A community study on the relationship of stress and periodontitis

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Non-surgical periodontal therapy with adjunctive chlorhexidine in Down syndrome adults

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Oral health-related quality of life and periodontal status

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A community study on the relationship of dental anxiety with oral health status and oral health-related quality of life

Objective: To investigate the relationship of dental anxiety with oral health status and oral health-related quality of life (OHQoL) among dentate subjects living in Hong Kong. Methods: One thousand Hong Kong residents who were aged 25-64 years and predominantly Chinese were asked to complete the Chinese short-forms of the Dental Anxiety Inventory (SDAxI) and Oral Health Impact Profile (OHIP-14S). Dental (DMFT index) and periodontal statuses [full-mouth clinical attachment level (CAL)] were also assessed. Results: Ninety-six (9.6%; mean SDAxI, 9.6), 799 (79.9%; mean SDAxI, 15.0), and 105 (10.5%; mean SDAxI, 27.4) participants had low, average, and high dental anxiety, respectively. The mean DMFT/CAL scores of each SDAxI subgroup were 8.5/1.4, 9.3/1.9, and 9.8/3.6, respectively. The corresponding mean OHIP-14S scores for each SDAxI subgroup were 4.0, 8.1, and 13.2, respectively. Post hoc analysis, adjusted for possible confounding factors, revealed statistically significant differences in DMFT and CAL scores in subjects with low versus high level of SDAxI, and significant differences in OHIP-14S scores between all 3 SDAxI categories. Conclusion: The trait disposition of dental anxiety may be a significant risk indicator of poor dental and periodontal status and is associated with a worse OHQoL. © 2007 The Authors.postprin

Gastrointestinal bleeding in patients on novel oral anticoagulants: Risk, prevention and management

Novel oral anticoagulants (NOACs), which include direct thrombin inhibitor (dabigatran) and direct factor Xa inhibitors (rivaroxaban, apixaban and edoxaban), are gaining popularity in the prevention of embolic stroke in non-valvular atrial fibrillation as well as in the prevention and treatment of venous thromboembolism. However, similar to traditional anticoagulants, NOACs have the side effects of bleeding, including gastrointestinal bleeding (GIB). Results from both randomized clinical trials and observations studies suggest that high-dose dabigatran (150 mg b.i.d), rivaroxaban and high-dose edoxaban (60 mg daily) are associated with a higher risk of GIB compared with warfarin. Other risk factors of NOAC-related GIB include concomitant use of ulcerogenic agents, older age, renal impairment, Helicobacter pylori infection and a past history of GIB. Prevention of NOAC-related GIB includes proper patient selection, using a lower dose of certain NOACs and in patients with renal impairment, correction of modifiable risk factors, and prescription of gastroprotective agents. Overt GIB can be managed by withholding NOACs followed by delayed endoscopic treatment. In severe bleeding, additional measures include administration of activated charcoal, use of specific reversal agents such as idarucizumab for dabigatran and andexanent alfa for factor Xa inhibitors, and urgent endoscopic management.published_or_final_versio

Association between dental anxiety and periodontal attachment loss

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A community study on the relationship between stress, coping, affective dispositions and periodontal attachment loss

Background: Psychological factors may increase the risk for periodontal diseases. Contemporary conceptualization of the stress process supports the evaluation of stress at three levels: stressors, moderating and mediating factors, and stress reactions. Objective: This study was undertaken to investigate the relationship of periodontal disease in terms of clinical attachment level (CAL) to psychosocial stress, making reference to the major components of stress process. Methods: A cross-sectional study of 1000 subjects aged 25-64 years in Hong Kong was conducted. Subjects were asked to complete a set of questionnaires measuring stressors including changes, significant life event and daily strains, stress reactions including physiological and affective responses, and coping and affective dispositions. CAL was assessed. Results: Individuals with high mean CAL values had higher scores on the job and financial strain scales than periodontally healthy individuals (P < 0.05), after adjusting for age, gender, cigarette smoking and systemic disease. Depression, anxiety trait, depression trait, problem-focused coping, and emotion-focused coping were also related to CAL. Logistic regression analysis indicated that all these factors were significant risk indicators for periodontal attachment loss, except problem-focused coping, which reduced the odds of CAL. Individuals who were high emotion-focused copers, low problem-focused copers, trait anxious, or trait depressive had a higher odds of more severe CAL. Conclusion: Chronic job and financial strains, depression, inadequate coping, and maladaptive trait dispositions are significant risk indicators for periodontal attachment loss. Adequate coping and adaptive trait dispositions, evidenced as high problem-focused coping and low anxiety/ depression trait, may reduce the stress-associated odds. © Blackwell Munksgaard, 2006.postprin

Sjögren's syndrome sufferers have increased oral yeast levels despite regular dental care

Aim: To investigate the prevalence and quantity of oral yeasts and their association with oral candidiasis in Sjögren's syndrome (SS) patients receiving regular dental care. Materials and methods: Yeasts in oral rinse and full-mouth supra-gingival plaque samples from 25 primary SS, 27 secondary SS and 29 control subjects were selectively cultured. All yeasts except single-species isolates were genotyped using pulsed field gel electrophoresis (PFGE). Results: Ten (19%) SS sufferers had symptomless candidiasis. SS subjects had a higher prevalence (73%vs 7%) and quantity of yeasts than controls in both oral rinse and plaque samples (P < 0.05). The prevalence of yeasts in plaque was associated with candidiasis regardless of denture wearing (P ≤ 0.04). Candida albicans was the predominant yeast isolated. PFGE showed 20 (66% of total) C. albicans isolate pairs, i.e. C. albicans species isolated from plaque and oral rinse samples of the same individual, were of closely related genetic clonal types (P < 0.01). Conclusions: Despite effective oral hygiene, more SS subjects than controls had detectable levels of oral yeasts and their presence in supra-gingival plaque was associated with candidiasis. Candida albicans colonized supra-gingival biofilm even in well-maintained SS individuals, posing a challenge to the control of oral candidiasis. © 2007 The Authors.postprin

Descriptive Anatomy and Three-Dimensional Reconstruction of the Skull of the Early Tetrapod Acanthostega gunnari Jarvik, 1952

The early tetrapod Acanthostega gunnari is an iconic fossil taxon exhibiting skeletal morphology reflecting the transition of vertebrates from water onto land. Computed tomography data of two Acanthostega skulls was segmented using visualization software to digitally separate bone from matrix and individual bones of the skull from each other. A revised description of cranial and lower jaw anatomy in this taxon based on CT data includes new details of sutural morphology, the previously undescribed quadrate and articular bones, and the mandibular symphysis. Sutural morphology is used to infer loading regime in the skull during feeding, and suggests Acanthostega used its anterior jaws to initially seize prey while smaller posterior teeth were used to restrain struggling prey during ingestion. Novel methods were used to repair and retrodeform the skull, resulting in a three-dimensional digital reconstruction that features a longer postorbital region and more strongly hooked anterior lower jaw than previous attempts while supporting the presence of a midline gap between the nasals and median rostrals

A regimen of systematic periodontal care after removal of impacted mandibular third molars manages periodontal pockets associated with the mandibular second molars

Aim: This randomized, single-blinded control trial investigated the local effects of periodontal care on the mandibular second molar delivered during and after impacted third molar surgical extraction. Method: Thirty subjects (50% male, 32.1 ± 7.8 years) out of 35 enrolled, with a mesio-angular impacted mandibular third molar, having probing pocket depth (PPD) > 5 mm at adjacent second molar distal, and crestal radio-lucency between the two teeth, completed the study. Oral hygiene instruction, scaling and caries stabilization were performed before surgery. Controls (n = 16) had their third molar extracted followed by standard socket debridement. Test group subjects (n = 14) received the same treatment, except that before wound closure the operator was informed of the group allocation and ultrasonic root debridement on the second molar was performed, followed by a three-visit plaque control programme. Results: Six months post-extraction, statistically significantly (p < 0.007) better plaque control and shallower probing depths were observed at test second molars' distal (%plaque = 21; PPD = 3.2 ± 1.2 mm) than at control second molars (%plaque = 88; PPD = 5.2 ± 0.7 mm). Conclusions: The periodontal interventions investigated prevented residual pockets on periodontally involved second molars 6 months after ipsilateral impacted mandibular third molar removal. Copyright © Blackwell Munksgaard 2005.postprin