Special-needs patients.

Journal of the American Dental Association (1939) (Impact Factor: 2.01). 12/2005; 136(11):1512. DOI: 10.14219/jada.archive.2005.0070
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Available from: Frank Scannapieco, Oct 09, 2015
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    ABSTRACT: Type 2 diabetes mellitus, which afflicts 15 million Americans, is associated with accelerated cervical carotid artery atherosclerosis and a heightened risk of stroke. This study attempted to determine the prevalence of calcified atherosclerotic lesions in a group of patients with type 2 diabetes mellitus. The panoramic radiographs of 49 men (age range, 55 to 81; mean age, 66.2 years) receiving routine dental treatment and insulin for diabetes at a Department of Affairs Veterans clinic were evaluated for calcified atheromas. Age-match controls, free of diabetes, were assessed in a like manner. Statistical comparison of the atheroma prevalence rates was by means of the Fisher exact test, and statistical comparison of atherogenic risk factors was by means of t test with Bonferroni adjustment and, where necessary, the Mann-Whitney U test. The radiographs of the diabetics (mean age, 66.9 years) revealed that 20.4% had atheromas whereas those of the controls (mean age, 68.1 years) demonstrated that 4% had atheromas (a statistically significant difference; P =.0275). Also statistically significant was the prevalence of atherogenic risk factors (plasma glucose, low-density lipoproteins, and serum triglycerides) identified in the diabetic group. The radiographic appearance of the atheromas manifested by both groups of individuals, however, was similar, with the lesions located 1.5-2.5 cm inferior-posterior to angle of the mandible. People with type 2 diabetes have a greater prevalence of calcified atheromas on their panoramic radiographs than do nondiabetics.
    Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontology 05/2000; 89(4):420-4. DOI:10.1016/S1079-2104(00)70122-3 · 1.46 Impact Factor
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    ABSTRACT: This study was designed to explore the effect of periodontal therapy on glycemic control in persons with type 2 diabetes mellitus (DM). 36 patients with type 2 DM (treatment group) received therapy for adult periodontitis during an 18-month period. A 36-person control group was randomly selected from the same population of persons with type 2 DM who did not receive periodontal treatment. These groups were well matched for most of the parameters investigated. During the nine-month observation period, there was a 6.7% improvement in glycemic control in the control group when compared to a 17.1% improvement in the treatment group, a statistically significant difference. Several parameters that could confound or moderate this glycemic control were explored. These included the treatment of non-dental infections, weight and medication changes. No moderating effect was associated with any of these variables. However, there were too few subjects in the study to have the statistical power necessary to assess these possible moderators of glycemic control. We interpret the data in the study to suggest that periodontal therapy was associated with improved glycemic control in persons with type 2 DM.
    Journal Of Clinical Periodontology 05/2001; 28(4):306-10. DOI:10.1034/j.1600-051x.2001.028004306.x · 4.01 Impact Factor
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    ABSTRACT: Several recent studies provide evidence that the oral cavity may influence the initiation and/or the progression of lung diseases such as pneumonia and chronic obstructive pulmonary disease (COPD). Studies have shown that poor oral hygiene and periodontal disease may foster colonization of the oropharyngeal region by respiratory pathogens, particularly in hospital or nursing home patients. If aspirated, these pathogens can cause pneumonia, one of the most common respiratory infections, especially in institutionalized subjects. Other cross-sectional epidemiologic studies point to an association between periodontal disease and COPD. This systematic review examines the literature to determine if interventions that improve oral hygiene reduce the rate of pneumonia in high-risk populations. Do periodontal diseases or other indicators of poor oral health influence the initiation/progression of pneumonia or other lung diseases? MEDLINE, pre-MEDLINE, MEDLINE Daily Update, and the Cochrane Controlled Trials Register were searched to identify published studies that related variables associated with pneumonia and other lung disease to periodontal disease. Searches were performed for articles published in English from 1966 through March 2002. Randomized controlled clinical trials (RCTs), longitudinal, cohort, and case-control studies were included. Study populations included patients with any form of pneumonia or chronic obstructive pulmonary disease (COPD) and periodontal disease, as measured by assessments of gingival inflammation, probing depth, clinical attachment level, and/or radiographic bone loss, or oral hygiene indices. Limited to studies of humans. The summary statistics used to analyze the RCTs included weighted mean differences in rates of disease between control and intervention groups. For cohort studies that measured differences in rates of disease between groups with and without oral disease, weighted mean differences, relative risks, or odds ratios were compared. A meta-analysis was performed on the 5 intervention studies to determine the relationship between oral hygiene intervention and rate of pneumonia in institutionalized patients. Of the initial 1,688 studies identified, 36 satisfied all inclusion criteria and were read. Of these, 21 (11 case-control and cohort studies [study population 1,413] and 9 RCTs [study population 1,759]) were included in the analysis. 1. A variety of oral interventions improving oral hygiene through mechanical and/or topical chemical disinfection or antibiotics reduced the incidence of nosocomial pneumonia by an average of 40%. 2. Several studies demonstrated a potential association between periodontal disease and COPD. 1. Oral colonization by respiratory pathogens, fostered by poor oral hygiene and periodontal diseases, appears to be associated with nosocomial pneumonia. 2. Additional large-scale RCTs are warranted to provide the medical community with further evidence to institute effective oral hygiene procedures in high-risk patients to prevent nosocomial pneumonia. 3. The results associating periodontal disease and COPD are preliminary and large-scale longitudinal and epidemiologic and RCTs are needed.
    Annals of Periodontology 01/2004; 8(1):54-69. DOI:10.1902/annals.2003.8.1.54