Mea A. Weinberg

Mucocutaneous features of autoimmune blistering diseases

This review will describe adult onset mucocutaneous/autoimmune diseases that involve defects in cell-to-cell, cell-to-matrix, or cell-to-basement membrane adhesion. Included in this group are pemphigus, cicatricial pemphigoid, linear IgA bullous dermatosis, epidermolysis bullosa acquisita, and bullous systemic lupus erythematous. Detection and treatment of blistering disorders that manifest early in the oral cavity may prevent widespread involvement of skin. During the past few years, targets of autoantibodies have been clarified and new targets have been identified, allowing better understanding of the pathophysiology involved in these diseases. New information about more effective regimens with fewer side effects has also been obtained, presenting new treatment options. Clinical manifestations and management of these disorders will be described as well as histopathologic, ultrastructural, and immunopathologic studies that distinguish each disorder and facilitate diagnosis and treatment.

Tetracycline and Its Analogues: a Therapeutic Paradigm in Periodontal Diseases

This article discusses the use of tetracyclines in the clinical management of periodontal infections. A review of the drugs pharmacology, pharmacokinetics, and potential adverse effects shows that they are relatively safe if used in appropriate dosages and under controlled conditions. Current data suggest that the routine use of tetracyclines in conjunction with the treatment of periodontitis is unnecessary. However, their distinctive characteristics can be utilized in different delivery systems as an adjunctive aid to conventional treatment of juvenile and refractory forms of periodontitis.

The periodontist's role in obtaining clearance prior to patients undergoing a kidney transplant.

T here is ample evidence for the overall maintenance of good periodontal/dental health in patients with a chronic disease, including kidney disease,1,2 cardiovascular disease,3 respiratory diseases,4 pregnancy complications,5 Alzheimer’s disease,6 osteoporosis,7 and some types of cancer.8 A recent study9 documented that edentulism and low titers of Aggregatibacter actinomycetemcomitans (previously Actinobacillus actinomycetemcomitans) may be risk indicators for chronic kidney disease. Recently, a prediction model using multiple risk factors, including periodontal disease, was proposed to help identify individuals at high risk for chronic kidney disease.10 On the contrary, there are no epidemiologic studies documenting the benefit of periodontal treatment on the success of patients undergoing a kidney transplant. However, the role of the periodontist in controlling inflammation before the patient is cleared for transplant surgery continues to be important in the comprehensive medical/dental treatment of the patient. The need for periodontal/dental clearance for patients undergoing a kidney transplant was brought to our attention when a 41-year-old white male patient entered the private practice (of SLS) on September 11, 2008 with severe chronic periodontitis. The patient asked us to begin treatment immediately. He was waiting for a kidney transplant and reported that 14 potential donors had come forward since March 2008 who were the correct blood match but were disqualified for other medical reasons that were not disclosed. He was medically cleared on July 27, 2008 for the kidney transplant, but none of the physicians had inquired about or evaluated his dental health. Because he was aware of his periodontal disease, he searched the Internet for information about kidney transplants and came across a number of sites explaining that if his periodontal and dental health was not corrected, then a transplant could and should be denied. As of October 3, 2008, a potential female donor had gone farther in the process of donor acceptance, and the patient was cautiously optimistic that the female donor would be qualified. However, the patient was fearful that his periodontal condition would be discovered during the final medical evaluations, and he would be denied the transplant. Consequently, we completed his periodontal and dental treatment prior to his recent successful kidney transplant. In theUnitedStates, approximately257,000people have end-stage renal disease (ESRD),11,12 with an annual steady increase in newly diagnosed cases of ;10%.The twomaincausesofESRDarehypertension and diabetes mellitus, both of which have significant long-term deleterious effects on the cardiovascular system as well as the renal system.12 These already cardiovascularly compromised transplant patients are at a high risk for adverse cardiac outcomes. Other causes of ESRD include glomerulonephritis, chronic pyelonephritis, urologic disorders, and autoimmune diseases.11 Renal disease can be treated by monitoring the diet and fluid intake, dialysis, or a kidney transplant.13 As of 2009, patients on the waiting list for a kidney transplant has reached 100,000. The last published data in 2006 reported only 17,092 patients received a kidney transplant that year.14 The possible benefits of periodontal treatment on the success of patients undergoing an organ transplant are the control of oral inflammation and infection.13 Inflammation is widely recognized as playing a pivotal role in kidney disease15 and kidney transplant rejection.16 A recent study17 showed that serum interleukin (IL)-6 levels could identify individuals who are at greater risk for rejection, especially during the first year following transplant surgery, which is the most crucial time. Ioannidou et al.17 found that periodontal tissue destruction and local IL-6 synthesis were associated with elevated serum IL-6 levels in transplant recipients by being proinflammatory. Cardiovascular disease (atherosclerosis) is the leading cause of death in renal transplant recipients, andsystemic andperiodontal inflammationhave been suggested to be causal in its development.18 Seventy percent to 90% ofpatients who have undergonea renal transplant develop left ventricular hypertrophy

An Evaluation of Antibiotic Use in Periodontal and Implant Practices.

In past decades, warnings about overprescription and misuse of antibiotics- which are now considered to be responsible for antimicrobial resistance, allergies, ineffectiveness, and suprainfections-have been made to both medical and dental clinicians. To help assess the antibiotic prescribing habits of dentists, a survey was created and emailed through the Survey Monkey tool to 102 randomly selected board-certified periodontists. Each was asked to answer multiple-choice questions regarding their use of an antibiotic protocol in 10 specific periodontal or implant-related clinical circumstances. This group of practitioners and the 10 clinical circumstances were chosen to limit the wide variety of clinical conditions treated by dentists and to narrow the scope of variables when antibiotics are considered. All 102 participants returned the questionnaire, and 96% to 100% of respondents reported that they had treated 8 of the 10 circumstances, with 89.9% and 80.8% having treated the other two conditions listed in the survey; this allowed subsequent questioning of the respondents on their antibiotic prescribing protocols. Although the validity of antibiotics for dental procedures may be questioned based on present information, as many as 50% or more of the dentists answering the survey prescribed antibiotics. The prescription, initiation, and duration of antibiotics varied considerably in many of the 10 specific circumstances, including treatment of acute and chronic periodontitis, sinus or ridge augmentation, and immediate or delayed implant placement. Based on the results of the survey, it was obvious that definitive guidelines and protocols are needed as well as expanded postgraduate training regarding antibiotic use.

Periodontal Management of a Patient Undergoing Liver Transplantation.

This case report describes the periodontal management of a patient with end-stage liver disease undergoing liver transplantation. In the first part of this article, all medical and dental findings are reported to elaborate adequate diagnoses. A patient-specific treatment plan was structured given the challenging periodontal and systemic scenarios. The second part describes the periodontal therapy delivered in close interaction with the referring physicians. Last, the article reviews current principles and protocols in managing these patients.

The Dentist's Quick Guide to Medical Conditions: Weinberg/The Dentist's Quick Guide to Medical Conditions

The dentists quick guide to medical conditions , The dentists quick guide to medical conditions , کتابخانه دیجیتالی دانشگاه علوم پزشکی و خدمات درمانی شهید بهشتی