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Hobson RS, Crotty T, Thomason JM, Jepson NJA. A quantitative study of enamel acid etch patterns on surfaces used for retention of resin-bonded fixed prostheses. THE EUROPEAN JOURNAL OF PROSTHODONTICS AND RESTORATIVE DENTISTRY 2005; 13:123-8. [PMID: 16180638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
This study investigated the quality of in vivo etch patterns on the bonding surfaces of 46 abutment teeth following acid etching with 37% phosphoric acid for 30 seconds. Two-stage putty and light bodied addition cured silicone impressions of the etched lingual surfaces were used to form replicas that were then viewed using the scanning electron microscope. Over 69% of the lingual bonding surface area of incisors, canine and premolars were unetched, 16% barely etched, 7% etched and less than 2% ideally etched. There was no significant difference in the quality of etch between different tooth types. There was a significantly greater proportion of poorly etched enamel towards the cervical margin in comparison with the occlusal half. This may have implications in retention of resin bonded bridges.
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Abstract
Since the development of the ruby laser by Maiman in 1960, lasers have been widely employed in medicine for a number of years. The purpose of this paper is to summarize potential applications for lasers in dentistry, with special regard to periodontology. This article briefly describes clinical applications of lasers and laser safety. Particularly, the use of a diode laser seems to be promising, especially in already compromised transplant patients, who need to be treated with a technique where the operative and post-operative blood loss, post-operative discomfort and the recurrence of drug-induced gingival overgrowth need to be kept to a minimum or eliminated. Therefore, the use of lasers in periodontology may lead to an alteration in present clinical practice and help to establish the best management strategy because, by maintaining periodontal health, the life quality of patients can be improved.
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Ellis JS, Morgan CL, Kirby JA, Taylor JJ, Thomason JM. Plasma TGF-beta1 as a risk factor for gingival overgrowth. J Clin Periodontol 2004; 31:863-8. [PMID: 15367190 DOI: 10.1111/j.1600-051x.2004.00572.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
BACKGROUND AND AIMS Induction of the pro-fibrotic growth factor TGF-beta1 has been suggested as a possible mechanism through which immunosuppressant drugs may induce gingival overgrowth. This study aims to investigate plasma levels of TGF-beta1 and relate them to the development and severity of gingival overgrowth in immunosuppressed transplant patients. MATERIALS AND METHODS One hundred and thirty-two ciclosporin-treated and 13 tacrolimus-treated transplant patients and 24 drug-free control subjects underwent a full periodontal examination including a determination of the presence and severity of gingival overgrowth. RESULTS Plasma TGF-beta1 concentrations were determined by ELISA, and were found to be significantly elevated in samples from the transplant patients (mean=29.1 ng/ml) as compared with controls (mean=6.1 ng/ml, p<0.0001). There was no significant difference between the levels of plasma TGF-beta1 in the ciclosporin- and tacrolimus-treated patient groups. CONCLUSIONS Furthermore, concomitant treatment with calcium channel blockers did not influence the levels of plasma TGF-beta1 in the patients group. The relationship between gingival overgrowth, independent periodontal variables and TGF-beta1 plasma concentrations was examined using univariate and multivariate regression analyses; low TGF-beta1 plasma concentrations were found to be a risk factor for gingival overgrowth in immunosuppressed patients concomitantly receiving a calcium channel blocker.
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Rolland SL, Seymour RA, Wilkins BS, Parry G, Thomason JM. Post-transplant lymphoproliferative disorders presenting as gingival overgrowth in patients immunosuppressed with ciclosporin. A report of two cases. J Clin Periodontol 2004; 31:581-5. [PMID: 15191596 DOI: 10.1111/j.1600-051x.2004.00537.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Post-transplant lymphoproliferative disorder (PTLD) can occur in patients maintained on immunosuppressive therapy following transplantation. This paper describes two cases of PTLD occurring in gingival tissues, in patients receiving ciclosporin following cardiac transplantation. TREATMENT The lesions were localised to gingival tissues, mimicking ciclosporin-induced gingival overgrowth. They were removed surgically and the ciclosporin dose reduced to help prevent recurrence. CONCLUSION The importance of histopathological examination of all tissue removed during routine gingivectomy procedures for ciclosporin-induced gingival overgrowth is highlighted.
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Ruhl S, Hamberger S, Betz R, Sukkar T, Schmalz G, Seymour RA, Hiller KA, Thomason JM. Salivary proteins and cytokines in drug-induced gingival overgrowth. J Dent Res 2004; 83:322-6. [PMID: 15044507 DOI: 10.1177/154405910408300410] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Little is known about the involvement of saliva in gingival overgrowth (GO). It was hypothesized that, in this situation, the composition of saliva is altered. Thus, proteins, albumin, cytokines, and growth factors in whole and glandular saliva were investigated. Differences between glandular and gingival contributions to the composition of saliva were explored in patients medicated with cyclosporin who exhibited GO (responders), those without GO (non-responders), and non-medicated subjects (controls). In whole saliva, interleukin-1alpha (IL-1alpha), IL-6, IL-8, epidermal growth factor (EGF), nerve growth factor (NGF), and albumin were detected, but in glandular saliva only EGF and NGF were identified. Albumin and IL-6 differed significantly between responders and controls, although the overall profile of salivary proteins remained unchanged. Thus, inflammatory cytokines and albumin are confined to whole saliva and are associated with GO, whereas its content of EGF and NGF appears unaffected by cyclosporin.
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Ellis JS, Seymour RA, Taylor JJ, Thomason JM. Prevalence of gingival overgrowth in transplant patients immunosuppressed with tacrolimus. J Clin Periodontol 2004; 31:126-31. [PMID: 15016038 DOI: 10.1111/j.0303-6979.2004.00459.x] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
AIMS The study aims to determine the prevalence and severity of gingival overgrowth in a group of adult organ transplant recipients immunosuppressed with tacrolimus in comparison with ciclosporin, and to examine various risk factors for the development of gingival overgrowth. METHODS Forty patients taking tacrolimus were compared with 197 ciclosporin patients. Demographic, pharmacological and periodontal data were recorded for all patients. Comparison between the groups was made using independent sample t-tests, chi2 statistic or Mann-Whitney test. The effects of risk variables on overgrowth severity were examined using forward and backward stepwise regression analysis. RESULTS Those taking tacrolimus had a significantly lower mean gingival overgrowth score (14.1%) compared with ciclosporin (22.4%). Fifteen percent of the tacrolimus group had clinically significant gingival overgrowth compared with 30% in the ciclosporin group (p=0.053). CONCLUSIONS The prevalence and severity of gingival overgrowth is less in adult transplant patients taking tacrolimus compared with ciclosporin. Concomitant use of calcium channel blockers and previous medication with ciclosporin are significant risk factors for the presence and severity of gingival overgrowth. Patients who have alteration of their immunosuppressant from ciclosporin to tacrolimus may persist in demonstrating gingival overgrowth attributable to their ongoing therapy with calcium channel blockers.
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Welbury RR, Thomason JM, Fitzgerald JL, Steen IN, Marshall NJ, Foster HE. Increased prevalence of dental caries and poor oral hygiene in juvenile idiopathic arthritis. Rheumatology (Oxford) 2003; 42:1445-51. [PMID: 12810923 DOI: 10.1093/rheumatology/keg395] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Recent decades have seen a trend to treat juvenile idiopathic arthritis (JIA) with increasing immunosuppression to improve the long-term outcome. Poor oral hygiene and dental decay cause significant morbidity, and patients with chronic disease (who may be further immunocompromised by treatment) are at greater risk. This study investigated patients with JIA using standard measures of oral health. METHODS One hundred and forty-nine patients with JIA were included. The children were attending a regional paediatric rheumatology service and the adults were attending an adult rheumatology clinic. Random age- and sex-matched healthy controls were recruited from a dental teaching hospital. The structured dental examination included standard epidemiological indices of oral hygiene (gingival index, plaque index, oral cleanliness index) and dental decay [DMFT (decayed, missing or filled teeth) index]. RESULTS JIA patients, at all ages, had increased levels of dental decay and poor oral hygiene. This increased level of decay was statistically significant in the patients aged 0-11 yr. Significant levels of untreated caries and increased levels of missing teeth were found in JIA, suggesting that patients with JIA had less restorative dental treatment, with tooth extraction often the chosen option for the treatment of dental decay. CONCLUSIONS This is the largest study of oral health in JIA and is cross-sectional with non-diseased controls. It shows significantly increased levels of poor oral hygiene and dental decay in patients with JIA. The high levels of untreated dental decay suggest barriers to dental care. These results emphasize the role of regular dental care in the multidisciplinary management of JIA.
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Seymour RA, Preshaw PM, Thomason JM, Ellis JS, Steele JG. Cardiovascular diseases and periodontology. J Clin Periodontol 2003; 30:279-92. [PMID: 12694425 DOI: 10.1034/j.1600-051x.2003.00291.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Cardiovascular diseases represent a widespread heterogeneous group of conditions that have significant morbidity and mortality. The various diseases and their treatments can have an impact upon the periodontium and the delivery of periodontal care. AIM In this paper we consider three main topics and explore their relationship to the periodontist and the provision of periodontal treatment. METHOD The areas reviewed include the effect of cardiovascular drugs on the periodontium and management of patients with periodontal diseases; the risk of infective endocarditis arising from periodontal procedures; the inter-relationship between periodontal disease and coronary artery disease. RESULTS AND CONCLUSIONS Calcium-channel blockers and beta-adrenoceptor blockers cause gingival overgrowth and tooth demineralisation, respectively. Evidence suggests that stopping anticoagulant therapy prior to periodontal procedures is putting patients at a greater risk of thromboembolic disorders compared to the risk of prolonged bleeding. The relationship between dentistry and infective endocarditis remains a controversial issue. It would appear that spontaneous bacteraemia arising from a patient's oral hygiene practices is more likely to be the cause of endocarditis than one-off periodontal procedures. The efficacy of antibiotic prophylaxis is uncertain (and unlikely to be proven), and the risk of death from penicillin appears to be greater than the risk of death arising from infective endocarditis. Finally, the association between periodontal disease and coronary artery disease has been explored and there seem to be many issues with respect to data handling interpretation. Many putative mechanisms have been suggested; however, these only further highlight the need for intervention studies.
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Welbury RR, Thomason JM, Fitzgerald JL, Steen IN, Foster HE. Type and extent of enamel defects in juvenile idiopathic arthritis (JIA). EUROPEAN JOURNAL OF PAEDIATRIC DENTISTRY 2002; 3:217-21. [PMID: 12870996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 03/03/2023]
Abstract
AIM To establish whether there is an increased prevalence and extent of enamel defects associated with Juvenile Idiopathic Arthritis (JIA) in patients in the North of England. STUDY DESIGN clinical examination of subjects and age and sex matched controls. METHODS The labial surfaces of all erupted permanent teeth in subjects, as well as age and sex matched controls, were examined. They were classified for type and extent of defects according to the Modified DDE index. The records of 146 subjects and 142 controls were available for analysis. STATISTICS defects were expressed as the percentage of subjects or controls with or without any defects or specific types of defect. Fisher's exact test was used to compare the prevalence of disease in the two groups with significance being accepted at the 5% level. In addition, 95% confidence intervals for the relative risk of disease in the two groups were derived. RESULTS There was no significant difference between subjects and controls for the presence of any type of defect (p=0.48), demarcated opacities (p=0.39), diffuse opacities (p=0.71), or hypoplasias (p=0.19). There was no significant increase in severity of defects in subjects compared with controls. There was also no significant difference when comparing the group diagnosed before the age of 4 (0-3) and the group diagnosed after the age of 4 (>4) years. CONCLUSION There was no greater overall prevalence of enamel defects or specific type of defects and no greater extent of them in subjects with JIA compared with age and sex matched controls.
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Abstract
OBJECTIVES To investigate whether there are any differences in salivary flow rates and saliva composition that may contribute to the reported increase in caries prevalence in patients with juvenile idiopathic arthritis (JIA). DESIGN Randomized controlled trial. SETTING The sialochemistry of children with JIA has rarely been investigated. METHODS Unstimulated and stimulated whole saliva was collected from 17 randomly selected JIA patients and 17 age and sex matched controls. Both samples were analysed for salivary flow rate, pH, calcium and phosphate. RESULTS Unstimulated and stimulated JIA saliva flow rates, and the flow rate change from unstimulated to stimulated in JIA saliva were all significantly lower than the controls. There were no significant differences in the pH of unstimulated and stimulated JIA saliva compared with the controls, however, the change in pH (from unstimulated to stimulated) in the study group was significantly greater. The JIA patients had non-significantly lower levels of both calcium and phosphate ions in the unstimulated and stimulated samples. CONCLUSIONS This data would suggest that there is both a reduced resting salivary flow and a reduced response to stimulation in JIA patients, which may contribute to a previously reported higher caries prevalence.
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Feine JS, Carlsson GE, Awad MA, Chehade A, Duncan WJ, Gizani S, Head T, Lund JP, MacEntee M, Mericske-Stern R, Mojon P, Morais J, Naert I, Payne AGT, Penrod J, Stoker GT, Tawse-Smith A, Taylor TD, Thomason JM, Thomson WM, Wismeijer D. The McGill Consensus Statement on Overdentures. Montreal, Quebec, Canada. May 24-25, 2002. INT J PROSTHODONT 2002; 15:413-4. [PMID: 12170858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
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Feine JS, Carlsson GE, Awad MA, Chehade A, Duncan WJ, Gizani S, Head T, Lund JP, MacEntee M, Mericske-Stern R, Mojon P, Morais J, Naert I, Payne AGT, Penrod J, Stoker GT, Tawse-Smith A, Taylor TD, Thomason JM, Thomson WM, Wismeijer D. The McGill consensus statement on overdentures. Mandibular two-implant overdentures as first choice standard of care for edentulous patients. Montreal, Quebec, May 24-25, 2002. Int J Oral Maxillofac Implants 2002; 17:601-2. [PMID: 12182304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/26/2023] Open
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Feine JS, Carlsson GE, Awad MA, Chehade A, Duncan WJ, Gizani S, Head T, Heydecke G, Lund JP, MacEntee M, Mericske-Stern R, Mojon P, Morais JA, Naert I, Payne AGT, Penrod J, Stoker GT, Tawse-Smith A, Taylor TD, Thomason JM, Thomson WM, Wismeijer D. The McGill consensus statement on overdentures. Mandibular two-implant overdentures as first choice standard of care for edentulous patients. Gerodontology 2002; 19:3-4. [PMID: 12164236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
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Meechan JG, Parry G, Rattray DT, Thomason JM. Effects of dental local anaesthetics in cardiac transplant recipients. Br Dent J 2002; 192:161-3. [PMID: 11863154 DOI: 10.1038/sj.bdj.4801323] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To investigate the cardiovascular responses of cardiac transplant recipients to dental local anaesthetic solutions with and without epinephrine (adrenaline). MATERIALS AND METHODS A clinical study employing 30 patients (20 cardiac transplant recipients and ten healthy) awaiting gingival or minor oral surgery under local anaesthesia receiving either 4.4 ml lidocaine (lignocaine) with 1:80,000 epinephrine or 4.4 ml 3% prilocaine with 0.031 U/ml felypressin. RESULTS Cardiac transplant patients experienced a significant tachycardia 10 minutes after injection of the epinephrine-containing solution. No significant change in heart rate was detected after the injection of an epinephrine-free solution. Blood pressure was not affected. Periodontal surgery did not affect the responses to the local anaesthetics in the transplant recipients. CONCLUSIONS The cardiovascular response to dental local anaesthesia in cardiac transplant recipients is governed by the solution injected.
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Jepson NJ, Moynihan PJ, Kelly PJ, Watson GW, Thomason JM. Caries incidence following restoration of shortened lower dental arches in a randomized controlled trial. Br Dent J 2001; 191:140-4. [PMID: 11523885 DOI: 10.1038/sj.bdj.4801122] [Citation(s) in RCA: 67] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
CONTEXT Removable partial dentures used to restore the shortened lower dental arch may adversely affect the remaining natural teeth and are associated with a low prevalence of use. OBJECTIVE To report the findings for caries incidence 2 years after restoration of lower shortened arches with bilateral cantilever resin-bonded bridges (RBBs) and conventional partial dentures (RPDs). DESIGN Randomised controlled trial. SETTING Secondary care PATIENTS 25 male and 35 female subjects of median age 67 years. were randomly allocated to 'bridge' and 'denture' treatment groups of 30 patients each matched for age and sex. Caries incidence was recorded during dental examinations 3 months, 1 and 2 years after insertion of new lower prostheses. INTERVENTIONS Cantilever RBBs and conventional RPDs with cast metal frameworks. RESULTS There was a highly significant difference in the frequency of new caries lesions, 11 and 51 in the bridge and denture groups respectively (P < 0.01). 20 out of 27 bridge patients and 9 of 23 denture patients had no caries experience. Multivariate modeling identified treatment group as the only significant predictor of caries occurrence. CONCLUSIONS Two years after restoration of lower shortened arches for an elderly sample of patients, there was a significantly greater incidence of new and recurrent caries lesions in subjects restored with RPDs compared with cantilever RBBs.
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Ellis JS, Seymour RA, Robertson P, Butler TJ, Thomason JM. Photographic scoring of gingival overgrowth. J Clin Periodontol 2001; 28:81-5. [PMID: 11142671 DOI: 10.1034/j.1600-051x.2001.280112.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND A wide range of methods have been employed to determine the severity of gingival overgrowth resulting in uncertainty regarding the prevalence of the side-effect. There is no simple, non-invasive, objective, blind method for assessing gingival overgrowth. AIM This article aims to describe a method which is suitable for use in large-scale population studies. MATERIALS AND METHODS Photographs were taken of the anterior, buccal gingivae and teeth of 925 patients medicated with calcium channel blockers. In addition, each patient was ascribed a clinical gingival overgrowth score. 100 patients had repeat photographs, and a further 10 patients had alginate impressions taken. The models were scored for severity of gingival overgrowth using a described technique. The slides were scored using a modification of this technique. RESULTS When photographic and study model scores were compared, photographic scores were consistently higher, and as a result, a photographic score of 38.6% was considered to represent a significant overgrowth. There was good agreement between clinically determined scores and photographic scores (kappa=0.71). CONCLUSIONS The results indicate that this method is suitable for large-scale population studies where it also has the advantage of providing a continuous scale of gingival changes for subsequent statistical analysis.
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Moynihan PJ, Butler TJ, Thomason JM, Jepson NJ. Nutrient intake in partially dentate patients: the effect of prosthetic rehabilitation. J Dent 2000; 28:557-63. [PMID: 11082523 DOI: 10.1016/s0300-5712(00)00044-0] [Citation(s) in RCA: 65] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
OBJECTIVES The objectives of this study were to investigate the impact of prosthetic rehabilitation of the shortened dental arch on the intake of nutrients, non-starch polysaccharide (NSP) fruits and vegetables (dietary fibre), and to compare dietary intakes between patients receiving bilateral resin-bonded bridges with patients receiving conventional partial dentures. METHODS As part of an ongoing randomised clinical trial to compare the effectiveness of bilateral resin bonded bridges with conventional partial dentures, the diets of 40 partially dentate patients were assessed prior to and at 3 and 12 months following treatment with bilateral resin-bonded bridge-work or a lower partial denture. RESULTS At baseline, three months post treatment and one year post treatment there were no significant differences in the intake of nutrients between groups. A significant increase in the percentage of energy from fat was observed in the patients fitted with a lower partial denture. Apart from this, prosthetic rehabilitation did not result in any other change in the intake of nutrients or in the amount of fruits and vegetables consumed. Levels of intake of NSP, fruits and vegetables were low in both groups of patients on all occasions measured. CONCLUSIONS Prosthetic rehabilitation of the severely shortened dental arch does not result in dietary improvements. Dietary advice that takes into account all the factors that influence food choice (such as taste, cost and cooking skills) needs to be considered in this at risk group.
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Walton AG, Welbury RR, Thomason JM, Foster HE. Oral health and juvenile idiopathic arthritis: a review. Rheumatology (Oxford) 2000; 39:550-5. [PMID: 10852988 DOI: 10.1093/rheumatology/39.5.550] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Juvenile idiopathic arthritis (JIA) results in significant morbidity that includes an adverse impact on oral health that is generally not well recognized. This review describes current literature which demonstrates poor oral health in children with JIA. The impact of JIA on oral health is probably multifactorial and these factors are discussed. This review emphasizes the role of paediatric dentistry in the multidisciplinary management of JIA and highlights the need for further research.
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Abstract
BACKGROUND/AIMS Drug-induced gingival overgrowth remains a significant problem for the periodontologist. Many patients medicated with the drugs implicated in this unwanted effect experience significant, recurrent gingival problems that require repeated surgical excisions. In this review, we attempt to identify and quantify the various "risk factors" associated with both the development and expression of the drug-induced gingival changes. METHOD The risk factors appraised include age, sex, drug variables, concomitant medication, periodontal variables and genetic factors. Elucidation of such factors may help to identify "at risk patients" and then develop appropriate treatment strategies. RESULTS Of the factors identified, the only one that can be affected by the periodontologist is the patents' periodontal condition. However, drug variables and concomitant medication do impact upon the expression of gingival overgrowth. CONCLUSION The identification of risk factors associated with both the prevalence and severity of drug-induced gingival overgrowth is important for all parties involved with this unwanted effect. Both periodontologist and patient have an important rôle to play in improving oral hygiene and gingival health. Likewise, there is always an opportunity to establish a close liaison between the patient's physician and the periodontologist to try and identify alternative drug regimens that can help reduce the impact of this unwanted effect.
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Thomason JM, Girdler NM, Kendall-Taylor P, Wastell H, Weddel A, Seymour RA. An investigation into the need for supplementary steroids in organ transplant patients undergoing gingival surgery. A double-blind, split-mouth, cross-over study. J Clin Periodontol 1999; 26:577-82. [PMID: 10487307 DOI: 10.1034/j.1600-051x.1999.260903.x] [Citation(s) in RCA: 66] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Organ transplant patients are frequently medicated with triple immunosuppressive therapy that includes both cyclosporin and the corticosteroid, prednisolone. Many of these patients experience gingival overgrowth that necessitates surgical intervention. Chronic dosing with corticosteroids can lead to suppression of the hypothalamic-pituitary axis, and subsequent adrenocortical suppression. To circumvent possible suppression, supplementary steroids are administered to such patients prior to so-called "stressful events". We have examined the need for supplementary steroids in 20 organ transplant patients undergoing gingival surgery under local anaesthesia to correct their drug-induced gingival overgrowth. All patients were operated upon in the first half of the morning. Prior to gingival surgery, resting blood pressure (BP) and serum ACTH concentrations were determined. Immediately before surgery patients received either intravenous hydrocortisone 100 mg or placebo in random, double-blind order. Each patient required 2 gingivectomies and thus acted as their own placebo control. BP was measured at various time points throughout surgery and upto 2 h postoperatively. On completion of surgery, a further blood sample was taken to determine ACTH concentration. There was no significant difference (p>0.05) between placebo and hydrocortisone treatments for BP and ACTH measurements. No patient experienced any symptoms that were suggestive of adrenocortical suppression. One patient did experience postural hypotension prior to gingival surgery, but this is attributed to his antidepressant medication. We can conclude from this study that immunosuppressed organ transplant patients taking the maintenance dose of prednisolone (5-10 mg/day) do not require corticosteroid cover prior to gingival surgery under local anaesthesia. We would however, advocate monitoring of their blood pressure throughout the procedure.
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Meechan JG, Thomason JM. A comparison of 2 topical anesthetics on the discomfort of intraligamentary injections: a double-blind, split-mouth volunteer clinical trial. ORAL SURGERY, ORAL MEDICINE, ORAL PATHOLOGY, ORAL RADIOLOGY, AND ENDODONTICS 1999; 87:362-5. [PMID: 10102601 DOI: 10.1016/s1079-2104(99)70224-6] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The purpose of this volunteer clinical trial was to compare the effects of 5% lidocaine ointment and EMLA cream on the discomfort associated with intraligamentary injections. STUDY DESIGN A double-blind, split mouth study was conducted. Each of 10 healthy volunteers had 5% lidocaine and EMLA cream applied to the maxillary premolar buccal gingiva for 5 minutes before the administration of an intraligamentary injection. Discomfort during the injection was assessed through use of a visual analog scale. Data were analyzed by means of Student paired and unpaired t tests. RESULTS Injection discomfort on the side on which EMLA cream was applied was significantly less than on the lidocaine side (t = 2.32, P < .05). CONCLUSIONS EMLA cream reduced the discomfort associated with intraligamentary injections.
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Abstract
A review of the literature relating to juvenile chronic arthritis (JCA) is presented. It includes a description of the disease itself and identifies our knowledge of the increased risk of dental disease associated with this condition. In addition the impact of JCA therapy on the dental management of the patient is discussed. The review highlights the need for further research into the effects of the disease on dental caries, periodontal disease and saliva.
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Ellis JS, Seymour RA, Steele JG, Robertson P, Butler TJ, Thomason JM. Prevalence of gingival overgrowth induced by calcium channel blockers: a community-based study. J Periodontol 1999; 70:63-7. [PMID: 10052772 DOI: 10.1902/jop.1999.70.1.63] [Citation(s) in RCA: 167] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND The prevalence of gingival overgrowth induced by chronic medication with calcium channel blockers is uncertain. Although there have been several studies examining this question, the results are conflicting, with previous estimates ranging from 20% to 83%. There have been only 2 studies examining the prevalence of overgrowth induced by diltiazem and amlodipine, with estimates of 74% and 3.3%, respectively. METHODS The current study aimed to address the problems associated with these studies by examining a sample of patients taking one of 3 calcium channel blockers, who were drawn from a community-based population in northeastern England. Nine hundred eleven (911) subjects were recruited from general medical practices in the area. Of these, 442 were taking nifedipine, 181 amlodipine, and 186 diltiazem. In addition, 102 control subjects were examined. Drug and demographic data for each subject were recorded. The periodontal condition of all subjects was assessed including plaque index, papillary bleeding index, and a photograph of the anterior gingivae for subsequent analysis of overgrowth severity. RESULTS More than six percent (6.3%) of subjects taking nifedipine were seen to have significant overgrowth. This overgrowth was statistically greater than the amount of overgrowth seen in either of the other 2 drug groups or the control population. The prevalence of gingival overgrowth induced by amlodipine or diltiazem was not statistically significant when compared to the control group. The severity of overgrowth within the nifedipine group was found to be related to the amount of gingival inflammation and also to the gender of the subject, with males being 3 times as likely to develop overgrowth than females. CONCLUSIONS The prevalence of clinically significant overgrowth related to chronic medication with calcium channel blockers is low, i.e., 6.3% for nifedipine. Males are 3 times as likely as females to develop clinically significant overgrowth. The presence of gingival inflammation is an important cofactor for the expression of this effect.
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Thomason JM, Sloan P, Seymour RA. Immunolocalization of collagenase (MMP-1) and stromelysin (MMP-3) in the gingival tissues of organ transplant patients medicated with cyclosporin. J Clin Periodontol 1998; 25:554-60. [PMID: 9696255 DOI: 10.1111/j.1600-051x.1998.tb02487.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Cyclosporin-induced gingival overgrowth results from a disturbance in the homeostatic balance in the gingival tissues which is characterised by both an increase in the number of fibroblasts and in the volume of the extracellular matrix. Whilst the accumulation of the collagenous matrix is well recognised, little attention has been paid to the role of the degradative enzymes in the development of this condition in vivo. The matrix metalloproteinases MMP-1 (collagenase) and MMP-3 (stromelysin) were immunolocalized using specific polyclonal and monoclonal antisera in gingival specimens from 18 patients with drug-induced gingival overgrowth and 6 control subjects. A positive granular pattern of MMP-1 staining was seen in the vast majority of fibroblasts in specimens from drug-free controls throughout the connective tissue. This was in marked contrast to the findings in overgrown tissue, where positive cytoplasmic staining was shown by only a small number of fibroblasts. Where fibroblast staining occurred in overgrown tissue, the intracellular pattern was the same as in the drug free tissue. Positive staining was, however, largely confined to a small number of fibroblasts in the lamina propria of the outer gingival mucosa and even in this region there were areas that showed little or no fibroblast staining. This apparent cessation of collagenase production by many of the fibroblasts in gingival overgrowth supports the hypothesis that perturbation of collagenase activity is responsible for the disturbance in the homeostatic balance, which is pivotal to this condition.
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Seymour RA, Thomason JM, Nolan A. Angiotensin converting enzyme (ACE) inhibitors and their implications for the dental surgeon. Br Dent J 1997; 183:214-8. [PMID: 9345800 DOI: 10.1038/sj.bdj.4809469] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Angiotensin enzyme converting (ACE) inhibitors are a widely prescribed group of drugs used in the management of hypertension and heart failure. Several unwanted effects are associated with ACE inhibitors and this paper highlights those significant to the dental surgeon. Of particular concern is the problem of angioedema, which can be life threatening. Three case reports are presented that illustrate this problem and the management is discussed.
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