Try a new search

Format these results:

Searched for:

person:rgc1

Total Results:

83


Association among oral health parameters, periodontitis, and its treatment and mortality in patients undergoing hemodialysis

de Souza, Cleber M; Braosi, Ana Paula R; Luczyszyn, Sonia M; Olandoski, Marcia; Kotanko, Peter; Craig, Ronald G; Trevilatto, Paula C; Pecoits-Filho, Roberto
BACKGROUND: Chronic periodontitis (CP) is a continuous, reversible source of inflammation with a potential impact on mortality in patients undergoing hemodialysis (HD). This study investigates the impact of oral health indicators, CP, and its treatment on survival rates in a group of patients undergoing HD. METHODS: Clinically stable patients undergoing HD were referred for a dental examination. All patients were prospectively followed in the dialysis clinic, and all-cause mortality was recorded. Three groups of patients were analyzed: those who received CP treatment, those who did not, and patients without CP as a control group. RESULTS: A total of 122 patients (79 males and 43 females, aged 23 to 77 years; mean age: 50 years; range: 23 to 77 years) were enrolled. Forty percent reported having rarely been evaluated by a dentist, and 59% had CP. There were 34 fatal events during a mean follow-up time of 64.1 +/- 11.2 months. Oral factors associated with death in the univariate analysis were decreased frequency of dental visits; non-use of dental floss; increased decayed, missing, and filled teeth index; presence of CP; and absence of CP treatment. Patients with CP had a higher risk of death from all causes compared with patients without CP in the univariate analysis for untreated patients (hazard ratio 2.65 [95% confidence interval 1.06 to 6.59]; P = 0.036) and to a lesser extent for treated patients (2.36 [1.01 to 5.59]; P = 0.047). These significant differences were not maintained after adjustments for confounders in the multivariate model. CONCLUSIONS: These results suggest that poor oral health, including CP, is a common finding in patients undergoing HD. The results of this study call for intervention trials to test the hypothesis that treatment of CP improves survival in maintenance of patients undergoing HD.
PMID: 24224959
ISSN: 0022-3492
CID: 1067312

Effectiveness of a resin-modified glass ionomer liner in reducing hypersensitivity in posterior restorations: A study from the Practitioners Engaged in Applied Research and Learning Network

Strober, Brad; Veitz-Keenan, Analia; Barna, Julie Ann; Matthews, Abigail G; Vena, Donald; Craig, Ronald G; Curro, Frederick A; Thompson, Van P
BACKGROUND: The objectives of this randomized comparative effectiveness study conducted by members of the Practitioners Engaged in Applied Research and Learning (PEARL) Network were to determine whether using a resin-modified glass ionomer (RMGI) liner reduces postoperative hypersensitivity (POH) in dentin-bonded Class I and Class II resin-based composite (RBC) restorations, as well as to identify other factors (putative risk factors) associated with increased POH. METHODS: PEARL Network practitioner-investigators (P-Is) (n = 28) were trained to assess sensitivity determination, enamel and dentin caries activity rankings, evaluation for sleep bruxism, and materials and techniques used. The P-Is enrolled 341 participants who had hypersensitive posterior lesions. Participants were randomly assigned to receive an RBC restoration with or without an RMGI liner before P-Is applied a one-step, self-etching bonding agent. P-Is conducted sensitivity evaluations at baseline, at one and four weeks after treatment, and at all visits according to patient-reported outcomes. RESULTS: P-Is collected complete data regarding 347 restorations (339 participants) at baseline, with 341 (98 percent) (333 participants) recalled at four weeks. Treatment groups were balanced across baseline characteristics and measures. RBC restorations with or without an RMGI liner had the same one-week and four-week POH outcomes, as measured clinically (by means of cold or air stimulation) and according to patient-reported outcomes. CONCLUSIONS: Use of an RMGI liner did not reduce clinically measured or patient-reported POH in moderate-depth Class I and Class II restorations. Cold and air clinical stimulation findings were similar between groups. Practical Implications. The time, effort and expense involved in placing an RMGI liner in these moderate-depth RBC restorations may be unnecessary, as the representative liner used did not improve hypersensitivity outcomes.
PMCID:4264603
PMID: 23904575
ISSN: 0002-8177
CID: 509382

Periodontal diagnosis affected by variation in terminology

Martin, John A; Grill, Ashley C; Matthews, Abigail G; Vena, Don; Thompson, Van P; Craig, Ronald G; Curro, Frederick A
BACKGROUND: The randomized case presentation (RCP) study is designed to assess the degree of diagnostic accuracy for described periodontal cases. This is to lay the basis for practitioner calibration in the Practitioners Engaged in Applied Research and Learning (PEARL) Network for future clinical studies. METHODS: The RCP consisted of 10 case scenarios ranging from periodontal health to gingivitis and mild, moderate, and severe periodontitis. Respondents were asked to diagnose the described cases. Survey diagnoses were compared to two existing classifications of periodontal disease status. The RCP was administered via a proprietary electronic data capture system maintained by the PEARL Data Coordinating Center. Standard analytic techniques, including frequency counts and cross-tabulations, were used for categorical data with mean and standard deviation and median values reported for continuous data elements. RESULTS: Demonstrable variations in periodontal assessment for health, gingivitis, and mild, moderate, and severe periodontitis were found among the 130 PEARL general practitioners who participated in the RCP survey. The highest agreement for diagnosis among dentists was for severe periodontitis (88%) and the lowest for gingivitis (55%). The highest percentage of variation was found in cases with health and gingivitis. CONCLUSIONS: There was variation among PEARL practitioners in periodontal diagnosis that may affect treatment outcomes. Our findings add clinical support to recent publications suggesting a need for standardization of terminology in periodontitis diagnosis.
PMCID:4392916
PMID: 22702518
ISSN: 0022-3492
CID: 376972

Restoration Variables and Postoperative Hypersensitivity in Class I Restorations: PEARL Network Findings. Part 2

Blanchard, Peter; Wong, Ying; Matthews, Abigail; Vena, Donald; Craig, Ronald; Curro, Frederick; Thompson, Van
Background: This study investigated postoperative hypersensitivity at 1, 4, and 13 weeks following resin-based composite restoration of occlusal caries as well as the relationship to materials and technique employed by PEARL Network Practitioner Investigators (P-Is). Methods: PEARL P-Is (n = 45) enrolled patients with early occlusal caries lesions deemed to require treatment and placed restorations using their routine technique. Data on 485 restorations at 4 weeks included: baseline sensitivity; ranking of dentin caries activity; post-preparation use of antimicrobials, liners, and dentin bonding agent; type of resin-based composite (RBC) employed; whether layer or bulk fill was used; and patient demographics. Patients anonymously reported at 1, 4, and 13 weeks any sensitivity to hot, cold, sweets, clenching, and chewing as well as quality of life (QOL) related to the restoration(s). Results: Appreciable hypersensitivity (AH)-ie, sensitivity of 3 or greater on an 11-point anchored scale-was reported in 30% of all 668 eligible carious teeth at baseline. Among them, 10% of study teeth with no baseline AH had developed AH at 4 weeks post-treatment. With restoration, 63% of teeth with baseline AH no longer had AH, while the remainder had no improvement. Neither change in AH nor change in greatest sensitivity was associated with use of a liner, use of flowable or hybrid RBC, or bulk or layer technique. With use of an antimicrobial, at 1 week, there was a significant but transient effect on AH (P = 0.006), which was generally not present at 4 weeks, although it continued for one product. At 4 weeks, the change in greatest sensitivity was associated with the type of dentin bonding agent, total etch or self etch, (P = 0.004). Using similar materials and techniques, P-Is had widely differing patient-reported outcomes. Conclusion: Patient self-reported post-restoration AH-either acquired or remaining-at 4 weeks was generally not related to the materials or techniques recorded in these small- to moderate-sized occlusal restorations. However, the change in greatest sensitivity was associated with the type of dentin bonding agent used; but the clinical significance of this difference is questionable. Clinical Implications: The post-restoration levels of AH in early and moderate-sized posterior RBC restorations provide no justification for the use of a liner (CaOH, GI/RMGI, or flowable composite) as compared to the use of a dentin-bonding agent alone. Use of an antimicrobial had an effect on AH at 1 week that was generally transient.
PMCID:4392922
PMID: 23627487
ISSN: 1548-8578
CID: 316212

Risk factors for osteonecrosis of the jaws: a case-control study from the CONDOR Dental PBRN

Barasch, A; Cunha-Cruz, J; Curro, F A; Hujoel, P; Sung, A H; Vena, D; Voinea-Griffin, A E; Beadnell, Steven; Craig, Ronald G; DeRouen, Timothy; Desaranayake, Ananda; Gilbert, Ann; Gilbert, Gregg H; Goldberg, Ken; Hauley, Richard; Hashimoto, Mariko; Holmes, Jon; Latzke, Brooke; Leroux, Brian; Lindblad, Anne; Richman, Joshua; Safford, Monika; Ship, Jonathan; Thompson, Van P; Williams, O Dale; Wanrong, Yin
Case reports and cohort studies have linked bisphosphonate therapy and osteonecrosis of the jaws (ONJ), but neither causality nor specific risks for lesion development have been clearly established. We conducted a 1:3 case-control study with 3 dental practice-based research networks, using dentist questionnaires and patient interviews for collection of data on bisphosphonate therapy, demographics, co-morbidities, and dental and medical treatments. Multivariable logistic regression analyses tested associations between bisphosphonate use and other risk factors with ONJ. We enrolled 191 ONJ cases and 573 controls in 119 dental practices. Bisphosphonate use was strongly associated with ONJ (odds ratios [OR] 299.5 {95% CI 70.0-1282.7} for intravenous [IV] use and OR = 12.2 {4.3-35.0} for oral use). Risk markers included local suppuration (OR = 7.8 {1.8-34.1}), dental extraction (OR = 7.6 {2.4-24.7}), and radiation therapy (OR = 24.1 {4.9-118.4}). When cancer patients (n = 143) were excluded, bisphosphonate use (OR = 7.2 {2.1-24.7}), suppuration (OR = 11.9 {2.0-69.5}), and extractions (OR = 6.6 {1.6-26.6}) remained associated with ONJ. Higher risk of ONJ began within 2 years of bisphosphonate initiation and increased 4-fold after 2 years. Both IV and oral bisphosphonate use were strongly associated with ONJ. Duration of treatment >2 years; suppuration and dental extractions were independent risk factors for ONJ.
PMID: 23767159
ISSN: 0040-4284
CID: 399252

Postoperative Hypersensitivity and Its Relationship to Preparation Variables in Class I Resin-Based Composite Restorations: Findings from the Practitioners Engaged in Applied Research and Learning (PEARL) Network. Part 1

Berkowitz, Gary; Spielman, Howard; Matthews, Abigail; Vena, Donald; Craig, Ronald; Curro, Frederick; Thompson, Van
Background: This study investigated postoperative hypersensitivity at 1, 4, and 13 weeks following resin-based composite (RBC) restorations of occlusal caries and its relationship with prepreparation (baseline) sensitivity and preparation-related variables, including dentin caries activity, cavity dimension and volume, and lesion radiographic visibility. Methods: Investigators in a practice-based research network enrolled patients with occlusal caries deemed to require operative treatment. The 45 dental practitioners then placed restorations using their preferred techniques. Complete baseline data on 665 restorations from 602 patients included patient-reported sensitivity (pre-preparation); dentists' ranking of dentin caries on opening the enamel; measurements of preparation depth, width, and length; and patient demographics. At 1, 4, and 13 weeks post-treatment, patients anonymously reported any sensitivity to hot and cold stimuli, sweets, clenching, and chewing, as well as quality-of-life indicators related to the restorations. Results: At baseline, 30% of teeth had reported sensitivities of >/=3 on an anchored scale from 0 to 10 points and were designated as appreciable hypersensitivity (AH). Appreciable hypersensitivity at baseline was related to lesion radiographic visibility and patient age but not to dentin caries activity ranking, type of posterior tooth, gender, or race/ethnicity. Patients reported on 491 restorations at 4 weeks post-treatment-18% had AH. Of those who had AH, 39% (34 of 87) had no baseline AH. With restoration, 63% of teeth with baseline AH no longer had AH. Changes in AH were not associated with preparation depth, length, width, or volume. Conclusion: Patient-reported occlusal caries tooth sensitivity was high at baseline and eliminated by RBC restoration in 63% of cases; however, new sensitivity after restoration was reported in 10% of lesions that had none at pretreatment. Sensitivity was not related to preparation dimensions, volume, tooth type, or patient demographics (other than age) in these early lesions.
PMCID:4264581
PMID: 23631638
ISSN: 1548-8578
CID: 316232

Information-seeking behaviors of dental practitioners in three practice-based research networks

Botello-Harbaum, Maria T; Demko, Catherine A; Curro, Frederick A; Rindal, D Brad; Collie, Damon; Gilbert, Gregg H; Hilton, Thomas J; Craig, Ronald G; Wu, Juliann; Funkhouser, Ellen; Lehman, Maryann; McBride, Ruth; Thompson, Van; Lindblad, Anne
Research on the information-seeking behaviors of dental practitioners is scarce. Knowledge of dentists' informationseeking behaviors should advance the translational gap between clinical dental research and dental practice. A cross-sectional survey was conducted to examine the self-reported information-seeking behaviors of dentists in three dental practice-based research networks (PBRNs). A total of 950 dentists (65 percent response rate) completed the survey. Dental journals and continuing dental education (CDE) sources used and their influence on practice guidance were assessed. PBRN participation level and years since dental degree were measured. Full-participant dentists reported reading the Journal of the American Dental Association and General Dentistry more frequently than did their reference counterparts. Printed journals were preferred by most dentists. A lower proportion of full participants obtained their CDE credits at dental meetings compared to partial participants. Experienced dentists read other dental information sources more frequently than did less experienced dentists. Practitioners involved in a PBRN differed in their approaches to accessing information sources. Peer-reviewed sources were more frequently used by full participants and dentists with fifteen years of experience or more. Dental PBRNs potentially play a significant role in the dissemination of evidence-based information. This study found that specific educational sources might increase and disseminate knowledge among dentists.
PMCID:3832844
PMID: 23382524
ISSN: 0022-0337
CID: 240612

Dental Hygienists' Role in Practice Based Research: PEARL Network Evaluation

Grill, Ashley C; Johnson, Joanne; Collie, Damon; Thompson, Van P; Craig, Ronald G; Curro, Frederick A
PURPOSE: The goal of this paper is to evaluate the PEARL Network's satisfaction with training/support and assess the relationship between practice research coordinators (PRCs) involvement and study participation. METHODS: At the PEARL Network 2011 Annual Meeting, an evaluation form was completed by practitioner-investigators and PRCs who attended the annual meeting. Results from the paper evaluation form were entered into an Excel database, and analyzed using the statistical analysis software SPSS. The bivariate correlation test, Pearson Correlation, was conducted, and results were considered significant if p<0.05. RESULTS: During a program evaluation among 84 network respondents, a positive correlation (p=0.004) was found between the number of PRCs and the number of studies in which a site participates. In addition, there was a positive correlation between satisfaction with the training, support and involvement of PRCs in organizing study activities (p=0.008). There was also positive correlation between satisfaction with training/support and the number of PRCs utilized by the office (p=0.039). CONCLUSION: Practice research coordinators are key members of the research team, and they are important to conducting clinical studies in everyday practice.
PMID: 23433695
ISSN: 1043-254x
CID: 376992

Periodontal Diseases and Systemic Inflammation

Craig, Ronald G; Pernat, Andreja Marn; Pecoits-Filho, Roberto; Levin, Nathan W; Kotanko, Peter
PMID: 23043555
ISSN: 0894-0959
CID: 179285

Is Vitamin C Intake too Low in Dialysis Patients?

Raimann, Jochen G; Levin, Nathan W; Craig, Ronald G; Sirover, William; Kotanko, Peter; Handelman, Garry
Vitamin C has several well-established roles in physiology including synthesis of collagen, carnitine and epinephrine, absorption of dietary iron, and mobilization of storage iron for erythropoeisis. Loss of several of these functions explains the pathology of scurvy, where defective collagen synthesis and anemia are major symptoms. Vitamin C deficiency is very common in dialysis patients and may arise from dialytic vitamin C clearance, restricted intake of vitamin C-rich foods, and increased vitamin C catabolism in vivo from inflammation. In the dialysis population, greater vitamin C intake may be needed for optimal health. Relationships between intake, body distribution, inflammation, and dialytic losses are complex and need further study. Concern about vitamin C metabolism leading to accumulation of tissue oxalate has led to the recommendation that vitamin C intake equals, but not exceeds, the intake recommended for the general population. Vitamin C deficiency in dialysis patients may have clinical consequences; a study in Renal Research Institute clinics found an association with periodontal disease. Data also support a role for vitamin C in prevention of dialysis-related anemia. New research questions are proposed in this editorial, with a discussion of strategies to determine the optimal provision of vitamin C for CKD patients.
PMID: 23106569
ISSN: 0894-0959
CID: 180872