Faculty Bibliography

Sex hormones are associated with the onset and progression of periodontal disease. As levels of estrogen and progesterone elevate during puberty, menstruation, and pregnancy, so does the prevalence of gingivitis. Pharmacists with patients who are pregnant or planning to become pregnant should be counseled on proper oral home care and the importance of regular visits to a dentist or periodontist for a comprehensive periodontal exam. Also, it is important to try to identify periodontal risk factors and to offer treatment to help reduce the rate of premature births. Reduction of the inflammatory component may help decrease the risk of adverse pregnancies. New York is the first state to have guidelines for the oral health care of women of childbearing years. Specific advisory statements have been published assisting prenatal care providers and oral health professionals in the welfare of pregnant women. Pharmacists should counsel patients who take or will be taking bisphosphonates on the importance of receiving a dental examination prior to initiating bisphosphonate therapy. Patients should complete any nonelective dental procedures prior to starting therapy and have routine dental visits during bisphosphonate therapy

The concept of periodontal reevaluation of initial therapy needs to be revisited. From interviewing selective periodontists and reviewing the literature, it is apparent that the time period to perform a reevaluation is an ambiguous topic. This seems to be a dichotomy because today everything in dental medicine and medicine is evidence based. When reviewing selective literature sources, it was found that either a time period for reevaluation was given that was different in almost every publication, or a time period was not given but the subject of reevaluation was addressed. The objective of this commentary is to define reevaluation and to determine the best time interval after initial therapy to perform a reevaluation based on classic and current literature. Some questions that need to be addressed are the following: 1) Does too short of a time frame for reevaluation lead to the overtreatment of patients? 2) Is there a danger in reevaluating over too long of a time frame that will lead to disease progression and the return of pathogenic microbial flora? This would mean unnecessary periodontal breakdown could be occurring without appropriate further treatment. Many concerns need to be addressed, including when the appropriate time period is to measure the effects of initial therapy. After this time period, the stability of the periodontium should be evaluated rather than the effects of therapy

BACKGROUND: Several studies reported some success toward regeneration in infrabony defects using enamel matrix derivative (EMD). Clinically and statistically significant improvements in probing depth reduction, clinical attachment levels, and bone fill have been demonstrated. This multi-center study evaluated the potential for sensitization to EMD in a subgroup of periodontal patients treated at least twice with at least 2 months between treatments. METHODS: Three hundred seventy-six (376) patients in 11 university-based postgraduate periodontics programs and five private practices were selected. Surgeries were performed on infrabony defects. Following reflection of mucoperiosteal flaps and debridement of the root surface and defect, root conditioning (either citric acid pH = 1 or 24% EDTA) was performed and the site was irrigated with sterile saline. Enamel matrix derivative was reconstituted and applied to the exposed root surface and the bony defect. Flaps were sutured and pressure applied for 5 minutes. The second test defect was treated in a similar manner at least 8 weeks after the first surgery. The patient was given a diary card where any subjective adverse events (erythema, swelling, itching, headache, root hypersensitivity, or pain) were recorded at weeks 1 and 2 post-surgery. In addition, objective adverse events (gingival inflammation, ulcers, abscess, cratering, and lesions) were recorded by the investigator on an adverse event form. RESULTS: No clinical adverse reactions to multiple applications of EMD were noted. Of 376 patients, two were referred to a dermatologist for evaluation, but neither had signs indicating any adverse events due to EMD treatment. Instead their reactions were classified as a small local abscess and tinea cruris. The single immunoassay performed (on the patient with a small local abscess) did not demonstrate any EMD-reactive antibodies, neither IgE nor IgG. Other subjective/objective reactions that occurred during this study were of the type that are commonly experienced by patients immediately following periodontal surgery, but were not related to EMD. They included headache, swelling, itching, pain, and root hypersensitivity. CONCLUSIONS: This study demonstrated a lack of clinical adverse reactions following two separate applications of EMD. Any subjective/objective adverse reactions experienced by the patient were typical complications following routine periodontal surgery and were not directly related to the use of enamel matrix derivative

The body of knowledge that was the basis of the science and therapy of periodontics can be found in the literature of the 1950s and 60s. This information conveniently was presented in various textbooks. The evolution of research utilizing histochemistry and electron microscopy, along with disciplined clinical studies, has resulted in an exponential increase in information. A by-product of this worldwide effort is confusion resulting from the misuse and interchangeable application of terms disregarding the definitions originally accepted. Even with workshops designed in part to arrive at consensus to preclude confusion, the literature is replete with misleading use of nomenclature. The lack of attention to the appropriate use of terms is, at best, confusing to the student, researcher, and clinician. In the worst case, it may result in poor performance on examinations and improper evaluation of techniques and materials. Many periodontal terms are used inappropriately or are not completely understood, probably because these words have not been adequately described in the literature. Some of the more commonly used and confused terms will be discussed using literature to support the definitions