Elizabeth Krall Kaye

Age-dependent associations between chronic periodontitis/edentulism and risk of coronary heart disease.

Background— Several epidemiological studies have suggested periodontitis as a risk factor for coronary heart disease (CHD), but results have been inconsistent. Methods and Results— We evaluated the association between clinical and radiographic measures of periodontitis, edentulism, and incident CHD (angina, myocardial infarction, or fatal CHD) among 1203 men in the VA Normative Aging and Dental Longitudinal Studies who were followed up with triennial comprehensive medical and dental examinations up to 35 years (median 24 years). Cox proportional hazards models with time-varying effects of exposure and potential confounders were fit. We found a significant dose-dependent association between periodontitis and CHD incidence among men <60 years of age (hazard ratio 2.12, 95% confidence interval 1.26 to 3.60 comparing highest versus lowest category of radiographic bone loss, P for trend=0.02), independent of age, body mass index, smoking, alcohol intake, diabetes mellitus, fasting glucose, total cholesterol, high-density lipoprotein cholesterol, triglycerides, hypertension, systolic and diastolic blood pressure, education, marital status, income, and occupation. No association was found among men >60 years of age. Similar results were found when the sum of probing pocket depths was used as a measure of periodontitis. Among men ≥60 years of age, edentulous men tended to have a higher risk of CHD than dentate men in the lowest bone loss (hazard ratio 1.61, 95% confidence interval 0.95 to 2.73) and lowest pocket depth (hazard ratio 1.72, 95% confidence interval 1.03 to 2.85) categories, independent of confounders. Conclusions— Chronic periodontitis is associated with incidence of CHD among younger men, independent of established cardiovascular risk factors.

Complications of total elbow replacement: A systematic review

Total elbow arthroplasty (TEA) is becoming an increasingly popular reconstructive procedure. Improved surgical techniques, newer implant designs, and improving clinical results have each contributed to the rise in prevalence of this surgical intervention. Themost common indication remains rheumatoid arthritis (RA). However, with the advent of semiconstrained prostheses, the indications have expanded to include post-traumatic sequelae such as instability and arthritis, as well as acute comminuted distal humerus fractures in the elderly. The rate of complications following TEA, ranging from 20% to 45%, is higher than in other large joint replacements. In their review of the literature, Gschwend et al reported a complication rate of 43% including aseptic loosening, infections, ulnar nerve complications, instability, disassembly, dislocation, subluxation, intraoperative fractures, fractures of the prosthesis, and ectopic bone formation. In order to reduce these complications, a variety of technical advances have been made within the last decade in the areas of prosthetic design and surgical technique. Fully constrained prostheses have fallen out of favor due to their high rates of aseptic loosening. They have been largely replaced by linked and unlinked components. The linked prostheses are semi-constrained and utilize ‘‘sloppy hinges,’’ which both decrease the rate of aseptic

Does the Graft Source Really Matter in the Outcome of Patients Undergoing Anterior Cruciate Ligament Reconstruction? An Evaluation of Autograft Versus Allograft Reconstruction Results: A Systematic Review

Background Despite the large number of anterior cruciate ligament reconstructions performed each year, there remains a significant controversy regarding the effect of the graft source on the functional outcome of patients. Hypothesis There is no difference in outcomes of autograft versus allograft anterior cruciate ligament reconstructions. Study Design Systematic review. Methods The authors systematically identified prospective studies (Oxford level of evidence I or II only) that included autograft patients, allograft patients, or both. Objective outcomes that were reported were meta-analyzed; this included pivot-shift results, KT-1000 arthrometer results, International Knee Documentation Committee (IKDC) scores, Lysholm Scores, graft failures, and postoperative complications. Two statistical analyses were performed. First a primary statistical analysis was performed comparing pooled autograft data (bone–patellar–tendon bone and hamstrings combined) and pooled allograft data (bone–patellar–tendon bone and hamstrings combined). To have a more comprehensive understanding of the differences between each specific graft source, a secondary analysis was performed without pooling the data; this directly compared the 4 types of graft sources that were studied. Results Over 400 scientific manuscripts were initially reviewed; 31 manuscripts fulfilled all of the search criteria. There were very few statistically significant differences between autograft and allograft tissue. The KT-1000 arthrometer laxity testing revealed a mean of 1.4 ± 0.2 mm (weighted mean ± standard error of the mean) for the allograft group compared with 1.8 ± 0.1 mm for the autograft group (t = 2.40; P < .02). However, this difference was only for the mean score; there was no statistical significance when considering KT-1000 arthrometer measurements of greater than 3 or 5 mm. The percentage of patients receiving a final IKDC score of “A” (normal knee) was statistically significant for allograft tissue (43.9% ± 5.5%) versus autograft tissue (28.2% ± 1.0%) reconstructions. There was no statistically significant difference between the percentages of IKDC scores of A or B for patients receiving pooled allograft (82.9% ± 4.2%) versus pooled autograft (87.2% ± 0.9%) anterior cruciate ligament reconstruction (t = 1.01; P > .1). The graft failure rate was 4.7 ± 0.5 per 100 for autograft reconstructions and 8.2 ± 2.1 per 100 allograft reconstructions; although this may represent a trend, it is not statistically significant (t = 1.49; P > .1). The complication rate was slightly higher for autograft reconstructions at 3.5 ± 0.4 complications per 100 autograft reconstructions compared with 2.4 ± 1.1 complications per 100 allograft reconstructions, but not significant (t = 1.41; P > .1). Conclusion After a comprehensive examination and statistical analysis of the modern literature, the authors could not identify an individual graft source that was clearly superior to the other graft sources. This led them to believe that, with currently available data, the graft source has a minimal effect on the outcome of patients undergoing anterior cruciate ligament reconstruction.

Arthroscopic Versus Mini-open Rotator Cuff Repair A Comprehensive Review and Meta-analysis

Background Controversy remains regarding the results of all arthroscopic rotator cuff repairs compared with the mini-open approach. The purpose of this study was to perform a comprehensive literature search and meta-analysis of clinical trials comparing the results of arthroscopic rotator cuff repairs and mini-open rotator cuff repairs. Hypothesis There is no difference between the clinical results obtained from all arthroscopic rotator cuff repairs compared with mini-open repairs. Study Design Meta-analysis. Methods A computerized search of articles published between 1966 and July 2006 was performed using MEDLINE and PubMed. Additionally, a search of abstracts from 4 major annual meetings each held between 2000 and 2005 was performed to identify Level I to III studies comparing the results of arthroscopic rotator cuff repair and mini-open repair. Studies that included follow-up of an average of over 2 years and a minimum of 1 year and included the use of 1 of 4 validated functional outcome scores used to study shoulder injuries were included in the present meta-analysis. All outcome scores were converted to a 100-point scale to allow for outcome comparison. Results Five studies that met the inclusion criteria were identified. There was no difference in functional outcome scores or complications between the arthroscopic and mini-open repair groups. Conclusion Based on current literature, there was no difference in outcomes between the arthroscopic and mini-open rotator cuff repair techniques.

Tooth Loss and Periodontal Disease Predict Poor Cognitive Function in Older Men

OBJECTIVES: To determine whether rates of tooth loss, periodontal disease progression, and caries incidence predict cognitive decline in men.

Does Double-Row Rotator Cuff Repair Improve Functional Outcome of Patients Compared With Single-Row Technique? A Systematic Review

Background: The advantage of single-row versus double-row arthroscopic rotator cuff repair techniques has been a controversial issue in sports medicine and shoulder surgery. There is biomechanical evidence that double-row techniques are superior to single-row techniques; however, there is no clinical evidence that the double-row technique provides an improved functional outcome. Hypothesis: When compared with single-row rotator cuff repair, double-row fixation, although biomechanically superior, has no clinical benefit with respect to retear rate or improved functional outcome. Study Design: Systematic review. Methods: The authors reviewed prospective studies of level I or II clinical evidence that compared the efficacy of single- and double-row rotator cuff repairs. Functional outcome scores included the American Shoulder and Elbow Surgeons (ASES) shoulder scale, the Constant shoulder score, and the University of California, Los Angeles (UCLA) shoulder rating scale. Radiographic failures and complications were also analyzed. A test of heterogeneity for patient demographics was also performed to determine if there were differences in the patient profiles across the included studies. Results: Seven studies fulfilled our inclusion criteria. The test of heterogeneity across these studies showed no differences. The functional ASES, Constant, and UCLA outcome scores revealed no difference between single- and double-row rotator cuff repairs. The total retear rate, which included both complete and partial retears, was 43.1% for the single-row repair and 27.2% for the double-row repair (P = .057), representing a trend toward higher failures in the single-row group. Conclusion: Through a comprehensive literature search and meta-analysis of current arthroscopic rotator cuff repairs, we found that the single-row repairs did not differ from the double-row repairs in functional outcome scores. The double-row repairs revealed a trend toward a lower radiographic proven retear rate, although the data did not reach statistical significance. There may be a concerning trend toward higher retear rates in patients undergoing a single-row repair, but further studies are required.

Overweight and Obesity Predict Time to Periodontal Disease Progression in Men

AIMS To examine whether overweight and obesity indicators - body mass index (BMI), waist circumference (WC), and WC-to-height ratio - predict progression of periodontal disease in men. MATERIAL AND METHODS Participants were 1038 medically healthy, non-Hispanic, white males in the VA Dental Longitudinal Study who were monitored with triennial oral and medical examinations between 1969 and 1996. Periodontal disease progression in an individual was defined as having two or more teeth advance to levels of alveolar bone loss ≥40%, probing pocket depth ≥5 mm, or clinical attachment loss ≥5 mm after baseline. Extended Cox regression analyses estimated hazards of experiencing periodontal disease progression events due to overweight/obesity status, controlling for age, smoking, education, diabetes, recent periodontal treatment, recent prophylaxis, and number of filled/decayed surfaces. RESULTS Body mass index and WC-to-height ratio were significantly associated with hazards of experiencing periodontal disease progression events regardless of periodontal disease indicator. Adjusted hazard ratios for periodontal disease progression were 41-72% higher in obese men (BMI ≥30 kg/m(2)) relative to men with both normal weight and WC-to-height ratio (≤50%). CONCLUSION Both overall obesity and central adiposity are associated with an increased hazards of periodontal disease progression events in men.

Retained Asymptomatic Third Molars and Risk for Second Molar Pathology

Prophylactic extraction of unerupted asymptomatic third molars is the most common oral surgery procedure in the United States. However, limited evidence exists to justify its costs and associated morbidity. We analyzed data collected over 25 years from 416 adult men enrolled in the Veterans Affairs Dental Longitudinal Study to evaluate the association of retained asymptomatic third molars with risk of adjacent second molar pathology (caries and/or periodontitis), based on third molar status (i.e., absent, erupted, or unerupted). Unerupted molars were further categorized as either “soft tissue” or “bony” impacted. We found that the lowest prevalence and incidence of second molar pathology occurred when the adjacent third molar was absent. The presence of a third molar that was soft tissue impacted increased the risk of incident second molar pathology 4.88-fold (95% confidence interval: 2.62, 9.08). Having an erupted or “bony” impacted third molar increased the risk of incident second molar pathology by 1.74 (95% confidence interval: 1.34, 2.25) and 2.16 (95% confidence interval: 1.56, 2.99), respectively. The retention of third molars is associated with increased risk of second molar pathology in middle-aged and older adult men.

Vitamin D and Periodontal Health in Older Men

Vitamin D, an anti-inflammatory mediator, has potential benefits for physical and oral health. Although it is produced endogenously, some individuals have a greater need for dietary and supplemental sources. This repeated-measures cross-sectional study assessed associations between total vitamin D intake and periodontal health in older men. Participants were 562 members of the Department of Veterans Affairs Dental Longitudinal Study, mean age 62.9 years, who were examined 1 to 4 times between 1986 and 1998. A calibrated examiner measured probing pocket depth (PPD) and attachment loss (AL) on each tooth. Alveolar bone loss (ABL) was determined from radiographs. Severe periodontal disease was defined as PPD ≥ 5 mm on ≥ 1 tooth and AL ≥ 6 mm at ≥ 2 sites (not on same tooth), and moderate-to-severe alveolar bone loss as ABL ≥ 40% at ≥ 3 sites. Generalized estimating equations were used to compute the odds ratios (OR) and 95% confidence intervals (95% CI) of having periodontal disease by level of vitamin D intake. Total vitamin D intake ≥ 800 IU was associated with lower odds of severe periodontal disease (OR = 0.67, 95% CI = 0.55-0.81) and moderate-to-severe ABL (OR = 0.54, 95% CI = 0.30-0.96) relative to intake < 400 IU/day. Vitamin D intake may protect against periodontal disease progression.

Active and passive smoking: assessment issues in periodontal research

Tobacco use, particularly active cigarette smoking, is a strong modifiable risk factor for periodontitis. Our primary aim is to provide a systematic review of the impact of environmental tobacco smoke on periodontal diseases. Nine publications were identified by electronic literature search up to September 2010. Epidemiological data for a US population sample and a cohort of Japanese men suggest that environmental tobacco smoke exposure may be associated with increase periodontitis prevalence and increased risk of periodontitis progression. Secondly, several methodological issues related to cigarette smoking in clinical and epidemiological research studies are discussed. Tobacco use history is a multi-dimensional phenomenon, with characteristics such as intensity, duration and time since cessation. Understanding these complexities of smoking history and accurate measurement of the exposure, using biomarkers and/or self-reported data as appropriate, are of central importance in clinical and epidemiological studies on the effects of active and passive smoking. The most appropriate approach to assess smoking exposure will vary according to the purpose and design of a particular study.