Javed F, Tenenbaum HC, Nogueira-Filho G, Qayyum F, Correa FO, Al-Hezaimi K, Samaranayake LP. Severity of Periodontal Disease in Individuals Chewing Betel Quid With and Without Tobacco. Am J Med Sci. 2012 Nov 14. [Epub ahead of print] 

PMID:23249882

Abstract

BACKGROUND: The deleterious effects of chewing betel quid (BQ) with or without tobacco on periodontal health are poorly addressed. The aim of this study was to investigate the severity and extent of periodontal disease among individuals chewing BQ with and without tobacco. METHODS:: One hundred twenty individuals (70 BQ chewers: 35 with tobacco and 35 without tobacco) and 50 control individuals (non-chewers) were included in this study. Sociodemographic data and information regarding BQ chewing habit were collected using a questionnaire. Plaque index, bleeding on probing and probing pocket depth were measured. Numbers of missing teeth were recorded and marginal bone loss was measured on panoramic radiographs. Statistical analyses were performed using 1-way analysis of variance and Bonferroni post hoc test. RESULTS:: The socioeconomic status of subjects in the control group was significantly higher as compared with those chewing BQ either with or without tobacco. Plaque index, bleeding on probing and probing pocket depth were greater in subjects chewing BQ with tobacco than in those chewing BQ without tobacco and the controls. Subjects chewing BQ with tobacco had fewer teeth than those chewing BQ without tobacco and the controls. Marginal bone loss was higher in subjects chewing BQ with tobacco than in those chewing BQ without tobacco and the controls. CONCLUSIONS:: The severity of periodontal disease is enhanced in subjects chewing BQ with tobacco as compared with those chewing BQ without tobacco. Subjects with a low socioeconomic status and poor education are significantly more likely than others to develop periodontal disease.

Al-Hezaimi K, Rudek I, Al-Hamdan KS, Javed F, Iezzi G, Piattelli A, Wang HL. J Periodontol. 2012 Oct 22. [Epub ahead of print]

Efficacy of Acellular Dermal Matrix and Coronally Advanced Flaps for the Treatment of Induced Gingival Recession Defects: A Histomorphometric Study in Dogs.

Abstract

Background: Gingival recession (GR) defects can be treated by various methods including acellular dermal matrix (ADM) or by coronally advanced flaps (CAF). The aim of this histomorphometric experiment was to compare the efficacy of ADM and CAF for treating GR defects in dogs. Materials and methods: In eight beagle dogs, a critical size labial GR defect was surcically induced on bilateral maxillary cuspids under general anesthesia. Test-sites received ADM and CAF and control-sites underwent CAF-treatment alone. Plaque index (PI), bleeding index (BI) and gingival index (GI) were measured at 4- weeks (baseline), 8-weeks and 16-weeks. Width of keratinized gingiva (KG) was determined at baseline and at 16-weeks. Depth of recession and width of GR below the cementoenamel junction (CEJ) was also determined. After 4-months, animals were sacrificed and jaw blocks were histomorphometrically assessed for tissue thickness, distance from stent to the gingival margin and to the CEJ. Results: At 4-, 8- and 16-week intervals, there was no significant difference in the BI, GI and PI at the test- and control-sites. At 16-weeks, thickness of KG was significantly higher at the control-sites than test-sites (P<0.01). There was no difference in the midfacial recession depth and recession width at the test- and control-sites at baseline and before euthanasia (16-week). Histomorphometrically, there was no significant difference in tissue thicknesses and distances from the stent to the gingival margin and CEJ in the test- and control-sites. Conclusions: ADM might yield similar results to CAF alone and could decrease the amount of KG.

 

Javed F, Tenenbaum HC, Nogueira-Filho G, Nooh N, O'Bello Correa F, Warnakulasuriya S, Dasanayake AP, Al-Hezaimi K.

Periodontal Inflammatory Conditions Among Gutka-Chewers and Non-Chewers With and Without Prediabetes.

Background: It is known that gutka-chewing jeopardizes periodontal health; however, severity of periodontal inflammation in gutka-chewers with and without prediabetes remains unknown. The aim was to investigate the association of periodontal inflammatory conditions with gutka-chewing and pre-diabetes. Methods: In this cross-sectional study, the effect of gutka use on periodontal health was investigated among 44 individuals with prediabetes and 44 without prediabetes. Demographic information regarding age, sex, duration of prediabetes and gutka-chewing habits was collected using a questionnaire. Periodontal inflammatory conditions (plaque index [PI], bleeding on probing [BOP], probing depth [PD], marginal bone loss [MBL]), and fasting blood glucose levels (FBGL) were recorded. Group differences in periodontal inflammatory parameters were tested using univariate and multivariable analyses (alpha ≤ 5%). Results: Periodontal inflammatory parameters (PI, BOP, and PD) were significantly higher in prediabetic subjects irrespective of the gutka-chewing habit (p<0.05). Odds of periodontal inflammation in prediabetic individuals were 9 times higher compared to healthy controls (95% Confidence Interval [CI] = 3.4-23.6). Gutka chewing alone, chewing among prediabetics and chewing among healthy controls did not statistically significantly increase the odds of periodontal inflammatory conditions. Prediabetics were statistically significantly more likely to have periodontal inflammation as compared to non-prediabetics even after controlling for sex and gutka-chewing (OR=13.2; 95% CI = 4.3 - 40.7). Conclusions: In medically-healthy individuals, periodontal inflammatory conditions are worse in gutka-chewers as compared to non-chewers; whereas in patients with prediabetes, the severity of periodontal inflammation is governed by hyperglycemia as opposed to habitual gutka usage.

Javed F, Correa FO, Nooh N, Almas K, Romanos GE, Al-Hezaimi K. Orofacial Manifestations in Patients with Sickle Cell Disease. Am J Med Sci. 2012 Sep 17. [Epub ahead of print]

BACKGROUND:

The aim of this study was to review the orofacial manifestations in patients with sickle cell disease (SCD).

METHODS:

Indexed databases were explored using various combinations of the following keywords: "sickle cell anemia," "sickle cell disease," "oral health status" and "dental inflammation."

RESULTS:

Hypoxia has been associated with osteomyelitis of the jaws, particularly the mandible in patients with SCD. Bone marrow hyperplasia in these patients causes depression of nasal bridge, midfacial overgrowth and malocclusion. Mental nerve neuropathy due to osteomyelitis of the mandible causes numbness in the lower lip and chin. A diminished blood supply to teeth causes necrosis of the dental pulp in patients with SCD. Dental caries is a common manifestation in patients with SCD, particularly in those with underprivileged living standards. The association between SCD and periodontal inflammatory conditions remains unclear.

CONCLUSIONS:

Oral health problems in patients with SCD are rare and occur mainly as a result of the poor oral hygiene maintenance.

Javed F, Sundin U, Altamash M, Klinge B, Engström PE.  Self-perceived oral health and salivary proteins in children with type 1 diabetes. J Oral Rehabil. 2009 Jan;36(1):39-44.

The aim was to validate self-perceived oral health with salivary IgG as an inflammatory parameter in children with type 1 diabetes. Unstimulated whole saliva samples were collected from 36 children with well controlled and 12 with poorly controlled type 1 diabetes and 40 non-diabetic children (Controls). Salivary flow rate, random blood glucose level, salivary protein concentration and immunoglobulin A and G levels were recorded using standard techniques. Data concerning oral health and diabetes status were collected. Self-perceived gingival bleeding (bleeding gums), bad breath and dry mouth were higher in diabetic children when compared with those in controls (P < 0.05). Gingival bleeding was frequently perceived by children with poorly controlled compared to well-controlled type 1 diabetes (P < 0.05) and controls (P < 0.001). Bad breath was common perceived by children with poorly controlled compared to well-controlled type 1 diabetes (P < 0.05) and controls (P < 0.0001). Salivary flow rate was lower in the diabetic children compared to controls (P < 0.01) with no difference between children with poorly controlled and well-controlled type 1 diabetes. Salivary IgG per mg protein concentration was higher in the diabetics when compared with the control group (P < 0.0001). IgG per mg protein levels were also higher in children with poorly controlled when compared with well-controlled type 1 diabetes (P < 0.05). There was no difference in IgA per mg protein and total protein concentrations between children with poorly controlled and well-controlled type 1 diabetes. Self-perceived gingival bleeding and salivary IgG per mg protein concentration were increased in children with type 1 diabetes compared with controls. These variables were also increased in children with poorly controlled compared with well-controlled type 1 diabetes.

Dr. Fawad Javed (BDS, PhD): Dr. Fawad Javed (BDS, PhD): Javed F, Sundin U, Alt...

Dr. Fawad Javed (BDS, PhD): Dr. Fawad Javed (BDS, PhD): Javed F, Sundin U, Alt...: Dr. Fawad Javed (BDS, PhD): Javed F, Sundin U, Altamash M, Klinge B, Engströ... : Javed F ,  Sundin U ,  Altamash M ,  Klinge B ,  Engströ...

Javed F, Sundin U, Altamash M, Klinge B, Engströ...: Javed F ,  Sundin U ,  Altamash M ,  Klinge B ,  Engström PE . Self-perceived oral health and salivary proteins in children with type 1...

Javed F, Sundin U, Altamash M, Klinge B, Engström PE. Self-perceived oral health and salivary proteins in children with type 1 diabetes. J Oral Rehabil. 2009 Jan;36(1):39-44. 

The aim was to validate self-perceived oral health with salivary IgG as an inflammatory parameter in children with type 1 diabetes. Unstimulated whole saliva samples were collected from 36 children with well controlled and 12 with poorly controlled type 1 diabetes and 40 non-diabetic children (Controls). Salivary flow rate, random blood glucose level, salivary protein concentration and immunoglobulin A and G levels were recorded using standard techniques. Data concerning oral health and diabetes status were collected. Self-perceived gingival bleeding (bleeding gums), bad breath and dry mouth were higher in diabetic children when compared with those in controls (P < 0.05). Gingival bleeding was frequently perceived by children with poorly controlled compared to well-controlled type 1 diabetes (P < 0.05) and controls (P < 0.001). Bad breath was common perceived by children with poorly controlled compared to well-controlled type 1 diabetes (P < 0.05) and controls (P < 0.0001). Salivary flow rate was lower in the diabetic children compared to controls (P < 0.01) with no difference between children with poorly controlled and well-controlled type 1 diabetes. Salivary IgG per mg protein concentration was higher in the diabetics when compared with the control group (P < 0.0001). IgG per mg protein levels were also higher in children with poorly controlled when compared with well-controlled type 1 diabetes (P < 0.05). There was no difference in IgA per mg protein and total protein concentrations between children with poorly controlled and well-controlled type 1 diabetes. Self-perceived gingival bleeding and salivary IgG per mg protein concentration were increased in children with type 1 diabetes compared with controls. These variables were also increased in children with poorly controlled compared with well-controlled type 1 diabetes.

Javed F, Al-Hezaimi K, Warnakulasuriya S. Areca-nut chewing habit is a significant risk factor for metabolic syndrome: a systematic review. J Nutr Health Aging. 2012 May;16(5):445-8.

BACKGROUND:

Areca-nut (AN) chewing habit has been associated with oral diseases including oral cancer, oral submucous fibrosis and periodontal disease; however, some authors have reported that the AN-chewing abuse may also jeopardize the systemic health among its users.

OBJECTIVES:

The objective was to review any reported association between AN-chewing and the metabolic syndrome (MetS).

METHODS:

To address the research question "Is there an association between areca-nut chewing habit and the MetS?" the MEDLINE and PubMed databases were searched from 1991 up to and including April 2010. The search criteria included: human studies, metabolic syndrome, diabetes, areca nut (AN). Only articles published in English were included.

RESULTS:

Eight cohort studies were included in the review. The sample size of the selected studies ranged from 210 to 56,116 individuals (age range 15-83 years). The daily frequencies of AN-chewing reported by the users ranged between once a day to 76 times daily. The duration of use ranged from 6 years to ≥ 20 years. Two studies associated AN-chewing habit with hyperglycemia and type 2 diabetes while five studies studies reported an association between AN-chewing and metabolic syndrome. Four studies related AN-chewing with obesity and an increased body mass index. Higher triacylglycerol levels were reported in one study among AN-chewers compared to non-chewers. Though the numbers of publications on this subject are limited, the available studies indicate that AN-chewing could be associated with the metabolic syndrome, and individually with two of the recognized components of the syndrome i.e. diabetes mellitus and central obesity.

Javed F, Näsström K, Benchimol D, Altamash M, Klinge B, Engström PE. Comparison of periodontal and socioeconomic status between subjects with type 2 diabetes mellitus and non-diabetic controls. J Periodontol. 2007 Nov;78(11):2112-9.

BACKGROUND:

The association among periodontal conditions, socioeconomic status (SES), and diabetes has been reported. However, there is a lack of published data comparing periodontal conditions among individuals with poorly controlled type 2 diabetes mellitus (T2D). The aim of the present study was to compare the periodontal conditions and SES between subjects with T2D and non-diabetic controls.

METHODS:

A total of 75 (31 males and 44 females) individuals with T2D (62 poorly controlled and 13 well-controlled) and 99 non-diabetic patients (healthy controls; 51 males and 48 females) participated in the study. Plaque index (PI), bleeding on probing (BOP), and probing depth (PD) were investigated. Random blood glucose level was recorded. Premolar and molar marginal bone loss (MBL) was measured digitally on scanned orthopantomograms.

RESULTS:

Individuals with poorly controlled T2D had increased MBL in molars and maxillary premolars (P<0.05) compared to individuals with well-controlled T2D. PI, BOP, and PD of 4 to <6 mm were increased in individuals with poorly controlled T2D compared to those with well-controlled T2D (P<0.001). There was no difference between the diabetic groups when PD was >or=6 mm. Individuals with poorly controlled T2D had a lower SES compared to patients with well-controlled T2D (P<0.05). Illiteracy and the number of missing teeth were not different between the groups.

CONCLUSIONS:

Radiologic and clinical indicators of periodontal destruction were increased in individuals with poorly controlled T2D. Low SES aggravated the periodontal condition in individuals with T2D.

Javed F, Altamash M, Klinge B, Engström PE. Periodontal conditions and oral symptoms in gutka-chewers with and without type 2 diabetes. Acta Odontol Scand. 2008 Oct;66(5):268-73.

OBJECTIVE:

The aim of the study was to investigate the periodontal conditions and oral symptoms among gutka-chewers in subjects with and without type 2 diabetes (T2D).

MATERIAL AND METHODS:

Subjects aged between 45 and 64 years were included. "Gutka-chewers" were defined as subjects who had been chewing at least one sachet of gutka daily for at least 12 months. Subjects who reported never to have used tobacco in any form were categorized as "non-chewers". Periodontal conditions (plaque index [PI], bleeding on probing [BOP], and probing depth [PD] [4 mm<6 mm and > or =6 mm]), number of missing teeth, oral symptoms, reasons for gutka use, and random blood glucose levels were recorded. Exclusion criteria were smoking and use of antibiotics, non-steroidal anti-inflammatory drugs, and steroids.

RESULTS:

Mean durations of gutka use in subjects with and without T2D were 10.5 (range 8.0-15.5 years) and 8.4 (range 6.0-20.2 years) years correspondingly. In subjects with T2D, gutka-chewers (n=29) and non-chewers (n=44) showed no difference in periodontal conditions, missing teeth, and gingival bleeding. In subjects without T2D, gutka-chewers (n=36) had increased PI (p<0.01), BOP (p<0.001), PD (4 mm<6 mm) (p<0.01), number of missing teeth, and gingival bleeding (p<0.01) compared to non-chewers (n=42). Non-chewers in subjects with T2D had poorer periodontal conditions and increased oral symptoms compared to gutka-chewers and non-chewers in subjects without T2D.

CONCLUSION:

In subjects without T2D, gutka-chewers have severe periodontal conditions and oral symptoms compared to non-chewers. In subjects with T2D, the severity of these variables is related to glycemic levels rather than gutka consumption.

Javed F, Klingspor L, Sundin U, Altamash M, Klinge B, Engström PE. Periodontal conditions, oral Candida albicans and salivary proteins in type 2 diabetic subjects with emphasis on gender. BMC Oral Health. 2009 May 12;9:12.

BACKGROUND:

The association between periodontal conditions, oral yeast colonisation and salivary proteins in subjects with type 2 diabetes (T2D) is not yet documented. The present study aimed to assess the relationship between these variables in type 2 diabetic subjects with reference to gender.

METHODS:

Fifty-eight type 2 diabetic subjects (23 males and 35 females) with random blood glucose level >or= 11.1 mmol/L were investigated. Periodontal conditions (plaque index [PI], bleeding on probing [BOP], probing pocket depth [PD] (4 to 6 mm and >or= 6 mm), oral yeasts, salivary immunoglobulin (Ig) A, IgG and total protein concentrations, and number of present teeth were determined.

RESULTS:

Periodontal conditions (PI [p < 0.00001], BOP [p < 0.01] and PD of 4 to 6 mm [p < 0.001], salivary IgG (microg)/mg protein (p < 0.001) and salivary total protein concentrations (p < 0.05) were higher in type 2 diabetic females with Candida albicans (C. albicans) colonisation compared to males in the same group. Type 2 diabetic females with C. albicans colonisation had more teeth compared to males in the same group (p < 0.0001).

CONCLUSION:

Clinical and salivary parameters of periodontal inflammation (BOP and IgG (mug)/mg protein) were higher in type 2 diabetic females with oral C. albicans colonisation compared to males in the same group. Further studies are warranted to evaluate the association of gender with these variables in subjects with T2D.

Javed F, Romanos GE. Impact of diabetes mellitus and glycemic control on the osseointegration of dental implants: a systematic literature review. J Periodontol. 2009 Nov;80(11):1719-30.

BACKGROUND:

Implant treatment is an attractive substitute to traditional fixed/removable prosthetic appliances. In patients with diabetes, dental implant therapy has been considered a contraindication. Hyperglycemia augments the severity of periodontal disease, and glycemic control is an essential variable in determining the success of dental implants in subjects with diabetes. Subjects with well-controlled diabetes may not be significantly compromised and can have high dental implant success rates compared to individuals with poorly controlled diabetes. The focused questions addressed in this systematic review were as follows: Can patients with diabetes be good candidates for dental implant therapy? And how does hyperglycemia and glycemic control influence osseointegration?

METHODS:

A systematic literature search of MEDLINE/PubMed articles published from 1982 up to and including July 2009 was independently performed by two investigators. In addition, reference lists of original and review articles were searched. The search strategy was to use the following terms in different combinations: dental implants, immediate implants, osseointegration, periodontal disease, diabetes, hyperglycemia, metabolic control, and glycemic control. The search included studies on humans and diabetes-induced animal models. The selection criteria included all levels of available evidence. Suitable variables included the implant survival rate among individuals with diabetes, effects of hyperglycemia and glycemic control on bone, and maintenance of dental implants in subjects with diabetes. Articles published only in the English language were considered, and unpublished data were not sought.

RESULTS:

We initially identified 33 studies. Fifteen studies, which did not fulfill the selection criteria, were excluded. The included studies reported that poorly controlled diabetes negatively affects implant osseointegration; however, under optimal serum glycemic control, osseointegration can successfully occur in patients with diabetes. Animal studies have confirmed that osseointegration can be successfully achieved in insulin-controlled rats with diabetes, whereas in uncontrolled rats with diabetes, the bone-to-implant contact appears to decrease with time. The use of antiseptic mouthrinses and oral-hygiene maintenance helps in achieving a successful dental implant osseointegration in subjects with diabetes.

CONCLUSION:

A successful dental implant osseointegration can be accomplished in subjects with diabetes with good metabolic control (serum glycemic level and hemoglobin A1c in normal range) in a similar manner as in subjects without diabetes.

Javed F, Almas K. Osseointegration of dental implants in patients undergoing bisphosphonate treatment: a literature review. J Periodontol. 2010 Apr;81(4):479-84.

BACKGROUND:

Bisphosphonates (BPs) are an important group of drugs used for the treatment of metabolic and oncologic pathologies involving the skeletal system. Osteonecrosis of the jaw (ONJ) is a complication observed in patients using oral or intravenous (IV) BPs. It was suggested that all patients undergoing BP therapy who are expected to receive dental implants should be informed of the possible risks of development of ONJ. The aim of this literature review is to assess the osseointegration of dental implants in patients undergoing BP therapy.

METHODS:

The MEDLINE-PubMed databases of The National Library of Medicine, National Institutes of Health, Bethesda, Maryland, were searched for articles addressing the focused question: Can dental implants osseointegrate and remain functionally stable in patients undergoing oral and IV BP therapy? Databases were searched from 1995 up to and including February 2010 using the following terms in different combinations: bisphosphonate, dental implant, immediate-loading, implant survival rate, intravenous, oral, osseointegration, and osteonecrosis.

RESULTS:

The initial search yielded 89 articles. Scrutiny of the titles and abstracts reduced the number of articles to 12 (seven case reports and five retrospective studies). In 10 studies, the patients were using oral BPs, and in two studies, patients were using IV BPs. Six case reports showed that the placement of implants in patients using BPs could yield a successful osseointegration and function. Four retrospective studies demonstrated that BPs did not have a negative influence on implant success. Two studies showed a negative impact of BPs on implant success.

CONCLUSION:

Dental implants can osseointegrate and remain functionally stable in patients using BPs.

Javed F, Chotai M, Mehmood A, Almas K. Oral mucosal disorders associated with habitual gutka usage: a review. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2010 Jun;109(6):857-64. 

OBJECTIVE:

The aim of this study was to investigate the oral mucosal disorders associated with habitual gutka consumption.

METHODS:

Databases were searched from 1956 to June 2009 using the following terms: "gutka," "gutkha," "ghutka," "guttkha," "smokeless tobacco," "areca nut," "betel nut," "slaked lime," "dental," "oral," "periodontal," "inflammation," "submucous fibrosis," "carcinoma," and "cancer." The eligibility criteria included: human and experimental studies, use of control subjects, and articles published in English. Unpublished data were not sought. Odds ratios (ORs) and 95% confidence intervals (CIs) were computed.

RESULTS:

Twelve studies were included. Three studies associated gutka consumption with periodontal inflammation (ORs 1.64 [CI 1.2-2.1], 2.20 [CI 1.1-4.9], and 3.56 [CI 1.9-5.5]). Five studies showed a direct relationship between gutka usage and oral submucous fibrosis (ORs 1.65 [CI 1.2-2.3], 2.33 [CI 1.9-4.5], 2.98 [CI 1.5-3.9], 3.56 [CI 1.3-4.7], and 5.08 [CI 3.7-6.4]). An increased frequency of gutka usage was associated with malignant transformations in oral submucous fibrosis by 2 studies (ORs 4.59 [CI 2-5.6] and 18 [CI 5.8-61.6]). Two studies showed an extension of oral submucous fibrosis into the hypopharynx and esophagus in gutka users (ORs 4.59 [CI 2-5.6] and 33 [CI 2.2-46.6]).

CONCLUSIONS:

Habitual gutka usage is associated with severe oral mucosal disorders, and the consequences may extend beyond the oral cavity.

Qadri T, Poddani P, Javed F, Tunér J, Gustafsson A. A short-term evaluation of Nd:YAG laser as an adjunct to scaling and root planing in the treatment of periodontal inflammation. J Periodontol. 2010 Aug;81(8):1161-6.

BACKGROUND:

This split-mouth, single-masked, randomized, controlled clinical trial compares the short-term outcomes of a combined treatment with scaling and root planing (SRP) and neodymium-doped:yttrium, aluminum, and garnet (Nd:YAG)-laser irradiation with treatment with SRP alone.

METHODS:

Thirty patients were recruited. The mandibular left or right side was randomly assigned as the test side (SRP with laser treatment) or control side (SRP alone). The water-cooled Nd:YAG laser was used at 4 W, 80 mJ/pulse, 50 Hz, and with a pulse width of 350 micros. At baseline, gingival crevicular fluid (GCF) samples were taken from the test and control sides, and levels of matrix metalloproteinase (MMP)-8 and interleukin (IL)-1beta, -4, -6, and -8 were measured using standard techniques. The plaque index (PI), gingival index (GI), and probing depth (PD) were measured by calibrated examiners.

RESULTS:

At the 1-week follow-up, PD (P <0.001), PI (P <0.05), and GCF volume (P <0.001) showed significant improvement on test sides compared to control sides. At the 3-month follow-up, PD (P <0.01), PI (P <0.01), GI (P <0.01), and GCF volume (P <0.05) also showed significant improvement on test sides compared to control sides. At the 1-week follow up, IL-1beta and MMP-8 levels were significantly reduced on test sides compared to control sides. The 3-month follow-up confirmed that the improvements on test sites had been sustained compared to the treatment outcomes of control sites.

CONCLUSION:

In the short-term, SRP in combination with a single application of a water-cooled Nd:YAG laser significantly improves clinical signs associated with periodontal inflammation compared to treatment with SRP alone.

Javed F, Romanos GE. The role of primary stability for successful immediate loading of dental implants. A literature review. J Dent. 2010 Aug;38(8):612-20.

OBJECTIVES:

To assess the role of primary stability for successful immediate loading (IL) of dental implants.

DATA:

Original articles studying the role of primary stability for successful immediate loading of dental implants were included. The reference lists of potentially relevant review articles were also sought.

SOURCES:

The MEDLINE-PubMed databases were searched for appropriate articles addressing the objectives of the present study. Databases were searched from 1979 up to and including April 2010. The search was performed using a variety of keywords in different combinations. Articles published only in English language were included. Letters to the Editor, historical reviews and unpublished articles were not sought.

CONCLUSIONS:

There is a significant biological response by the hard and soft tissues to IL of dental implants. Within the limitations of the present literature review, it is evident that the core issue to observe during IL is the establishment of a good implant primary stability. There is sufficient evidence to suggest that the degree of achieved primary stability during IL protocols is dependent on several factors including bone density and quality, implant shape, design and surface characteristics and surgical technique. Further research is required in situations, such as poor bone quality and quantity and multiple implants or augmentation procedures, which may challenge the attainment of primary stability during IL. 

Qadri T, Javed F, Poddani P, Tunér J, Gustafsson A. Long-term effects of a single application of a water-cooled pulsed Nd:YAG laser in supplement to scaling and root planing in patients with periodontal inflammation. Lasers Med Sci. 2011 Nov;26(6):763-6. 

The aim of this work was to investigate the long-term effects of a single application of a water-cooled pulsed neodymium yttrium aluminium garnet (Nd:YAG) laser, in combination with scaling and root planing (SRP) for the treatment of periodontal inflammation. Twenty-two patients were included in this split-mouth single blind randomized controlled clinical trial. The parameters of the air and water-cooled Nd:YAG laser were: 4 W, 80 mJ/pulse, 50 Hz and a pulse width of 350 μs. The "test side" was treated with a single application of Nd:YAG laser and SRP; while the "control side " was treated with SRP alone. At baseline, and after a median follow-up time of 20 months (range 12-39), periodontal inflammatory parameters (plaque index [PI], gingival index [GI], probing pocket depth [PPD]), and marginal bone loss (on digital bite-wing radiographs) were measured. Gingival crevicular fluid (GCF) was collected from the teeth 35, 36, 45, and 46 at baseline and at follow-up. Pl (p < 0.01), GI (p < 0.01), and PPD (p < 0.001) were significantly lower on the test side compared to the control side at follow-up. Radiological results showed significantly less bone loss on the test side compared to the control side (p < 0.05). GCF volume was lower on the test side compared to the control side (p < 0.01). In conclusion, a single application of Nd:YAG laser in combination with SRP had a positive long-term effect on periodontal health compared to treatment by SRP alone.

Javed F, Bello Correra FO, Chotai M, Tappuni AR, Almas K. Systemic conditions associated with areca nut usage: a literature review. Scand J Public Health. 2010 Dec;38(8):838-44. 

AIM:

The adverse effects of areca nut (AN) chewing habit on oral health have been reported. However, the hazards related to the habit are not restricted to the oral cavity but they can also jeopardise the systemic health. Since no review reporting the harmful effects of AN chewing on systemic health is yet available, the aim of the present study was to review the systemic conditions associated with AN usage.

METHODS:

To address the focused question ''What are the deleterious effects of AN usage on systemic health?'', the MEDLINE PubMed databases were explored from 1966 up to and including May 2010. The eligibility criteria included: human studies, individuals using AN, use of controls, and articles published in English. Hand-searching was also performed. Unpublished data was excluded.

RESULTS:

The review included 28 articles. Seven studies associated AN chewing with cardiovascular disorders and three studies related the habit with cerebrovascular disorders. Eight studies related AN chewing with obesity, hyperglycaemia, metabolic syndrome, and type 2 diabetes mellitus. Five studies related AN chewing with the development of hepatic disorders. Two studies associated the chewing habit with oesophageal inflammation and fibrosis. Three studies associated AN chewing with respiratory discomfort. Renal disorders were related with the chewing abuse in two studies. Two studies showed an adverse effect of AN chewing on birth outcome.

CONCLUSIONS:

AN chewing adversely affects systemic health by damaging the vital organs.

Javed F, Al-Hezaimi K, Salameh Z, Almas K, Romanos GE. Proinflammatory cytokines in the crevicular fluid of patients with peri-implantitis. Cytokine. 2011 Jan;53(1):8-12. 

The aim of this study was to review the proinflammatory cytokine profiles in the peri-implant crevicular fluid (PICF) of patients with peri-implantitis (PI). Databases were explored from 1994 up to and including July 2010 using various combinations of the following keywords: "cytokine", "crevicular fluid", "implant", "inflammation", "peri-implantitis" and "periodontitis". The eligibility criteria included: (1) original research articles; (2) clinical and experimental studies; (3) use of control group; (4) reference list of pertinent original and review studies; (5) use of statistical methods; (6) intervention: patients with and without PI; and (7) articles published only in English-language. Fifteen studies (14 case-controls and one case-report) were included. Four studies showed high levels of interleukin (IL)-1 beta (β) in the PICF of implants affected by PI (test) compared to healthy (control) sites. Two studies showed an over-expression of IL-6 and IL-8 in the PICF of implants affected by PI compared to healthy implants. One study showed an increased secretion of IL-6, IL-8 and matrix metalloproteinase-1 by fibroblastic cells cultured from test- compared to control sites. Six studies reported high levels of tumor necrosis factor-alpha (TNF-α) levels in the PICF from test-sites (sites with PI) compared to the control sites. Two studies reported a positive association between polymorphism of IL-1 gene and PI. One study showed a negative association between polymorphism of TNF-α and an increased risk of PI. Raised levels of proinflammatory cytokines are exhibited in the PICF of patients with PI.

Javed F, Al-Hezaimi K, Al-Rasheed A, Almas K, Romanos GE. Implant survival rate after oral cancer therapy: a review. Oral Oncol. 2010 Dec;46(12):854-9.

The overall impression regarding the success of dental implants (DI) in patients having undergone oral cancer therapy remains unclear. The aim of the present review study was to assess the implant survival rate after oral cancer therapy. Databases were explored from 1986 up to and including September 2010 using the following keywords in various combinations: "cancer", "chemotherapy", "dental implant", "oral", "osseointegration", "radiotherapy", "surgery" and "treatment". The eligibility criteria were: (1) original research articles; (2) clinical studies; (3) reference list of pertinent original and review studies; (4) intervention: patients having undergone radio- and chemotherapy following oral cancer surgery; and (5) articles published only in English. Twenty-one clinical studies were included. Results from 16 studies reported that DI can osseointegrate and remain functionally stable in patients having undergone radiotherapy following oral cancer surgery; whereas three studies showed irradiation to have negative effects on the survival of DI. Two studies reported that DI can osseointegrate and remain functionally stable in patients having undergone chemotherapy. It is concluded that DI can osseointegrate and remain functionally stable in patients having undergone oral cancer treatment. 

Meherali SM, Parpio Y, Ali TS, Javed F. Nurses' knowledge of evidence-based guidelines for prevention of ventilator-associated pneumonia in critical care areas: a pre and post test design. J Ayub Med Coll Abbottabad. 2011 Jan-Mar;23(1):146-9.

BACKGROUND:

Ventilator associated pneumonia (VAP) is a common hospital acquired pneumonia in ventilated patients. VAP is associated with increased morbidity, mortality duration of hospitalization and cost of treatment. Critical care nurses are usually unaware of evidence based preventive guidelines for VAP, resulting in negative impact on all aspects of patient care. This study investigated the impact of a 5-hour teaching module on nurses' knowledge to practice evidence based guidelines for the prevention of VAP.

METHODS:

This study was conducted at a private tertiary care teaching hospital in Karachi, Pakistan. Single group pre-test design was used. Forty nurses were included in the study. The knowledge of nurses was assessed before, immediately after and 4 weeks after the intervention. The final sample (n=40) was selected on the basis of the set inclusion criteria. The demographic data sheet was used to collect relevant information about the participants. Knowledge was assessed through a self-developed validated tool, consisting of multiple choice questions. The difference in knowledge was analysed through repeated measures of analysis of variance. The mean scores at 3 time points were compared using the Tukey's multiple comparison procedure.

RESULTS:

Knowledge scores of participants increased significantly after the educational intervention in the first post-test; however, there was a decline in the score in post-test 2.

CONCLUSION:

the 5-hour teaching module significantly enhanced nurses' knowledge towards evidence based guidelines for the prevention of VAP. Further research is needed to assess the impact of training on nursing practice and to explore factors affecting attitudinal change.