IUSD Research Day 2015

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    The Effects of Poor Dental Knowledge on Oral Health.
    (04/13/15) Ison, Kayla; Helwig, Melissa; Rettig, Pamela; Helwig, Melissa; Rettig, Pamela; Dental Hygiene
    Objective: 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.
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    Role of Peptidoglycan Recognition Proteins in Pathogenesis of Preeclampsia and Periodontitis.
    (04/13/15) Dukka, Himabindu; John, Vanchit; Blanchard, Steven; Reiter, Jill; Dukka, Himabindu; John, Vanchit; Periodontics
    Preeclampsia (PE) is a pregnancy related disease and is the leading cause of maternal and fetal morbidity and mortality. Altered immune-inflammatory responses at the placental level in response to infectious agents (eg: periodontal pathogens) have been proposed to be etiological for this pregnancy complication. A new class of Pattern Recognition Receptors called Peptidoglycan Recognition Proteins (PGRP) constituting 4 distinct molecules PGRP 1-4 is emerging as key player in modulating host responses to peptidoglycan and its breakdown products. A critical knowledge gap exists on the role of PGRPs in the innate immune responses that occur at the maternal-fetal interface in response to pathogens and their components that may be present in maternal circulation secondary to chronic infections. The aim of this pilot study is to investigate the expression PGRPs in the placenta of pre-eclamptic women. This case control study consisted of subjects with: (1) normal term pregnancies (n=20) (2) pre-eclampsia (n=20). A real time quantitative PCR was used to analyze the relative mRNA expression of TLR2, TLR4, NOD1, NOD2, PGRP1, PGRP2, PGRP3, and PGRP4. Immunohistochemistry was performed to determine the cell type(s) expressing the PGRP proteins in the placental tissue. Summary statistics (mean, standard deviation, range, 95% confidence interval for the mean) were calculated for PGRP 1-4 expression for each group. The PCR data showed the expression of PGRPs 1, 3 and 4 when compared with positive controls such as liver, brain, skin and T-cells. This study demonstrated the expression of PGRPs 1, 3 and 4 by the placental samples. There was an up-regulation of PGRP-1 (1.4 fold) and down regulation of PGRP-3 (1.3 fold) and PGRP-4 (1.6 fold). TLR2, TLR4 and NOD2 mRNA were elevated in placental samples. The results from this novel research could lead to development of salivary and/or plasmatic biomarkers for early detection of PE and warrants further investigation. (This project is supported by the Delta Dental Master Thesis Award, No: 141031)
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    Histomorphological Comparison of Platelet Rich Fibrin Combinations for Ridge Preservation.
    (04/13/15) Hamada, Yusuke; John, Vanchit; Blanchard, Steven; Hamada, Yusuke; Blanchard, Steven; Periodontics
    Background: 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.
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    Dental Hygienist's Role in Assessing Peri-Implantitis.
    (04/13/15) Creed, Courtney; Skinner, A; Blanchard, Jane; Creed, Courtney; Blanchard, Jane; Dental Hygiene
    The objective of this clinical case presentation is to discuss peri-implantitis due to its increasing prevalence in dental hygiene practice. Assessment: A 79 year old Caucasian female presented to the Dental Hygiene Clinic for periodontal maintenance and a dental exam. The medical history reveals a history of hypertension, atrial fibrillation, and the patient is taking Coumadin. The patient presented with generalized mild plaque-induced marginal and papillary gingivitis, however, the gingiva around the implant replacing #19 showed moderate gingival inflammation as evidenced by dark pink, bulbous, and spongy tissue with moderate bleeding on probing (BOP). The patient also presented with generalized chronic periodontitis as evidenced by 4-5mm clinical attachment level (CAL). Peri-implantitis was diagnosed on the implant with 6-9mm probing depths, 85% bone loss present on radiographs, and suppuration. DH Care Plan: Routine periodontal maintenance, oral hygiene instruction, and referral to the Graduate Periodontics Clinic for further evaluation of the implant. Follow up: The implant was diagnosed with a hopeless prognosis and scheduled for removal in the Graduate Periodontics Clinic. However, before the scheduled extraction, the patient reported that the implant had "fallen out" and it was not present at the 3 month periodontal maintenance appointment. Conclusion: Early recognition and intervention of peri-implant mucositis and peri-implantitis is crucial for the survival of the implant. Once peri-implantitis has reached an advanced stage, the prognosis of the implant is very poor and may require surgical treatment.
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    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 Hygiene
    Objective: 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.
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    Using Margin Elevation with Bonded Ceramics: A Case Report.
    (04/13/15) Rouse, Matt; Cook, N. Blaine; Rouse, Matt; Cook, N. Blaine; Aesthetic Dentistry
    Thirty 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.
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    Maintaining Oral Health with Parkinson’s disease and Arthritis.
    (04/13/15) Jones, Lindsey; Minett, C; Rettig, Pamela; Jones, Lindsey; Rettig, Pamela; Dental Hygiene
    Objective: 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 early
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    Impact of a Tobacco CE Program for Indiana Healthcare Providers.
    (04/13/15) Harvey, Savannah; Romito, Laura; Harvey, Savannah; Romito, Laura; Tobacco
    Purpose: 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)
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    Recognition and Treatment of Amlodipine (Norvasc) Induced Gingival Hyperplasia.
    (04/13/15) Silcox, Darci; Thompson, N; Rackley, R. Hunter; Silcox, Darci; Rettig, Pamela; Dental Hygiene
    Objective: The objective of this clinical case presentation is to help dental hygienist recognize and understand the treatment of gingival hyperplasia. Assessment: A 56 year old Caucasian male presented to the dental hygiene clinic with the chief complaint, “I want my teeth cleaned.” The patient’s last cleaning was in 2011 at Indiana University School of Dentistry (IUSD). The patient’s medical history revealed that he smokes one pack of cigarettes a day and has been taking the calcium channel blocker amlodipine for approximately two months for hypertension. The patient’s gum tissue presented clinically as pink, stippled, rolled, and bulbous with a hyperplastic appearance. The mandibular attached gingiva in particular, was firm and had an enlarged clinical appearance. Amlodipine is known to cause gingival hyperplasia. Drug-induced gingival hyperplasia was reclassified in 1999 by the APP as a dental plaque-induced gingival disease. Amlodipine is a commonly prescribed drug with the prevalence of gingival hyperplasia being reported as high as 33.3%. Gingival hyperplasia can manifest from mild to severe depending on modifying factors including the patient’s ability to remove plaque biofilm and the length of time the patient is on amlodipine. DH Care Plan: Treatment for this patient at the IUSD hygiene clinic includes scaling and root planing on the maxilla, with full mouth debridement, and a tissue re-evaluation 4-6 weeks after treatment. Each case of gingival hyperplasia should be treated based on the individual’s needs; this can include non-surgical therapy, surgical procedures, or a combination of both. Evaluation: Due to time constraints associated with this presentation, this patient has yet to be re-evaluated after treatment at IUSD. Conclusion: Hygienist must stress the importance of plaque control and spend quality time on oral hygiene instructions. If a patient is on a medication known to cause gingival hyperplasia it is important to note any changes at each visit.
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    Motivational Factors for the Non- Compliant Patient.
    (04/13/15) Miller, Nia; Ranis, D; Maxwell, Lisa; Miller, Nia; Maxwell, Lisa; Dental Hygiene
    Objective: 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.