Publications by authors named "Philip M Preshaw"

95 Publications

No Benefit of an Adjunctive Phototherapy Protocol in Treatment of Periodontitis: a Split-Mouth Randomised Controlled Trial.

J Clin Periodontol 2021 Apr 4. Epub 2021 Apr 4.

Research Centre for the Study of Periodontal and Peri-implant Diseases, University of Ferrara, Italy.

Aim: To assess the efficacy of a commercially-available adjunctive phototherapy protocol ('Perio-1') in treatment of periodontitis.

Materials And Methods: In an examiner-blind, randomised, controlled, split-mouth, multi-centre study, 60 periodontitis patients received root surface debridement (RSD) in sextants either alone (control sextants) or with the adjunctive phototherapy protocol (test sextants). Re-evaluation was performed at 6, 12 and 24 weeks.

Results: No statistically significant differences in mean (± standard deviation) clinical attachment level (CAL) change from baseline to week 24 were observed between test (-1.00±1.16 mm) and control sextants (-0.87±0.79 mm) at sites with probing pocket depths (PPDs) ≥ 5 mm ("deep sites") at baseline (p=0.212). Comparisons between test and control sextants for all other parameters (CAL change at all sites, PPD change at deep sites/all sites, bleeding on probing, plaque scores), and for all change intervals, failed to identify any statistically significant differences.

Conclusions: The phototherapy protocol did not provide any additional clinical benefits over those achieved by RSD alone. (German Clinical Trials Register DRKS00011229).
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http://dx.doi.org/10.1111/jcpe.13465DOI Listing
April 2021

Interventions for tobacco cessation delivered by dental professionals.

Cochrane Database Syst Rev 2021 02 19;2:CD005084. Epub 2021 Feb 19.

School of Dental Sciences, Newcastle University, Newcastle upon Tyne, UK.

Background: Dental professionals are well placed to help their patients stop using tobacco products. Large proportions of the population visit the dentist regularly. In addition, the adverse effects of tobacco use on oral health provide a context that dental professionals can use to motivate a quit attempt.

Objectives: To assess the effectiveness, adverse events and oral health effects of tobacco cessation interventions offered by dental professionals.

Search Methods: We searched the Cochrane Tobacco Addiction Group's Specialised Register up to February 2020.

Selection Criteria: We included randomised and quasi-randomised clinical trials assessing tobacco cessation interventions conducted by dental professionals in the dental practice or community setting, with at least six months of follow-up.

Data Collection And Analysis: Two review authors independently reviewed abstracts for potential inclusion and extracted data from included trials. We resolved disagreements by consensus. The primary outcome was abstinence from all tobacco use (e.g. cigarettes, smokeless tobacco) at the longest follow-up, using the strictest definition of abstinence reported. Individual study effects and pooled effects were summarised as risk ratios (RR) and 95% confidence intervals (CI), using Mantel-Haenszel random-effects models to combine studies where appropriate. We assessed statistical heterogeneity with the I statistic. We summarised secondary outcomes narratively.

Main Results: Twenty clinical trials involving 14,897 participants met the criteria for inclusion in this review. Sixteen studies assessed the effectiveness of interventions for tobacco-use cessation in dental clinics and four assessed this in community (school or college) settings. Five studies included only smokeless tobacco users, and the remaining studies included either smoked tobacco users only, or a combination of both smoked and smokeless tobacco users. All studies employed behavioural interventions, with four offering nicotine treatment (nicotine replacement therapy (NRT) or e-cigarettes) as part of the intervention. We judged three studies to be at low risk of bias, one to be at unclear risk of bias, and the remaining 16 studies to be at high risk of bias. Compared with usual care, brief advice, very brief advice, or less active treatment, we found very low-certainty evidence of benefit from behavioural support provided by dental professionals, comprising either one session (RR 1.86, 95% CI 1.01 to 3.41; I = 66%; four studies, n = 6328), or more than one session (RR 1.90, 95% CI 1.17 to 3.11; I = 61%; seven studies, n = 2639), on abstinence from tobacco use at least six months from baseline. We found moderate-certainty evidence of benefit from behavioural interventions provided by dental professionals combined with the provision of NRT or e-cigarettes, compared with no intervention, usual care, brief, or very brief advice only (RR 2.76, 95% CI 1.58 to 4.82; I = 0%; four studies, n = 1221). We did not detect a benefit from multiple-session behavioural support provided by dental professionals delivered in a high school or college, instead of a dental setting (RR 1.51, 95% CI 0.86 to 2.65; I = 83%; three studies, n = 1020; very low-certainty evidence). Only one study reported adverse events or oral health outcomes, making it difficult to draw any conclusions.

Authors' Conclusions: There is very low-certainty evidence that quit rates increase when dental professionals offer behavioural support to promote tobacco cessation. There is moderate-certainty evidence that tobacco abstinence rates increase in cigarette smokers if dental professionals offer behavioural support combined with pharmacotherapy. Further evidence is required to be certain of the size of the benefit and whether adding pharmacological interventions is more effective than behavioural support alone. Future studies should use biochemical validation of abstinence so as to preclude the risk of detection bias. There is insufficient evidence on whether these interventions lead to adverse effects, but no reasons to suspect that these effects would be specific to interventions delivered by dental professionals. There was insufficient evidence that interventions affected oral health.
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http://dx.doi.org/10.1002/14651858.CD005084.pub4DOI Listing
February 2021

Impact of diabetes and periodontal status on life quality.

BDJ Open 2021 Feb 4;7(1). Epub 2021 Feb 4.

School of Dental Sciences, Newcastle University, Newcastle upon Tyne, UK.

Objectives: To investigate impact of periodontal status on quality of life (QoL) in type-1 (T1D) and type-2 (T2D) diabetes patients pre- and post-periodontal treatment using the Well-being Questionnaire 12 (W-BQ12) and Audit of Diabetes-Dependent Quality of Life-19 (ADDQoL-19).

Methods: W-BQ12 and ADDQoL-19 were self-completed by 56 T1D and 77 T2D patients at baseline and by those with periodontitis 3 and 6-months after therapy.

Results: At baseline, T1D patients had significantly higher general W-BQ12 [Median (IQR); 24.00 (20.25-27.75)] and positive well-being scores [8.00 (6.00-9.00)] (indicating better QoL) compared to T2D patients [22.00 (15.50-26.00) and 6.00 (3.50-9.00)], respectively (p < 0.05). Within both groups, general W-BQ12 scores did not differ significantly between patients with periodontal health, gingivitis, or periodontitis (p > 0.05). Significantly higher general W-BQ12 scores were observed in T1D patients at month 3 [28.00 (22.00-29.50)] compared to baseline [22.00 (17.00-24.50)] (p < 0.01), suggesting an initial improvement in QoL post-treatment. ADDQoL-19 identified that diabetes had greatest impact on the domain 'freedom to eat', with participants placing most importance on 'family life'. No significant changes in ADDQoL-19 scores were seen post-treatment (p > 0.05).

Conclusions: Diabetes had impacts upon aspects of life quality in both T1D and T2D patients, though any additional impact based on periodontal status was not observed when using W-BQ12 and ADDQoL-19.
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http://dx.doi.org/10.1038/s41405-021-00061-wDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7862251PMC
February 2021

Perceived influences on smoking behaviour and perceptions of dentist-delivered smoking cessation advice: A qualitative interview study.

Community Dent Oral Epidemiol 2020 Oct 6;48(5):433-439. Epub 2020 Jul 6.

Centre for Clinical Research, The University of Queensland, Herston, Queensland, Australia.

Objectives: Many factors lead to the commencement and maintenance of smoking, and better understanding of these is relevant in the management of oral health, particularly as smoking cessation advice (SCA) from the dental team is a key component of patient care. Whereas most previous research has focused on dental professionals' perceptions of providing SCA, and identified facilitators and barriers to its provision, there has been more limited research focusing on patients' perceptions of receiving SCA in the dental context. Accordingly, this study aimed to explore the views of smokers with periodontitis receiving dentist-delivered SCA.

Methods: One-to-one, semi-structured interviews were conducted with a purposive sample of 28 adults who smoked tobacco and had recently received SCA during dentist-delivered periodontal therapy. Participants were sampled to reflect a range of ages and smoking behaviours. The interview schedule was based on the Theoretical Domains Framework (TDF) to explore perceived influences on smoking behaviour. Interviews also elicited participants' views on dentist-delivered SCA. Interviews were audio-recorded, transcribed verbatim and analysed thematically, drawing on the TDF.

Results: A broad range of perceived influences on smoking behaviour emerged from the data. Influences were allocated into seven prominent TDF domains: (i) social influences (family and friends, social pressures); (ii) social/professional role and identity (secret smoking); (iii) knowledge (experiences/perceptions of smoking cessation medications); (iv) environmental context and resources (social, home and workplace environment, cost of smoking, resentment towards authority); (v) emotions (stress management, pleasure of smoking and fear of quitting); (vi) nature of the behaviour (habitual nature, link to other behaviours, smell); and (vii) beliefs about consequences (health). With regard to views on dentist-delivered SCA, five main themes emerged: (i) opportunistic nature; (ii) personal impact and tangible prompts; (iii) positive context of cessation attempt; (iv) lack of previous support; and (v) differences between dentist-delivered SCA and other setting SCA.

Conclusions: Smokers with periodontitis consider that a wide range of factors influence their smoking behaviour. Dentist-delivered SCA was supported and positively received. Important aspects included the opportunistic nature, personal impact, use of tangible prompts and positive context (of the quit attempt). Future research should focus on optimizing dentist-led smoking cessation intervention based on the themes identified.
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http://dx.doi.org/10.1111/cdoe.12556DOI Listing
October 2020

An Unexplored Pharmacologic/Diagnostic Strategy for Peri-Implantitis: A Protocol Proposal.

Diagnostics (Basel) 2020 Dec 5;10(12). Epub 2020 Dec 5.

National University Centre for Oral Health, Faculty of Dentistry, National University of Singapore, Singapore 119077, Singapore.

Dental implants are widely utilized for the replacement of missing teeth and are increasingly being placed in patients with systemic diseases, as well as in those who are medically healthy. Furthermore, it is recognized that peri-implant mucositis and peri-implantitis are highly prevalent, affecting large numbers of patients with implants, and it is pertinent to consider whether there may be any systemic impact of these conditions, given that there are known links between periodontitis and a number of chronic inflammatory diseases. In this article, we propose that the potential systemic complications of peri-implant diseases should be investigated in future clinical research, together with studies to identify whether systemically-administered host modulation therapies (HMTs) may be of benefit in the treatment of peri-implant diseases. These "HMTs" may prove a useful adjunct to routinely employed debridement and disinfection protocols, as well as potentially being of benefit in reducing risks of systemic complications. We also consider the use of chair-side diagnostic tests for active matrix metalloproteinase-8 (aMMP-8) in the detection of peri-implant disease given the ability of such tests to detect active tissue breakdown associated with peri-implantitis and periodontitis before conventional clinical and radiographic measurements indicate pathologic changes. These novel diagnostic and therapeutic strategies are relevant to consider as they may improve the management of peri-implant disease (beyond local debridement procedures), especially in those patients in whom systemic inflammation might be of concern.
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http://dx.doi.org/10.3390/diagnostics10121050DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7762163PMC
December 2020

Exploring the use of mouth guards in Muay Thai: a questionnaire survey.

BDJ Open 2020 15;6:20. Epub 2020 Oct 15.

National University Centre for Oral Health, National University of Singapore, Singapore, Singapore.

Objective: To identify Muay Thai participants' attitudes towards use of mouth guards and their experiences of dental trauma.

Materials And Methods: An online cross-sectional survey was used to record Muay Thai participants' experiences and opinions regarding use of mouth guards. Participants were recruited from a Muay Thai gym in the north east of England.

Results: 92 respondents took part in the survey. 3% reported having never worn a mouth guard, whereas 61% reported routinely wearing mouth guards during a fight. Significantly more (73%) younger participants (18-29 years) reported wearing mouth guards during fights compared to those aged 30 years and older (50%) ( < 0.05). Mouth-formed ('boil and bite') were the most frequently used type of mouth guard (60% of users), followed by custom-made mouth guards provided by a dentist (32%). Factors such as protection, breathing, good fit and comfort were all considered important in the choice of mouth guard. 14% of respondents had experienced dental injuries, with chipped/broken teeth being the most common.

Conclusion: Given the risk for dental trauma in Muay Thai, it is important that participants are advised regarding mouth guard use, particularly those that do not routinely wear them.
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http://dx.doi.org/10.1038/s41405-020-00048-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7567060PMC
October 2020

Pterostilbene complexed with cyclodextrin exerts antimicrobial and anti-inflammatory effects.

Sci Rep 2020 06 3;10(1):9072. Epub 2020 Jun 3.

Faculty of Dentistry, National University of Singapore, Singapore, Singapore.

Resveratrol (RES) is a natural polyphenol with potential as an adjunctive therapeutic modality for periodontitis. However, its inferior pharmacokinetics and toxicity concerns about its commonly used solvent dimethyl sulfoxide (DMSO) hinder translation to clinical applicability. Our study aimed to investigate the comparative antimicrobial properties of RES and its analogues (pterostilbene [PTS], oxyresveratrol [OXY] and piceatannol [PIC]), utilizing 2-hydroxypropyl-β-cyclodextrin (HPβCD) as a solubiliser, which has a well-documented safety profile and FDA approval. These properties were investigated against Fusobacterium nucleatum, a key periodontal pathogen. PTS demonstrated the most potent antibacterial effects in HPβCD, with MIC > 60-fold lower than that of RES, OXY and PIC. In addition, PTS inhibited F. nucleatum biofilm formation. PTS exerted antimicrobial effects by eliciting leakage of cellular contents, leading to loss of bacterial cell viability. PTS also conferred immunomodulatory effects on F. nucleatum-challenged macrophages via upregulation of antioxidant pathways and inhibition of NF-κB activation. Given the superior antimicrobial potency of PTS against F. nucleatum compared to RES and other analogues, and coupled with its immunomodulatory properties, PTS complexed with HPβCD holds promise as a candidate nutraceutical for the adjunctive treatment of periodontitis.
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http://dx.doi.org/10.1038/s41598-020-66031-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7271226PMC
June 2020

'We do not seem to engage with dentists': a qualitative study of primary healthcare staff and patients in the North East of England on the role of pharmacists in oral healthcare.

BMJ Open 2020 02 28;10(2):e032261. Epub 2020 Feb 28.

Faculty of Health Sciences and Wellbeing, University of Sunderland, Sunderland, UK.

Objective: To explore the attitudes towards, and perceptions of, primary care healthcare staff and patients, regarding the role of clinical pharmacists in the provision of oral health advice and collaboration with dentists in general practice.

Design: Interpretivist methodology using qualitative semi-structured interviews and focus groups.

Participants: 22 participants; 10 pharmacists; 3 general practitioners; 2 nurses; 1 practice manager; 6 patients.

Setting: Primary care general medical practices in the North East of England and the University of Sunderland Patient Carer and Public Involvement group.

Methods: One-to-one semi-structured interviews were performed with primary care healthcare staff. An iterative approach using constant comparative analysis facilitated the ongoing enrichment of data; salient themes were identified using Framework Analysis and related back to extant literature. A focus group was held with patients to further explore key themes.

Results: Four salient and inter-related themes emerged: enhanced clinical roles; indicating rapidly changing roles of pharmacists working in general practice, increased responsibility and accountability of pharmacist prescribers and the delivery of advanced clinical services; limited knowledge; indicating basic understanding of appropriate oral health advice, but limited insight and provision of advice to patients with regards to links with systemic diseases and medication; geographical/situational isolation of the dental team; indicating the disparate contexts and challenges of multidisciplinary working in oral health, and patients' attitudes towards dental care; integration of oral health advice; indicating the potential of pharmacists to integrate oral health advice into current roles and to target specific patient groups in practice.

Conclusions: The lack of integration between oral and general healthcare services potentially impacts negatively on patient care, requiring further interprofessional oral health education. The developing role of the pharmacist in general practice represents an opportunity to integrate oral health advice and/or interventions into the management of patients in this setting.
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http://dx.doi.org/10.1136/bmjopen-2019-032261DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7050309PMC
February 2020

Treatment of periodontitis reduces systemic inflammation in type 2 diabetes.

J Clin Periodontol 2020 06 12;47(6):737-746. Epub 2020 May 12.

School of Dental Sciences, Newcastle University, Newcastle upon Tyne, UK.

Aims: To assess the impact of periodontal treatment on systemic inflammation in type 2 diabetes.

Materials And Methods: Adults with type 2 diabetes (n = 83) and without diabetes (controls, n = 75) were recruited, and participants with periodontitis received periodontal treatment and 12 months' follow-up. Biomarkers for periodontal inflammation (gingival crevicular fluid interleukin-6, tumour necrosis factor-α, interleukin-1β, interferon-γ, matrix metalloproteinase-8, matrix metalloproteinase-9, adiponectin) and serum markers of inflammation and diabetes control (glycated haemoglobin, high sensitivity C-reactive protein, interleukin-6, tumour necrosis factor-α, interleukin-1β, interferon-γ, leptin, adiponectin) were measured. Structural equation modelling was used to evaluate periodontal treatment effects on oral and systemic inflammation.

Results: Periodontal treatment resulted in significant improvements in clinical status and reductions in gingival crevicular fluid biomarkers from baseline to month 12. Structural equation modelling identified that, at baseline, individuals with diabetes and periodontitis had significantly higher systemic inflammation than non-diabetic controls with periodontitis (Δ = 0.20, p = .002), with no significant differences between groups for oral inflammation. There was a greater reduction in systemic inflammation following periodontal treatment in individuals with diabetes and periodontitis compared to those with periodontitis but not diabetes (Δ = -0.25, p = .01).

Conclusions: Diabetes and periodontitis together appear to increase systemic inflammation, with evidence of reductions following periodontal treatment.
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http://dx.doi.org/10.1111/jcpe.13274DOI Listing
June 2020

Uptake of best practice recommendations in the management of patients with diabetes and periodontitis: a cross-sectional survey of healthcare professionals in primary care.

BMJ Open 2020 01 30;10(1):e032369. Epub 2020 Jan 30.

School of Epidemiology and Public Health, and the School of Psychology, University of Ottawa, Ottawa, Ontario, Canada.

Objectives: To investigate the practices of healthcare professionals in relation to best practice recommendations for the multidisciplinary management of people with diabetes and periodontitis, focusing on two clinical behaviours: informing patients about the links between diabetes and periodontitis, and suggesting patients with poorly controlled diabetes go for a dental check-up.

Design: Cross-sectional design utilising online questionnaires to assess self-reported performance and constructs from Social Cognitive Theory (SCT) and Normalisation Process Theory.

Setting: Primary care medical practices (n=37) in North East, North Cumbria and South West of England Clinical Research Networks.

Participants: 96 general practitioners (GPs), 48 nurses and 21 healthcare assistants (HCAs).

Results: Participants reported little to no informing patients about the links between diabetes and periodontitis or suggesting that they go for a dental check-up. Regarding future intent, both GPs (7.60±3.38) and nurses (7.94±3.69) scored significantly higher than HCAs (4.29±5.07) for SCT proximal goals (intention) in relation to informing patients about the links (p<0.01); and nurses (8.56±3.12) scored significantly higher than HCAs (5.14±5.04) for suggesting patients go for a dental check-up (p<0.001). All professional groups agreed on the potential value of both behaviours, and nurses scored significantly higher than GPs for legitimation (conforms to perception of job role) in relation to informing (nurses 4.16±0.71; GPs 3.77±0.76) and suggesting (nurses 4.13±0.66; GPs 3.75±0.83) (both p<0.01). The covariate background information (OR=2.81; p=0.03) was statistically significant for informing patients about the links.

Conclusions: Despite evidence-informed best practice recommendations, healthcare professionals currently report low levels of informing patients with diabetes about the links between diabetes and periodontitis and suggesting patients go for a dental check-up. However, healthcare professionals, particularly nurses, value these behaviours and consider them appropriate to their role. While knowledge of the evidence is important, future guidelines should consider different strategies to enable implementation of the delivery of healthcare interventions.
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http://dx.doi.org/10.1136/bmjopen-2019-032369DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7045148PMC
January 2020

Efficacy of adjunctive therapies in patients with gingival inflammation: A systematic review and meta-analysis.

J Clin Periodontol 2020 07;47 Suppl 22:125-143

National University Centre for Oral Health, National University of Singapore, Singapore, Singapore.

Aim: To evaluate the efficacy of adjunctive therapies in reducing gingivitis and plaque by means of a systematic review of randomized clinical trials (RCTs).

Material And Methods: A search protocol was designed to identify 6-month RCTs that investigated the efficacy of adjuncts to mechanical plaque control on gingivitis and plaque. Following screening, relevant information was extracted, and quality and potential risk of bias were estimated. Mean treatment differences were calculated to obtain standardized mean differences and weighted mean differences (SMD and WMD) as appropriate.

Results: Meta-analyses included 70 studies of adjunctive antiseptics. Compared with mechanical plaque control alone, adjuncts yielded statistically significant reductions in gingival index (n = 72; SMD = -1.268; 95% CI [-1.489; -1.047]; p < .001; I  = 96.2%), bleeding (%) (n = 26, WMD=-14.62%; 95% CI [-18.01%; -11.23%]; p < .001; I  = 95.1%), plaque index (n = 93, SMD = -1.017; 95% CI [-1.194; -0.840]; p < .001; I  = 95.3%) and plaque (%) (n = 23; WMD = -18.20%; 95% CI [-24.00%; -12.50%]; p < .001; I  = 96.9%). Mouthrinses resulted in greater reductions in per cent plaque compared with dentifrices (meta-regression, coefficient = 13.80%; 95% CI [2.40%; 25.10%]; p = .020). The antiseptic agents were similarly effective in reducing gingivitis and plaque in patients with dental plaque-induced gingivitis (intact periodontium) or previously treated periodontitis with gingival inflammation.

Conclusion: Adjunctive antiseptics in mouthrinses and dentifrices provide statistically significant reductions in gingival, bleeding and plaque indices.
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http://dx.doi.org/10.1111/jcpe.13244DOI Listing
July 2020

A qualitative study exploring strategies to improve the inter-professional management of diabetes and periodontitis.

Prim Care Diabetes 2020 04 9;14(2):126-132. Epub 2019 Dec 9.

Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, UK.

Aims: To explore inter-professional communication and collaboration in guideline-concordant diabetes and periodontitis care.

Methods: Qualitative design using iterations of workshops to identify ways to improve multidisciplinary working attended by staff from medical and dental primary care practices, and people with diabetes (n=43). Workshops were semi-structured around a topic guide. Recruitment was via the UK Clinical Research Network, and a patient and public involvement group in the North of England.

Results: Medical practice participants were unaware of the bidirectional evidence linking diabetes and periodontitis and stated that they had never received a referral from a dental professional in this context. The patient participants with diabetes reported never having been informed about the links between diabetes and periodontitis from either their family physician or dentist. Medical and dental practice participants gave negative accounts of inter-professional communication, with claims of inappropriate requests and defensive or non-responses that stymied future interaction. Indirect communication through the patient was suggested as an alternative to direct communication.

Conclusions: Indirect referral, whereby the patient is signposted to a healthcare professional, was suggested by medical and dental professionals as a useful alternative to the traditional (and time consuming) letter or telephone call, particularly in the case of suspected diabetes or periodontitis.
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http://dx.doi.org/10.1016/j.pcd.2019.11.010DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7059110PMC
April 2020

Periodontitis and diabetes.

Br Dent J 2019 Oct;227(7):577-584

NIHR Fellow, School of Dental Sciences, Newcastle University, Newcastle upon Tyne, UK.

Periodontitis and diabetes are complex chronic diseases, linked by an established bidirectional relationship. Risk for periodontitis is increased two to three times in people with diabetes compared to individuals without, and the level of glycaemic control is key in determining risk. In people who do not have diabetes, periodontitis is associated with higher glycated haemoglobin (HbA1c) and fasting blood glucose levels, and severe periodontitis is associated with increased risk of developing diabetes. In people with type 2 diabetes, periodontitis is associated with higher HbA1c levels and worse diabetes complications. Treatment of periodontitis in people with diabetes has been shown to result in improved glycaemic control, with HbA1c reductions of 3-4 mmol/mol (0.3-0.4%) in the short term (3-4 months) post-treatment. Given that treatment of periodontitis results in clinically relevant reductions in HbA1c, the dental team has an important role in the management of patients with diabetes. Improved interprofessional working in relation to diabetes and periodontitis has been advocated by professional and scientific organisations, though practical and systemic barriers make this challenging. This paper reviews current evidence linking periodontitis and diabetes, and considers the role of the dental team in the wider context of management of patients with diabetes and periodontitis.
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http://dx.doi.org/10.1038/s41415-019-0794-5DOI Listing
October 2019

A Prototype Antibody-based Biosensor for Measurement of Salivary MMP-8 in Periodontitis using Surface Acoustic Wave Technology.

Sci Rep 2019 07 30;9(1):11034. Epub 2019 Jul 30.

Centre for Oral Health Research & Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK.

Periodontitis is an economically important disease which is highly prevalent worldwide. Current diagnostic approaches are time-consuming and require interpretation of multiple aspects of clinical and radiographic assessment. Chair-side monitoring of inflammatory mediators of periodontitis could provide immediate information about disease activity, which can inform patient management. We aimed to develop a novel prototype biosensor to measure salivary matrix metalloproteinase-8 (MMP-8) using specific antibodies and surface acoustic wave (SAW) technology. The analytical performance of the prototype biosensor was compared to standard enzyme-linked immunosorbent assay (ELISA) using unstimulated saliva samples obtained from patients with periodontitis before and after non-surgical treatment (N = 58), patients with gingivitis (N = 54) and periodontally healthy volunteers (N = 65). Receiver operator characteristic (ROC) analysis for distinguishing periodontitis from health revealed an almost identical performance between the sensor and ELISA assays (area under curve values (AUC): ELISA 0.93; SAW 0.89). Furthermore, both analytical approaches yielded readouts which distinguished between heath, gingivitis and periodontitis, correlated identically with clinical measures of periodontal disease and recorded similar post-treatment decreases in salivary MMP-8 in periodontitis. The assay time for our prototype device is 20 minutes. The prototype SAW biosensor is a novel and rapid method of monitoring periodontitis which delivers similar analytical performance to conventional laboratory assays.
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http://dx.doi.org/10.1038/s41598-019-47513-wDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6667706PMC
July 2019

General dental practitioners' perceptions of, and attitudes towards, improving patient safety through a multidisciplinary approach to the prevention of medication-related osteonecrosis of the jaw (MRONJ): a qualitative study in the North East of England.

BMJ Open 2019 06 17;9(6):e029951. Epub 2019 Jun 17.

Faculty of Health Sciences and Wellbeing, University of Sunderland, Sunderland, UK.

Objective: To explore general dental practitioners' (GDPs') perceptions of, and attitudes towards, the risks of medication-related osteonecrosis of the jaw (MRONJ) and the current/potential multidisciplinary approach(es) to prevention of the condition.

Design: Interpretivist methodology using a grounded theory approach and constant comparative analysis to undertake an iterative series of semistructured interviews. Ritchie and Spencer's framework analysis facilitated the identification and prioritisation of salient themes.

Setting: Primary care general dental practices in the North East of England.

Participants: 15 GDPs.

Results: GDPs are aware of the risk of MRONJ with commonly implicated medicines; however, they report limited collaboration between professional groups in person-centred avoidance of complications, which is a key requirement of the preventive advice recommended in extant literature. Four salient and inter-related themes emerged: (1) perception of knowledge; indicating the awareness of the risk, limited knowledge of implicated medications and experience of managing the condition; (2) risk; indicating the importance of accurate medication histories, the treatment of low risk patients in primary dental care, counselling of poorly informed patients, the fear of litigation and perceived low priority of oral health in the context of general health and well-being; (3) access and isolation; referring to access to general medical records, professional isolation and somewhat limited and challenging professional collaborative relationships; (4) interprofessional working; indicating oral health education of other professional groups, collaboration and communication, and a focus on preventive care.

Conclusions: Patients continue to be at risk of developing MRONJ due to limited preventive interventions and relatively disparate contexts of multidisciplinary team healthcare. Effective collaboration, education and access to shared medical records could potentially improve patient safety and reduce the potential risk of developing MRONJ.
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http://dx.doi.org/10.1136/bmjopen-2019-029951DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6597093PMC
June 2019

A feasibility study with embedded pilot randomised controlled trial and process evaluation of electronic cigarettes for smoking cessation in patients with periodontitis.

Pilot Feasibility Stud 2019 4;5:74. Epub 2019 Jun 4.

3Institute of Health & Society, Newcastle University, Newcastle upon Tyne, NE2 4AX UK.

Background: Tobacco smoking is a major risk factor for several oral diseases, including periodontitis, and electronic cigarettes (e-cigarettes) are increasingly being used for smoking cessation. This study aimed to assess the viability of delivering and evaluating an e-cigarette intervention for smoking cessation within the dental setting, prior to a definitive study.

Methods: A feasibility study, comprising a pilot randomised controlled trial and qualitative process evaluation, was conducted over 22 months in the Newcastle upon Tyne Hospitals NHS Dental Clinical Research Facility, UK. The pilot trial comprised a two-armed, parallel group, individually randomised, controlled trial, with 1:1 allocation. Participant eligibility criteria included being a tobacco smoker, having periodontitis and not currently using an e-cigarette. All participants received standard non-surgical periodontal therapies and brief smoking cessation advice. The intervention group additionally received an e-cigarette starter kit with brief training. Proposed outcomes for a future definitive trial, in terms of smoking behaviour and periodontal/oral health, were collected over 6 months to assess data yield and quality and estimates of parameters. Analyses were descriptive, with 95% confidence intervals presented, where appropriate.

Results: Eighty participants were successfully recruited from a range of dental settings. Participant retention was 73% ( = 58; 95% CI 62-81%) at 6 months. The e-cigarette intervention was well received, with usage rates of 90% ( = 36; 95% CI 77-96%) at quit date. Twenty percent ( = 8; 95% CI 11-35%) of participants in the control group used an e-cigarette at some point during the study (against advice). The majority of the outcome measures were successfully collected, apart from a weekly smoking questionnaire (only 30% of participants achieved ≥ 80% completion). Reductions in expired air carbon monoxide over 6 months of 6 ppm (95% CI 1-10 ppm) and 12 ppm (95% CI 8-16 ppm) were observed in the control and intervention groups, respectively. Rates of abstinence (carbon monoxide-verified continuous abstinence for 6 months) for the two groups were 5% ( = 2; 95% CI 1-17%; control group) and 15% ( = 6; 95% CI 7-29%; intervention group).

Conclusions: Data suggest that a definitive trial is feasible and that the intervention may improve smoking quit rates. Insights were gained into how best to conduct the definitive trial and estimates of parameters to inform design were obtained.

Trial Registration: ISRCTN, ISRCTN17731903; registered 19 September 2016 http://www.isrctn.com/ISRCTN17731903.
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http://dx.doi.org/10.1186/s40814-019-0451-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6547559PMC
June 2019

Effect of nicotine on human gingival, periodontal ligament and oral epithelial cells. A systematic review of the literature.

J Dent 2019 07 25;86:81-88. Epub 2019 May 25.

Centre for Oral Health Research, School of Dental Sciences, Newcastle University, UK; National University Centre for Oral Health, National University of Singapore, Singapore.

Objectives: A systematic review was conducted to evaluate the in vitro effects of nicotine on human gingival, periodontal ligament and oral epithelial cells, specifically: cell viability, cell attachment, cell proliferation and inflammatory mediator production.

Materials And Methods: This report followed the PRISMA statement. Two reviewers performed a literature search up to October 2018 in 3 databases: MEDLINE, EMBASE and Web of Science, supplemented by manual searching. Inclusion criteria comprised: in vitro studies evaluating human gingival fibroblasts, human periodontal ligament cells or human gingival/oral epithelial cells; nicotine exposure as a variable; including an appropriate control (no nicotine); published in English. Quality assessment was based on a 15-item checklist.

Results: Of 356 potentially eligible studies, 42 were included. The median quality assessment score was 8/15. Study designs were highly heterogeneous. IC values for nicotine (exposure concentration causing 50% cell death or inhibition of cell growth or other utilised toxicity metric) derived from ten studies ranged from 6 μM to 25 mM. Studies investigating cell attachment, proliferation and inflammatory mediator production suggested that effects can be seen at a wide range of nicotine concentrations, but results were often contradictory.

Conclusions: According to findings from in vitro studies, nicotine, at levels found in tobacco smokers, nicotine replacement therapy users and e-cigarette users, is unlikely to be cytotoxic to human gingival and periodontal cells, though saliva levels in smokeless tobacco users may be high enough to achieve cytotoxicity. There was limited and contradictory evidence for nicotine effects on cell attachment, proliferation and inflammatory mediator production.

Clinical Significance: It is well established that whole tobacco smoke is highly damaging to oral tissues. The specific effects of nicotine are not well understood but are of increasing importance given the recent popularity of novel nicotine products. Increased knowledge on this topic will help to better inform dental professionals and patients.
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http://dx.doi.org/10.1016/j.jdent.2019.05.030DOI Listing
July 2019

Perceptions and attitudes of patients towards medication-related osteonecrosis of the jaw (MRONJ): a qualitative study in England.

BMJ Open 2019 03 3;9(3):e024376. Epub 2019 Mar 3.

School of Medicine, University of Sunderland, Sunderland, UK.

Objective: To explore the impact of medication-related osteonecrosis of the jaw (MRONJ) on quality of life and to explore the attitudes and perceptions of patients towards the multidisciplinary approach to the prevention of the condition.

Design: Interpretivist methodology using qualitative semistructured interviews.

Setting: Primary care general medical practices and secondary care dental services in England.

Participants: 23 patients; 6 with MRONJ, 13 prescribed bisphosphonates, 4 with osteoporosis not currently prescribed any medication.

Results: Patients felt that MRONJ had a significant negative impact on their quality of life and had poor knowledge of the preventive strategies recommended in the literature. Patients demonstrated positive attitudes towards a multidisciplinary approach to care; however, they perceived prescribers as having the key role in articulating risk. Four salient and inter-related themes emerged from the interviews: (1) perception of knowledge, indicating limited awareness of the condition, risk factors and preventive strategies; (2) quality of life, indicating the lived experiences of patients and the physical, psychological and social impacts of MRONJ; (3) interprofessional management, indicating a perceived organisational hierarchy, professional roles and responsibilities, prioritising aspects of care, articulation of risk and communication and (4) wider context, indicating demands on National Health Service resources and barriers to dental care.

Conclusions: MRONJ has a significant detrimental impact on quality of life, yet appropriate preventative education is not apparent. Effective interprofessional patient education and prevention to mitigate against the risk of developing MRONJ is required.
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http://dx.doi.org/10.1136/bmjopen-2018-024376DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6443056PMC
March 2019

An model to assess effects of a desensitising agent on bacterial biofilm formation.

Acta Biomater Odontol Scand 2019 24;5(1):1-8. Epub 2018 Dec 24.

Centre for Oral Health Research, School of Dental Sciences, Newcastle University, Newcastle-Upon-Tyne, England, UK.

Desensitising agents are added to dentifrices to occlude exposed dentine tubules and reduce pain associated with dentine hypersensitivity. In occluding the tubules these agents may alter the surface layer of the dentine and consequently affect bacterial biofilm formation. This research sought to examine the effects of desensitising agents on dentinal biofilms using an in vitro model. A constant depth film fermenter (CDFF) was selected to mimic the oral environment and human dentine with exposed tubules was analysed. Calcium sodium phosphosilicate (CSPS) was selected as a model desensitising agent. Dentine discs were treated with pumice or CSPS-containing dentifrices with or without fluoride, or left untreated (control). Dual-species biofilms of and were grown in artificial saliva and analysed by viable counts, polymerase chain reaction (PCR) and scanning electron microscopy (SEM). SEM images confirmed the presence of occluded tubules after CSPS application and demonstrated the formation of biofilms containing extracellular matrix material. Analysis of PCR and viable count data using a one-way ANOVA showed no significant differences for bacterial composition for any of the four treatments. There were, however, trends towards increased numbers of bacteria for the pumice and CSPS treated samples which was reversed by the addition of fluoride to CSPS. In conclusion, CSPS was not found to have a significant effect on biofilms and an model for testing desensitising agents has been developed, however, further work is required to improve the reproducibility of the biofilms formed and to explore the trends seen.
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http://dx.doi.org/10.1080/23337931.2018.1544847DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6327931PMC
December 2018

Exploring changes in oral hygiene behaviour in patients with diabetes and periodontal disease: A feasibility study.

Int J Dent Hyg 2019 Feb 10;17(1):55-63. Epub 2018 Oct 10.

Centre for Oral Health Research, School of Dental Sciences and Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK.

Objective: Exploring the feasibility to understand changes in oral hygiene behaviour using the Health Action Process Approach (HAPA) model applied to qualitative research interviews in patients with diabetes and periodontitis undergoing standard periodontitis treatment.

Methods: Patients with type 1/2 diabetes and chronic periodontitis (n = 8) received standard non-surgical periodontal treatment accompanied with personalized oral hygiene instructions by a dental hygienist. Clinical indices (% bleeding on probing (BOP), probing depth (PD), clinical attachment level (CAL), % of sites with PD ≥ 5 mm, periodontal epithelial surface area (PESA) and periodontal inflammatory surface area (PISA) were recorded pre- and post-treatment. At 3 months post-treatment, patients were interviewed using a topic guide relating to oral health. A behaviour change framework was constructed from elements of the HAPA model and used directly to map interview data to evaluate oral hygiene behaviour in these patients.

Results: Data from this feasibility study suggest a clinical improvement in periodontal status, albeit only monitored for 3 months. Application of the HAPA model highlighted the behavioural change pathway that diabetes patients undertake before, during and after periodontal treatment. The data suggest that patients move through all elements of the motivation phase and all elements of the volition phase except for the recovery self-efficacy element.

Conclusion: The novel approach of applying the HAPA model to qualitative research data allowed for the collection of richer data compared to quantitative analysis only. Findings suggest that, in general, patients with periodontitis and diabetes successfully manage to incorporate new oral hygiene behaviours into their daily routine.
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http://dx.doi.org/10.1111/idh.12365DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7379549PMC
February 2019

Periodontal manifestations of systemic diseases and developmental and acquired conditions: Consensus report of workgroup 3 of the 2017 World Workshop on the Classification of Periodontal and Peri-Implant Diseases and Conditions.

J Periodontol 2018 06;89 Suppl 1:S237-S248

Research Unit for Oral-Systemic Connection, Division of Oral Science for Health Promotion, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan.

Background: A variety of systemic diseases and conditions can affect the course of periodontitis or have a negative impact on the periodontal attachment apparatus. Gingival recessions are highly prevalent and often associated with hypersensitivity, the development of caries and non-carious cervical lesions on the exposed root surface and impaired esthetics. Occlusal forces can result in injury of teeth and periodontal attachment apparatus. Several developmental or acquired conditions associated with teeth or prostheses may predispose to diseases of the periodontium. The aim of this working group was to review and update the 1999 classification with regard to these diseases and conditions, and to develop case definitions and diagnostic considerations.

Methods: Discussions were informed by four reviews on 1) periodontal manifestions of systemic diseases and conditions; 2) mucogingival conditions around natural teeth; 3) traumatic occlusal forces and occlusal trauma; and 4) dental prostheses and tooth related factors. This consensus report is based on the results of these reviews and on expert opinion of the participants.

Results: Key findings included the following: 1) there are mainly rare systemic conditions (such as Papillon-Lefevre Syndrome, leucocyte adhesion deficiency, and others) with a major effect on the course of periodontitis and more common conditions (such as diabetes mellitus) with variable effects, as well as conditions affecting the periodontal apparatus independently of dental plaque biofilm-induced inflammation (such as neoplastic diseases); 2) diabetes-associated periodontitis should not be regarded as a distinct diagnosis, but diabetes should be recognized as an important modifying factor and included in a clinical diagnosis of periodontitis as a descriptor; 3) likewise, tobacco smoking - now considered a dependence to nicotine and a chronic relapsing medical disorder with major adverse effects on the periodontal supporting tissues - is an important modifier to be included in a clinical diagnosis of periodontitis as a descriptor; 4) the importance of the gingival phenotype, encompassing gingival thickness and width in the context of mucogingival conditions, is recognized and a novel classification for gingival recessions is introduced; 5) there is no evidence that traumatic occlusal forces lead to periodontal attachment loss, non-carious cervical lesions, or gingival recessions; 6) traumatic occlusal forces lead to adaptive mobility in teeth with normal support, whereas they lead to progressive mobility in teeth with reduced support, usually requiring splinting; 7) the term biologic width is replaced by supracrestal tissue attachment consisting of junctional epithelium and supracrestal connective tissue; 8) infringement of restorative margins within the supracrestal connective tissue attachment is associated with inflammation and/or loss of periodontal supporting tissue. However, it is not evident whether the negative effects on the periodontium are caused by dental plaque biofilm, trauma, toxicity of dental materials or a combination of these factors; 9) tooth anatomical factors are related to dental plaque biofilm-induced gingival inflammation and loss of periodontal supporting tissues.

Conclusion: An updated classification of the periodontal manifestations and conditions affecting the course of periodontitis and the periodontal attachment apparatus, as well as of developmental and acquired conditions, is introduced. Case definitions and diagnostic considerations are also presented.
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http://dx.doi.org/10.1002/JPER.17-0733DOI Listing
June 2018

Periodontal manifestations of systemic diseases and developmental and acquired conditions: Consensus report of workgroup 3 of the 2017 World Workshop on the Classification of Periodontal and Peri-Implant Diseases and Conditions.

J Clin Periodontol 2018 06;45 Suppl 20:S219-S229

Research Unit for Oral-Systemic Connection, Division of Oral Science for Health Promotion, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan.

Background: A variety of systemic diseases and conditions can affect the course of periodontitis or have a negative impact on the periodontal attachment apparatus. Gingival recessions are highly prevalent and often associated with hypersensitivity, the development of caries and non-carious cervical lesions on the exposed root surface and impaired esthetics. Occlusal forces can result in injury of teeth and periodontal attachment apparatus. Several developmental or acquired conditions associated with teeth or prostheses may predispose to diseases of the periodontium. The aim of this working group was to review and update the 1999 classification with regard to these diseases and conditions, and to develop case definitions and diagnostic considerations.

Methods: Discussions were informed by four reviews on 1) periodontal manifestions of systemic diseases and conditions; 2) mucogingival conditions around natural teeth; 3) traumatic occlusal forces and occlusal trauma; and 4) dental prostheses and tooth related factors. This consensus report is based on the results of these reviews and on expert opinion of the participants.

Results: Key findings included the following: 1) there are mainly rare systemic conditions (such as Papillon-Lefevre Syndrome, leucocyte adhesion deficiency, and others) with a major effect on the course of periodontitis and more common conditions (such as diabetes mellitus) with variable effects, as well as conditions affecting the periodontal apparatus independently of dental plaque biofilm-induced inflammation (such as neoplastic diseases); 2) diabetes-associated periodontitis should not be regarded as a distinct diagnosis, but diabetes should be recognized as an important modifying factor and included in a clinical diagnosis of periodontitis as a descriptor; 3) likewise, tobacco smoking - now considered a dependence to nicotine and a chronic relapsing medical disorder with major adverse effects on the periodontal supporting tissues - is an important modifier to be included in a clinical diagnosis of periodontitis as a descriptor; 4) the importance of the gingival phenotype, encompassing gingival thickness and width in the context of mucogingival conditions, is recognized and a novel classification for gingival recessions is introduced; 5) there is no evidence that traumatic occlusal forces lead to periodontal attachment loss, non-carious cervical lesions, or gingival recessions; 6) traumatic occlusal forces lead to adaptive mobility in teeth with normal support, whereas they lead to progressive mobility in teeth with reduced support, usually requiring splinting; 7) the term biologic width is replaced by supracrestal tissue attachment consisting of junctional epithelium and supracrestal connective tissue; 8) infringement of restorative margins within the supracrestal connective tissue attachment is associated with inflammation and/or loss of periodontal supporting tissue. However, it is not evident whether the negative effects on the periodontium are caused by dental plaque biofilm, trauma, toxicity of dental materials or a combination of these factors; 9) tooth anatomical factors are related to dental plaque biofilm-induced gingival inflammation and loss of periodontal supporting tissues.

Conclusion: An updated classification of the periodontal manifestations and conditions affecting the course of periodontitis and the periodontal attachment apparatus, as well as of developmental and acquired conditions, is introduced. Case definitions and diagnostic considerations are also presented.
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http://dx.doi.org/10.1111/jcpe.12951DOI Listing
June 2018

Host modulation therapy with anti-inflammatory agents.

Authors:
Philip M Preshaw

Periodontol 2000 2018 02 29;76(1):131-149. Epub 2017 Nov 29.

Host modulation therapy refers to a treatment concept in which drug therapies are used as an adjunct to conventional periodontal treatment to ameliorate destructive aspects of the host inflammatory response. This strategy is not new in the treatment of periodontitis. Previously, nonsteroidal anti-inflammatory drugs have been investigated in this regard, with evidence of reductions in alveolar bone resorption when these drugs are used for prolonged periods of time. However, the risk of significant unwanted effects precludes the use of both nonselective nonsteroidal anti-inflammatory drugs and the selective cyclooxygenase-2 inhibitors as adjunctive treatments for periodontitis. Currently, the only available adjunctive host response modulator that is licensed for the treatment of periodontitis is subantimicrobial dose doxycycline, which functions as an inhibitor of matrix metalloproteinases. Although clinical benefits have been shown in carefully conducted randomized controlled trials, the efficacy of subantimicrobial dose doxycycline in routine clinical practice has yet to be determined. Anti-cytokine therapies have been developed for use in the treatment of rheumatoid arthritis, the pathogenesis of which bears many similarities to that of periodontitis; however, the significant risk of unwanted effects (as well as cost and lack of human trials in the treatment of periodontal diseases) precludes the use of any of the currently available anti-cytokine therapies in the treatment of periodontitis. The identification of pro-resolving lipid mediators as well as small molecule biologicals that influence inflammatory responses offers the best potential, at the present time, for the development of novel host response modulators in periodontal therapy, but much research remains to be done to confirm safety and efficacy.
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http://dx.doi.org/10.1111/prd.12148DOI Listing
February 2018

Attitudes and perceptions of GPs and community pharmacists towards their role in the prevention of bisphosphonate-related osteonecrosis of the jaw: a qualitative study in the North East of England.

BMJ Open 2017 09 29;7(9):e016047. Epub 2017 Sep 29.

Faculty of Health Sciences and Wellbeing, University of Sunderland, Sunderland, UK.

Background: Bisphosphonate-related osteonecrosis of the jaw (BRONJ) is a rare, yet significant, adverse effect of bisphosphonate therapy. A multidisciplinary approach to the prevention of BRONJ is recommended due to the significant morbidity and difficulty treating the condition. Current evidence suggests that both general practitioners (GPs) and community pharmacists have limited knowledge relating to BRONJ and that preventative strategies are rarely implemented.

Objective: To explore the attitudes and perceptions of GPs and community pharmacists on the risks and preventative strategies for the development of BRONJ.

Design: Interpretivist methodological approach using qualitative semistructured interviews.

Participants: 9 community pharmacists and 8 GPs.

Setting: Primary Care in North East England and Cumbria, UK.

Methods: Using a Grounded Theory methodology and integrating a process of constant comparison in the iterative enrichment of data sets, semistructured interviews were undertaken, transcribed and analysed using framework analysis. Salient themes were identified and related back to extant literature in the field.

Results: Four salient and inter-related themes emerged: (1) uncertain knowledge, indicating limited exposure of respondents to BRONJ, and limited awareness of the implications of its diagnosis, risk factors and preventative strategies; (2) patient specific, referring to the complexity of patients, patient education and prioritising aspects of care; (3) wider context, indicating a lack of interdisciplinary communication and referral processes between professions, workload pressures, access and patient receptivity to dental services; and (4) professional, reflecting professional roles and responsibilities, authority and educational initiatives CONCLUSIONS: Effective communication or collaborative care between GPs and community pharmacists for the prevention of BRONJ is not apparent. Interventions to mitigate against the risk of developing BRONJ and clarity of GP and community pharmacy roles are required.
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http://dx.doi.org/10.1136/bmjopen-2017-016047DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5640123PMC
September 2017

Standardized screening for periodontitis as an integral part of multidisciplinary management of adults with type 2 diabetes: an observational cross-sectional study of cohorts in the USA and UK.

BMJ Open Diabetes Res Care 2017 7;5(1):e000413. Epub 2017 Jul 7.

School of Dental Sciences, Centre for Oral Health Research, Newcastle University, Newcastle upon Tyne, UK.

Objective: To determine prevalence and factors predictive of periodontitis by using a standardized assessment model in adults with type 2 diabetes.

Research Design And Methods: We performed an observational cross-sectional study to determine the burden of periodontitis in adults with type 2 diabetes attending urban, ambulatory referral centers in the USA and UK. Full-mouth probing was performed and periodontitis was diagnosed based on either a low (≥5 mm at ≥1 site) or high pocket probing-depth threshold (≥6 mm at ≥1 site). Results were stratified into a five-stage schema and integrated with other clinical variables into the novel Diabetes Cross-Disciplinary Index to function as a balanced health scorecard. Corresponding demographic and routinely collected health data were obtained and comparisons were made between patients with and without periodontitis. Multivariable logistic regression was performed to identify factors predictive of the presence or absence of periodontitis.

Results: Between our two cohorts, 253 patients were screened. Caucasians comprised >90% and Hispanic Americans >75% of the UK and US cohorts, respectively. Males and females were equally distributed; mean age was 53.6±11 years; and 17 (6.7%) were edentulous. Of the 236 dentate patients, 128 (54.2%) had periodontitis by low threshold and 57 (24.2%) by high threshold. Just 17 (7.2%) were periodontally healthy. No significant differences in age, HbA1c, blood pressure, body mass index, low-density lipoprotein cholesterol, or smoking status (all p>0.05) were identified between those with or without periodontitis (regardless of threshold) and none was found to be a significant predictor of disease.

Conclusions: Periodontitis is frequent in adults with type 2 diabetes and all should be screened. Periodontal health status can be visualized with other comorbidities and complications using a novel balanced scorecard that could facilitate patient-clinician communication, shared decision-making, and prioritization of individual healthcare needs.
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http://dx.doi.org/10.1136/bmjdrc-2017-000413DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5530235PMC
July 2017

Dental caries and periodontal diseases in the ageing population: call to action to protect and enhance oral health and well-being as an essential component of healthy ageing - Consensus report of group 4 of the joint EFP/ORCA workshop on the boundaries between caries and periodontal diseases.

J Clin Periodontol 2017 Mar;44 Suppl 18:S135-S144

Department of Operative Dentistry, Charitè - Universitätsmedizin Berlin, Berlin, Germany.

Background: Over the last two decades, progress in prevention and treatment of caries and periodontal diseases has been translated to better oral health and improved tooth retention in the adult population. The ageing population and the increasing expectations of good oral health-related quality of life in older age pose formidable challenges to clinical care and healthcare systems.

Aims: The objective of this workshop was to critically review scientific evidence and develop specific recommendations to: (i) prevent tooth loss and retain oral function through prevention and treatment of caries and periodontal diseases later in life and (ii) increase awareness of the health benefits of oral health as an essential component of healthy ageing.

Methods: Discussions were initiated by three systematic reviews covering aspects of epidemiology of caries and periodontal diseases in elders, the impact of senescence on caries and periodontal diseases and the effectiveness of interventions. Recommendations were developed based on evidence from the systematic reviews and expert opinion.

Results: Key messages included: (i) the ageing population, trends in risk factors and improved tooth retention point towards an expected increase in the total burden of disease posed by caries and periodontal diseases in the older population; (ii) specific surveillance is required to monitor changes in oral health in the older population; (iii) senescence impacts oral health including periodontitis and possibly caries susceptibility; (iv) evidence indicates that caries and periodontal diseases can be prevented and treated also in older adults; (v) oral health and functional tooth retention later in life provides benefits both in terms of oral and general quality of life and in terms of preventing physical decline and dependency by fostering a healthy diet; (vi) oral healthcare professionals and individuals should not base decisions impacting tooth retention on chronological age but on level of dependency, life expectancy, frailty, comfort and quality of life; and (vii) health policy should remove barriers to oral health care for vulnerable elders.

Conclusions: Consensus was reached on specific actionable priorities for public health officials, oral healthcare professionals, educators and workforce planners, caregivers and relatives as well as for the public and ageing patients. Some priorities have major implications for policymakers as health systems need to adapt to the challenge by systemwide changes to enable (promote) tooth retention later in life and management of deteriorating oral health in increasingly dependent elders.
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http://dx.doi.org/10.1111/jcpe.12681DOI Listing
March 2017

Age-related changes in immune function (immune senescence) in caries and periodontal diseases: a systematic review.

J Clin Periodontol 2017 Mar;44 Suppl 18:S153-S177

Division of Oral Microbiology and Immunology, Department of Operative Dentistry, Periodontology and Preventive Dentistry, RWTH Aachen University Hospital, Aachen, Germany.

Aim: To systematically review the evidence regarding immune senescence in the pathogenesis of periodontitis and dental caries.

Methods: A systematic search of electronic databases utilizing medical subject headings (MeSH terms) supplemented by screening of review articles and other relevant texts was undertaken.

Results: Seventy-three articles were included (43 for periodontitis, 30 for caries). Study results were found to be generally heterogeneous. Regarding periodontitis, human studies suggest evidence for altered neutrophil function and increased production of pro-inflammatory mediators (e.g. interleukin-1β, interleukin-6 and prostaglandin E ) in older compared to younger subjects, and animal experiments suggest increased expression of genes that contribute to a pro-inflammatory state in older compared to younger animals. Regarding dental caries, research relating to changes in immune functioning and the impact of ageing is in its infancy. A small number of studies have reported components of innate and adaptive immunity that affect the composition of saliva and dental biofilms with possible impacts on caries progression.

Conclusion: There is evidence that immune functioning related to periodontitis and (less investigated) dental caries alters with increasing age. In both conditions, age-associated mechanistic changes in immune functioning are complex and incompletely understood and it is not clear how these relate to disease susceptibility.
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http://dx.doi.org/10.1111/jcpe.12675DOI Listing
March 2017

EFP Delphi study on the trends in Periodontology and Periodontics in Europe for the year 2025.

J Clin Periodontol 2016 06 10;43(6):472-81. Epub 2016 May 10.

University of Granada, Granada, Spain.

Aim: The aim was to assess the potential trends in Periodontology and Periodontics in Europe that might be anticipated by the year 2025, using the Delphi method.

Material And Methods: The expert opinion of 120 experts was sought through the use of an open-ended questionnaire, developed by an advisory group, containing 40 questions concerning the various trends in periodontology.

Results: The experts (113 responders) expect a stabilization of the prevalence of periodontitis, both for the chronic as well as the aggressive cases, but an increase in implant-related diseases up to the year 2025. Concurrently, the importance of implants is seen to be increasing. They foresee an increased demand for postgraduate periodontology and implantology training. This is mirrored in an increase in publications for implant dentistry and increase in demand and need for training. Concerning the patients, better-informed individuals seeking more routine check-ups are expected.

Conclusion: A continued need for specialized periodontists, but also well trained dental practitioners is foreseen for next decade in Europe. Apart from periodontology they will be increasingly exposed to and trained in implant dentistry.
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http://dx.doi.org/10.1111/jcpe.12551DOI Listing
June 2016