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Perio Reports


Perio Reports  Vol. 23 No. 2
Perio Reports provides easy-to-read research summaries on topics of specific interest to clinicians.
Perio Reports research summaries will be included in each issue to keep you on the cutting edge
of dental hygiene science.
Piezoelectric Scaler More Comfortable

The two most commonly used power scalers are the magnetostrictive and the piezoelectric. These power scalers use different technology to convert power to vibration and each has a different tip stroke – elliptical for the magnetostrictive and linear for the piezoelectric. Both are cooled with water lavage, but the piezoelectric produces less heat than the magnetostrictive. Power scalers remove less root surface structure compared to hand instruments. Research is lacking comparing these two power scalers for effectiveness and patient comfort.

Researchers at Baylor College of Dentistry compared the magentostrictive (Cavitron) and the piezoelectric (EMS) in a group of 75 patients with early to severe periodontal disease to determine patient perceptions of pain, vibration and noise. The first 37 patients were treated with the Cavitron on the right side and the EMS on the left side. The remaining study subjects were treated with the power scalers on opposite sides of the mouth. The dental hygiene clinician began treatment on the right side for all patients and each side was treated for approximately 30 minutes.

After each half-mouth treatment, subjects were asked to rate pain, vibration and noise experience using a visual analog scale. They put a mark on a line from zero to 100 to reflect their experience. Zero being no pain and 100 being the worst pain ever.

Patients reported no difference between the Cavitron and the EMS for noise. Scores for pain and vibration were lower in the EMS group compared to the Cavitron group.

Clinical Implications: When you have both a magnetostrictive and a piezoelectric power scaler in your operatory, patients might find the piezoelectric more comfortable.

Muhney, K., Dechow, P.: Patients' Perception of Pain During Ultrasonic Debridement: A Comparison Between Piezoelectric and Magnetostrictive Scalers. JDH 84: 185-189, 2010.
Nurse Practitioners Screening for Perio

Research confirms an oral-systemic link, as stated in 2000, by Surgeon General David Satcher, ''Oral health and general health are inseparable… the mouth is a portal of entry for infections that can affect local tissues and may spread to other parts of the body.'' Despite growing evidence in medical and dental journals of the oral-systemic link, medical professionals lack information and actions reflecting that link. A study of internal medicine trainees found them unprepared to screen or discuss periodontal health as it related to general health. Only two percent reported screening their patients for periodontal disease.

Researchers at the University of Missouri-Kansas City assessed the willingness to screen patients for periodontal disease among a group of medical-care providers, the majority being nurse practitioners (NP), since they are likely to engage patients in a discussion of oral-systemic health. Written questionnaires were given to 200 medical care providers attending a women's health conference, with 137 returned. Some questions focused on knowledge of periodontal disease and the link with general health and others evaluated attitudes, opinions, practice behaviors and perceived competency to screen and refer for periodontal disease.

Ninety percent of the respondents were NP with an average of 15 years of experience. Twenty-two percent reported routinely screening for periodontal disease and they were also more confident in their education.

Clinical Implications: Medical and dental educational institutions are in a unique position to work together creating interdisciplinary opportunities to bring the latest research and knowledge about the oral-systemic connection to students pursuing various medical and dental careers.

Ward, A., Cobb, C., Kelly, P., Walker, M., Williams, K.: Application of the Theory of Planned Behavior to Nurse Practitioners' Understanding of the Periodontal Disease- Systemic Link. J Perio 81: 1805-1813, 2010
Treatment Safe for Pregnant Women

Many studies have evaluated the association between periodontal disease and premature, low birth-weight babies, but none have demonstrated a direct cause and effect. Such a study would be lengthy, expensive and difficult to complete. One barrier to undertaking this study is the random assignment of pregnant women with periodontal disease to the no-treatment control group. Ethics committees find this unacceptable.

Researchers at Feira de Santana State University, in Bahia, Brazil devised a study design to avoid assigning a control group. The group of pregnant women with untreated periodontal disease was identified after giving birth. Seven days after giving birth, a periodontal examination was provided and those with periodontal disease were recruited as controls. Birth weights of their babies were recorded.

A group of periodontally healthy pregnant mothers and a group of pregnant mothers with periodontal disease were the test groups. Those with periodontal disease were treated with SRP and seen monthly during their pregnancy for follow-up care. The healthy subjects were also seen monthly for prophylaxis to maintain oral health.

The rate of low birth-weight was 11 percent in both the treated periodontal group and the healthy group. It was twice as high in the untreated periodontal group, although this group also had more risk factors for pre-term, low birthweight deliveries.

Although this study does not show benefit from periodontal therapy in preventing pre-term, low birth-weight babies, it does confirm that periodontal therapy is safe for pregnant women.

Clinical Implications: This is additional evidence that treating pregnant women for periodontal disease during pregnancy is safe.

Gomes-Filho, I., Cruz, S., Costa, M., Passos, J., Cerqueira, E., Sampaio, F., Pereira, E., Miranda, L.: Periodontal Therapy and Low Birth Weight: Preliminary Results from an Alternative Methodologic Strategy. J Perio 81:1725-1733, 2010.
Dental Hygiene Care Prevents Disease

Early intervention during pregnancy and as the first teeth develop is the best time to provide oral health education and preventive dental care.

Researchers at the Hannover Medical School in Hannover, Germany designed a four-phase study over 14 years to provide oral health education and dental care to pregnant mothers and their children. Phase one included education of pregnant mothers. Phases two and three provided preventive care for mothers and children until age three and age six. This report is of phase four, evaluation of the children at 13-14 years of age whose dental care was provided by their family dentist since age six. An age-matched control group was randomly selected from a nearby high school.

At age three, all of the children were caries-free and without fillings and with no detectable Strep mutans, compared to 82 percent caries- and filling-free in the control group. At age six, 75 percent of the test group was still caries- and filling-free, compared to 50 percent in the control group.

The study began with 86 mother-child pairs, but due to relocation, 29 adolescents were available for phase four. Sixty-six percent were caries and filling-free, 24 percent were caries-free with fillings and three teenagers had active caries. In the control group, 30 percent were caries- and filling-free, 27 percent caries-free with fillings and 13 had active caries. The test group visited the dentist more often than the controls.

Clinical Implications: Oral health education and dental care during pregnancy and early childhood will influence the future oral health of the children.

Meyer, K., Geurtsen, W., Günay, H.: An Early Oral Health Care Program Starting During Pregnancy: Results of a Prospective Clinical Long-Term Study. Clin Oral Invest 14: 257-264, 2010.
Needle Breakage

Although needle breakage is an infrequent complication of local anesthesia today, when it does happen, it carries potentially serious complications. Since the 1960s, disposable stainless steel needles have been regulated by the International Organization for Standardization. The use of disposable needles, advances in metallurgy and better anesthesia training are responsible for fewer broken needles. Needle breakage now is due to using inappropriate injection techniques or choosing the wrong needle. In 1955, Monoject, the first disposable plastic needle was introduced, followed in 1956 by a plastic, disposable syringe, replacing glass syringes.

Researchers at the University of Zurich in Switzerland reviewed the literature from 1900 until today for needle breakage. They focused on disposable needle breakages from 1966 to the present, realizing that most needle breaks go unreported. Of the cases reported, 23 patients were under 16 years old and 40 patients were older than 16 years old, with an average age for all of 28 years old, and a range from three to 71 years.

The majority (70 percent) of needles broke during inferior alveolar nerve block injections. Other needle fractures occurred in buccal areas and a few occurred during intraosseous injections. Reasons for needle breakage include unexpected patient movement, use of 30-gauge, short needles for block injections and needle bending, especially at the hub.

Clinical Implications: A few rules to follow to avoid needle breakage – use a needle of sufficient dimension (25-27 gauge) and at least 35mm in length for the inferior alveolar injections, leave at least 5mm of the needle outside the tissue and avoid bending needles at the hub.

Augello, M., vonJackowski, J., Grätz, W., Jacobsen, C.: Needle Breakage During Local Anesthesia in the Oral Cavity - A Retrospective of the Last 50 Years with Guidelines for Treatment and Prevention. Clin Oral Invest 14: online July 13, 2010.
The Future of Salivary Perio Tests

Traditionally, periodontal diagnosis has included probing depths, bleeding on probing, attachment loss and radiographic findings. The future will bring chairside diagnostics using either saliva or crevicular fluid. Saliva is the most likely for several reasons: collection is rapid, non-invasive and it is readily abundant. Saliva testing would be the easiest for both dental office and home testing. Biomarkers being evaluated currently are associated with inflammation, collagen breakdown and bone remodeling. Biomarkers of periodontal disease might be elevated due to the presence of systemic inflammation from rheumatoid arthritis.

Researchers at the University of Kentucky in Lexington compared clinical examinations and salivary samples from three age- and sex-matched groups. Each group consisted of 35 adults: 1) periodontally healthy, 2) chronic periodontal disease and 3) rheumatoid arthritis. The goal was to determine the influence of rheumatoid arthritis on three salivary biomarkers for periodontitis: interleukin-1 (IL-1), tumor neucrosis factor (TNF) and matrix metalloproteinase- 8 (MMP-8).

The arthritis and healthy groups had less periodontal disease than the perio group, however the arthritis group had more bleeding than the healthy group. MMP-8 and IL-1 were higher in saliva for those with periodontitis. IL-1 was higher for those with arthritis than the healthy controls. Periodontal disease is associated with higher levels of IL-1 and MMP-8. Increased IL-1 levels in arthritis patients compared to healthy controls indicates that systemic inflammatory disease markers are detected in saliva.

Clinical Implications: The future will bring chairside saliva tests. With more research, the extent to which rheumatoid arthritis influences biomarkers for periodontitis will be determined.

Mirrielees, J., Crofford, L., Lin, Y., Kryscio, R., Dawson, D., Ebersole, J., Miller, C.: Rheumatoid Arthritis and Salivary Biomarkers of Periodontal Disease. J Clin Perio 37: 1068-1074, 2010.
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