Dietary Flavonoids Associated with Periodontal Health

Dietary Flavonoids Associated with Periodontal Health

Scientific rationale for the study: Higher fruit and vegetable intake, a source of flavonoids, is associated with improved periodontal healing at 8–12 weeks post‐SRP. Whether this association is sustained at 3–4 years post‐SRP, and if flavonoid intake is also associated with periodontal health was studied.

Principal findings: Higher flavonoid intake is associated with reduced probing depth and lower salivary IL‐1β at 3–4 years post‐SRP among patients that receive regular periodontal maintenance. These associations persisted when other confounders were considered.

Practical implications: Flavonoids, at levels present in foods, is associated with lower salivary IL‐1β which may be a marker of a diet that supports periodontal health.

Written by: Taylor Sparrow, David W. Doddington, Jenalyn L. Yumol, Peter C. Fritz, & Wendy E. Ward

Dietary Protein for Periodontal Health

Dietary Protein for Periodontal Health

Many epidemiological studies have shown positive associations between specific nutrients – including calcium, vitamins C and D, specific fatty acids – and periodontal health. Protein is a much less studied nutrient from this perspective although it serves as a building block for bone and the periodontium, and also assists with repair of these tissues. Protein has been studied in terms of bone health and risk of fracture, with many but not all studies reporting that higher intakes of protein are associated with higher bone mineral density (BMD). The association between bone and periodontal health, specifically lower hip and/or spine BMD being associated with greater tooth loss and/or clinical attachment loss, may suggest that the periodontium is also influenced by dietary protein intake. Protein is often a nutrition topic of interest given general societal interest in plant-based diets for health, and issues relating to sustainability of the food supply. This nutrition update will provide an overview of the link between periodontal and bone health, and also discuss the potential role of higher than recommended levels of protein intake for musculoskeletal health including periodontal health. Practical aspects about how to incorporate current recommended levels of protein in the diet, with consideration of energy levels and other bone-supporting nutrients in foods, will also be discussed.

Written by: Wendy E. Ward, BArts&Sci, BSc, MSc, PhD; Peter C. Fritz, BSc, DDS, FRCD(C), PhD, MBA

Oral Health, Nutritional Choices, and Dental Fear and Anxiety

Oral Health, Nutritional Choices, and Dental Fear and Anxiety

Oral health is an integral part of overall health. Poor oral health can lead to an increased risk of chronic diseases including diabetes mellitus, cardiovascular disease, and some types of cancer. The etiology of these diseases could be linked to the individual’s inability to eat a healthy diet when their dentition is compromised. While periodontal or implant surgery may be necessary to reconstruct tissue around natural teeth or replace missing teeth, respectively, some individuals avoid such interventions because of their associated fear and anxiety. Thus, while the relationship between poor oral health, compromised nutritional choices and fear and anxiety regarding periodontal procedures is not entirely new, this review provides an up-to-date summary of literature addressing aspects of this complex relationship. This review also identifies potential strategies for clinicians to help their patients overcome their fear and anxiety associated with dental treatment, and allow them to seek the care they need.

Written by: Jennifer Beaudette, Peter C. Fritz, Phillip J. Sullivan, and Wendy E. Ward

The Dental Hygiene Periodontal Residency Program: A Novel Program Developing Future Leaders of Tomorrow

The Dental Hygiene Periodontal Residency Program: A Novel Program Developing Future Leaders of Tomorrow

This paper describes one ecosystem that has been created to foster synergy between dentistry, dental hygiene, university research and college training as well as industry partnerships to produce the future dental hygienist leaders of tomorrow.

Written by: Peter C. Fritz, BSc, DDS, FRCD(C), PhD (Perio), MBA; Carolyn Triemstra, BRLS, MEd.; Amanda B. Longo, BSc, MSc, PhD; Taylor Sparrow, BSc, RDH; Wendy E. Ward, BSc, MSc, PhD

Factors that Influence Pain and the Use of Pain Medication following Periodontal Surgery

Factors that Influence Pain and the Use of Pain Medication following Periodontal Surgery

To determine the relationship between anticipated pain and actual pain experienced following soft tissue grafting or implant surgery; to identify the factors that predict actual pain experienced and the use of pain medication following soft tissue grafting or implant surgery. Prior to dental implant placement (n = 98) or soft tissue grafting (n = 115) and for seven days following the procedure, patients completed a visual analog scale indicating anticipated or experienced pain, respectively. The use of pain medication and alcohol, and smoking were measured.  Actual pain experienced on day 1 was lower (p < .01) than anticipated pain and continued to decrease (p ≤ .01) for each of the 7 consecutive days. Anticipated and actual pain were positively correlated. Increasing age (p < .05), having sedation during the surgery (p < .05), and lower use of pain pills (p < .01) predicted lower pain experienced. Actual pain experienced was a predictor of pain pill use (p < .01). Greater nervousness (p < .01) prior to surgery was a predictor of greater anticipated pain. Patients anticipated more pain than they actually experienced. Sedation, age and number of pain pills used predicted pain experienced.

Written by: Jennifer Beaudette, Peter C. Fritz, Phillip J. Sullivan, and Wendy E. Ward

Rapid Review on Radiation and CBCT in Dental Practice

Rapid Review on Radiation and CBCT in Dental Practice

Exposure to ionizing radiation and its potential risks are often major concerns of our patients. Ambiguity and confusion exist among the general public, mainly due to the risks discussed in the media and from spurious online information. This leads to confusion, fear, and avoidance by the patient. Therefore, this review aims to attenuate the ambiguity and to provide a clear and evidence-based summary of the current knowledge base for the reader.

As dental professionals, we are aware of the benefits of dental radiography in diagnosis and treatment planning. Therefore, this article aims to arm treatment providers with a thorough understanding of the associated risks and benefits of dental radiography, specifically in regard to an imaging technology that has disrupted dental imaging; 3-dimensional cone beam computed tomography (CBCT).

Written by: Amanda B. Longo and Peter C. Fritz

The Fonthill Dental Surgery Complications Classifications Scale

The Fonthill Dental Surgery Complications Classifications Scale

A lack of consensus on how to classify post‐operative complications in dentistry limits the ability for comparison of outcomes among treatments and their primary providers. Therefore, the Fonthill Dental Surgery Complication Classification Scale has been proposed as a uniform reporting tool to allow for the standardized quality assessment of dental treatment. This instrument classifies negative outcomes arising after dental treatment and is based on the clinician and the clinician time required to resolve the complication in seven classes of increasing severity.

The scale was evaluated in a cohort of 2,382 consecutive patients, of which 9% experienced a complication, the majority of which were Class I or Class II—resolved without intervention by the dental surgeon. Four scenarios where interpretation of the scale was required are presented with an explanation of their complication class.

This classification system will ultimately prove reliable in measuring clinician success rate and aiding in the decision‐making process for patients, clinicians, and financial providers.

Written by: Peter C. Fritz & Amanda B. Longo

 

The Fonthill Implant Care Protocol

The Fonthill Implant Care Protocol

This article is focused on the best evidence to prevent peri-implant mucositis and peri-implantitis using a systematic approach which is personalized for the patient. This critical update has eliminated several steps from our former algorithm and replaced them with innovative approaches generated from new concepts of peri-implant health.

The Fonthill Implant Care Protocol adapts the “recall hour” into six stages outlined in Figure 1. The six stages of Implant Care are to assess, disclose, motivate and empower, instrument, check and document, and recall. These six stages are adapted from the Guided Biofilm Therapy protocol for dental biofilm management as proposed by EMS (Nyon, Switzerland). Our evolving supportive implant maintenance protocol continues to successfully maintain more than 8000 implants in a private specialty practice (Fonthill, ON, Canada). The protocol is useful for all implant designs and for implants not having had previous implant care. This protocol allows the early identification of peri-implant mucositis and peri-implantitis and has recently been tailored to reflect the disruptions in biofilm management strategies.

Written by: Peter C. Fritz; Donna M. Lavoie; Roxanne More; Linda M. Dakin; Angie Nahli; Amanda B. Longo

 

Peri-Implant Diseases And Conditions

Peri-Implant Diseases And Conditions

In 2017, the world of periodontology was redefined with significant updates to the classification system for periodontal and peri-implant disease. The work of more than 170 leading clinicians, scientists, and educators from around the globe culminated in the publication of 17 articles and four consensus statements summarizing a contemporary, evidence-based and clinically relevant system. This system is modelled after others used in medicine and stratifies the severity, rate of progression, and the extent of periodontal disease and helps to clarify clinical approaches for treatment. Since its unveiling in 2017, this comprehensive classification system has become the new standard of clinical practice around the world. It encourages clinicians to view the patient through a systemic lens, connecting and reinforcing the link between oral health and overall health. An executive summary of the updates to the new global classification system for periodontal disease have been shared in an earlier version of this publication.

The previous periodontal classification system was published in 1999, at a time when dental implants had only been in North America for approximately 20 years. Since then, dental implants have become an increasingly popular treatment option for the replacement of missing teeth. It soon became apparent that much like natural teeth, the supporting structures of dental implants can experience disease and therefore require specialized considerations for diagnosis of a healthy versus diseased state. It is obvious today that there can be no implantology without periodontology and the periodontal classification system from 1999 did not capture this relationship. The new system elegantly defines peri-implant diseases and conditions in great detail. The aim of this executive summary is to highlight the principal concepts and key updates in regard to peri-implant health and disease culminating from the 2017 World Workshop on the Classification of Periodontal and Peri-Implant Diseases and Conditions.

Written by: Amanda B. Longo, BSc, MSc, PhD; Peter C. Fritz, BSc, DDS, FRCD(C), PhD (Perio), MBA

The New Global Classification System for Periodontal and Peri-Implant Diseases

The New Global Classification System for Periodontal and Peri-Implant Diseases

These are exciting times in the world of periodontology. The 2017 World Workshop, a combined collaboration by the European Federation of Periodontology (EFP) and the American Academy of Periodontology (AAP), has culminated in a new classification system for periodontal and peri-implant diseases and conditions. This is the first major update to the classification of periodontal disease since 1999 and is the most evidence-based and clinically relevant system that has ever been proposed. More than 170 leading clinicians and researchers from across the globe (including representation from Canadian periodontists) were involved in the monumental task of revising, clarifying and improving the classification system so we, the clinicians, can better communicate with each other and be more effective in our treatment of our patients.

Importantly, this classification system is the new standard of salient clinical information that all dental professionals around the world should be aware of and should adopt in their practice with regards to periodontal and peri-implant diseases.

The comprehensive classification is based upon the most contemporary evidence and includes a staging and grading system for periodontitis, indicating severity and extent of disease, accounting for lifetime disease experience and considering the patient’s overall health status. The complete review of primary information and consensus reports for the innovative model for understanding and diagnosing periodontal diseases was simultaneously published in 17 articles including four review papers in the Journal of Clinical Periodontology and the Journal of Periodontology in June 2018. The new classification system (Table 1) will be presented for the first time in North America at the American Academy of Periodontology meeting in November 2018 in Vancouver.

This paper aims to distill the most striking changes and the most important concepts into several key tables suitable for immediate chair side implementation. There are many significant changes in this update that will improve the clinician’s understanding of periodontal disease progression, potential risk factors and allows the clinician to diagnose the patient based on a system of staging and grading, similar to the system used in the practice of oncology, never before employed in periodontal diagnosis.

Written by: Peter C. Fritz, BSc, DDS, FRCD(C), PhD (Perio), MBA; Wendy E. Ward, B.Arts&Sci, BSc, MSc, PhD; Amanda B. Longo, BSc, MSc, PhD