Research Interests:
Research Interests:
Research Interests:
Research Interests:
Research Interests:
Four human immunodeficiency virus–positive homosexual men with 2- to 4.5-year histories of recurrent oral warts that had failed to respond to conventional surgical and other treatment modalities were offered treatment with interferon-α.... more
Four human immunodeficiency virus–positive homosexual men with 2- to 4.5-year histories of recurrent oral warts that had failed to respond to conventional surgical and other treatment modalities were offered treatment with interferon-α. All had multiple or large oral warts, 3 had skin warts, 2 had a history of anal warts, and 1 had penile lesions. All 4 patients were treated
Research Interests:
Most jurisdictions grant dental licensure to graduating students following successful completion of a clinical exam. Testing agencies, which are independent of dental schools, nevertheless conduct their exams at school facilities. Patient... more
Most jurisdictions grant dental licensure to graduating students following successful completion of a clinical exam. Testing agencies, which are independent of dental schools, nevertheless conduct their exams at school facilities. Patient participation in these exams raises ethical concerns regarding such issues as unlicensed providers' performing irreversible procedures with minimal supervision and graduates' limited accessibility to provide follow-up treatment. To address these concerns, a collaborative effort between University at Buffalo School of Dental Medicine faculty and testing agency personnel was launched. The aims of this article are to describe the development and implementation of the resulting Buffalo Model, to highlight ethical advantages in its application, and to identify areas of improvement to be addressed in future iterations. With the Buffalo Model, modifications were made to the traditional exam format in order to integrate the exam into the school cur...
Research Interests:
During the course of HIV disease, oral lesions frequently are the initial manifestation of underlying immune deterioration. Typically, these lesions are readily accessible and lend themselves to being examined. Therefore, it is important... more
During the course of HIV disease, oral lesions frequently are the initial manifestation of underlying immune deterioration. Typically, these lesions are readily accessible and lend themselves to being examined. Therefore, it is important to perform oral examinations routinely both in dental and medical settings. The recognition and treatment of these early signs of immune suppression may have a significant impact on the survival and the quality of life of HIV-infected patients. This article briefly discusses the HIV epidemic and common intraoral manifestations associated with HIV disease progression.
Research Interests:
Research Interests:
Research Interests:
Research Interests:
Research Interests:
Research Interests:
Research Interests:
Research Interests:
More than 7 percent of all adults in the United States have met diagnostic criteria for alcohol abuse and alcohol dependence. Many of these people and even occasional users of alcohol may exhibit medical complexities, particularly liver... more
More than 7 percent of all adults in the United States have met diagnostic criteria for alcohol abuse and alcohol dependence. Many of these people and even occasional users of alcohol may exhibit medical complexities, particularly liver disease, that can adversely affect provision of routine dental care. This article highlights some of the important clinical topics associated with alcoholic liver disease as it relates to dental care and provides guidelines on treatment of affected people.
Research Interests:
Lupus erythematosus, or LE, is a connective tissue disease that affects a number of organ systems. Patients with this condition can experience several other serious conditions--bleeding, infection, endocarditis, adrenal insufficiency and... more
Lupus erythematosus, or LE, is a connective tissue disease that affects a number of organ systems. Patients with this condition can experience several other serious conditions--bleeding, infection, endocarditis, adrenal insufficiency and mucocutaneous disease--that can affect the provision of dental care. The authors describe considerations for managing dental treatment of patients with LE.
Research Interests:
Research Interests:
Research Interests:
Research Interests:
Research Interests:
The purpose of this study was to assess the association between metabolic control and immune dysfunction, and postoperative complications and wound healing after dental extractions in people with type 2 diabetes and control participants.... more
The purpose of this study was to assess the association between metabolic control and immune dysfunction, and postoperative complications and wound healing after dental extractions in people with type 2 diabetes and control participants. The authors performed a prospective, case-control study enrolling 53 participants with type 2 diabetes and 29 participants who did not have type 2 diabetes. Exclusion criteria included being a smoker and having teeth with periodontal pockets deeper than 4 millimeters, among others. All participants underwent an extraction of 1 erupted tooth. The investigators assessed patients' signs and symptoms at 3, 7, 21, and 60 days after surgery. The investigators measured glycemic control and immunologic profile at the time of the extraction. They compared the pattern of healing and the incidence of postextraction complications between the 2 groups. Even in the presence of impaired neutrophil function and poor glycemic control, we found no increase in the number of postoperative complications. There was no association between delayed wound epithelialization on postoperative day 21 and level of glycemic control, and reduced neutrophil function. On postoperative day 60, all alveolar sockets were epithelialized completely and showed no signs of infection. The study results suggest that type 2 diabetes per se or glycemic control is not a risk factor for experiencing postoperative complications in people undergoing dental extractions. Although people with type 2 diabetes may have impaired neutrophil function, the study results revealed that having this condition was not associated with an increased risk of experiencing postoperative complications. Additional research studies with larger sample sizes of patients who have diabetes are needed to confirm this study's findings. The results allow clinicians to infer that people with type 2 diabetes undergoing dental extractions of erupted teeth that do not have an acute odontogenic infection should not receive antibiotic prophylaxis simply because of their diabetic status or level of glycemic control.
Research Interests:
India has a high prevalence of cardiovascular disease (CVD), diabetes mellitus (DM), tuberculosis (TB), human immunodeficiency virus/acquired immune-deficiency syndrome (HIV/AIDS) and hepatitis B. United States-based studies indicate... more
India has a high prevalence of cardiovascular disease (CVD), diabetes mellitus (DM), tuberculosis (TB), human immunodeficiency virus/acquired immune-deficiency syndrome (HIV/AIDS) and hepatitis B. United States-based studies indicate provider and patient support for medical screening in the dental setting. We assessed patient attitudes towards, and willingness to participate in, medical screening in the dental setting in India. A 5-point Likert scale survey (with scores ranging from 1 = very important/willing to 5 = very unimportant/unwilling) was given to a convenience sample of adult patients visiting five university-based dental clinics (clinic group) and one private-practice setting (private group). The Mann-Whitney U-test was used to compare mean response scores between patient groups. Logistic regression was used to assess factors associated with a favourable outcome. Both patient groups felt it important for dentists to identify increased risk for medical conditions (89.3% vs...
Research Interests:
Research Interests:
We assessed primary care physicians' attitudes toward medical screening in a dental setting. A 5-point Likert scale (1 = very important/willing, 5 = very unimportant/unwilling) survey was mailed to a nationwide sample of primary care... more
We assessed primary care physicians' attitudes toward medical screening in a dental setting. A 5-point Likert scale (1 = very important/willing, 5 = very unimportant/unwilling) survey was mailed to a nationwide sample of primary care physicians in the United States. Descriptive statistics were used for all questions, and the Friedman nonparametric analysis of variance was used for multipart questions. Of 1,508 respondents, the majority felt it was valuable for dentists to conduct screening for cardiovascular disease (61 percent), hypertension (77 percent), diabetes mellitus (71 percent), and HIV infection (64 percent). Respondents were willing to discuss results with the dentist (76 percent), accept patient referrals (89 percent), and felt it was unimportant that the medical referral came from a dentist rather than a physician (52 percent). The most important consideration was patient willingness (mean rank 2.55), and the least important was duplication of roles (mean rank 3.52)...
Research Interests: Dentistry, Public Health Dentistry, Screening, Humans, Female, and 7 moreMale, Physicians, Attitudes, Young Adult, Aged, Middle Aged, and Adult
Screening and monitoring for systemic disease risk in a dental setting are valuable components for more effective disease prevention and control and health care delivery. This strategy can identify patients at increased risk of disease... more
Screening and monitoring for systemic disease risk in a dental setting are valuable components for more effective disease prevention and control and health care delivery. This strategy can identify patients at increased risk of disease yet unaware of their increased risk and who may benefit from proven prevention/intervention strategies. The involvement of oral health care professionals in strategies to identify individuals at risk for coronary heart disease and diabetes will extend preventive and screening efforts necessary to slow the development of these diseases, and provide a portal for individuals who do not see a physician on a regular basis to enter into the general health care system.
Research Interests:
Lymph node enlargement may be an incidental finding on examination, or may be associated with a patient complaint. It is likely that over half of all patients examined each day may have enlarged lymph nodes in the head and neck region.... more
Lymph node enlargement may be an incidental finding on examination, or may be associated with a patient complaint. It is likely that over half of all patients examined each day may have enlarged lymph nodes in the head and neck region. There are no written guidelines specifying when further evaluation of lymphadenopathy is necessary. With such a high frequency of occurrence, oral health care providers need to be able to determine when lymphadenopathy should be investigated further. Although most cervical lymphadenopathy is the result of a benign infectious etiology, clinicians should search for a precipitating cause and examine other nodal locations to exclude generalized lymphadenopathy. Lymph nodes larger than 1 cm in diameter are generally considered abnormal. Malignancy should be considered when palpable lymph nodes are identified in the supraclavicular region, or when nodes are rock hard, rubbery, or fixed in consistency. Patients with unexplained localized cervical lymphadenop...
Research Interests: Dentistry, Rheumatoid Arthritis, Toxoplasmosis, Humans, Systemic Lupus Erythematosus, and 12 moreDifferential Diagnosis, Quintessence, Sjogren´s Syndrome, Respiratory Tract Infections, Bacterial infections, Neck, Virus diseases, Lymphatic Diseases, Cat Scratch Disease, Medical History Taking, Drug hypersensitivity, and Head and neck neoplasms
The most common orofacial disorders found among HIV-infected children are oral candidiasis, parotid gland enlargement, lymphadenopathy, and oral dryness. These changes are strongly related to immune suppression, immune deterioration, and... more
The most common orofacial disorders found among HIV-infected children are oral candidiasis, parotid gland enlargement, lymphadenopathy, and oral dryness. These changes are strongly related to immune suppression, immune deterioration, and HIV disease progression. The classification of oral lesions in pediatric patients needs to be updated to reflect the relationship between immunologic and virologic markers.
Research Interests:
A palatal lesion was the initial manifestation of disseminated cryptococcosis in a patient with acquired immunodeficiency syndrome (AIDS). The diagnosis was initially verified with cytologic smears in situ and later confirmed with... more
A palatal lesion was the initial manifestation of disseminated cryptococcosis in a patient with acquired immunodeficiency syndrome (AIDS). The diagnosis was initially verified with cytologic smears in situ and later confirmed with pathologic findings from an excisional biopsy specimen. As cryptococcosis is one of the major opportunistic infections in persons with AIDS, an increased incidence of oral manifestations of cryptococcosis can be expected.
Research Interests:
Dental pulp tissue from a patient with acquired immune deficiency syndrome (AIDS) was examined to determine the presence of the human immunodeficiency virus (HIV). The results found a high concentration of proviral HIV DNA.
Research Interests:
HIV disease, once considered an acute disease with a 100% mortality rate but a very short symptomatic stage, has begun to emerge as a preventable, treatable, chronic disease. Interactions between patients, dentists, and physicians are... more
HIV disease, once considered an acute disease with a 100% mortality rate but a very short symptomatic stage, has begun to emerge as a preventable, treatable, chronic disease. Interactions between patients, dentists, and physicians are essential to gain the information necessary to provide appropriate dental care for both short-term and long-term survivors. The prognosis and survival time of the dental patient may influence treatment protocols and necessitate modified dental procedures. Certain clinical and laboratory parameters, which may be useful indicators of disease progression, need to be recognized by the dental clinician. These parameters include systemic signs, symptoms, and serologic data as well as intraoral manifestations associated with HIV disease. Although a perfect classification system for progression of HIV disease does not exist, trends among larger cohorts may enable health care providers to estimate the prognosis and survival of HIV-infected patients on an indivi...
Research Interests:
Research Interests:
Research Interests:
Research Interests:
Post-procedural complications were assessed for 331 patients with AIDS after a wide range of outpatient dental procedures. Only patients with a CD4+ cell count < or = 200 cells/mm3 were included. Patients' charts were... more
Post-procedural complications were assessed for 331 patients with AIDS after a wide range of outpatient dental procedures. Only patients with a CD4+ cell count < or = 200 cells/mm3 were included. Patients' charts were reviewed retrospectively by the treating dentist. The overall complication rate was 0.9 percent.
Research Interests:
Research Interests: Dentistry, Decision Making, Research Design, Dental Research, Qualitative Research, and 15 moreCritical Appraisal, Prevention, Humans, Dental Caries, Ct, RCT, Meta Analysis, Observational Studies, EBD, Cost Benefit Analysis, Dental Care, Evidence based dentistry, GRADE, Review Literature As Topic, and Randomized Controlled Trials as Topic
Research Interests:
Research Interests:
Research Interests:
Research Interests:
Four human immunodeficiency virus-positive homosexual men with 2- to 4.5-year histories of recurrent oral warts that had failed to respond to conventional surgical and other treatment modalities were offered treatment with... more
Four human immunodeficiency virus-positive homosexual men with 2- to 4.5-year histories of recurrent oral warts that had failed to respond to conventional surgical and other treatment modalities were offered treatment with interferon-alpha. All had multiple or large oral warts, 3 had skin warts, 2 had a history of anal warts, and 1 had penile lesions. All 4 patients were treated with a combination of intralesional and subcutaneous interferon-alpha. Adverse side effects were dose-related, mild, and transient; they included flulike symptoms (3 patients), hair loss and tachycardia (1 patient), and transient changes in the white blood cell count. All patients responded to therapy and remained free of disease up to 42 months. Intralesional injection with interferon-alpha appears to provide excellent clinical control for recurrent, multiple, and extensive oral warts in the human immunodeficiency virus-positive population, and is a useful adjunct to initial surgical removal of oral warts.
Research Interests:
Whether oral lesions were associated with human immunodeficiency virus-type 1 (HIV-1) status in a cohort of pregnant Malawian women was studied. Six hundred thirty-eight women participated in a randomized prospective study at 3 prenatal... more
Whether oral lesions were associated with human immunodeficiency virus-type 1 (HIV-1) status in a cohort of pregnant Malawian women was studied. Six hundred thirty-eight women participated in a randomized prospective study at 3 prenatal clinics in a rural area of southern Malawi. Oral examinations, followed by collection of oral fluid specimens with an HIV-1 oral specimen collection device, were performed. The specimens were tested for antibodies against HIV-1. Sixty-one oral lesions were found in 60 participants. While traditional HIV-1 associated lesions were rare, benign migratory glossitis was unexpectedly common (6%). Oral hairy leukoplakia was significantly more common among women who were HIV-1 positive than among women who were HIV-1 negative. An HIV-1 prevalence rate of 21.8% was estimated among the women, with the highest rate of HIV-1 infection (34.1%) among women aged 25 to 29 years. Stratifying lesions showed a small number of oral hairy leukoplakia to be markers for HIV-1. A high seroprevalence was found in this rural cohort, but there were unexpectedly few oral lesions. The relatively few oral lesions diagnosed may indicate a recent infection with HIV.