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ORAL DIAGNOSIS/ORAL MEDICINE
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Diabetes in the dental office: using NHANES III to estimate the probability of undiagnosed disease
Borrell LN, Kunzel C, Lamster I, Lalla E. J Periodont Res 2007;42(6):559–565.[Medline]
In view of the marked increase in the incidence of type 2 diabetes in the United States and studies suggesting a two-way relationship between diabetes and periodontitis, the authors proposed that the dental office can serve as a venue for screening for undiagnosed diabetes. Accordingly, they conducted a study to develop a predictive tool by which dentists can determine the probability of a patient’s having undiagnosed disease using self-reported information obtained during a medical history and a clinical periodontal examination.
Using data from the Third National Health and Nutrition Examination Survey and appropriate statistical methods, the authors determined that 45-year-old people with self-reported hypertension and high cholesterol levels and a family history of diabetes, as well as clinically assessed periodontitis (at least two sites with clinical attachment loss of 6 millimeters or greater and at least one site with pocket depth of 5 mm or greater), have a probability of having undiagnosed diabetes ranging from 27 to 53 percent, depending on ethnicity. Mexican-American adults had the highest probabilities, followed by African-Americans and Caucasians. The probabilities increased with advancing age, irrespective of ethnicity. These findings suggest that patients who have a specific cluster of medical risk factors plus periodontitis are at greatest risk of having undiagnosed diabetes.
Significance.
The results of this study provide a tool by which the dentist can identify the patients most at risk of having undiagnosed diabetes and serve as a basis for referral to their primary care physician for blood glucose testing to establish a diagnosis.
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RESTORATIVE DENTISTRY
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Deep caries lesions after incomplete dentine caries removal: 40-month follow-up study
Maltz M, Oliveira EF, Fontanella V, Carminatti G. Caries Res 2007;41(6):493–496.[Medline]
The authors conducted this prospective study to determine whether complete removal of carious dentin is required for the treatment of deep carious lesions approaching the pulp. They studied 32 permanent posterior teeth at risk of experiencing pulp exposure in 27 patients, aged 12 to 23 years. Their treatment involved removing necrotic dentin, leaving a layer of soft dentin on the surface of the pulp, removing carious tissue from the surrounding cavity walls, covering the pulp chamber with calcium hydroxide cement, and sealing the cavity with zinc oxide–eugenol cement. Standardized bitewing radiographs were taken at the time of treatment and six to seven, 14 to 18, and 36 to 45 months later. At the six- to seven-month follow-up, the investigators assessed clinical symptoms and pulp sensitivity by using a cold stimulus, reopened the cavity for microbiological sampling, and restored the teeth over a calcium hydroxide cement base.
During the first six to seven months after treatment, 31 of the treated teeth were asymptomatic; during the remainder of the study, two patients required endodontic treatment after their restorations fractured. The authors followed the status of 24 patients for up to 45 months, and these patients all remained asymptomatic. Although some lesions decreased in depth, none increased, as determined by means of radiographic analysis. The authors conclude that partial removal of carious dentin and sealing of the cavity can be appropriate treatment for deep lesions in permanent teeth, as well as in primary teeth.
Significance.
The management of deep carious lesions is an issue of concern to practicing dentists. Although this small study provides some support for partial removal of carious dentin, a larger study comparing complete and partial removal of deep caries being conducted by the Practitioners Engaged in Applied Research and Learning Network,1 administered by the New York University College of Dentistry, New York City, should provide additional data to help clinicians select the most appropriate treatment method.
1 Practitioners Engaged in Research and Learning. PEARL studies: Current PEARL studies—Complete vs. partial removal of deep caries. "https://web.emmes.com/study/pearl/studies/studies.htm". Accessed Feb. 4, 2008.
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ORAL RADIOLOGY
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Diagnosing osteoporosis by using dental panoramic radiographs: the OSTEODENT project
Devlin H, Karayianni K, Mitsea A, et al. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2007;104(6):821–828.[Medline]
The authors conducted this multicenter study to determine criteria for identifying people most at risk of experiencing osteoporosis by using panoramic radiographs, with special reference to cortical thickness measurements and assessment of cortical porosity (mandibular cortical index [CI]). Six hundred fifty-three postmenopausal women, aged 45 to 70 years, received dual-energy X-ray absorptiometry scans of the left hip and lumbar spine to measure bone mineral density, as well as dental panoramic radiographs. Three experienced radiologists made independent measurements of the mandibular cortical width in the mental foramen region and determinations of the CI. The authors analyzed cortical widths and CI values by using a software program designed to identify variables with highest predictive value. They classified 141 (21.6 percent) of the women as having osteoporosis. The investigators found that mandibular cortical width was a better predictor of osteoporosis than was CI, and that there was no benefit to combining the two. Women with a mandibular cortical width of 3 millimeters or less had the greatest likelihood of having osteoporosis.
Significance.
A mandibular cortical width of 3 mm or less on panoramic radiographs can be used to identify patients with the highest probability of having osteoporosis and can serve as the basis for referral to their physicians for further investigation.
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ORAL/SYSTEMIC DISEASE CONNECTION
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The relationship between periodontitis and preterm low birthweight
Vettore MV, Leal M doC, Leao AT, da Silva AM, Lamarca GA, Sheiham A. J Dent Res 2008;87(1):73–78.[Abstract/Free Full Text]
The authors conducted this case-control study in Brazil to further investigate the much-discussed relationship between periodontal disease and preterm, low–birth weight babies. The "cases" consisted of 110 women with preterm births (less than 37 weeks’ gestation) and 96 with low–birth weight babies (less than 2,500 grams at birth), of which 63 were both preterm and low birth weight. Exclusion criteria included having chronic hypertension, fewer than 15 teeth, antibiotic use in the previous week, dentures, professional tooth cleaning in the previous six months, chronic diabetes, HIV infection and given birth to more than one child in the current delivery. The authors compared the cases with a control group of mothers who had babies with normal gestations and birth weights. The women in both groups were older than 30 years. The investigators obtained data from structured interviews, medical records and periodontal clinical examinations, including pocket depth and clinical attachment measurements at six sites per tooth for all teeth except third molars. The analysis included 13 different definitions of periodontal disease based on various combinations of pocket depths and attachment levels that had been used in previously published studies by other investigators, as well as two additional measures to assess periodontal inflammatory load.
The authors failed to find an association between periodontal disease and preterm, low–birth weight babies, irrespective of the periodontal disease definition tested. The case subjects had significantly lower body mass index than did the control subjects, and they were more likely to have smoked during pregnancy, had inadequate prenatal care, had previous preterm, low–birth weight babies and had gestational hypertension. The authors concluded that periodontal disease is not a risk factor for these adverse pregnancy outcomes.
Significance.
Studies conducted to investigate the relationship between periodontitis and adverse pregnancy outcomes have had contradictory results. It is likely that this is due to such factors as variations in study design, the nature of the subject populations, the ability to control for potential confounders and variability in definitions of periodontal disease. Although the authors of this study sought to successfully deal with methodological issues involved with case-control studies, the applicability of the study’s findings to all subject populations needs to be confirmed.
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ORAL DIAGNOSIS/ORAL MEDICINE
RESTORATIVE DENTISTRY
