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Bianchi G, de'Angelis N, Gavriilidis P, Sobhani I, de'Angelis GL, Carra MC. Oral microbiota in obstructive sleep apnea patients: a systematic review. Sleep Breath 2023; 27:1203-1216. [PMID: 36207622 DOI: 10.1007/s11325-022-02718-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 09/13/2022] [Accepted: 09/27/2022] [Indexed: 11/07/2022]
Abstract
PURPOSE Evidence suggests that patients with obstructive sleep apnea (OSA) are at increased risk of suffering from periodontitis, a chronic inflammatory disease of the tooth-supporting tissues associated with a dysbiotic oral microbiota. This systematic review aims to explore the current literature about the composition of the oral microbiota in patients with OSA compared to those without OSA. METHODS Medline, Embase, and Cochrane Library were searched in May 2022 to identify original articles investigating the oral microbiota composition and/or oral microbiome (any microbiological technique) of patients with OSA (adults or children) vs. controls. Case report, reviews, and animal studies were excluded. RESULTS Of over 279 articles initially identified, 8 were selected, of which 3 dealt with pediatric patients. Overall, 344 patients with OSA and 131 controls were included. Five studies used salivary samples, 2 oral mucosal swabs, and 1 subgingival plaque sample. With different methods to characterize oral microbiota, 6/8 studies observed significant differences between patients with OSA patients and controls in the composition and relative abundance of several bacteria species/genera linked to periodontitis. CONCLUSION Within the limitations of the available literature, the present systematic review indicates that OSA and related conditions (e.g., mouth breathing) are associated with different oral microbiota compositions, which may underlie the association between OSA and periodontitis.
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Affiliation(s)
- Giorgio Bianchi
- Service of General Surgery, Henri Mondor University Hospital, Creteil, France
- Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Nicola de'Angelis
- Service of General Surgery, Henri Mondor University Hospital, Creteil, France
- Faculté de Santé, Université Paris Est, UPEC, Creteil, France
| | - Paschalis Gavriilidis
- Department of HBP Surgery, University Hospitals Coventry and Warwickshire NHS Trust, Clifford Bridge Road, Coventry, CV2 2DX, UK
| | - Iradj Sobhani
- Department of Gastroenterology, APHP-Henri Mondor University Hospital, Creteil, France
- EC2M-EA7375 Research Team, Henri Mondor Campus, Paris East University, Creteil, France
| | - Gian Luigi de'Angelis
- Gastroenterology and Endoscopy Unit, Department of Medicine and Surgery, University Hospital of Parma, Parma, Italy
| | - Maria Clotilde Carra
- Service of Odontology, Unit of Oral and Periodontal Surgery, Rothschild University Hospital and University Paris Cité, 5, rue Santerre, Paris, France.
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Hajishengallis G, Li X, Divaris K, Chavakis T. Maladaptive trained immunity and clonal hematopoiesis as potential mechanistic links between periodontitis and inflammatory comorbidities. Periodontol 2000 2022; 89:215-230. [PMID: 35244943 DOI: 10.1111/prd.12421] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Periodontitis is bidirectionally associated with systemic inflammatory disorders. The prevalence and severity of this oral disease and linked comorbidities increases with aging. Here, we review two newly emerged concepts, trained innate immunity (TII) and clonal hematopoiesis of indeterminate potential (CHIP), which together support a potential hypothesis on how periodontitis affects and is affected by comorbidities and why the susceptibility to periodontitis and comorbidities increases with aging. Given that chronic diseases are largely triggered by the action of inflammatory immune cells, modulation of their bone marrow precursors, the hematopoietic stem and progenitor cells (HSPCs), may affect multiple disorders that emerge as comorbidities. Such alterations in HSPCs can be mediated by TII and/or CHIP, two non-mutually exclusive processes sharing a bias for enhanced myelopoiesis and production of innate immune cells with heightened proinflammatory potential. TII is a state of elevated immune responsiveness based on innate immune (epigenetic) memory. Systemic inflammation can initiate TII in the bone marrow via sustained rewiring of HSPCs, which thereby display a skewing toward the myeloid lineage, resulting in generation of hyper-reactive or "trained" myeloid cells. CHIP arises from aging-related somatic mutations in HSPCs, which confer a survival and proliferation advantage to the mutant HSPCs and give rise to an outsized fraction of hyper-inflammatory mutant myeloid cells in the circulation and tissues. This review discusses emerging evidence that supports the notion that TII and CHIP may underlie a causal and age-related association between periodontitis and comorbidities. A holistic mechanistic understanding of the periodontitis-systemic disease connection may offer novel diagnostic and therapeutic targets for treating inflammatory comorbidities.
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Affiliation(s)
- George Hajishengallis
- Department of Basic and Translational Sciences, Penn Dental Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Xiaofei Li
- Department of Basic and Translational Sciences, Penn Dental Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Kimon Divaris
- Division of Pediatrics and Public Health, Adams School of Dentistry, University of North Carolina, Chapel Hill, NC, USA.,Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - Triantafyllos Chavakis
- Institute for Clinical Chemistry and Laboratory Medicine, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
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Aleksejūnienė J, Pūrienė A, Rimkervicius A, Amariei C, Oancea R, Porosencova T, Porosencov E, Nikolovska J, Mirnaya E, Serova-Papakul A, Eaton KA. Knowledge, dentist confidence and management of periodontal patients among general dentists from Belarus, Lithuania, Macedonia, Moldova and Romania. BMC Oral Health 2020; 20:47. [PMID: 32041598 PMCID: PMC7011211 DOI: 10.1186/s12903-020-1033-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Accepted: 01/31/2020] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Evidence concerning periodontal practice in Eastern European countries is scarce. The aim of the present study was to investigate periodontal risk knowledge, patient management and self-perceived confidence among General Dentists (GDs) from five Eastern European regarding their provision of periodontal care. METHODS GDs from Belarus, Lithuania, Macedonia, Moldova and Romania participated in a questionnaire survey. Power calculations were used to identify the sample size for each country. The structured questionnaire included several domains of inquiry. The socio-demographic domain inquired about dentist's age, gender and years of clinical experience. The dental practice domain inquired about practice location, practising or not practising in a group practice and having or not having a periodontist or a dental hygienist in the practice. The distributions of answers across-countries were compared employing one way ANOVA (comparison of means) or Chi square test (comparison of proportions). For each country, the predictors of the study outcomes: a summative knowledge score for periodontal risks and dentist's confidence level were identified employing either linear or logistic multiple regression models. RESULTS The sample comprised 390 Belarussian, 488 Lithuanian, 349 Macedonian, 316 Moldovan, and 401 Romanian GDs. The majority of GDs (~ 80%) practiced in urban areas. Age and gender distributions differed significantly among countries. Significant across-country differences were found regarding working/not working in a group practice, having/not having access to a periodontist/dental hygienist and in proportions of patients receiving periodontal treatments or being referred to specialists. None of Macedonian patients nor the majority of Moldovan patients (78%) were referred to periodontists. There were also significant across-country differences in diagnosis, patient management and periodontal knowledge. Only in the Lithuanian cohort were dentists' confidence levels associated significantly with their knowledge. In all countries, taking a medical history was a consistent and significant predictor of having higher periodontal knowledge score. Except in Belarus, periodontal risk assessment was a significantly consistent predictor of certainty levels associated with the provision of periodontal treatments. CONCLUSIONS There were substantial differences among GDs in the five countries regarding diagnosis, dentist's confidence and management of periodontal patients.
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Affiliation(s)
| | - Alina Pūrienė
- Medical Faculty, University of Vilnius, Vilnius, Lithuania
| | | | - Corneliu Amariei
- Romanian Association of OroDental Public Health, Bucharest, Romania
| | - Roxana Oancea
- Faculty of Dentistry, University of Medicine and Pharmacy “Victor Babes”, Timișoara, Romania
| | - Tatiana Porosencova
- Faculty of Dentistry, State University of Medicine and Pharmacy “Nicolae Testemițanu”, Chisinau, Republic of Moldova
| | - Egor Porosencov
- Faculty of Dentistry, State University of Medicine and Pharmacy “Nicolae Testemițanu”, Chisinau, Republic of Moldova
| | - Julijana Nikolovska
- Faculty of Dental Medicine, University of Sts Cyril and Methodius, Skopje, Macedonia
| | - Elena Mirnaya
- Dental Faculty, Bellarussian State Medical University, Minsk, Belarus
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Vergnes JN, Canceill T, Monsarrat P. Intensive periodontal therapy and type 2 diabetes. Lancet Diabetes Endocrinol 2019; 7:174-175. [PMID: 30782466 DOI: 10.1016/s2213-8587(19)30029-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2018] [Accepted: 01/14/2019] [Indexed: 11/21/2022]
Affiliation(s)
- Jean-Noel Vergnes
- Department of Epidemiology and Public Health, Paul Sabatier University, Dental Faculty, Toulouse University Hospital (CHU de Toulouse), 31400 Toulouse, France; Division of Oral Health and Society, Faculty of Dentistry, McGill University, Montreal, QC, Canada.
| | - Thibault Canceill
- Department of Oral Rehabilitation, Paul Sabatier University, Dental Faculty, Toulouse University Hospital (CHU de Toulouse), 31400 Toulouse, France
| | - Paul Monsarrat
- Department of Oral Rehabilitation, Paul Sabatier University, Dental Faculty, Toulouse University Hospital (CHU de Toulouse), 31400 Toulouse, France; STROMALab, University of Toulouse, Institut National de la Santé et de la Recherche Médicale (INSERM U1031), Toulouse, France
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El Tantawi M, AlAgl A. Disability and the impact of need for periodontal care on quality of life: A cross-sectional study. J Int Med Res 2017. [PMID: 28635358 PMCID: PMC5805219 DOI: 10.1177/0300060517715376] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Objective The need for periodontal care may negatively impact daily life. We compared
the need for periodontal care and its impact on daily life between disabled
and healthy adults in the Eastern Province, Saudi Arabia. Methods In this cross-sectional study of 819 adults, a questionnaire was used to
assess personal background factors; the impact of periodontitis on pain,
avoiding foods, embarrassment, sleeplessness, work absence, and
discontinuing daily activities; and risk factors (smoking, diabetes,
toothbrushing, insurance, professional tooth cleaning, and dental visits).
The outcome was clinically assessed need for periodontal care impacting
daily life. The relationship between the outcome and risk factors adjusted
for personal background and disability was assessed using ordinal
regression. Results Healthy and disabled persons had a high need for periodontal care (66.8%).
Current smokers had a higher likelihood and health-insured persons had a
lower likelihood of need for periodontal care impacting daily life
regardless of whether disability was considered. Conclusions Most adults needed periodontal care, and disabled persons experienced a
greater impact on life. Current smokers and uninsured persons were more
likely to need periodontal care impacting daily life. Our findings are
important for the prevention of periodontitis through tobacco cessation and
extending insurance coverage.
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Affiliation(s)
- Maha El Tantawi
- Department of Preventive Dental Sciences, College of Dentistry, University of Dammam, Saudi Arabia
| | - Adel AlAgl
- Department of Preventive Dental Sciences, College of Dentistry, University of Dammam, Saudi Arabia
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Brown LM, Bowman P, O’Rourke VJ, Mercado F, Marshall R, Parsons S. Periodontal Referral Patterns in Australia: 2000 Versus 2015. J Periodontol 2017; 88:869-875. [DOI: 10.1902/jop.2017.160774] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Leah M. Brown
- School of Dentistry, University of Queensland, Brisbane, Queensland, Australia
| | - Patrick Bowman
- School of Dentistry, University of Queensland, Brisbane, Queensland, Australia
| | - Vincent J. O’Rourke
- School of Dentistry, University of Queensland, Brisbane, Queensland, Australia
| | | | | | - Scott Parsons
- Private practice, Canberra, New South Wales, Australia
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Cobb CM. Lasers and the treatment of periodontitis: the essence and the noise. Periodontol 2000 2017; 75:205-295. [DOI: 10.1111/prd.12137] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Rams TE, Loesche WJ. Relationship Between Periodontal Screening and Recording Index Scores and Need for Periodontal Access Surgery. J Periodontol 2017; 88:1042-1050. [PMID: 28517975 DOI: 10.1902/jop.2017.170070] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND The validity of using pretreatment Periodontal Screening and Recording (PSR) index sextant scores to estimate periodontal access surgery needs is evaluated in patients with chronic periodontitis before and after completion of non-surgical periodontal therapy. METHODS In 110 adults, pretreatment probing data identified 486 sextants with PSR scores of 4 and 125 sextants with PSR scores of 3. Periodontal access surgery needs for all sextants were determined prior to treatment and after completion of non-surgical periodontal therapy for 213 sextants in 38 patients by two experienced periodontist examiners. RESULTS PSR scores of 4 identified untreated sextants with periodontal access surgery needs significantly better than PSR scores of 3 (odds ratio = 27.8; P <0.001) in multilevel, mixed-effects, logistic regression modeling analysis. However, only 37.6% of sextants with both pretreatment PSR scores of 4 and a pretreatment periodontal access surgery need continued to have surgical access needs after completion of non-surgical periodontal therapy. A higher percentage of sextants with PSR scores of 4 or 3 revealed periodontal access surgical needs when Class II or III furcation involvements and/or Grade II or III tooth mobility were also detected in the sextant than when these parameters were not detected. CONCLUSIONS Pretreatment PSR index scores of 4 were a strong indicator of periodontal access surgery needs in untreated dentition sextants but markedly overestimated surgical access needs remaining after completion of non-surgical periodontal therapy. These findings raise questions about the usefulness of pretreatment PSR evaluations for estimating potential periodontal access surgery needs in patients to be initially treated with non-surgical periodontal therapy.
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Affiliation(s)
- Thomas E Rams
- Department of Periodontology and Oral Implantology, Temple University School of Dentistry, Philadelphia, PA.,Department of Microbiology and Immunology, Temple University School of Medicine, Philadelphia, PA
| | - Walter J Loesche
- Deceased; previously, Department of Biologic and Materials Sciences, University of Michigan School of Dentistry, Ann Arbor, MI.,Deceased; previously, Department of Microbiology and Immunology, University of Michigan School of Medicine, Ann Arbor, MI
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Thevissen E, De Bruyn H, Colman R, Koole S. Attitude of dental hygienists, general practitioners and periodontists towards preventive oral care: an exploratory study. Int Dent J 2017; 67:221-228. [PMID: 28303564 DOI: 10.1111/idj.12289] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
INTRODUCTION Promoting oral hygiene and stimulating patient's responsibility for his/her personal health remain challenging objectives. The presence of dental hygienists has led to delegation of preventive tasks. However, in some countries, such as Belgium, this profession is not yet legalized. The aim of this exploratory study was to compare the attitude towards oral-hygiene instructions and patient motivational actions by dental hygienists and by general practitioners/periodontists in a context without dental hygienists. MATERIALS AND METHODS A questionnaire on demographics (six items), oral-hygiene instructions (eight items) and patient motivational actions (six items) was distributed to 241 Dutch dental hygienists, 692 general practitioners and 32 periodontists in Flanders/Belgium. Statistical analysis included Fisher's exact-test, Pearson's chi-square test and multiple (multinomial) logistic regression analysis to observe the influence of profession, age, workload, practice area and chair-assistance. RESULTS Significant variance was found between general practitioners and dental hygienists (in 13 of 14 items), between general practitioners and periodontists (in nine of 14 items) and between dental hygienists and periodontists (in five of 14 items). In addition to qualification, chair-assistance was also identified as affecting the attitude towards preventive oral care. CONCLUSION The present study identified divergence in the application of, and experienced barriers and opinions about, oral-hygiene instructions and patient motivational actions between dental hygienists and general practitioners/periodontists in a context without dental hygienists. In response to the barriers reported it is suggested that preventive oriented care may benefit from the deployment of dental hygienists to increase access to qualified preventive oral care.
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Affiliation(s)
- Eric Thevissen
- Department of Periodontology and Oral Implantology, Dental School, Ghent University, Ghent, Belgium.,Praktijk voor Parodontologie, Hasselt, Belgium
| | - Hugo De Bruyn
- Department of Periodontology and Oral Implantology, Dental School, Ghent University, Ghent, Belgium.,Department of Prosthodontics, School of Dentistry, Malmö University, Malmö, Sweden
| | - Roos Colman
- Biostatistics Unit, Department of Public Health, Ghent University, Ghent, Belgium
| | - Sebastiaan Koole
- Department of Periodontology and Oral Implantology, Dental School, Ghent University, Ghent, Belgium
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Cheung MC, Kao PLH, Lee N, Sivathasan D, Vong CW, Zhu J, Polster A, Darby I. Interest in dental implantology and preferences for implant therapy: a survey of Victorian dentists. Aust Dent J 2016; 61:455-463. [DOI: 10.1111/adj.12411] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/17/2016] [Indexed: 01/14/2023]
Affiliation(s)
- MC Cheung
- Melbourne Dental School; The University of Melbourne; Victoria Australia
| | - PLH Kao
- Melbourne Dental School; The University of Melbourne; Victoria Australia
| | - N Lee
- Melbourne Dental School; The University of Melbourne; Victoria Australia
| | - D Sivathasan
- Melbourne Dental School; The University of Melbourne; Victoria Australia
| | - CW Vong
- Melbourne Dental School; The University of Melbourne; Victoria Australia
| | - J Zhu
- Melbourne Dental School; The University of Melbourne; Victoria Australia
| | - A Polster
- Melbourne Dental School; The University of Melbourne; Victoria Australia
| | - I Darby
- Melbourne Dental School; The University of Melbourne; Victoria Australia
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Wakabayashi N, Wada J. Structural factors affecting prosthodontic decision making in Japan. JAPANESE DENTAL SCIENCE REVIEW 2015. [DOI: 10.1016/j.jdsr.2015.04.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Beikler T, Flemmig TF. EAO consensus conference: economic evaluation of implant-supported prostheses. Clin Oral Implants Res 2015; 26 Suppl 11:57-63. [DOI: 10.1111/clr.12630] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/12/2015] [Indexed: 10/23/2022]
Affiliation(s)
- Thomas Beikler
- Section of Periodontics; Heinrich-Heine University; Düsseldorf Germany
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Gilbert GH, Gordan VV, Korelitz JJ, Fellows JL, Meyerowitz C, Oates TW, Rindal DB, Gregory RJ. Provision of specific dental procedures by general dentists in the National Dental Practice-Based Research Network: questionnaire findings. BMC Oral Health 2015; 15:11. [PMID: 25608862 PMCID: PMC4324862 DOI: 10.1186/1472-6831-15-11] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2014] [Accepted: 01/14/2015] [Indexed: 12/22/2022] Open
Abstract
Background Objectives were to: (1) determine whether and how often general dentists (GDs) provide specific dental procedures; and (2) test the hypothesis that provision is associated with key dentist, practice, and patient characteristics. Methods GDs (n = 2,367) in the United States National Dental Practice-Based Research Network completed an Enrollment Questionnaire that included: (1) dentist; (2) practice; and (3) patient characteristics, and how commonly they provide each of 10 dental procedures. We determined how commonly procedures were provided and tested the hypothesis that provision was substantively related to the three sets of characteristics. Results Two procedure categories were classified as “uncommon” (orthodontics, periodontal surgery), three were “common” (molar endodontics; implants; non-surgical periodontics), and five were “very common” (restorative; esthetic procedures; extractions; removable prosthetics; non-molar endodontics). Dentist, practice, and patient characteristics were substantively related to procedure provision; several characteristics seemed to have pervasive effects, such as dentist gender, training after dental school, full-time/part-time status, private practice vs. institutional practice, presence of a specialist in the same practice, and insurance status of patients. Conclusions As a group, GDs provide a comprehensive range of procedures. However, provision by individual dentists is substantively related to certain dentist, practice, and patient characteristics. A large number and broad range of factors seem to influence which procedures GDs provide. This may have implications for how GDs respond to the ever-changing landscape of dental care utilization, patient population demography, scope of practice, delivery models and GDs’ evolving role in primary care. Electronic supplementary material The online version of this article (doi:10.1186/1472-6831-15-11) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Gregg H Gilbert
- Department of Clinical and Community Sciences, School of Dentistry, University of Alabama at Birmingham, SDB Room 109, 1530 Third Avenue South, Birmingham, AL 35294-0007, USA.
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Abstract
Periodontitis is an infectious disease that affects the tooth-supporting tissues and exhibits a wide range of clinical, microbiological and immunological manifestations. The disease is associated with and is probably caused by a multifaceted dynamic interaction of specific infectious agents, host immune responses, harmful environmental exposure and genetic susceptibility factors. This volume of Periodontology 2000 covers key subdisciplines of periodontology, ranging from etiopathogeny to therapy, with emphasis on diagnosis, classification, epidemiology, risk factors, microbiology, immunology, systemic complications, anti-infective therapy, reparative treatment, self-care and affordability issues. Learned and unlearned concepts of periodontitis over the past 50 years have shaped our current understanding of the etiology of the disease and of clinical practice.
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Economics of periodontal care: market trends, competitive forces and incentives. Br Dent J 2013. [DOI: 10.1038/sj.bdj.2013.1115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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