The Effects of Dilantin on the Oral Cavity Over Time.

PosterThe objective of this case presentation is to discuss the long-term effects of Dilantin in causing gingival hyperplasia as seen in a patient. Assessment: A 54 year old African American male patient presented to the Dental Hygiene Clinic at Indiana University School of Dentistry (IUSD) with a chief complaint of “I need to get my teeth cleaned for my three month appointment.” The patient was referred to our clinic from the IUSD Graduate Periodontal clinic for his three month periodontal maintenance appointment. Medical history indicates he suffers from epilepsy and has been taking Dilantin for over forty years. An intraoral examination revealed advanced localized periodontal disease in the lower right quadrant with probing depths ranging from 1-10mm and clinical attachment levels ranging from 1-8mm. Patient also presented with generalized healthy gingiva as evidenced by coral, firm, and stippled tissue. The intraoral radiographs reveal generalized mild bone loss as evidenced by 3-4mm from crest of bone to CEJ. The patient’s oral hygiene habits include: brushing twice a day, flossing once a day, and using an antimicrobial mouth rinse once a day. DH Care Plan: periodontal maintenance, topical fluoride varnish, review of oral hygiene, and review of the use of a water irrigator. Evaluation: The patient was referred to the Graduate Periodontal department for further evaluation due to the increase of gingival overgrowth on #31 distal and the presence of exudate. The dentist who performed the last dental exam in the Dental Hygiene Clinic feels the patient will need another gingivectomy. Conclusions: From the review of the evidence-based literature, the Dilantin is the cause of the gingival hyperplasia that this specific patient has been experiencing over the years and his need for continuous periodontal surgery

Dental Anxiety: The Effects on Oral Health and Dental Treatment.

PosterObjective: The objective of this case presentation is to educate the dental professional on the management of a patient with dental anxiety. Assessment: A 20 year old Caucasian male presented to the dental hygiene clinic for a cleaning at the request of his grandmother. The patient reported a negative medical history with the exception of anxiety to dental care. Due to this anxiety, consent was obtained from the patient to speak with the grandmother in regards to his medical history. At this time, the grandmother disclosed that the patient had a traumatic dental experience as a child and has not been to the dentist since that event occurred. Clinically, the patient presented with generalized severe gingivitis as evidenced by red, rolled, spongy tissue with bleeding upon probing due to the presence of heavy calculus. Despite the inflammation present, bones levels are healthy. The patient reported never brushing his teeth due to pain and fear of causing pain to himself. DH Care plan: Patient received full mouth debridement, modified adult prophylaxis, and extensive oral hygiene instruction. Treatment: Experimental techniques were utilized throughout the course of treatment in order to ease anxiety while providing effective treatment. Results: Experimental methods that were used throughout treatment proved effective for the completion of full mouth debridement and adult prophylaxis. Conclusions: The patient presented with extensive gingivitis and heavy calculus deposits. For optimal success in the future, a short recall is necessary for the patient to receive continued extensive dental hygiene therapy

Modification of Dental Hygiene Care in a Breast Cancer Patient.

PosterObjective: The objective of this clinical case presentation is to evaluate the treatment of a patient undergoing chemotherapy for breast cancer and identify necessary modifications throughout the dental hygiene appointment. Background Information: A 72-year old, Caucasian female patient presented to the dental hygiene clinic with the chief complaint of “I want to get my teeth cleaned.” The patient also reported symptoms of xerostomia and burning sensation of the gingiva. The patient receives regular periodontal maintenance care every three months at a private practice. The medical history revealed breast cancer, hypertension and history of myocardial infarction. The patient’s breast cancer is currently being treated with chemotherapy and radiation. Clinical Examination: The patient presented clinically with generalized mild plaque-induced marginal papillary gingivitis as evidenced by red, rolled, spongy gingiva with bleeding on probing and generalized moderate chronic periodontitis as evidenced by 4-5mm clinical attachment levels. Radiographically, the patient presented with localized mild horizontal bone loss as evidenced by 3-4mm measured from the cementoenamel junction to the crest of the alveolar bone around teeth numbers 4 (distal), 15 (mesial), 19, 27, 29 and 31. Oral hygiene habits consist of patient brushing at least once per day, but seldom flossing or using mouthwash. The patient is at high risk for dental caries due to active decay, medication-induced xerostomia and inadequate home care. DH Care Plan: Periodontal maintenance with extensive oral hygiene instructions were performed. Toothpaste and mouth rinse for dry mouth were recommended at the initial appointment. Evaluation: This patient will return for periodontal maintenance in March 2015. At that time oral hygiene and caries risk will be evaluated. Conclusion: In this case report, the complaints of a patient with a history of breast cancer, xerostomia, and burning of the gingiva were addressed

Maintaining Oral Health with Parkinson’s disease and Arthritis.

PosterObjective: The objective of this case presentation is to discuss the modifications of dental care for a patient with Parkinson’s disease. Background: A 72 year old Caucasian male presented to the dental hygiene clinic for a periodontal maintenance appointment. Significant findings in the medical history include current treatment of Parkinson’s disease, arthritis in the hands and feet, and medications Omeprazole, Fluoxetine, Gemfibrozil, Gabapentin, Levodopa, and Clonazepam. Assessment: Patient presents with generalized moderate plaque induced gingivitis evidenced by reddish-pink gingiva, 60% BOP, bulbous, spongy papillae. Clinically the patient presented with generalized 4-8mm clinical attachment levels. Radiographically, the patient presented with generalized mild to moderate bone loss evidenced by 3-5mm from the CEJ. The primary contributing factor to the gingival inflammation was the plaque score of 97%. The patient struggles with oral hygiene due to his Parkinson’s disease and arthritis in hands. DH Care Plan: patient received full mouth debridement, instruction on a modified floss holder with clay, product recommendations of xylitol gum and toothpaste to reduce xerostomia. Results: Oral health indicators from previous appointments showed minimal or no improvements due to the patient’s medical condition. Conclusions: Since last recall a few sites had improved including probing depths by 1-2mm. Patient was referred to a comprehensive care clinic for extraction of tooth number four, and an implant is treatment planned for replacement. It is recommended that the patient continue on 3 month intervals to monitor his oral health status and identify dental disease earl

The Effects of Poor Dental Knowledge on Oral Health.

PosterObjective: The objective of this clinical case report is to evaluate the effects of low dental knowledge and low socioeconomic status on the oral health of an individual. Background: A 32 year old Hispanic male presented to the dental hygiene clinic as a new patient with a negative medical history with the exception of untreated hypertension diagnosed at his last physical examination 5 years earlier. Patient reported smoking 2 to 3 cigarettes per day. Patient had received a prophylaxis 5 years ago in Mexico at a free clinic, but he has never been able to receive regular dental care due to his low socioeconomic status. Patient had limited oral health education prior to his visit to the dental hygiene clinic. Assessment: Patient presented with generalized moderate to severe plaque induced marginal gingivitis as evidenced by red, spongy, rolled gingiva, and a bleeding score of 74%. The periodontal description revealed generalized mild chronic periodontitis as evidenced by 4-5mm CAL and localized moderate chronic periodontitis as evidenced by 6-7mm CAL on #1, #4, #5, #11, #13, #14, and #18. Patient also presented with generalized mild horizontal bone loss on radiographs as evidenced by 2.6mm to 3.5mm measurements from crest of alveolar bone to the CEJ. The patient’s plaque score ranged from 18% to 26% and generalized moderate to heavy supragingival and subgingival calculus was detected. Active decay was found on #2, #16, #17, #28, and #30. Dental Hygiene Care Plan: Patient received scaling and root planing in all four quadrants, a tissue re-evaluation and extensive oral hygiene instruction. Results: At the tissue re-evaluation, the patient’s gingival health and probing depths were improved. Conclusion: The patient’s positive response to treatment is the result of the thorough scaling and root planning therapy, extensive patient education, and patient compliance

Seprase: An overview of an important matrix serine protease

Seprase or Fibroblast Activation Protein (FAP) is an integral membrane serine peptidase, which has been shown to have gelatinase activity. Seprase has a dual function in tumour progression. The proteolytic activity of Seprase has been shown to promote cell invasiveness towards the ECM and also to support tumour growth and proliferation. Seprase appears to act as a proteolytically active 170-kDa dimer, consisting of two 97- kDa subunits. It is a member of the group type II integral serine proteases, which includes dipeptidyl peptidase IV (DPPIV/CD26) and related type II transmembrane prolyl serine peptidases, which exert their mechanisms of action on the cell surface. DPPIV and Seprase exhibit multiple functions due to their abilities to form complexes with each other and to interact with other membrane-associated molecules. Localisation of these protease complexes at cell surface protrusions, called invadopodia, may have a prominent role in processing soluble factors and in the degradation of extracellular matrix components that are essential to the cellular migration and matrix invasion that occur during tumour invasion, metastasis and angiogenesis

Phylogenetics of Seed Plants: An Analysis of Nucleotide Sequences from the Plastid Gene rbcL

We present the results of two exploratory parsimony analyses of DNA sequences from 475 and 499 species of seed plants, respectively, representing all major taxonomic groups. The data are exclusively from the chloroplast gene rbcL, which codes for the large subunit of ribulose-1,5-bisphosphate carboxylase/oxygenase (RuBisCO or RuBPCase). We used two different state-transformation assumptions resulting in two sets of cladograms: (i) equal-weighting for the 499-taxon analysis; and (ii) a procedure that differentially weights transversions over transitions within characters and codon positions among characters for the 475-taxon analysis. The degree of congruence between these results and other molecular, as well as morphological, cladistic studies indicates that rbcL sequence variation contains historical evidence appropriate for phylogenetic analysis at this taxonomic level of sampling. Because the topologies presented are necessarily approximate and cannot be evaluated adequately for internal support, these results should be assessed from the perspective of their predictive value and used to direct future studies, both molecular and morphological. In both analyses, the three genera of Gnetales are placed together as the sister group of the flowering plants, and the anomalous aquatic Ceratophyllum (Ceratophyllaceae) is sister to all other flowering plants. Several major lineages identified correspond well with at least some recent taxonomic schemes for angiosperms, particularly those of Dahlgren and Thorne. The basalmost clades within the angiosperms are orders of the apparently polyphyletic subclass Magnoliidae sensu Cronquist. The most conspicuous feature of the topology is that the major division is not monocot versus dicot, but rather one correlated with general pollen type: uniaperturate versus triaperturate. The Dilleniidae and Hamamelidae are the only subclasses that are grossly polyphyletic; an examination of the latter is presented as an example of the use of these broad analyses to focus more restricted studies. A broadly circumscribed Rosidae is paraphyletic to Asteridae and Dilleniidae. Subclass Caryophyllidae is monophyletic and derived from within Rosidae in the 475-taxon analysis but is sister to a group composed of broadly delineated Asteridae and Rosidae in the 499-taxon study

Phylogenetics of Seed Plants: An Analysis of Nucleotide Sequences from the Plastid Gene rbcL

We present the results of two exploratory parsimony analyses of DNA sequences from 475 and 499 species of seed plants, respectively, representing all major taxonomic groups. The data are exclusively from the chloroplast gene rbcL, which codes for the large subunit of ribulose-1,5-bisphosphate carboxylase/oxygenase (RuBisCO or RuBPCase). We used two different state-transformation assumptions resulting in two sets of cladograms: (i) equal-weighting for the 499-taxon analysis; and (ii) a procedure that differentially weights transversions over transitions within characters and codon positions among characters for the 475-taxon analysis. The degree of congruence between these results and other molecular, as well as morphological, cladistic studies indicates that rbcL sequence variation contains historical evidence appropriate for phylogenetic analysis at this taxonomic level of sampling. Because the topologies presented are necessarily approximate and cannot be evaluated adequately for internal support, these results should be assessed from the perspective of their predictive value and used to direct future studies, both molecular and morphological. In both analyses, the three genera of Gnetales are placed together as the sister group of the flowering plants, and the anomalous aquatic Ceratophyllum (Ceratophyllaceae) is sister to all other flowering plants. Several major lineages identified correspond well with at least some recent taxonomic schemes for angiosperms, particularly those of Dahlgren and Thorne. The basalmost clades within the angiosperms are orders of the apparently polyphyletic subclass Magnoliidae sensu Cronquist. The most conspicuous feature of the topology is that the major division is not monocot versus dicot, but rather one correlated with general pollen type: uniaperturate versus triaperturate. The Dilleniidae and Hamamelidae are the only subclasses that are grossly polyphyletic; an examination of the latter is presented as an example of the use of these broad analyses to focus more restricted studies. A broadly circumscribed Rosidae is paraphyletic to Asteridae and Dilleniidae. Subclass Caryophyllidae is monophyletic and derived from within Rosidae in the 475-taxon analysis but is sister to a group composed of broadly delineated Asteridae and Rosidae in the 499-taxon study

A multi-ancestry genome-wide study incorporating gene-smoking interactions identifies multiple new loci for pulse pressure and mean arterial pressure

Elevated blood pressure (BP), a leading cause of global morbidity and mortality, is influenced by both genetic and lifestyle factors. Cigarette smoking is one such lifestyle factor. Across five ancestries, we performed a genome-wide gene-smoking interaction study of mean arterial pressure (MAP) and pulse pressure (PP) in 129 913 individuals in stage 1 and follow-up analysis in 480 178 additional individuals in stage 2. We report here 136 loci significantly associated with MAP and/or PP. Of these, 61 were previously published through main-effect analysis of BP traits, 37 were recently reported by us for systolic BP and/or diastolic BP through gene-smoking interaction analysis and 38 were newly identified (P <5 x 10(-8), false discovery rate <0.05). We also identified nine new signals near known loci. Of the 136 loci, 8 showed significant interaction with smoking status. They include CSMD1 previously reported for insulin resistance and BP in the spontaneously hypertensive rats. Many of the 38 new loci show biologic plausibility for a role in BP regulation. SLC26A7 encodes a chloride/bicarbonate exchanger expressed in the renal outer medullary collecting duct. AVPR1A is widely expressed, including in vascular smooth muscle cells, kidney, myocardium and brain. FHAD1 is a long non-coding RNA overexpressed in heart failure. TMEM51 was associated with contractile function in cardiomyocytes. CASP9 plays a central role in cardiomyocyte apoptosis. Identified only in African ancestry were 30 novel loci. Our findings highlight the value of multi-ancestry investigations, particularly in studies of interaction with lifestyle factors, where genomic and lifestyle differences may contribute to novel findings.Peer reviewe