• Can treating oral inflammation lead to the reduction in a systemic outcome? A systematic review looking into pregnancy and diabetes.

      Guy, Veronica; Oates, Thomas W. (2018)
      The contribution of periodontal disease to the development of adverse systemic consequences remains controversial. It is hypothesized that inconsistencies between studies is due in part to limitations in study design. This review assessed systemic conditions including adverse pregnancy outcomes and glycemic control for patients with diabetes in a combined manner based on a shared inflammatory mechanism of consequence. It is thought that the systemic consequences of periodontal inflammation can directly influence these systemic conditions. Therefore, this systematic review aimed to evaluate the consideration of the patients' medical management during the study and also the number of study participants as two important factors influencing the study outcomes. An article search was performed using OVID Medline, Cochrane library and EMBASE and a manual search was performed through November 2017. Randomized controlled trials published between 2000 and 2017 looking into the effectiveness of periodontal therapy on the rate of pre-term birth in a pregnant population and on glycated hemoglobin A1c in a type 2 diabetics were included. Primary outcomes were changes in HbA1c and differences in frequency of occurrence of pre-term birth. Medical management of the systemic condition under study was categorized from 0-3, based on stringency of study design and consideration for medical management during study participation. Risk of bias regarding randomization, allocation of sequence concealment, blinding, incomplete outcome data, selective outcome reporting and other biases were averaged using a cumulative assessment of factors considered in prior systematic reviews with shared studies. After article selection, randomized controlled trials including 17 on diabetes and 13 on pregnancy were combined for evaluation. Both increased sample size (R2=0.09, R value = 0.3) and improved stringency of medical management (Figures 13 & 14) were associated with diminished effects of periodontal therapy on systemic outcomes. Interestingly, risk of bias as assessed in previous systematic reviews showed a modest correlation (R2=0.104, R value= 0.32) with primary outcomes. This systematic review demonstrates that the disparate results in studies of periodontal therapy affecting systemic outcomes may be explained in part by study design, specifically stringency in consideration of medical management and sample size. The potential for confounding factors influencing outcomes remains a concern.
    • Effects of Glycemic Control on Dental Implant Stabilization for Patients with Type 2 Diabetes

      Slevin, Terry; Oates, Thomas W. (2017)
      This study evaluated the effects of hyperglycemia on dental implant integration using resonance frequency analysis in 161 patients over a four-month period following placement of two mandibular implants. HbA1c levels were determined at the time of surgery, two and four months following placement. Stability was normalized relative to the change from baseline. Implant stability was analyzed for associations relative to HbA1c categories (<6%, 6.0-7.9%, 8.0-9.9%, 10.0-12.0%). Statistically significant differences were noted with respect to change in RFA relative to HbA1c and time with the poorly controlled group showing the greatest mean decrease in stability (p<0.001). The calculated time for implants to return to baseline levels of stability increased in direct proportion to increasing hyperglycemia, with the poorly controlled group taking twice as long to return to baseline as the control group. This study demonstrates important compromises in implant stabilization in type 2 diabetic patients in direct relation to increasing HbA1c levels consistent with alterations in bone healing for patients with worsening glycemic control.
    • Effects of Glycemic Control on Soft Tissue Wound Healing around Dental Implants for Patients with Type 2 Diabetes

      Hurwitz, Morgan Barker; Oates, Thomas W. (2019)
      This study evaluated the effects of glycemic status on soft tissue wound healing following dental implant placement. A total of 164 edentulous patients with HbA1c levels up to 11.5% received two mandibular transmucosal dental implants. Patients’ self-reported pain (VAS and # days with pain) and soft tissue healing (edema, erythema, exudate, oral pain, flap closure, infection, and hematoma) were evaluated one week after placement. HbA1c and diabetes status were not significantly associated with any soft tissue healing complications. Pain_VAS was significantly correlated with Edema, Infection, Days in Pain and Oral Pain. Flap Closure was correlated with Oral Pain. Infection was correlated with Oral Pain and Days_Pain. Stepwise regression also identified HbA1c as significantly contributing to the VAS pain score. The findings of this study clarify the low risk for post-surgical healing complications independent of poor glycemic control, extending the opportunities for dental implant therapy for patients with diabetes.
    • Improved oral health quality of life and satisfaction with implant-supported overdentures for patients with type 2 diabetes

      Herrero, Frances; Oates, Thomas W. (2018)
      Diabetes mellitus is considered a relative contraindication to implant therapy. Recent studies suggest risks may be less than previously thought. The potential benefits for diabetic patients remains to be determined. The goal of this study was to examine the benefits of implant-supported mandibular overdentures (IOD) for patients with type 2 diabetes. One hundred fifty-seven patients received two mandibular implants. Patients completed an Oral Health-Related Quality of Life (OHRQoL), a Patient Satisfaction questionnaire, and HbA1c was measured at baseline and six and twelve months after restoration. Sixty-three patients reported no diabetes, 65 patients were well controlled (6.1%< HbA1c <8.1%) and 29 were poorly controlled (8.1%< HbA1c <12.0%). IOD treatment resulted in significantly higher OHRQoL summary scores and general satisfaction (100mm VAS) compared to baseline across all patient groups. No statistically significant changes in HbA1c were observed after treatment. Patients with diabetes benefit from IOD independent of glycemic status.
    • Knowledge, Perceptions and Behavior regarding E-cigarettes among Dental Practitioners

      Joshi, Shashank; Oates, Thomas W. (2018)
      Background: The increased use of e-cigarettes represents an emerging concern for dental practitioners with the potential to impact clinical care. The concerns for, and effects of, e-cigarettes remain poorly understood, especially with long-term use. Given current limits to our understanding of the effects of e-cigarette use, the goal of this study was to assess the level of concern among dental practitioners and the effects of these concerns on the care provided for patients using e-cigarettes. Methods: Dental practitioners (n=187) in Maryland completed a 28-item survey of e-cigarette knowledge, perception and their current clinical practices for patients using e-cigarettes. A knowledge score was computed, and associations between participant demographic characteristics and knowledge survey items, perception survey items and knowledge score levels, and behavior survey items and knowledge score levels were explored. Results: Most practitioners do not see or do not ask patients about E-cigarette use (33%), switching from conventional cigarette to E-cigarette use (38%) or dual use (55%). Majority of practitioners classified as medium to high knowledge 75% (141/187), felt they were well-informed and have up to date knowledge about E-cigarettes compared to 25% classified as low knowledge (46/187). Practice behaviors were not significantly different across knowledge score groupings. High knowledge groups modified their practice behavior positively in all the categories, except high knowledge group did not feel concerned with recommending dental implants in e-cigarette smokers (mode=5). Low knowledge group consistently had negative practice behavior except more positive response within the group for recommending stopping of E-cigarettes before invasive procedures was observed (mode = 5). Conclusions: The evidence and knowledge about e-cigarette risks on oral health is lacking and is not yet fully influencing practice behaviors. This study reinforces the value of disseminating and translating this evidence to dental practitioners through early inclusion of this topic in dental and hygiene training programs and through continuing education courses.