Advances in all aspects of science and discovery continue to occur at an exponential rate, leading to a wealth of new knowledge and technologies that have the potential to transform dental practice. ...This “new science” within the areas of cell/ molecular biology, genetics, tissue engineering, nanotechnology, and informatics has been available for several years; however, the assimilation of this information into the dental curriculum has been slow. For the profession and the patients it serves to benefit fully from modern science, new knowledge and technologies must be incorporated into the mainstream of dental education. The continued evolution of the dental curriculum presents a major challenge to faculty, administrators, and external constituencies because of the high cost, overcrowded schedule, unique demands of clinical training, changing nature of teaching/assessment methods, and large scope of new material impacting all areas of the educational program. Additionally, there is a lack of personnel with adequate training/experience in both foundational and clinical sciences to support the effective application and/or integration of new science information into curriculum planning, implementation, and assessment processes. Nonetheless, the speed of this evolution must be increased if dentistry is to maintain its standing as a respected health care profession. The influence of new science on dental education and the dental curriculum is already evident in some dental schools. For example, the Marquette University School of Dentistry has developed a comprehensive model of curriculum revision that integrates foundational and clinical sciences and also provides a dedicated research/scholarly track and faculty development programming to support such a curriculum. Educational reforms at other dental schools are based on addition of new curricular elements and include innovative approaches that introduce concepts regarding new advances in science, evidence‐based foundations, and translational research. To illustrate these reforms, the Marquette curriculum and initiatives at the University of Connecticut and the University of Texas Health Science Center at San Antonio dental schools are described in this article, with recognition that other dental schools may also be developing strategies to infuse new science and evidence‐based critical appraisal skills into their students’ educational experiences. Discussion of the rationale, goals/objectives, and outcomes within the context of dissemination of these models should help other dental schools to design approaches for integrating this new material that are appropriate to their particular circumstances and mission. For the profession to advance, every dental school must play a role in establishing a culture that attaches value to research/discovery, evidence‐based practice, and the application of new knowledge/technologies to patient care.
For decades there has been an ongoing search for clinically acceptable methods for the accurate, non‐invasive diagnosis and prognosis of periodontitis. There are several well‐known inherent drawbacks ...with current clinical procedures. The purpose of this review is to summarize some of the newly emerging diagnostic approaches, namely, infrared spectroscopy, optical coherence tomography (OCT), and ultrasound. The history and attractive features of these new approaches are briefly illustrated, and the interesting and significant inventions related to dental applications are discussed. The particularly attractive aspects for the dental community are that some of these methods are totally non‐invasive, do not impose any discomforts to the patients during the procedure, and require no tissue to be extracted. For instance, multiple inflammatory indices withdrawn from near infrared spectra have the potential to identify early signs of inflammation leading to tissue breakdown. Morphologically, some other non‐invasive imaging modalities, such as OCT and ultrasound, could be employed to accurately measure probing depths and assess the status of periodontal attachment, the front‐line of disease progression. Given that these methods reflect a completely different assessment of periodontal inflammation, if clinically validated, these methods could either replace traditional clinical examinations for the diagnosis of periodontitis or at least serve as attractive complementary diagnostic tools. However, the potential of these techniques should be interpreted more cautiously given the multifactorial character of periodontal disease. In addition to these novel tools in the field of periodontal inflammatory diseases, other alternative modalities like microbiologic and genetic approaches are only briefly mentioned in this review because they have been thoroughly discussed in other comprehensive reviews.
Periodontitis has been traditionally regarded as a chronic inflammatory oral infection. However, recent studies indicate that this oral disease may have profound effects on systemic health. The ...search for cellular/molecular mechanisms linking periodontitis to changes in systemic health and systemic physiology has resulted in the evolution of a new area of lipid research establishing linkages between existing multidisciplinary biomedical literature, recent observations concerning the effects of serum lipids on immune cell phenotype/function, and a heightened interest in systemic responses to chronic localized infections. There appears to be more than a casual relationship between serum lipid levels and systemic health (particularly cardiovascular disease, diabetes, tissue repair capacity, and immune cell function), susceptibility to periodontitis, and serum levels of pro‐inflammatory cytokines. In terms of the potential relationship between periodontitis and systemic disease, it is possible that periodontitis‐induced changes in immune cell function cause metabolic dysregulation of lipid metabolism through mechanisms involving proinflammatory cytokines. Sustained elevations of serum lipids and/or pro‐inflammatory cytokines may have a serious negative impact on systemic health. The purpose of this paper is to present the background, supporting data, and hypotheses related to this concept. As active participants in this emerging and exciting area of investigation, we hope to stimulate interest and awareness among biomedical scientists and practitioners. J Periodontol 2000;71:1375‐1384.
There is increasing evidence that oral health is a critical component of overall health and that poor oral health may lead to initiation or exacerbation of chronic inflammatory diseases/conditions ...and adverse pregnancy outcomes. Added to this is an increasing awareness that among non‐dental health care professions curricula (e.g., medicine, nursing, pharmacy, and allied health) there is an apparent lack of information regarding the interrelationships between oral health and overall health or recognition of the significance of oral health in achieving and sustaining general health outcomes. This study explored the amount of information related to oral‐systemic science currently being taught in the predoctoral/undergraduate professional curricula of pharmacy, nursing, and medical schools in English‐speaking universities around the world. The Oral‐Systemic Health Educational Curriculum Survey was circulated online to associate or academic deans at medical, nursing, and pharmacy schools in universities across Canada, the United States, Europe, Asia, Australia, and New Zealand. The survey found that 53.7 percent of the respondents ranked the inclusion of oral‐systemic science as somewhat important, 51.2 percent reported no or limited requirements to incorporate oral health education within their curricula, and 59.6 percent rated their current curricula in oral‐systemic health as inadequate. The majority of students in these programs are not being instructed to examine the mouth, nor are they being taught how to perform an oral examination. Despite growing awareness of emerging evidence of oral‐systemic relationships and recommendations that all health care providers should contribute to enhancing oral health, this knowledge base appears to be substantially deficient in the curricula of pharmacy, nursing, and medical students in many universities. This study provides the first formal documentation that the curricula of non‐dental health care professions, specifically in medicine, nursing, and pharmacy, do not contain adequate content related to oral‐systemic health.
Background: Epidemiological studies suggest a relationship between periodontitis and coronary artery disease, but the mechanism has not been established. Recent studies in animals indicate that low ...dose endotoxin, as in a Gram‐negative infection, can induce hyperlipidemia and myeloid cell hyperactivity. The association between periodontitis, systemic exposure to Porphyromonas gingivalis, lipopolysaccharides (LPS), and hyperlipidemia has not been examined in humans.
Methods: Sera were obtained from 26 adult periodontitis patients and 25 healthy control (C) subjects selected from patients and staff. Serum antibodies against Porphyromonas gingivalis and its LPS were analyzed by enzyme‐linked immunosorbent assay (ELISA) and Western blotting, respectively. Serum triglycerides (TG) and cholesterol (CHOL) were assayed by a commercial laboratory. The associations between AP and blood levels of TG, CHOL, and anti‐P. gingivalis whole cells and LPS were examined by logistic regression analysis. Peripheral blood polymorphonuclear leukocytes (PMNs) from 6 healthy fasted donors were incubated with purified TG (0.1 mg/ml) for 2 hours at 37°C, stimulated with 100 ng/ml P. gingivalis LPS, and the release of IL‐1β measured by ELISA.
Results: The presence of periodontitis was significantly associated with age (odds ratio = 3.5, P = 0.04), elevated TG levels (odds ratio = 8.6, P = 0.0009), elevated CHOL levels (odds ratio = 7, P = 0.004), elevated ELISA titer (odds ratio = 35, P = 0.003) and reactivity with P. gingivalis LPS (odds ratio = 41, P = 0.001). PMNs from all 6 healthy patients released modest levels of IL‐1β (10 to 60 pg/ml) when stimulated with 100 ng/ml P. gingivalis LPS. Addition of TG resulted in a significant increase (P <0.05) in IL‐1β secreted that ranged from 7 to 150% over LPS alone. No IL‐1β was elicited by TG or vehicle alone.
Conclusions: The results of this study indicate the presence of a significant relationship between periodontitis, hyperlipidemia, and serum antibodies against P. gingivalis LPS that warrants further examination in a larger patient population. Furthermore, these studies indicate that elevated triglycerides are able to modulate IL‐1β production by PMNs stimulated with P. gingivalis LPS. J Periodontol 1999;70:1429‐1434.
To evaluate the effect of functional cyclic loading on two retrieved abutment screws used with single implant supporting cement-retained porcelain-fused-to-metal crowns by characterizing the ...structure, properties, and biotribologic behavior after long-term use in vivo.
Two abutment screws were retrieved from the same patient and same implant at two different times. An external hex implant was used to replace a missing central incisor. A traumatic incident occurred 9 months after insertion and displaced the implant palatally by bending the screw. A second, similar incident occurred 31 months after insertion. In both cases, the abutment screws were retrieved and subjected to thorough nondestructive and destructive testing.
Light and scanning electron microscopic examinations revealed very minimal surface deterioration of the thread profile for the first screw (in service for 9 months) and demonstrated advanced metal adhesive wear in the form of galling for the second screw (in service for 31 months). The galling led to moderate thinning of the thread profile. Both screws were composed of Au-based alloy, where the microstructure of the matrix consisted of homogeneous equiaxed fine grains with two different second phase particles.
It appears that the occurrence of adhesive wear on abutment screws in the form of galling is highly related to the length of in-service time in the mouth. This biotribologic behavior was inevitable and considered to be a normal consequence of long-term use in vivo. Metallurgic analysis indicated that both screws were identical in terms of composition and microstructure.
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