J. S. Ellis

A Randomized Controlled Trial of Implant-retained Mandibular Overdentures

Evidence from randomized clinical trials of implant-retained overdentures is very limited at the present time. The aim of this study was to compare implant-retained mandibular overdentures and conventional complete dentures in a randomized controlled trial (RCT). Our a priori hypothesis was that implant-retained mandibular overdentures would be significantly better than conventional complete dentures. Edentulous patients (n = 118) were randomly allocated to either an Implant Group (n = 62) or a Denture Group (n = 56). Patients completed the Oral Health Impact Profile (OHIP) and a denture satisfaction scale pre-treatment and three months post-treatment. Upon completion of treatment, both groups reported improvement (p < 0.001, Wilcoxon Ranks Sum test) in oral-health-related quality of life and denture satisfaction. There were no significant post-treatment differences between the groups, but a treatment effect may be masked by application of “intention to treat” analysis. The OHIP change scores were significantly greater for patients receiving implants than for those who refused them.

Prognostic indicators for conventional complete denture therapy: A review of the literature

OBJECTIVES To review the current literature on prognostic indicators for conventional complete denture therapy. DATA Original articles studying outcome measures and patient satisfaction with conventional complete dentures. SOURCES Ovid databases from 1988 to present and subsequent review of related articles from the 1960s onwards. Searches were limited to English language only and used a variety of keywords. CONCLUSIONS There remains a paucity of research in this area. From the best available data, construction of technically correct dentures, a well-formed mandibular ridge and accuracy of jaw relations are positive indicators for success. Patient neuroticism and a poorly formed mandibular ridge are negative indicators for success. Other prognostic indicators have not been shown to be of significant value. There exists a minority of patients who will never adapt to any conventional complete denture. This problem is more acute in the mandible than the maxilla. There is need for further research in this area.

Researching the impact of oral health on diet and nutritional status: Methodological issues

OBJECTIVES Assessment of the impact of dental function on diet and nutritional status requires robust methodologies and a standardised approach to increase accuracy of results and to facilitate cross study comparisons. The objectives of this paper are: to report the outcomes of a consensus workshop that critically reviewed publications reporting on dietary methodologies in relation to the impact of oral health on nutrition; to highlight future directions for research and; to make recommendations for appropriate use of methodologies for future research. DATA Data relevant to nutrition and dental status published from 1980 to 2005 in English were presented at the consensus workshop for discussion and appraisal. SOURCES Relevant papers were retrieved through PubMed. Relevant texts were obtained from the library at Newcastle University, UK. STUDY SELECTION A purposive sample of original articles that illustrated the application of a range of nutritional methodologies to the study of oral health impacts was identified. Original flagship texts on nutritional methodologies were reviewed. CONCLUSIONS Numerous studies have shown an association between loss of teeth and inferior diet. Further research is required to elucidate the impact of novel approaches to prosthetic rehabilitation and the impact of contemporaneous dietary and dental intervention on diet, nutritional status, disease progression and quality of life. The recommendation of the consensus workshop was that future studies should adopt a comprehensive approach to the assessment of nutrition that encompasses measurement of diet, body composition, biochemical indices of intake and levels of nutrients, and functional biomarkers of disease.

Automated gas chromatographic assay for amlodipine in plasma and gingival crevicular fluid

This paper describes an automated capillary gas chromatographic method for the determination of amlodipine in plasma, and in sub-microlitre volumes of gingival crevicular fluid (GCF), in order to assess if amlodipine is present in GCF under conditions of gingival overgrowth, as has been shown for nifedipine, another dihydropyridine drug. Liquid-liquid extraction followed by derivatisation was employed to isolate amlodipine and render it suitable for gas chromatography. Amlodipine was analysed in plasma and GCF of four patients undergoing amlodipine therapy for cardiovascular disorders, three of whom had significant gingival overgrowth. Amlodipine was detected in the plasma of all patients and in massive concentrations in the GCF of those patients with overgrowth, 23- to 290-fold greater than in their plasma. Like nifedipine, amlodipine sequestration into GCF appears to be linked with gingival overgrowth.

Gingival sequestration of nifedipine in nifedipine-induced gingival overgrowth

The mechanism of gingival overgrowth associated with long-term use of nifedipine and of other drugs that affect calcium homoeostasis, such as cyclosporin and phenytoin, is unknown. With an ultrasensitive assay, we measured the pharmacokinetics of nifedipine in plasma and gingival crevicular fluid (GCF) of nine patients receiving this drug for angina and hypertension. In seven patients, the maximum nifedipine concentration was in the range 15-316 (mean 84 [SD 105]) times greater in GCF than in plasma. The two patients with low (undetectable) GCF nifedipine did not have overgrowth. We propose that gingival tissues sequester nifedipine and that the very high nifedipine concentrations predispose the tissues to overgrowth.

An evaluation of the multiple mini-interview as a selection tool for dental students

Objective This research evaluated the mutliple mini-interview (MMI) process as part of the admissions procedure for a dental school.Design The thematic analysis of a paper-based questionnaire.Materials and methods Following screening an MMI was arranged for 190 candidates applying to study dentistry with written feedback obtained from candidates and interviewers.Results A 100% response rate to the paper-based questionnaire was achieved for candidates and a 90% response rate was obtained from interviewers. With specific reference to how candidates perceived their performance, 127 (67.9%) felt they had performed well with 24 (19.3%) unsure and 36 (12.8%) saying their performance was not ideal. Candidates generally thought that they had prepared as well as they could have done for the MMIs and 146 (77.2%) thought that they had done enough at interview to merit being offered a place to study dentistry. The MMI experience was considered favourable and from 137 written comments received by candidates 39 were most positive with reference to the MMIs. A thematic analysis of the comments identified a number of emergent themes including lack of control, anxiety and nervousness, preparedness and comparisons with conventional interviews.Conclusion The MMI appears to be useful in the selection of dental students.

Nifedipine pharmacological variables as risk factors for gingival overgrowth in organ-transplant patients

Abstract The prevalence and severity of gingival overgrowth in organ-transplant patients medicated with cyclosporin are greater in patients concomitantly medicated with nifedipine; however, no relationship between the gingival overgrowth and any of the nifedipine pharmacological variables has been demonstrated. The study examined the effect of five nifedipine pharmacological variables (nifedipine dosage, plasma concentration and gingival crevicular fluid concentration, M1 metabolite plasma concentration and the nifedipine:M1 ratio). The effect of the nifedipine variables on the gingival overgrowth score were examined using univariate and multivariate regression analysis. Adjustment for the effect of other risk factors was made by adding the distribution of each of the nifedipine variables in turn to a stepwise regression model containing previously identified risk factors for this condition. Despite the high levels of nifedipine sequestered in the GCF, only the plasma concentration of nifedipine was identified as a risk factor for the severity of gingival overgrowth in these patients (P = 0.01) once adjusted for other known risk factors (r2 for the model = 55%).

Introduction of an e-portfolio in clinical dentistry: staff and student views.

INTRODUCTION An electronic portfolio was introduced for undergraduate students in the School of Dental Sciences at Newcastle University. Its introduction was evaluated in terms of both staff and student response. METHODS A quantitative-qualitative methodology was adopted. Student views were examined quantitatively using a Likert scale based questionnaire both pre- and post-introduction of the eportfolio. Staff views were examined qualitatively by the use of focus groups. RESULTS AND DISCUSSION Findings included that the system was easy to use and it provided a large quantity of high quality data. The aim of the system to improve reflection and feedback was not perceived as a benefit by staff or students. The need for training was highlighted and a major disadvantage of the system was its time consuming nature. The evaluation has lead to further development of the system and continued evaluation will be important.

Do implant-supported dentures facilitate efficacy of eating more healthily?

UNLABELLED Edentulous persons have poor diet quality demonstrating a need for dietary intervention. Implant-supported mandibular overdentures (IODs) have functional advantages over conventional dentures (CD), but whether they enhance the ability to eat more healthily following dietary advice is unknown. OBJECTIVES This study aimed to compare the effectiveness of dietary intervention between IODs and CD patients. METHODS Edentulous adults (28 IOD and 26 CD) received customised dietary advice. The percentage contribution of dietary fats, carbohydrate and protein to energy (kcal) intake, dietary intakes of fibre, fruits, vegetables and antioxidants, and plasma antioxidants were assessed pre- and at 3 and 6 months post-dietary intervention. RESULTS Both groups increased fruit and vegetable intake at 3 and 6 months following dietary intervention but intakes between groups did not differ. The IOD group had reduced % energy from total fat at 3 and 6 months and from saturated fat at 3 months. The CD group had reduced % energy from saturated by 6 months. The IOD group had a significantly lower % energy intake from saturated fat at 3 months and higher intake of non-starch polysaccharide (NSP) compared with the CD group. Both groups showed improvements in serum antioxidant status but the IOD group had significantly higher plasma antioxidant capacity post intervention compared with the CD group. CONCLUSIONS Dietary intervention benefits denture patients. IOD patients showed moderately greater dietary improvements compared with conventional denture patients.

Change in cardiovascular risk status after dental clearance

There is considerable debate over the relationship between periodontal and cardiovascular disease. It has been postulated that inflammatory mediators prevalent in periodontal disease may impact on atheroma formation and the thrombotic process. In cross-sectional, observational studies, periodontitis is associated with elevated C-reactive protein (CRP), hyperfibrinogenaemia and moderate leukocytosis. CRP levels have also been shown to decrease following periodontal therapy. CRP is a reliable marker of the acute phase reaction to infections and/or inflammation and is a powerful predictor of future coronary events.