New research paradigm

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M Perno Goldie

New research paradigm

Author's af®liation: M Perno Goldie, Seminars for Women's Health, San Carlos, CA, USA

Abstract: Scientists are looking at a variety of ways to

Correspondence to: M Perno Goldie Seminars for Women's Health, 155 Normandy Court, San Carlos, CA 94070, USA E-mail: [email protected]

and biology. Biological in¯uences are many, including a

prevent disease and help insure wellness across the lifespan. Health and disease are linked to human behavior, environment, person's sex. Age-old infectious diseases continue to warrant our attention, whether they are acute or chronic. Changing models of disease are focusing on quality of life issues, taking into account the physiological and social in¯uences that affect one's life from cradle to grave. This article reviews recent discoveries in the area of antibiotics, premedication, genetics, obesity, tongue piercing, and tongue splitting. As oral health care professionals, dental hygienists should be aware of the latest trends in research, and models of disease prevention and maintenance of wellness. Key words: infectious diseases; minocycline; obesity; periodontal disease; antibiotic premedication; total joint replacements The classi®cation of dental caries and periodontal disease as infectious diseases was an innovation that changed the perception of oral health. Researchers now understand that health and disease are intricately tied to interactions of human behaviour, environment and biology. These facts are now guiding oral health exploration and are integrated into the Surgeon General's Report on Oral Health (1). Acute infectious diseases that were once life-threatening have been declining, while the incidence of chronic and degenerative diseases is rising. The changing models of disease

Dates: Accepted 23 July 2003

and demographics induce scientists to focus on improving the quality of life from in-utero until the end of life, rather than focusing on disease process itself. It has become clear that looking at a single

To cite this article:

molecule, cell or system in isolation is a concept lacking in merit.

Int J Dent Hygiene 1, 2003; 233±235

Instead, scientists and professionals should observe the interaction

Perno Goldie M:

of behavioural, environmental and genetic in¯uences that increase

New research paradigm Copyright # Blackwell Munksgaard 2003 ISSN 1601-5029

or minimise a person's risk of disease. Because of the human genome project, we are now aware that most diseases have a genetic component including inherited,

Perno Goldie. New research paradigm

infectious, carcinogenic and chronic disabling diseases and dis-

The organisations have created a new handout that oral health

orders (2). We have learned that there are inherited susceptibility

care professionals may share with their clients (8). The handout

genes that predispose to disorders such as diabetes and severe

may be reproduced, without ®rst obtaining reprint permission

periodontitis. It is also known that certain chronic diseases may

from the American Dental Association Publishing Division. The

share genetic components that determine diagnostic and ther-

handout, entitled Your joint replacement, dental procedures, and

apeutic approaches. As a result, researchers are now focusing

antibiotics, contains an explanatory section, and a place for the

further on the oral/systemic health connection. The following are

date of the surgery, the attending orthopaedic surgeon and a

some examples concerning recent research that impacts oral

telephone number (8).

health care delivery.

The 1997 Advisory Statement has been utilised extensively by

A recent case report stated that minocycline, a commonly

dentists, dental hygienists and orthopaedic surgeons. The

prescribed antibiotic in the treatment of acne and rheumatoid

updated version provides the latest rationale for the recommen-

arthritis, can cause the teeth and bone to discolour. The dis-

dations provided by the organisations. The statement (and client

coloration may also cause the gingival tissue to appear blackish

handout) states (8):

blue in colour. Clients taking this drug or healthcare professionals

For the ®rst two years after a joint replacement, all patients may

who prescribe it should be made aware of the possibility of oral

need antibiotics for all high-risk dental procedures. After two years, only high-risk patients may need to receive antibiotics for high-risk

discoloration. Those on long-term minocycline therapy should be made aware of the possibility of pigmentation of bone and soft tissue that may be reversible with discontinuation of therapy. However, minocycline-induced staining of the permanent dentition may not be reversible (3). Dental hygienists should make susceptible clients aware of this news. In the United States, obesity has risen at an epidemic rate during the past 20 years. One of the national health objectives for

procedures. The bacteria commonly found in the mouth may travel through the bloodstream and settle in your arti®cial joint. This increases your risk of contracting an infection. Ask your dentist about preventive antibiotics for all dental procedures with a high risk of bleeding or producing high levels of bacteria in your blood. Your dentist and your orthopaedic surgeon, working together, will develop an appropriate course of treatment for you.

High-risk procedures, per the handout, are (8):

the year 2010 is to reduce the prevalence of obesity among adults

1 Having had a joint replacement less than two years ago;

to less than 15% (4). Research indicates that the situation is

2 Previous infections in the arti®cial joint;

worsening rather than improving (5). This mounting prevalence

3 Having an in¯ammatory type of arthritis, type 1 diabetes or

of increased body weight and obesity has considerable health


concerns. Obesity has been implicated as a risk factor for several

4 A suppressed immune system or being in a malnourished state;

chronic health conditions, as well as being associated with

5 A history of prior or present malignancy.

increased mortality (6). Recently, an association between obesity

Oral procedures that may create a bacteremia are (8):

and periodontal disease was found in a Japanese population. A

1 Dental extractions;

recent study examined the relation between body weight and

2 Periodontal procedures;

periodontal disease in a representative United States sample. The

3 Dental implants or replantation of avulsed teeth;

conclusions showed a signi®cant association between obesity and

4 Selective endodontic treatment beyond the root apex;

prevalence of periodontal disease, only among individuals aged

5 Initial placement of orthodontic bands (not brackets);

18±34 years. The prevalence of periodontal disease is 76% higher

6 Intraligamentary and intraosseous local anaesthetic injections;

among the young obese than among persons with normal weight,

7 Dental hygiene procedures such as prophylaxis.

as measured by body mass index (BMI) (7).

Recommended premedication is as follows (8):

In addition, there is a new Position Paper published by the

1 If the client is not allergic to penicillin: 2 g of amoxicillin, cepha-

American Dental Association (ADA) on Antibiotic Prophylaxis for

lexin or cephradine (orally), or 2 g of ampicillin or 1 g of cefazolin

Dental Patients With Total Joint Replacements (8). The ADA

(intramuscularly or intravenously), 1 h before the procedure.

and the American Academy of Orthopaedic Surgeons convened

2 If the client is allergic to penicillin: 600 mg of clindamycin (orally or

an expert panel of dentists, orthopaedic surgeons and infectious

intravenously) 1 h before the procedure.

disease specialists, and published their ®rst Advisory Statement on

In summary, the 2003 statement includes some variations of

Antibiotic Prophylaxis for Dental Patients with Prosthetic Joints

the classi®cation of those at potential risk, and a list of dental

in 1997. It was the ®rst occasion that national health organisations

procedures that could produce bacteremia. However, the sug-

had issued statements on this topic. The 2003 advisory statement

gested antibiotics and antibiotic regimens remain the same as in

is the ®rst periodic update of the 1997 statement.

1997. Dental hygienists should stress impeccable self-care with

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Int J Dent Hygiene 1, 2003; 233±235

Perno Goldie. New research paradigm

powered toothbrushes, interdental cleaners, ¯oss and oral irriga-

According to the Pennsylvania Dental Association, surgery to

tors. Bacteremia is more common in the face of chronic in¯am-

restore a split tongue could be the most dangerous part of the

mation, such as periodontal infection.

tongue-splitting procedure. The reversal procedure consists of

Another area of constantly changing and new information

opening the healed split and stitching the lobes of the tongue

involves oral piercing. In a recent case report, mucogingival

together. Despite reconstruction costs averaging $2500, potential

defects because of oral jewellery were described (9). In addition

long-term effects of this surgery consist of nerve damage, scarring

to soft tissue damage, infection, potential for haemorrhaging,

and decreased tongue ¯exibility (10).

allergies and other complications, oral jewellery can damage teeth

As dental hygienists, we should be aware of the latest trends

by cracking or chipping. This recent article demonstrates the

and advise clients accordingly in a non-judgemental manner. Our

potential for periodontal defects, such as pocketing, recession and

focus, as also, is oral health as a part of total health. Stay tuned for

gingival lesions (9).

more of What is New in Research!

Another trend among young people is tongue splitting or forking. Tongue splitting is noted in several forms of yoga and has been growing steadily in popularity among heavy-body modi®ers since early 1998. The tongue is divided from the tip towards the back of the tongue for about 3±5 cm (1±2 inches), according to client preference. The result is a bisected tongue, not unlike that of a lizard's tongue. When performed by a board-certi®ed surgeon in a hospital or surgery centre, complications could be minimised or eliminated. Swelling, discomfort, dif®culty in eating and talking can occur even when the procedure is performed correctly. However, when performed by noneducated lay people, infection, haemorrhaging and even death can occur. New York has passed a law stating that unauthorised individuals cannot perform this procedure. Fines and jail time can be imposed if the law is disregarded. Illinois has also been trying to pass a bill, but the issue of individual rights continues to arise.

References 1 2 3 Ayangco L, Sheridan PJ. Minocycline-induced staining of torus palatinus and alveolar bone. J Periodontol 2003; 74 (5): 669±71. 4 #partb 5 6 Field AE, Coakley EH, Must A et al. Impact of overweight on the risk of developing common chronic diseases during a 10-year period. Arch Intern Med 2001; 161: 1581±6. 7 Mohammad AS, Bissada NF, Borawski EA. Obesity and periodontal disease in young, middle-aged, and older adults. J Periodontol 2003; 74 (5): 610±5. 8 American Dental Association & American Academy of Orthopaedic Surgeons. Association report on antibiotic prophylaxis for dental patients with total joint replacements. JADA 2003; 134 (7): 899. 9 Brooks JK, Hooper KA, Reynolds MA. Formation of mucogingival defects associated with intraoral and perioral piercing. JADA 2003; 134 (7): 837±43. 10

Int J Dent Hygiene 1, 2003; 233±235

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