Faculty Bibliography

Oral cancers account for approximately 3 percent of all cases of cancer in the United States. An estimated 30,000 people will be diagnosed with oral cancer this year, and about one half of them will eventually die of the disease. The most common type of oral cancer is squamous cell carcinoma. Sixty percent of oral cancers are well advanced by the time they are detected, even though physicians and dentists frequently examine the oral cavity. The two most important risk factors for oral cancer are tobacco use and heavy alcohol consumption. The keys to reducing mortality are prevention and control. The earlier any intraoral or extraoral abnormalities or lesions are detected and biopsied, the more lives can be saved. Controversy exists whether screening programs effectively reduce the mortality rate. Specific step-by-step guidelines should be followed to perform an adequate examination of the head and neck

BACKGROUND: Previous studies have demonstrated that enamel matrix derivative (EMD) has the ability to improve clinical parameters when used to treat intraosseous defects. The purpose of the present study was to compare at 12 months postsurgery sites treated with open flap debridement (OFD) alone to those treated with OFD and EMD. METHODS: Twenty-three subjects with at least 2 intrabony defects were chosen. Fifty-three defects received EMD in conjunction with OFD. Thirty-one defects in these same 23 subjects were treated with OFD alone. Stents were fabricated to serve as fixed reference points. Re-entries were performed at least 1 year after initial surgery. Soft tissue measurements were recorded prior to initial surgery and prior to re-entry for gingival (GI) and plaque (PI) indices, probing depth (PD), gingival margin position, and clinical attachment level (CAL). Hard tissue measurements were recorded during the initial and re-entry surgery for level of crestal bone and depth of defect. Statistical analysis was conducted using the method of generalized estimating equations to determine changes in GI, PI, PD, CAL, fill of the osseous defect, and crestal resorption. Percent of defect fill was also calculated. RESULTS: In all categories, treatment with EMD (test) was superior to treatment without EMD (control). Average PI and GI were not significantly different either initially or prior to re-entry. The average PD reduction was 2.7 mm greater with EMD than controls. The average CAL gains were 1.5 mm greater, and the average fill of osseous defect 2.4 mm greater with EMD than controls. The average percent of defect fill after adjusting for crestal bone loss was more than 3 times greater for EMD versus control-treated sites (74% defect fill with EMD versus 23% defect fill for control sites). CONCLUSIONS: This study indicates that treatment of periodontal intraosseous defects with EMD is clinically superior to treatment without EMD (open flap debridement) in every parameter evaluated. Re-entry data demonstrate that percent fill of osseous defects treated with EMD compares favorably with the treatment results utilizing bone grafts or membrane barriers, according to published literature

The condition of delayed or altered passive eruption exists in adults when the gingival unit remains positioned on the convex prominence of the enamel rather than at or in proximity to the cementoenamel junction. Treatment protocol is based on periodontal, esthetic, and prosthetic considerations. In addition, the gingival/osseous relationship becomes important for proper diagnosis and treatment. The purpose of this article is to increase awareness of the pathognomonic signs and symptoms of delayed passive eruption so that appropriate treatment can be rendered

Animal models are needed to objectively evaluate the pathogenesis of human periodontal diseases and its various treatment modalities. Selection of the appropriate animal model depends on the similarity of the periodontium and the nature of the disease to that of humans. The more commonly used animal models for studying the pathogenesis of periodontal disease, use of implants and guided tissue regeneration have been dogs and nonhuman primates. Periodontal disease in rodents has not been found to be as closely related to the human varieties. Rats and hamsters are best suited for caries and calculus research. Ferrets may be a promising new model for studying periodontal disease and calculus formation. Variables unique to each animal species are manifested by a wide range of clinical and histopathological features. Different species have distinct diets, habits, life spans, tissue structures, host defense mechanisms and genetic traits. This article describes the diversity seen in animal models used to study microbiological, immunological, and clinical features of periodontal disease and its prevention and treatment

Diagnosing periodontal diseases involves determining the classification of the disease and the recognition of disease severity at the time of the clinical examination. Traditional diagnostic methods, such as radiographs and periodontal probing, have several limitations. Newer diagnostic techniques have been developed that could help determine whether specific sites are actively breaking down or if the site will experience future active disease. The newest technique is a genetic susceptibility test to identify patients who are at an increased risk for periodontal disease before problems develop. The screening of at-risk patients after initial therapy with these newly developed monitoring tests may lead to improved treatment and prevention of periodontal disease