Periodontics

Periodontitis is estimated to be the sixth most prevalent disease in the world, and clinicians are likely to encounter this disease and other gingival conditions on a regular basis. It is therefore important to have a sound understanding of both the pathophysiology and management of periodontitis and related conditions. Periodontal disease may also be seen as a manifestation of systemic disease, so it may provide a window into the patient’s general health. Common conditions, such as diabetes mellitus, have a well- established relationship with the progression of periodontal disease, but rare genetic conditions, such as Ehlers– Danlos syndrome, may produce unusual findings. Therefore, the clinician should have a good breadth of knowledge and be able to examine the patient as a whole, relating oral signs to systemic symptoms in order to diagnose and manage appropriately. The general dental practitioner’s role will focus mainly on diagnosis and non- surgical management of these patients, but awareness of the more advanced treatment will ensure appropriate referral and allow an informed discussion with the patient. A key challenge in the successful management of these patients is often getting them to obtain a suitable level of plaque control to stabilize the disease and maintain health. Ability to communicate this effectively and encourage excellent oral care is an invaluable asset. The questions in this chapter will test the readers’ knowledge of the fundamentals of periodontal diagnosis and practical skills. Moreover, questions are also presented examining the relationship with systemic disease and advanced treatment concepts. It is hoped that the questions in this chapter will test the readers’ baseline knowledge and promote further reading around complex or contentious subjects. Key topics include: ● Diagnosis/ disease classification ● Aetiology ● Systemic conditions ● Non- surgical management/ cause- related therapy ● Adjunctive therapies ● Surgical management/ corrective therapy ● Supportive therapy.

Download Full-text

Acute Noncalculous Cholecystitis in a Three-Year-Old Child: Report of a Case Diagnosed at Operation

Clinical Pediatrics ◽

10.1177/000992286200100210 ◽

1962 ◽

Vol 1 (2) ◽

pp. 105-110

Author(s):

James W. Hopkins ◽

Hugh B. Lynn ◽

John C. Dower

Keyword(s):

Abdominal Pain ◽

Acute Cholecystitis ◽

Surgical Management ◽

Short Duration ◽

Common Duct ◽

Systemic Disease ◽

Older Children ◽

Child Report ◽

The Common ◽

Systemic Symptoms

Several generalizations emerge from these studies and are illustrated by our three-year-old patient. Cholecystitis in childhood is “very uncommon, probably rare,” and, “Certainly choledocholithiasis is rare” (Ulin14). An acute systemic disease is often a forerunner of acute cholecystitis in children and may be causally related in some cases; it may obscure the diagnosis. Systemic symptoms accompanying localized abdominal findings should strengthen the suspicion of acute cholecystitis. Abdominal pain and guarding and evidence of a mass are the keys to the diagnosis. The pain patterns of radiating colic and gastro-intestinal upset of the adult are not often seen in childhood. The etiology of acute noncalculous type of cholecystitis is not known. Acute symptoms of short duration and bacterial and polymorphonuclear infiltration of the wall of the gallbladder tend to distinguish childhood cholecystitis from its adult counterpart clinically and pathologically. Stones, when present, are often of hemolytic origin and occur more frequently in older children. An important difference in the surgical management of affected children as compared with adults is that jaundice alone, or stones in the gallbladder, usually do not demand exploration of the common duct. Cholecystectomy, when not contraindicated by severe associated illness, appears to be the treatment of choice.

Download Full-text

Oral Health in Rheumatoid Arthritis: Listening to Patients

JDR Clinical & Translational Research ◽

10.1177/23800844211012678 ◽

2021 ◽

pp. 238008442110126

Author(s):

J.L.P. Protudjer ◽

C. Billedeau ◽

K. Hurst ◽

R. Schroth ◽

C. Stavropoulou ◽

...

Keyword(s):

Rheumatoid Arthritis ◽

Health Care ◽

Oral Health ◽

Periodontal Disease ◽

Health Knowledge ◽

Care Delivery ◽

Oral Care ◽

Oral Health Care ◽

Personal Hygiene ◽

Health Maintenance

Introduction: Rates of periodontal disease and tooth loss are increased in individuals with rheumatoid arthritis (RA). Understanding factors that contribute to the increased burden of periodontal disease in RA is critical to improving oral health and arthritis outcomes. Objectives: To determine the perceptions held by people with RA relating to their oral health, to identify patient-centered priorities for oral health research, and to inform optimal strategies for delivering oral health knowledge. Methods: Semistructured interviews were conducted with patients with RA. Recorded interview transcripts were iteratively reviewed to reveal surface and latent meaning and to code for themes. Constructs were considered saturated when no new themes were identified in subsequent interviews. We report themes with representative quotes. Results: Interviews were conducted with 11 individuals with RA (10 women [91%]; mean age, 68 y), all of whom were taking RA medication. Interviews averaged 19 min (range, 8 to 31 min) and were mostly conducted face-to-face. Three overall themes were identified: 1) knowledge about arthritis and oral health links; 2) oral health care in RA is complicated, both in personal hygiene practices and in professional oral care; and 3) poor oral health is a source of shame. Participants preferred to receive oral health education from their rheumatologists or dentists. Conclusions: People with RA have unique oral health perceptions and experience significant challenges with oral health care due to their arthritis. Adapting oral hygiene recommendations and professional oral care delivery to the needs of those with arthritis are patient priorities and are required to improve satisfaction regarding their oral health. Knowledge Translation Statement: Patients living with long-standing rheumatoid arthritis described poor oral health–related quality of life and multiple challenges with maintaining optimal oral health. Study findings indicate a need for educational materials addressing oral health maintenance for patients with rheumatic diseases and their providers.

Download Full-text

PARE0023 ORAL HEALTH IN RHEUMATOID ARTHRITIS: LISTENING TO PATIENTS

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2020-eular.612 ◽

2020 ◽

Vol 79 (Suppl 1) ◽

pp. 1297.2-1297

Author(s):

J. Protudjer ◽

C. Billedeau ◽

C. Stavropoulou ◽

A. Cholakis ◽

R. Schroth ◽

...

Keyword(s):

Rheumatoid Arthritis ◽

Oral Health ◽

Periodontal Disease ◽

Oral Care ◽

Structured Interviews ◽

Face To Face ◽

Oral Health Education ◽

To Receive ◽

Latent Content

Background:Rates of periodontal disease and tooth loss are increased in rheumatoid arthritis (RA). Periodontal disease may exacerbate RA inflammation and complicate RA care. Understanding factors that contribute to the increased burden of periodontal disease in RA is critical to improving oral health and possibly arthritis outcomes. People with RA may have unique needs and/or barriers to maintain oral health.Objectives:To determine from people with RA what are their experiences and perceptions about their oral health, their most important questions relating to oral health, and how they wish to receive oral health information.Methods:Semi-structured interviews were conducted with RA patients. Recorded interview transcripts underwent iterative content analysis. Transcripts were initially reviewed to develop a coding guide. Latent content, or larger themes, were then applied to the transcripts. Constructs were considered saturated when no new themes were identified with subsequent interviews. We report identified themes with representative quotes.Results:Interviews with 11 RA (10[91%] female; all on RA medication) averaged 19 minutes (range 8-31 minutes) and were mostly conducted face-to-face. Many believed RA medication contributed to dry mouth. Most participants had not previously considered other links between oral health and RA. Themes identified included the need for complicated oral health routines, barriers of cost and access to dental care, and shame relating to oral health (Table 1). Participants preferred to receive oral health education from their rheumatologists or dentists over printed or online resources.Conclusion:RA patients have unique needs relating to oral health and report poor oral quality of life. Strategies to optimize oral health in RA may include educational tools for optimizing oral self-care appropriate for RA, and improved access to oral care professionals who are aware of the needs of arthritis patients.Disclosure of Interests:Jennifer Protudjer: None declared, Corrie Billedeau: None declared, Chrysi Stavropoulou: None declared, Anastasia Cholakis: None declared, Robert Schroth: None declared, Carol Hitchon Grant/research support from: UCB Canada; Pfizer Canada

Download Full-text

Teaching the new periodontal disease classification

BDJ ◽

10.1038/s41415-021-3147-0 ◽

2021 ◽

Vol 230 (11) ◽

pp. 752-752

Author(s):

Paul Hellyer

Keyword(s):

Periodontal Disease ◽

Disease Classification

Download Full-text

Implant Treatment with 12-Year Follow-Up in a Patient with Severe Chronic Periodontitis: A Case Report and Literature Review

Case Reports in Dentistry ◽

10.1155/2019/3715159 ◽

2019 ◽

Vol 2019 ◽

pp. 1-8 ◽

Cited By ~ 1

Author(s):

Keisuke Seki ◽

Yoshiyuki Hagiwara

Keyword(s):

Periodontal Disease ◽

Chronic Periodontitis ◽

Case Reports ◽

English Literature ◽

Supportive Therapy ◽

Periodontal Treatment ◽

Periodontal Tissues ◽

Severe Periodontitis ◽

And Control ◽

Implant Treatment

Tooth loss among adults is associated with progressive periodontitis. Implant prosthetic treatment has long been utilized in periodontal patients. Even when the implants are applied, ongoing management of periodontal disease and control of inflammation is necessary to maintain a healthy oral cavity. Lack of appropriate periodontal treatment can result in recurrence of periodontal disease during a maintenance period; loss of the supportive capacity of the periodontal tissues will increase the susceptibility of residual teeth to traumatic force. For this reason, it is worthwhile to improve oral function by applying implants as a fixed device. Here, we report that implant treatment in a patient with generalized severe chronic periodontitis helped maintain the periodontal and peri-implant tissue for a long term. We propose that initial periodontal treatment and ongoing supportive therapy can help maintain implants in patients with severe periodontitis. In addition, we reviewed case reports in the English literature so far.

Download Full-text

Caregivers’ attitudes, knowledge and practices of oral care at nursing homes in Serbia

Vojnosanitetski pregled ◽

10.2298/vsp141001065s ◽

2016 ◽

Vol 73 (7) ◽

pp. 668-673 ◽

Cited By ~ 3

Author(s):

Ivica Stancic ◽

Milos Petrovic ◽

Aleksandra Popovac ◽

Miroslav Vasovic ◽

Nebojsa Despotovic

Keyword(s):

Oral Health ◽

Nursing Homes ◽

Periodontal Disease ◽

Oral Hygiene ◽

Oral Care ◽

The Elderly ◽

Oral Diseases ◽

Closed Type ◽

Work Shifts ◽

Self Administered Questionnaire

Background/Aim. Within the elderly population, residents in nursing homes, there is a greather risk of caries, periodontal disease and teeth loss. Assistance of caregivers in maintaininig good oral hygiene besides improving oral health can improve of residents general health and the qulity of their lives. The aim of this study was to examine the attitudes of caregivers and knowledge about oral health, as well as the practice regarding oral care they apply at nursing homes in Serbia. Methods. The survey was conducted at the Gerontology Center Belgrade, consisting of four nursing homes located in the urban area. The study included 58 caregivers. They were contacted on working days, in all work shifts, during January, February and March of 2013. They were asked to fill in a self-administered questionnaire consisting of 26 closed-type questions. Results. The caregivers mostly considered that it was very important to take care of oral health of the residents, but 69% responded that the level of their oral health was low or very low. As the main barriers to oral hygiene maintenance, the caregivers indicated lack of time. The caregivers had more knowledge about periodontal disease than about the main cause of caries and its prevention. Formal medical education had the influence on the knowledge about oral diseases. Oral hygiene procedures carried out by the mayority of caregivers were denture cleaning and tooth brushing. Conclusion. The caregivers were aware of the limitations in everyday oral care of nursing homes residents in Serbia, although solving these problems requires the involvement of the entire public health service.

Download Full-text

Osteoarthritis, Gout, and Infectious Arthritis

Mayo Clinic Internal Medicine Board Review ◽

10.1093/med/9780190464868.003.0079 ◽

2016 ◽

pp. 813-828

Author(s):

Clement J. Michet ◽

Floranne C. Ernste

Keyword(s):

Weight Loss ◽

Neck Pain ◽

Nerve Root ◽

Overuse Injury ◽

Systemic Disease ◽

Infectious Arthritis ◽

Systemic Symptoms

Cervicothoracic complaints can be classified into 3 categories on the basis of etiology: mechanical, neurogenic, and pain secondary to other systemic processes. Mechanical neck complaints are often secondary to trauma, overuse injury, malposture, and osteoarthritis. Neurogenic neck complaints are experienced acutely after trauma or gradually as a result of progressive osteoarthritis with subsequent nerve root impingement. Neck pain secondary to systemic disease often is associated with systemic symptoms such as fever, chills, weight loss, rash, polyarthralgia, or polymyalgia.

Download Full-text

The Relationship Between Periodontal Disease and Systemic Disease in the Elderly

Improving Oral Health for the Elderly ◽

10.1007/978-0-387-74337-0_12 ◽

2008 ◽

pp. 247-271 ◽

Cited By ~ 2

Author(s):

Dana L. Wolf ◽

Panos N. Papapanou

Keyword(s):

Periodontal Disease ◽

Systemic Disease ◽

The Elderly ◽

The Relationship

Download Full-text

Association Between Periodontal Disease and Atherosclerotic Cardiovascular Diseases: Revisited

Frontiers in Cardiovascular Medicine ◽

10.3389/fcvm.2020.625579 ◽

2021 ◽

Vol 7 ◽

Author(s):

Faraedon Zardawi ◽

Sarhang Gul ◽

Ali Abdulkareem ◽

Aram Sha ◽

Julian Yates

Keyword(s):

Cardiovascular Disease ◽

Periodontal Disease ◽

Atherosclerotic Cardiovascular Disease ◽

Periodontal Pathogens ◽

Systemic Level ◽

Prevalent Disease ◽

Atherosclerotic Cardiovascular Diseases

Atherosclerotic cardiovascular disease (ACVD) is an inflammatory disease of the coronary arteries associated with atheroma formation, which can cause disability and often death. Periodontitis is ranked as the sixth most prevalent disease affecting humans affecting 740 million people worldwide. In the last few decades, researchers have focused on the effect of periodontal disease (PD) on cardiovascular disease. The aim of this review was to investigate the association between these two diseases. PD is a potential risk factor that may initiate the development, maturation, and instability of atheroma in the arteries. Two mechanisms were proposed to explain such association, either periodontal pathogens directly invade bloodstream or indirectly by increasing systemic level of inflammatory mediators. Interestingly, it has been suggested that improvement in the condition of one disease positively impact the condition of the other one. Highlighting the association between these two diseases, the importance of early diagnosis and treatment of PD and its impact on cardiovascular status may be of great value in reducing the complications associated with ACVDs. Further in vitro and in vivo studies with longer follow up are necessary to confirm the causal relationship between PD and ACVDs.

Download Full-text