Browse
Recent Submissions
Item Effects of Stannous and Sodium Fluoride on Human Gingival Fibroblasts.(04/13/15) Mummert, Lauren; Windsor, L. Jack; Mummert, Lauren; Windsor, L. Jack; PeriodonticsBackground: Periodontal diseases are inflammatory conditions of the tooth supporting tissues. Although bacterial byproducts have been linked to periodontal diseases, host responses have also been implicated. This includes the matrix metalloproteinases (MMPs) that are released from human gingival fibroblasts (HGFs) and induce connective tissue degradation. Fluoride has been shown to have inhibitory effects on MMPs in solution. The effects of fluoride on MMP expression from HGFs have not yet been examined. Methods: HGFs cultured from a sample of clinically non-inflamed gingival connective tissues were incubated with stannous fluoride and sodium fluoride to determine their effects on cell proliferation. HGFs were then incubated with or without stannous fluoride or stannous fluoride at the highest concentrations that did not affect cell proliferation and analyzed for MMP expression. Results: The highest concentrations that did not affect proliferation with respect to HGFs were 0.004% stannous fluoride and 0.0125% sodium fluoride. At these levels, MMP expression in HGFs did not differ significantly from untreated HGFs. Conclusions: MMP expression in HGFs was unaffected by treatment with stannous fluoride or sodium fluoride at the concentrations tested. Although these concentrations of sodium fluoride and stannous fluoride with respect to HGFs are lower than some fluoridated mouth rinses and dentifrices, the exact concentrations to which HGFs are exposed following exposure to a fluoridated medicament is unknown. This concentration is likely lower than the concentration of stannous fluoride or sodium fluoride in the medicament due to their position in the lamina propria.Item Motivational Factors for the Non- Compliant Patient.(04/13/15) Miller, Nia; Ranis, D; Maxwell, Lisa; Miller, Nia; Maxwell, Lisa; Dental HygieneObjective: To evaluate the oral hygiene attitudes of non-compliant patients and find motivating strategies to improve their adherence to oral hygiene recommendations. Assessment: A 33 year old male Caucasian patient presented to our clinic with the chief complaint of “I need to get my teeth cleaned.” He had not been to the dentist in 17 years. His medical history was positive for HIV/AIDS. The patient stated that he has smoked a half of a pack of cigarettes daily for the last 20 years and that he drinks socially. The patient stated that he brushes once a day with a manual toothbrush and rarely flosses. His gingival description was generalized mild plaque induced marginal, papillary gingivitis as evidenced by pale pink, bulbous, spongy gingiva with slight BOP. Localized moderate to severe plaque induced gingivitis on lingual mandibular tissue as evidenced by red, rolled, inflamed papilla with easy BOP on the mandible. His periodontal description was generalized 4-6 mm CAL most likely due to inflammation from pseudo-pocketing. Generalized healthy bone levels as evidenced radiographically by 1-2 mm measurements from the CEJ to crest of alveolar bone. DH Care Plan: Prophylaxis, extensive OHI that includes finding motivating factors for this patient to maintain effective plaque control at home. Evaluation: When evaluating this patient’s success in treatment, we found he was not compliant 5 out of the 10 appointments that we had agreed to schedule. His behavior and attitude remained unchanged despite the efforts used to motivate the patient. His attitude reflected his desire for a quick resolution to improve his oral health, rather than making the commitment and effort to alter his lifestyle. Conclusion: Finding the right motivating strategies for your patient will determine how successful their treatment outcomes will be in achieving optimal oral health.Item Maintaining Oral Health with Parkinson’s disease and Arthritis.(04/13/15) Jones, Lindsey; Minett, C; Rettig, Pamela; Jones, Lindsey; Rettig, Pamela; Dental HygieneObjective: 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 earlyItem Diabetes and Periodontal Disease: The Need for Interprofessional Patient Care.(04/13/15) Zhuravlev, Elena; Chilman, L; Rackley, R. Hunter; Zhuravlev, Elena; Rackley, R. Hunter; Dental HygieneObjective: The objective of this clinical case presentation is to emphasize the importance of an interprofessional approach to health care. Specifically, this case will emphasize the importance of managing diabetes in a periodontal patient. Background: A 69 year old patient presented with the chief complaint of, “I want my teeth cleaned.” The medical history revealed several medications and conditions that could potentially impact the oral cavity. The patient presented with type II diabetes mellitus, which became uncontrolled during the treatment; was taking a calcium channel blocker to control his high blood pressure, and was using a bi-pap machine for his sleep apnea. The patient also was obese and gave a history of bariatric surgery, GERD, and recent back pain. Assessment: The initial clinical examination of this patient revealed generalized mild bone loss as evidenced by 3-4mm from the CEJ radiographically (generalized moderate plaque induced gingivitis with dark pink spongy tissue with bulbous papilla that did not adhere tightly to the tooth with bleeding) and generalized mild chronic periodontitis as evidenced by 4-5mm CAL and 6mm CAL associated with swollen gingiva. Localized severe periodontitis of 8mm CAL on tooth number 19 was present. Dental Hygiene Treatment Plan: Scaling and root planing was performed for selective areas along with a periodontal tissue re-evaluation. Treatment: The treatment was performed throughout three separate appointments. At the beginning of treatment the patient’s A1C was 8.5% and his blood glucose was 195 mg/dl. Results: The re-evaluation appointment revealed slight improvement in the health of the gingiva, but minimal to no improvement in probing depths. Conclusion: This case highlights the need for an interprofessional approach to patient care. Problems with diabetes management, as well as other contributing factors, have been known to impact periodontal therapy outcomes.Item Caries Presentation in Illict Drug Users and Excessive Soft Drink Consumers.(04/13/15) Parker, Eric; Ehrlich, Ygal; Pfotenhauer, David; Bringas, Josef; Warner, Ned; Parker, Eric; Ehrlich, Ygal; EndodonticsAdvanced cervical caries in anterior teeth is common to two different patient behaviors. Rampant cervical caries (“meth mouth”) is a common presentation in drug users. Extensive consumption of soft drinks also presents a similar pattern of cervical caries. Two cases are presented and dental treatment considerations are discussed. Case One: excessive soft drink consumption. A young male presented to IUSD for evaluation and treatment of a painful #9. Clinical exam: #9 had extensive facial and cervical caries with a pulp exposure. Cervical caries on teeth #6, 7,8,10,11,12,13. Patient’s history revealed frequent daily consumption of multiple sweet soft drinks. #9 had become increasingly painful and that caused him to seek treatment. Pulpal and Percussion/Palpation testing and radiographic exam of #9 were conducted. Diagnosis: #9 Pulpal Necrosis with Symptomatic Apical Periodontitis. Treatment: Oral hygiene instruction to reduce the frequency of soft drink consumption. #9 was endodontically treated and restored. Caries in #6, 7,8,10,11,12,13 were treated and teeth restored. Case Two: cocaine abuse. A young female presented to IUSD for evaluation and treatment of a painful #9. Clinical exam: #9 had extensive cervical caries. Cervical caries on #7, 8, 9 and dental attrition. Patient reports having used cocaine for many years. Pulpal and Percussion/Palpation testing and radiographic exam of #9 were conducted. Diagnosis: #9 Pulpal Necrosis with Symptomatic Apical Periodontitis. Treatment considerations: Local anesthesia was achieved without the use of epinephrine due to possible occasional unreported use of cocaine. #9 was endodontically treated and restored. Patient did not return for continued treatment at IUSD. Conclusion: Cervical caries in anterior teeth associated with soft drinks demonstrate similar characteristics to those observed in patients with reported cocaine abuse. This should alert dental providers dentists to be aware of both illicit drug use and soft drink intake as part of the patient’s medical, dental, and social history information.Item The Effects of Poor Dental Knowledge on Oral Health.(04/13/15) Ison, Kayla; Helwig, Melissa; Rettig, Pamela; Helwig, Melissa; Rettig, Pamela; Dental HygieneObjective: 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.Item Histomorphological Comparison of Platelet Rich Fibrin Combinations for Ridge Preservation.(04/13/15) Hamada, Yusuke; John, Vanchit; Blanchard, Steven; Hamada, Yusuke; Blanchard, Steven; PeriodonticsBackground: Most commonly used techniques to preserve ridge dimensions following tooth extraction involve bone substitutes and membranes to cover the graft. The use of autologous Platelet Rich Fibrin (PRF) is a recent introduction to be used as a membrane as well as mixed with the graft material. PRF is an inexpensive autologous gel enriched with platelets from venous blood that is easily processed in a clinical setting and contains growth factors including PDGF, TGF-β, VEGF, EGF and IGF1. The aim of this case report is to compare the histomorphologic results of various combinations of PRF, freeze dried bone allograft (FDBA) and polylactic acid membranes (Guidor) in extraction sockets in a single patient. Material and Methods: A 49-year old female patient with a 12 pack-year smoking history presented for extraction of maxillary teeth for an implant retained complete denture. On the day of surgery, 40ml of venous blood was drawn and centrifuged to produce four PRF gels. Two PRF gels were minced and mixed with FDBA. Two clots were processed to be used as membranes to cover the sockets. Teeth #s 4, 6, 11, and 13 were extracted with minimal trauma and sockets were thoroughly debrided. Varying combination of FDBA, PRF, and Guidor membranes were used for ridge preservation grafting in the four sockets. Four and half months following extraction, trephine cores were taken at the time of implant placement and submitted for histological analysis. Results: Clinical healing was uneventful at all sockets but soft tissue healing appeared slightly rapid on sites covered with PRF membranes. However, histologic healing showed more vital bone formation around residual graft materials with Guidor membranes sites. Conclusions: Within the limits of this case report, although PRF membranes seemed to slightly enhance soft tissue healing, the use of Guidor membranes appeared to improve bone remodeling.Item Using Margin Elevation with Bonded Ceramics: A Case Report.(04/13/15) Rouse, Matt; Cook, N. Blaine; Rouse, Matt; Cook, N. Blaine; Aesthetic DentistryThirty years ago, glass ionomer was first used as a means of bonding resin matrix composite to dentin. Today this method is used to elevate the margin of a preparation to a level which gives the clinician more access to the operating field. This technique has been described in the dental literature with resin composites bonded with resin adhesives. There are still inherent problems with this approach, however, since resin adhesives are subject to hydrolysis, marginal leakage, and recurrent caries. Studies have demonstrated the ability of glass ionomer to chemically bond to dentin; glass ionomer can also be dissolved/etched by phosphoric acid and predictably bonded to resin composites, eliminating the problem of hybrid layer hydrolysis which occurs with resin bonding agents. Margin elevation takes advantage of the favorable properties of glass ionomer cements (adhesion through chemical bond to dentin, fluoride release, biocompatibility, coefficient of thermal expansion similar to tooth structure, and decreased interfacial bacteria penetration/caries activity) while allowing overlaying of a suitable direct or indirect restorative material. This technique should be utilized when a preparation stands an increased risk of contamination or has a gingival margin on dentin/cementum. This case describes restoration of a tooth with a deep subgingival margin located on cervical dentin. The tooth was prepared for a ceramic onlay. Resin-modified glass ionomer was then inserted into the mesial proximal box and re-prepared with the occlusal wall of the glass ionomer becoming the new gingival margin, allowing significantly increased access and isolation. The tooth was then restored with an e.max onlay and cemented with RelyX Unicem. The restoration has been examined at a 6-month recall. With proper case selection and attention to detail, glass ionomer margin elevation is an excellent technique for bonding ceramics to teeth which cannot be isolated adequately for impression and/or resin bonding.Item Impact of a Tobacco CE Program for Indiana Healthcare Providers.(04/13/15) Harvey, Savannah; Romito, Laura; Harvey, Savannah; Romito, Laura; TobaccoPurpose: To assess an evidence-based continuing education (CE) program for Indiana healthcare practitioners focusing on tobacco use and dependence which emphasized team-based tobacco dependence treatment. Methods: Program impact was assessed by changes in participants’ self-reported knowledge and clinical application of course concepts and strategies via a 26-item immediate post- CE survey and a 19 -item 3-month follow-up survey. Surveys included multiple-choice and 5-point Likert-style scaled items. The three month follow-up surveys were mailed / delivered electronically to participants; non-responders were sent two reminders. De-identified data were analyzed in aggregate using descriptive statistics, Spearman correlation coefficients, and Mantel-Haenszel chi-square tests. Results: CE programs were held in Tell City, Madison, Lafayette, Goshen, Richmond and Vincennes with a total of 252 participants. Initial survey response was 98.4% (n=248): dental assistants (2%), dental hygienists (83%), dentists (8.5%), and other healthcare professionals (6.45%). Overall, participants reported less knowledge before than immediately after (p<.0001) and 3 months after (p<.0001) the CE program. Reported knowledge at 3 months was less than immediately after the program (p<.002). Participants planned to apply CE program communication strategies (99%), implement brief tobacco intervention strategies (85%), and refer patients to local cessation resources (95%) or the Indiana Quitline (96%). Response rate for the 3 month survey was 54% (n=136). Respondents reported currently playing an active role in team-based tobacco cessation (48%,78), applying CE communication strategies (85%,109), and implementing brief tobacco interventions (71%,90). Sixty-eight respondents reported referring patients to local counselors; eighty-three referred to the Indiana Quitline. Conclusion: Tobacco dependence CE may be beneficial to enhance health care practitioners’ knowledge and willingness to integrate tobacco interventions in their healthcare settings. However, this does not assure that they will change their practice behaviors by utilizing the learned concepts and tobacco interventions with patients. (Funded by the Indiana State Dept. of Health)Item Importance of Vertical Dimension in Facial Esthetics.(04/13/15) Supornpun, Noppamath; Levon, John; Supornpun, Noppamath; Levon, John; Aesthetic DentistryThe objective is to discuss the importance in the determination of the vertical dimension of occlusion in prosthodontic treatment. Case I: A 43-year-old Caucasian female presented with chief complaints of both poor function and esthetics. The medical history revealed a history of cirrhosis, Hepatitis B and depression. In 2011, she presented edentulous with some lower impacted teeth. Three sets of complete dentures were fabricated and delivered. These dentures caused her various problems including complaint of the thick and overextended borders, unacceptable esthetics and ear pain. Due to lack of posterior inter-occlusal space, vertical dimension was increased so much that the resulting dentures were unsatisfying esthetically and auricular discomfort. Case II: A 75-year-old Caucasian male presented with a chief complaints of a broken denture, joint discomfort and esthetic concern. The medical history revealed a history of angina pectoris, hypertension and depression. He continuously complained about his joint pain and broken prosthesis since 2011. Repairs were done several times but they did not eliminate his problem. In 2013, he was diagnosed with a loss of vertical dimension. When his vertical was reestablished at its proper position, his joint discomfort was resolved and his esthetics was greatly improved. Conclusion: Determination of the proper vertical dimension of occlusion is a crucial factor in the overall success of a restorative case. For correct diagnosis and treatment, the restorative dentist should use past dental history, facial profile, past photographs, provisional prosthesis and mounted diagnostic casts.
- «
- 1 (current)
- 2
- 3
- »