Leena Palomo

Objectives: Identify the social determinants of health (SDH) factors associated with the prevalence of severe periodontal disease in postmenopausal women (PMW) and to compare periodontal parameters with demographic, lifestyle factors, anthropometric measurements and pre-existing diseases in the northeast region of Ohio. Methods: Retrospective, cross-sectional study was conducted using the Case Cleveland Clinic Postmenopausal Wellness Consortium (CCCPWC), a database of over 900 PMW. The periodontal parameters median probing depth (MPD), number of loss teeth (TL), bleeding on probing (BOP) were collected from charts as endpoint measurements. Recession (MR) was likewise collected as a supporting metric. Results: PMW with diabetes had significantly higher TL (13 vs 5; p < 0.001) and BOP (86.2% vs 59.2%; p=0.02); those with osteoporosis had significantly higher TL (10 vs 5; p < 0.001) and significantly higher BOP (80% vs 59.9%; p=0.005). MPD was greater in smokers (2 mm vs. 1 mm, p...

According to the new classification proposed by the recent 2017 World Workshop on Periodontal and Peri-implant Diseases and Conditions, periodontitis, necrotizing periodontal diseases, periodontitis as a manifestation of systemic diseases, and systemic diseases or conditions affecting the periodontal supporting tissues, are considered as separate entities. Scientific evidence has demonstrated that periodontal diseases are not just simple bacterial infections but rather complex diseases of multifactorial complexity that interplay with the subgingival microbes, the host immune, and inflammatory responses. Despite dental plaque biofilm being considered the primary risk factor for periodontitis in the vast majority of patients that dentists encounter on a daily basis, there are other factors that can also contribute and/or accelerate pathologic progressive attachment loss. In this article, the authors aim to briefly review and discuss the present evidence regarding the association betwe...

Tooth mobility is often discussed among dental healthcare providers according to a numerical scale, i.e., 1, 2 or 3, without a clear understanding of the definition of each category. Thus, a comprehensive review to examine and discuss the various classifications is needed. PURPOSE The aim of this comprehensive review is to discuss the main clinical classifications of tooth mobility. MATERIALS AND METHODS The authors conducted electronic searches in MEDLINE, Scopus, and Pubmed. Additionally, the authors manually searched the textbooks, gray literature and bibliographies of all relevant articles. RESULTS The most commonly referenced clinical index for mobility was the Miller Index. Yet, many other mobility classifications exist as well as modifications of those indices. The literature has been very inconsistent and at times inaccurate when classifying mobility: 1) various stages of mobility using Grades, Classes and scores interchangeably; and 2) not defining the meaning of the actual numerical scores/terminologies. DISCUSSION In order to avoid ambiguity and provide clarity regarding the impact of degrees of mobility when used clinically, this review comprehensively discusses different classifications and definitions of tooth mobility with attention to the importance of using them consistently and accurately. There is a need to standardize one classification for mobility.

Gingival recession is a frequent mucogingival defect in the adult population. It affects the esthetics and is related to hypersensitivity and a high risk of periodontal attachment loss. The connection between orthodontic treatment and periodontal health has been debated for a long time. A healthy periodontium can be preserved during safe orthodontic tooth movement even in patients with poor mucogingival anatomy. This article aimed to review the strategies around managing the risks of mucogingival and apical root changes owing to maxillary canine impaction, with a special focus on gingival recession and impacted maxillary canine treatment. Maxillary canines are the second most frequently impacted teeth after the third molars. They can be located in the labial or buccal aspect of the alveolar bone. If interceptive procedures fail, the next step is the challenging and time-consuming comprehensive orthodontic-surgical treatment. Determining the exact impacted canine location, its relation to the adjacent teeth and structures, the least invasive surgical approach, and the best path for traction are all a part of the standard diagnostic process. It has also been suggested that orthodontists should evaluate periodontal risks to achieve the best possible results. Clinical examination and cone beam computed tomography provide valuable information for the treatment plan that yields good results with a healthy periodontium.

Sclerostin modulation is a novel therapeutic bone regulation strategy. The anti-sclerostin drugs, proposed in medicine for skeletal bone loss may be developed for jaw bone indications in dentistry. Alveolar bone responsible for housing dentition share common bone remodeling mechanisms with skeletal bone. Manipulating alveolar bone turnover can be used as a strategy to treat diseases such as periodontitis, where large bone defects from disease are a surgical treatment challenge and to control tooth position in orthodontic treatment, where moving teeth through bone in the treatment goal. Developing such therapeutics for dentistry is a future line for research and therapy. Furthermore, it underscores the interprofessional relationship that is the future of healthcare.

This randomized, single-blinded, controlled study compares the effectiveness of two modes of delivering the same set of oral hygiene instructions: those loaded on a computer-assisted teaching format versus those given personally by a self-care instructor. 60 participants with mild to moderate periodontitis were randomized to either the computer-teaching format or the self-care instructor. Plaque score and bleeding indices were assessed at baseline and at 4 week re-evaluation to compare the instructional modalities. At baseline, there was no difference in the parameters between the two groups. At re-evaluation, all parameters were significantly improved compared to baseline; however, there was no difference between any parameters in the computer group versus the instructor. Plaque score was significantly different between younger and older participants, such that participants under 50 years old had lower plaque scores when they received instructions using the computer format (72.5 ± ...

Interrelationships between traditional dental variables are becoming more evident in far reaching aspects of life such as psychosocial interaction, self-esteem, overall health and even occupational performance. This study compares quality of life (QoL) in postmenopausal women (PMW) with poor oral health (POH) with QoL in PMW with good oral health. 200 randomly recruited PMW received a dental evaluation and completed Utian Quality of Life Survey. The participants were divided into POH and healthy groups based on dental exam. Mean scores were calculated for each QoL item, domain and the overall summary score. For each of the four parameters for periodontitis diagnosis, periodontitis patients’ QoL outcomes were compared to those of healthy patients using T-test with threshold of significance at p

To compare bone thickness buccal to the teeth in the esthetic zone of postmenopausal women, premenopausal women, younger men and older men. Retrospective data were randomly selected from 4 groups: 59 premenopausal women, 60 postmenopausal women, 60 men less than age 50, and 60 men more than 50. Half-root and bone crest landmarks were identified on each participant's cone beam computed tomography for teeth 7 to 10 and 23 to 26. Buccal bone thickness was measured by calibrated examiners. Group averages were calculated and compared between groups using analysis of variance (P < 0.05). When comparing premenopausal to postmenopausal women and postmenopausal women to older men, anterior bone thickness was significantly different for tooth maxillary and mandibular lateral incisors and overall maxillary and mandibular central incisors. In addition, significant differences were observed between these groups within the maxilla comparing lateral incisors, central incisors (P < 0.05), and within the mandible when comparing lateral and central incisors at (P < 0.05) at bone crest and half-root, respectively. Buccal bone in the anterior esthetic zone bone is thin in all segments of the population, but significantly thinner in postmenopausal women. In this cohort, when anterior implants are planned, it is essential to make informed treatment planning decisions. Strategies are available to manage the thinner bony housing, but require further research specific to this growing consumer cohort.

High BMI is associated with increasing susceptibility to periodontal disease through its impact on metabolic and immune parameters; these same parameters are said to be protective against osteopenia in overweight and obese postmenopausal women (PMW). Reportedly, exercise protects against both periodontitis and osteopenia. Little is known about the periodontitis in PMW with high BMI. Objective: Are BMI and exercise related to periodontitis in overweight, osteopenic PMW?Methods: Fifty-six overweight, nonsmoking, caucasian PMW having oral hygiene score of 80% plaque free sites or better and T-score -2.0 (osteopenic) and lower underwent periodontal examination and CT scan. Periodontal probing depth (PD) in mm, bleeding on probing percentage (BOP) and bone height from cemento-enamel junction to bone crest (BL) in mm were measured. Height and weight were measured, BMI calculated. Questionnaire was used to assess exercise. Results: In simple linear regression, BMI was correlated with PD, b...

Objectives: To detect a difference in bone thickness supporting the maxillary first molars between patients treated with rapid maxillary expansion (RME) and patients treated without expansion following orthodontics. To relate bone thickness supporting the maxillary first molars to the amount of expansion. Methods: The RME group consisted of 17 male and 15 female patients, with a mean age of 13.67 1.25 years. The non-expansion group consisted of 17 male and 15 female, with a mean age of 13.82 0.67 years. CBCT images were used to measure intermolar width and bone thickness supporting the maxillary first molars. Results: Subjects with RME had a mean intermolar expansion of 3.05 mm 2.10 mm, (P < 0.001). The mean thickness of bone on the mesiobuccal significantly decreased from 1.46 mm to 1.18 mm (P < 0.001). There was no correlation between the change in intermolar width and change in mesiobuccal bone thickness of the maxillary first molars. Conclusions: There was a statistically ...

The purpose of this study was to compare periodontal status of postmenopausal women with mild to moderate osteoporosis who use risedronate therapy with those who do not. In this cross-sectional study, a total of 60 age-matched postmenopausal women with mild to moderate osteoporosis diagnosed by a bone density scan T score below -2.5 at either spine or hip were divided into two groups. Women in the experimental group had used systemic risedronate once weekly (35 mg) for at least 3 months. Women in the control group had never used bisphosphonate therapy. The periodontal status of each subject was evaluated through a clinical periodontal examination including evaluation of periodontal probing depth, gingival recession, gingival index, plaque score, attachment loss, and alveolar bone level. The significance in differences between the two groups was assessed using two-tailed paired t tests. Significant differences (P < 0.05) were found between risedronate and control groups for period...

As the baby boomer generation in the United States ages, more patients are using bisphosphonates for systemic bone diseases like osteoporosis. Because of their ability to inhibit bone resorption and osteoclastic activity, bisphosphonates may also be beneficial in modulating host response for periodontal disease management. This literature review examines the mechanism of action for bisphosphonates and their uses in treating periodontal disease. The dental profession should continue to evaluate this class of drugs and to closely monitor patients who are on bisphosphonate therapy.

Article Title and Bibliographic Information Body mass index as a predictive factor of periodontal therapy outcomes. Suvan J, Petrie A, Moles DR, Nibali L, Patel K, Darbar U, Donos N, Tonetti M, D'Aiuto F. J Dent Res 2014;93(1):49-54. Reviewer Leena Palomo, DDS, MSD Purpose/Question Is overweight/obesity a predictor of clinical response following nonsurgical periodontal therapy in patients with severe periodontitis? Source of Funding Johnson & Johnson Consumer Services EAME Limited funded this project. The study center is partially funded by the National Institute of Health Research (NIHR), the research arm of the Department of Health. The investigator has received a Clinical Senior Lectureship Award supported by the UK Clinical Research Collaboration Type of Study/Design This is a post-hoc, secondary analysis of data from 5 randomized clinical trials of nonsurgical periodontal therapy Level of Evidence Level 2: Limited-quality, patient-oriented evidence Strength of Recommendation Grade N/A, not applicable. Although the current study draws its sample from a database of other studies, it presents the outcome of a single evaluation

Healthcare professionals should be aware that systemic bone conditions impact the periodontium. Bisphosphonate drugs used for systemic bone loss affect the maxilla and mandible. Alveolar bone loss in periodontitis and skeletal bone loss share common mechanisms. At present, bisphosphonates are in wide use for prevention and treatment of osteoporosis, Paget's disease and metastatic bone conditions. This therapy is linked to a negative side effect called osteonecrosis of the jaws. At the same time, bisphosphonate therapy is also reported to be beneficial to the periodontium. In fact, periodontal therapy using bisphosphonates to modulate host response to bacterial insult may develop into a potential strategy in populations in which periodontal therapy is not convenient. Unlocking the full potential of bisphosphonates involves understanding the mechanisms of action of different classes of bisphosphonates, limiting unwanted side effects and expanding its indications. Developing bisphosphonates to slow the progression of periodontal disease depends on identifying an effective dosage regimen and delivery system that would reach the target site in the periodontium, while limiting unwanted side effects.

Copyright © 2015 Christine DeBaz et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Introduction. The aim of this study is to compare the quality of life (QoL) in partially edentulous osteoporotic women who have missing teeth restored with dental implant retained restorations with those who do not and, secondarily, to report the rate of osteonecrosis in this sample.Methods. 237 participants completed the Utian QoL survey, a 23-question documentmeasuring across psychosocial domains of well-being including occupational, health, emotional, and sexual domains which together contribute to an overall score. The subset of participants having dental implant supported prosthesis (64) was compared to the subset having

Three-dimensional imaging in dentistry offers many advantages with respect to diagnosis and treatment planning. This article focuses on cone beam computerized tomography (CBCT), which combines conventional x-ray and computerized volumetric reconstruction to reproduce a 3- dimensional image. A search of the peer-reviewed dental literature was performed to determine clinical applications in dentistry. Applications include 3-dimensional imaging for implant placement, extraction or exposure of impacted teeth, definition of anatomical structures, airway analysis, and temporomandibular joint imaging related to the diagnosis of joint disorders.

OBJECTIVES: to determine 1) if bacterial DNA can be detected in synovial fluid of subjects undergoing primary or revision surgery for hip and knee arthroplasty; 2) if bacterial DNA in the synovial fluid of patients undergoing revision surgery is similar to that detected in the same patient's dental plaque. MATERIALS AND METHODS: 10 subjects presenting for primary joint arthroplasty (primary surgery group) and 10 for revision surgery to replace failed joint prosthesis (revision surgery group) were enrolled in the study. Periodontal examination and plaque sample collection were performed for the revision group before surgery. Synovial fluid was collected from all subjects intra-operatively by needle aspiration. Polymerase chain reaction (PCR) was performed on all synovial fluid samples using universal primers. PCR was also performed on the plaque samples of the subjects that tested positive for periodontal pathogen DNA in the synovial fluid to investigate similarities in bacterial...

Objectives: to assess if significant weight loss after bariatric surgery would improve the response to periodontal therapy in obese patients who did not have the surgery. Methods: Thirty obese (BMI >30 kg/m2) subjects affected with chronic periodontitis participated in the study. Of these, 15 subjects had previously undergone bariatric surgery (BS) and lost at least 40% of their excess weight for at least 6 months postsurgery(test group). The other 15 subjects were also obese, but did not have the surgery, nor lost weight (control group). All participants received non-surgical periodontal therapy (scaling and root planing and oral hygiene instructions). Probing depth (PD), clinical attachment level (CAL), bleeding on probing (BOP), gingival index (GI) and plaque index (PI) were measured at baseline and at 4-6 weeks following the periodontal treatment. Descriptive statistics, linear mixed effects models and linear regression models were used for data analysis. Results: The mean ag...

Objective: The objective of this study was to determine if there is a difference between parotid and whole saliva salivary pyrophosphate levels in “heavy” versus “light” calculus formers as determined by the Green and Vermillion index. Method: Forty-four subjects were randomized into 2 groups based upon index scores. Baseline medical/dental information was collected and all subjects underwent periodontal examination, supra-gingival scaling with hand instrumentation, supra-gingival calculus collection, and stimulated whole and parotid saliva collection. Parotid saliva collection was performed using a sterile Carlson –Crittenden cup collection apparatus. Salivary flow was determined volumetrically, supra-gingival calculus was collected and weighed, and salivary pyrophosphate levels were determined fluorometrically using the PhosphoWorks™ Fluorometric Pyrophosphate assay kit (Interchim, Montluçon, France). Result: “Heavy” calculus formers had lower pyrophosphate levels than “light” cal...

Published case series and systematic reviews have documented an association between bisphosphonates and osteonecrosis of the jaw. However, a cause-and-effect relationship has not been established, and most of the reported cases have been in patients with cancer who were receiving much higher doses than those used to treat osteoporosis or Paget disease of bone. The risk, if any, to patients with these latter conditions receiving these drugs appears to be very small.