Periodontal health in patients with or without dry mouth: A retrospective study

Periodontal health in patients with or without dry mouth: A retrospective study

 

As our first line of treatment, patients to our office with a diagnosis of periodontal disease undergo non-surgical scaling and root planing (SRP) by our team of periodontal hygienists.  Following this initial treatment, patients return for their regular and ongoing periodontal maintenance appointments.

We have long known that our saliva, specifically our salivary flow rate (how much saliva we are able to produce) has an essential role in oral health.  

Therefore, the goal of this study was to ask the question “Do patients with dry mouth maintain similar clinical outcomes as patients without dry mouth 1-5 years after their initial deep cleaning?”

What we found: Probing depth (mm), the main clinical indicator for periodontal health, was similar in patients with and without dry mouth 1-5 years after their initial treatment.  

This is great news for patients who suffer from a condition known clinically as xerostomia, or dry mouth.  As long as patients with xerostomia continue to attend their regular and ongoing maintenance appointments, they see no difference in their oral health status compared to those with a normal salivary flow rate.

Written by: Taylor Sparrow, Peter C. Fritz, Philip Sullivan, and Wendy E. Ward

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

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

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

 

How much is my dental surgery going to hurt?

How much is my dental surgery going to hurt?

Many of our patients experience fear and extreme anxiety at the dentist and while we do our best to create a calm and tranquil environment, the fear of pain associated with periodontal treatment may still be a deterrent for some.

Therefore, to answer one of the most commonly asked questions “Is this going to hurt?”, we conducted a study that was published in the Journal of Clinical Periodontology.

Over a period of two years, we enrolled 213 patients requiring either dental implant or grafting surgery.  The average age of the patients that were recruited was 51 years, but ranged from 19-80 years.  Prior to their surgery, patients were asked to rate the amount of pain that they anticipated feeling from No Pain to Worst Pain Imaginable.  For 7 days following their surgery, patients were asked to rate the amount of pain they experienced on the same scale.

When all of the data was analyzed, we found that the actual pain that patients experienced after periodontal surgery was lower than the pain they anticipated feeling.

With these findings, we are now able to provide our patients with an evidence-based answer when they ask us “Is this going to hurt?”  Happily, we are able to put them at ease by sharing with them that in fact, periodontal surgery hurts less than they expect!

Some factors that we found did predict the amount of pain a patient would feel are:

  1. Anticipated Pain – if you expect it to hurt, you’ll report it hurting more
  2. Age – older individuals reported it hurting less
  3. Sedation – those who had their periodontal surgery under sedation with one of our Registered Nurses reported experiencing less pain

Some factors that we found did not predict the amount of pain a patient would feel are:

  1. Nervousness
  2. Gender
  3. Surgery Type (dental implant vs. soft tissue grafting)
  4. Smoking Status

Also collected as part of the study, we found that patients needed only 600mg of Ibuprofen for relief of their post-operative pain and discomfort.  This reinforces Dr. Fritz’s mandate of never prescribing narcotics to any of this patients.

This study was conducted by Jennifer Beaudette as part of her Master’s of Science research through the Faculty of Applied Health Sciences at Brock University.  Jen has since completed her M.Sc. and is currently pursuing a Ph.D at Brock University.