Faculty Bibliography

Background: Chronic inflammation has been implicated in the pathogenesis of gestational diabetes mellitus (GDM). Periodontal disease is associated with increased levels of inflammatory mediators and may be a risk factor for GDM. The authors aimed to examine the association between periodontitis and GDM among non-smoking pregnant females. Methods: This case-control study included 50 females who were diagnosed with GDM and 50 age- and hospital-matched females without diabetes in Khon Kaen, Thailand. Full-mouth periodontal examinations were performed during pregnancy by two calibrated dentists who were unaware of the case-control status. Periodontitis was defined as >/=1 site with probing depth (PD) >/=5 mm and clinical attachment level (CAL) >/=2 mm at the same site. Serum samples were collected to measure C-reactive protein (CRP), tumor necrosis factor-alpha, and interleukin-6 levels. Analyses were performed using conditional logistic regression. Results: Fifty percent of the case females had periodontitis compared to 26% of the controls. Females with GDM had significantly higher mean PD and CAL, more sites with bleeding on probing, and increased levels of CRP compared to the controls. Periodontitis was significantly associated with GDM (odds ratio = 3.00, 95% confidence interval = 1.19 to 7.56). The association remained significant with additional adjustment for family history of diabetes, prepregnancy body mass index, and weight gain during pregnancy. Conclusions: The results suggest that periodontitis is associated with GDM. Therefore, clinicians should assess periodontal conditions of pregnant females.

ARTICLE TITLE AND BIBLIOGRAPHIC INFORMATION: Scaling and root planing treatment for periodontitis to reduce preterm birth and low birth weight: a systematic review and meta-analysis of randomized controlled trials. Kim AJ, Lo AJ, Pullin DA, Thornton-Johnson DS, Karimbux NY. J Periodontol 2012;83:1508-19. REVIEWER: Ananda P. Dasanayake, BDS, MPH, PhD, FACE PURPOSE/QUESTION: Authors perform an updated systematic review and meta-analysis of randomized controlled trials (RCTs) to evaluate the efficacy of scaling and root planning (SRP) in reducing preterm birth and low birth weight SOURCE OF FUNDING: None declared TYPE OF STUDY/DESIGN: Systematic review with meta-analysis of data LEVEL OF EVIDENCE: Level 2: Limited-quality, patient-oriented evidence STRENGTH OF RECOMMENDATION GRADE: Grade A: Consistent, good-quality patient-oriented evidence.

We examined whether colonization of selected oral pathogens is associated with gastric precancerous lesions in a cross-sectional study. A total of 119 participants were included, of which 37 were cases of chronic atrophic gastritis, intestinal metaplasia, or dysplasia. An oral examination was performed to measure periodontal indices. Plaque and saliva samples were tested with real-time quantitative PCR for DNA levels of pathogens related to periodontal disease (Porphyromonas gingivalis, Tannerella forsythensis, Treponema denticola, Actinobacillus actinomycetemcomitans) and dental caries (Streptococcus mutans and S. sobrinus). There were no consistent associations between DNA levels of selected bacterial species and gastric precancerous lesions, although an elevated but non-significant odds ratio (OR) for gastric precancerous lesions was observed in relation to increasing colonization of A. actinomycetemcomitans (OR = 1.36 for one standard deviation increase, 95% Confidence Interval = 0.87-2.12), P. gingivalis (OR = 1.12, 0.67-1.88) and T. denticola (OR = 1.34, 0.83-2.12) measured in plaque. To assess the influence of specific long-term infection, stratified analyses by levels of periodontal indices were conducted. A. actinomycetemcomitans was significantly associated with gastric precancerous lesions (OR = 2.51, 1.13-5.56) among those with >/= median of percent tooth sites with PD>/=3 mm, compared with no association among those below the median (OR = 0.86, 0.43-1.72). A significantly stronger relationship was observed between the cumulative bacterial burden score of periodontal disease-related pathogens and gastric precancerous lesions among those with higher versus lower levels of periodontal disease indices (p-values for interactions: 0.03-0.06). Among individuals with periodontal disease, high levels of colonization of periodontal pathogens are associated with an increased risk of gastric precancerous lesions.

BACKGROUND: /st> Ayurveda, an ancient medical science originating in India, also is practiced in the United States. The authors conducted a study primarily to explore the involvement of ayurvedic practitioners in treating oral diseases. METHODS: /st> Eighty-five practitioners participated in this cross-sectional survey. The authors obtained self-reported data on demographics of the practitioners, the general and oral health conditions they treated, and the treatment modalities used. They performed descriptive statistical and logistic regression analyses by using statistical software. RESULTS: /st> Participants predominantly were female and white or non-Hispanic, as well as part-time practitioners. Their educational backgrounds ranged from a 5½-year bachelor's degree in ayurveda to short-term training. Of the 60 respondents who answered the question about treating oral diseases, 25 (42 percent) reported that they did so. Conditions treated were related to oral malodor, gingival or periodontal disease and toothache. Ayurvedic treatments administered for these conditions primarily were preventive in nature. CONCLUSIONS: /st> Ayurvedic practitioners in the United States treat a variety of oral diseases by using predominantly preventive traditional care. Ayurvedic practitioners of Asian origin and those who practiced for a longer duration were more likely to report that they treated oral diseases. Larger, population-based studies are needed to understand more fully the current role of ayurvedic practitioners in oral health care. Ayurvedic treatment modalities aimed at oral diseases need to be evaluated through rigorous randomized controlled trials for safety and effectiveness. Practice Implications Patients with limited or no access to oral health care might seek ayurvedic treatment, and those who have access to conventional oral health care might wish to complement it with ayurvedic treatment. Practitioners can incorporate preventive ayurvedic treatments, which are based mainly on natural products, into overall preventive care regimens, if proven safe and effective.

ARTICLE TITLE AND BIBLIOGRAPHIC INFORMATION: A meta-analysis of randomized controlled trials shows no evidence that periodontal treatment during pregnancy prevents adverse pregnancy outcomes. Baccaglini L. J Am Dent Assoc 2011;142(10):1192-3. REVIEWER: Ananda P. Dasanayake, BDS, MPH, PhD, FACE PURPOSE/QUESTION: To determine whether scaling and root planning performed on pregnant women with mild to moderate periodontal disease is efficacious in reducing preterm birth, low birth weight, or other poor pregnancy outcomes SOURCE OF FUNDING: Information not available TYPE OF STUDY/DESIGN: Systematic review with meta-analysis LEVEL OF EVIDENCE: Level 1: Good-quality, patient-oriented evidence STRENGTH OF RECOMMENDATION GRADE: Grade A: Consistent, good-quality patient-oriented evidence.

In-office dental unit waterline (DUWL) testing systems are commercially available for monitoring DUWL bacteria. The current study compared Aquasafe, Petrifilm, and Heterotrophic Plate Count Sampler (HPCS) with R2A plating methodology, considered the gold standard for enumerating heterotrophic bacteria in potable water. Samples were collected from 20 dental units. Heterotrophic bacterial counts of