS, FACD

http://www.ineedce.com/coursereview.aspx?url=2346%2fPDF%2f1208cei_nabors_web.pdf&scid=14880

Enamel pearl case studies

01/04/2013

By John Y. Kwan, DDS, Robert Gottlieb, DDS, and Suzanne Newkirk, RDH

http://www.dentistryiq.com/articles/2013/01/enamel-pearl-case-studies.html

Case #1: “Enamel projection with furcation involvement”
by Dr. John Y. Kwan

The below pictures and corresponding video show a tooth with an enamel projection which has developed bone loss.

In the video “Enamel Projection,” a Satelec diamond tip was made Magnetostrictive by the Tony Riso Co. and is used to remove the projection and clean into the furcation.


Photo 1


Photo 2

Photo #1 identifies the enamel projection. Photo #2 shows the curved unltrasonic insert removing the projection and cleaning into the furcation.


As the above picture demonstrates, the enamel projection has been removed and the furcation is now clean and clearly defined post instrumentation.
Prior to the Perioscopy System, this area would have required surgical intervention to view and treat.
The below Enamel Projection video may be viewed at:
http://www.youtube.com/watch?v=d7OkAnXaoh4
Case #2
By Dr. Robert Gottlieb and Suzanne Newkirk, RDH

The below pictures and corresponding video show an enamel pearl found on a molar tooth that developed a periodontal infection with a 6mm pocket depth.

With Perioscopy, the doctor removed the enamel pearl quickly and efficiently with no post treatment discomfort or downtime for the patient.


Enamel pearl MB #3 pre treatment


Post enameloplasty the root is clean


3 months post treatment pocket is now 3mm

To view the video “Enameloplasty visualized with the Perioscope”, go to:
https://www.youtube.com/watch?v=S1IKT2KoVj4
Conclusion:
We suggest that the Perioscopy System as a diagnostic tool in the detection and treatment of various anatomical factors, such as cervical enamel projections (CEP’s) and enamel pearls may help reduce potential for localized periodontal destruction.

Dr. Kwan is a board-certified periodontist and maintains a private practice providing periodontal and implant care in Oakland/Berkeley, Calif. He is an Associate Clinical Professor at the University of California, San Francisco School of Dentistry. Dr. Kwan is also the President/CEO of Perioscopy Incorporated.

Dr. Bob Gottlieb received his Certificate in Periodontics from the University of Washington. Practicing for 35 years, he was voted one of Seattle’s Best Dentists. Dr. Gottlieb mentors and directs numerous study clubs.
Ms. Newkirk graduated from the University of Alaska, Anchorage, in 1981 and has dedicated the last 30 years to excellence in clinical dental hygiene and periodontics. Suzanne is a periodontal therapist, dental hygiene coach and mentor. She is also a Perioscopy instructor and speaker. Ms. Newkirk is a member of the American Dental Hygienists' Association and Washington State Dental Hygienists' Association.
To read articles in RDH eVillage FOCUS written by John Kwan, Robert Gottlieb, and Suzanne Newkirk, click on Kwan, Gottlieb, and Newkirk.

Subgingival anomalies and pathologies viewed with the Perioscope: root fractures (Part 3)

01/04/2013

By John Y. Kwan, DDS, Robert Gottlieb, DDS, and Suzanne Newkirk, RDH

http://www.dentistryiq.com/articles/2013/01/subgingival-anomalies-and-pathologies-viewed-with-the-perioscope-root-fractures-part-3.html

In the abstract “A Review of Root Fractures: Diagnosis, Treatment and Prognosis,” by Malhotra, Kundabala and Acharaya**, root fractures are defined as fractures involving the dentin, cementum and pulp and occur in less than 8 percent of traumatic injuries to permanent teeth.

Root fractures are broadly classified as horizontal (transverse) and vertical root fractures (VRF) and can vary in severity.
Treatment of root fractures depends on a number of factors and is typically determined by the extent of the subgingival fracture, remaining coronal tooth structure, location of the fracture line, pulp vitality and length and morphology of the roots. Frequently, an interdisciplinary or multidisciplinary approach is required for complete rehabilitation of the tooth.
Case #1: Horizontal Root Fracture #9
By Robert Gottlieb, DDS, and Suzanne Newkirk, RDH
This 48-year-old female patient was referred for evaluation of tooth #9, which presented with a 7mm pocket on the straight facial and a 9mm pocket on the mesial.


#9 Pre-treatment photo


#9 Pre-op X-ray

Note: Endodontic work #’s 7-10 were done years previously in England.

Looking toward the apex of the tooth, the below photo and corresponding video clearly show a horizontal fracture traversing the root.


Root fractures that develop communication between the gingival sulcus and the fracture site have a poor prognosis because of bacterial contamination.

Due to the extent of the above fracture, treatment recommendations for this patient included extraction and immediate implant placement, which the patient proceeded with.

The video “Horizontal Root Fractures: Why Guess about a fracture?” may be viewed at:
http://www.youtube.com/watch?v=t-coebmV6cM

Case #2: Horizontal Hair Line Fracture #19
By Robert Gottlieb, DDS, and Suzanne Newkirk, RDH
Root fractures in posterior teeth usually occur as a result of indirect trauma such as parafunctional habits, traumatic occlusion, extensive tooth decay and iatrogenic causes, and may be symptomatic, or non-symptomatic.

This 52-year-old male was referred for a complete periodontal exam. A chief complaint was sensitivity on the lower left to cold, touch and pressure on tooth #19, which had recently had a small occlusal composite placed.

The below photo and corresponding video clearly show two hair line vertical fractures connected to a horizontal fracture traversing the buccal surface of tooth #19.


Minor insults (hair line fractures) may lead to concussion injury, or nonvitality. Management of hairline root fractures may include constant observation and vitality tests performed on a regular basis.

The video “Hair line root fractures viewed with the Perioscope” may be viewed at:
http://www.youtube.com/watch?v=d5vC8vWwhUU

Case #3: Vertical Root Fracture #15
By Dr. John Y. Kwan

Vertical root fractures typically extend through the long axis of the root toward the apex and commonly occur in endodontically treated teeth. Depending upon the severity of the fracture, an interdisciplinary and/or multidisciplinary approach may be required for functional and esthetic rehabilitation of the tooth.

Intraosseous fractures typically create deep, narrow, sharply defined isolated periodontal pockets and radiographic examination may reveal unilateral thickening of PDL along the fracture side of the root.

If the fracture is not apparent radiographically, diagnostic tests may be considered using a bite-test, transillumination test, or confirmation of the VRF via surgical exploration.

Confirmation of root fractures with Perioscopy provides the most minimally invasive, non-surgical method available.

The below photo and corresponding video clearly show a vertical root fracture.


The video “Root Fracture #15M: Perioscopy Video” may be viewed at:
http://www.youtube.com/watch?v=hk7-R3RJG3w

We believe that appropriate management and treatment of root fractures begins with the correct diagnosis.

Prior to Perioscopy, confirmation of root fractures was frequently done via exploratory flap surgery. Perioscopy provides the most minimally invasive, non-surgical modality available for confirmation of root fractures.

More information on Perioscopy may be found at:
http://www.perioscopyinc.com/perioscopy-technology.php

** A Review of Root Fractures: Diagnosis, Treatment and Prognosis
Dent Update. 2011 Nov;38(9):615-6, 619-20, 623-4 passim. Department of Conservative Dentistry and Endodontics, Manipal College of Dental Sciences, Mangalore, Manipal University, India.
http://eprints.manipal.edu/2352/1/A_Review_of_Root_Fractures-_Final_print.pdf

Dr. Kwan is a board-certified periodontist and maintains a private practice providing periodontal and implant care in Oakland/Berkeley, Calif. He is an Associate Clinical Professor at the University of California, San Francisco School of Dentistry. Dr. Kwan is also the President/CEO of Perioscopy Incorporated.
Dr. Bob Gottlieb received his Certificate in Periodontics from the University of Washington. Practicing for 35 years, he was voted one of Seattle’s Best Dentists. Dr. Gottlieb mentors and directs numerous study clubs.

Ms. Newkirk graduated from the University of Alaska, Anchorage, in 1981 and has dedicated the last 30 years to excellence in clinical dental hygiene and periodontics. Suzanne is a periodontal therapist, dental hygiene coach and mentor. She is also a Perioscopy instructor and speaker. Ms. Newkirk is a member of the American Dental Hygienists' Association and Washington State Dental Hygienists' Association.

To read articles in RDH eVillage FOCUS written by John Kwan, Robert Gottlieb, and Suzanne Newkirk, click on Kwan, Gottlieb, and Newkirk.

Why dental hygienists require special exercise

01/04/2013

By Bethany Valachi, PT, MS, CEAS

 

http://www.dentistryiq.com/articles/2013/01/why-dental-hygienists-require-special-exercise.html

In a society that bombards us with exercise options, from Ab-blasters to Bun-busters, it’s hard to imagine that strengthening your muscles could be anything but beneficial. Yet, because dental hygienists are predisposed to unique muscle imbalances, all exercise is not necessarily good exercise for dental hygienists. In fact, certain generic exercises, Pilates routines and gym equipment can actually throw hygienists into the vicious pain cycle.
When hygienists become familiar with their muscle imbalances, they are better able to select exercises and modify existing exercise routines to improve their health—not make it worse. In addition to selecting which exercises, it is imperative to understand how hygienists should strengthen these muscles. Recent research shows that a method called muscular endurance training can help dental professionals reduce work-related pain. Other research supports specific types of exercise in reducing pain.(1)

VIEW VIDEO: “Why Dental Professionals Require Specific Exercise”
https://www.youtube.com/watch?v=u4AyD0szkg0
VIEW SAMPLE MUSCULAR ENDURANCE EXERCISES:
http://www.posturedontics.com/video_highlights_smart_moves.php
Unbalanced muscles
In order to perform the precision tasks of dentistry, the arms must have a stable base from which to operate. For example, the delivery of dental hygiene requires excellent endurance of the shoulder girdle stabilizing muscles for safe shoulder movement and working posture (Fig 1-in blue).


These shoulder stabilizing muscles tend to fatigue quickly with forward head, rounded upper back and elevated arm postures—all commonly seen among hygienists. When these muscles fatigue, other muscles must compensate and become overworked, tight and painfully ischemic (Fig 1-in red).


An effective exercise regimen for hygienists will target specific shoulder girdle, trunk and back stabilizing muscles, without engaging the muscles that are prone to tightness and ischemia.(2) This requires expert knowledge of biomechanics and kinesiology. In addition, specific muscles that are prone to tightness and ischemia must be targeted with stretching exercise and avoid strengthening.

How to Develop an Effective Exercise Program
• Target the correct muscles with muscular endurance training: Use light resistance and high repetitions (15-20 reps) when training these muscles, usually an elastic exercise band is sufficient for the shoulder muscles, while gravity-resisted exercise on the floor or an exercise ball is good for the trunk muscles.
• Perform strengthening exercises 3 times a week, always allowing 1 day in-between sessions.
• Target specific tight, ischemic muscles with regular chairside stretching. Stretching should be performed daily.(3)
Exercise Safely
• Strengthening exercises should only be performed when there is no musculoskeletal pain and full range of motion is present.
• It is a good idea to seek professional guidance from a physical or occupational therapist when beginning any new exercise regimen and to ensure good technique.
Conclusion
Embarking upon an exercise program requires prudence and discretion, considering team members’ predisposition to certain muscle imbalances. Selecting improper exercises can lead to imbalance, ischemia, nerve impingement, and other pain syndromes. Developing balanced musculoskeletal health with a well-designed exercise program can help hygienists prevent work-related pain, avoid injuries, extend their careers and improve their quality of life.
References
1. http://archive.constantcontact.com/fs053/1102140918816/archive/1109746968813.html.
2. http://www.posturedontics.com/pdf/Ch%209%20Exercise%20Guidelines.pdf.
3. http://www.posturedontics.com/video_CS.php.

Bethany Valachi, PT, MS, CEAS, is a physical therapist, dental ergonomic consultant, and CEO of Posturedontics, a company that provides research-based education. Clinical instructor of ergonomics at OHSU School of Dentistry, Valachi lectures internationally at dental meetings, schools and study clubs. She covers 24 exercises for dental professionals in her new research-based exercise DVD, “Smart Moves for Dental Professionals On the Ball” Home Exercise DVD, available at www.posturedontics.com. Also included in the DVD kit are exercises that dental hygienists should avoid. Enter Discount Code OTB2013 upon checkout to receive RDH eVillage special discount.

To read more about exercise, click here.

To read more from Bethany Valachi, click here.

Study Identifies New Characteristic of Binge Eating

Released: 1/3/2013 12:15 PM EST
Source: University of Alabama at Birmingham

Newswise — A study from the University of Alabama at Birmingham (UAB) suggests food concocting – the making of strange food mixtures like mashed potatoes and Oreo cookies, frozen vegetables mixed with mayonnaise, and chips with lemon, pork rinds, Italian dressing and salt – is common among binge eaters. The findings, available online and to be published in the International Journal of Eating Disorders, reveal that 1 in 4 survey participants secretly create concoctions.
Investigators hope the survey and findings will help bring this oppressive behavior into the open to better understand and help the estimated 8 million people in the U.S. suffering from binge-eating disorders. UAB researchers investigated a behavior that had been anecdotally noted by eating disorder clinicians but never systematically investigated.
According to the study, people who concoct are more likely to binge eat than those who overeat without bingeing. Those who concoct reported the same emotions as drug users during the act; they also reported later feelings of shame and disgust, which could fuel an existing disorder.
Mary Boggiano, Ph.D., associate professor in the Department of Psychology and primary investigator of the study, said study participants self-reported their emotions while concocting. The answers revealed a vast majority felt “excited” and “anxious” during the process.
“While they are food concocting and binge eating they report being excited, in a frenzy, and high, but afterwards they feel awful about themselves,” said Boggiano.
According to Boggiano, the actual number of binge eaters who also practice food concocting is likely to be higher than that revealed in their survey.
“We found significant numbers in a non-clinical population,” said Boggiano. “If the same survey was given to people in a hospital, clinical or psychiatric setting, they would certainly report higher levels.”
Boggiano’s team developed their study around the novel “famine hypothesis,” theorizing that concocting would be linked to caloric deprivation. This was based on documented accounts of odd food concoctions created by victims of natural famine and POWs, as well as refugees during wartime food shortages.
Consistent with this hypothesis, the UAB team found that while food concocting is more prevalent in binge eaters, it is dietary restraint — or food deprivation — that uniquely accounted for the pervasiveness of concocting.
The research team looked at why people practice food concocting. The majority, 41.2 percent of those who concocted, said the behavior was due to a craving. Only 9 percent reported hunger as a motive.
Boggiano said that is not surprising because most binges occur after a normal meal, when sated, and may be part of the “loss of control” criterion of binge eating. Her previous research showed that having a history of dieting, regardless of hunger, led to binge eating when a preferred food was available.
Boggiano believes food concocting has never been studied scientifically because nobody has thought to quantify the behavior or consider that it may worsen eating disorders if linked to negative emotions.
In addition, patients may not disclose this behavior because of shame.
“Secrets can kill us,” said Boggiano. “The more secretive a patient is with aspects of an addiction or eating disorder, the worse off he or she will be because they will continue to engage in their secret, maladaptive behavior.”
The food concocting study surveyed 507 students from UAB and the University of Texas at El Paso enrolled in Psychology 101 classes, along with 45 clients seeking outpatient treatment for eating disorders in Cincinnati, Ohio. The sample included males and females and was 45.5 percent non-Hispanic White, 40 percent Hispanic and 10 percent African-American. There was no difference in concocting susceptibility between sexes or ethnicities.

Breast Cancer Diagnosed Between Mammograms Isn't More Aggressive

Summary and Comment

Breast Cancer Diagnosed Between Mammograms Isn't More Aggressive

Women with "interval" breast cancers had the same prognosis as women with breast cancers who were never screened.

Are breast cancers diagnosed in women who have had previously normal screening mammograms more aggressive than breast cancers diagnosed in women who haven't undergone screening mammograms? To find out, Norwegian investigators carried out a population-based observational study.

In Norway, older women (age, 50–72) now are invited to receive screening mammography every 2 years. Study participants were 1800 women with "interval breast cancer" (diagnosed within 26 months of their last normal screening mammograms and before their next scheduled mammograms) and 5300 women with breast cancer who had not undergone screening mammography. Compared with the nonscreened group, women in the interval-cancer group exhibited slightly higher percentages of lobular cancers, large tumors (>2 cm), negative lymph nodes, and stage II (vs. stage I) disease. However, breast cancer–related mortality and overall mortality at 10 years were not significantly different between the groups. Notably, in the interval-cancer group, tumor size, node status, grade, and hormone-receptor status were not associated with time since last normal screening mammogram.

Comment: In this study, women with interval breast cancers had the same prognosis as women with breast cancer who had not been screened. The investigators did not compare the prognosis of women with interval breast cancers to the prognosis of women with screen-detected breast cancers, because screen-detected breast cancers are affected by length bias sampling, lead time bias, and overdiagnosis bias. Thus, the comparisons in this study are valid.

— Paul S. Mueller, MD, MPH, FACP

Published in Journal Watch General Medicine January 2, 2013

Citation(s):

Kalager M et al. Prognosis in women with interval breast cancer: Population based observational cohort study. BMJ 2012 Nov 16; 345:e7536. (http://dx.doi.org/10.1136/bmj.e7536)

Original article (Subscription may be required)

Medline abstract (Free)