Gender and Ethnic Medicine Project: Oral Health


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Video 1: Click the picture above to listen to Dr Cohen giving the rationale why you should learn about oral health issues... Video 2: Click the picture above to see Dr Cohen perform an Oral Health Exam...

Video 3: Click the picture above to see Drs Cohen and Yeh discuss Oral Health issues related to Gender, Ethnicity, Age and more...

You might subscribe to the GEM discussions in iTunes, and listen to them on your iPod

videos - introduction - links - anatomy - disease - systemics - additional references

Introduction

While there is considerable overlap in the knowledge base of medical and dental care practitioners, there are often many differences in professional training that limit the integration of general health care and oral health care. These limitations have serious implications for quality of care and integration of the continuum of care for patients. It is our charge to help overcome these barriers and propose learning objectives for medical students, residents and physicians in several areas germane to oral health.

Four major topics comprise the knowledge and skill base that all medical providers should have regarding oral health. These four components include: Oral anatomy and Oral assessment; Oral Diseases/Disorders; The Oral Systemic Link; and Effects of pharmacologic agents on the oral cavity. In the following document, learning objectives and resources have been provided for each of the topics listed above.

Gender and ethnic disparities must be considered when addressing the integration of oral health and general health. Women have special oral health care needs and consideration that men do not have. For example, female hormonal fluctuations associated with puberty, menses, pregnancy, use of oral contraceptives and menopause may cause changes in periodontal tissues. Cleft palate occurs more often in females. Women are twice as likely to report orofacial pain and nine times as likely to have Sjogren's Syndrome. Temporomandibular disorders are often more prevalent in women. Women are more susceptible to eating disorders and to being victims of domestic violence, both conditions which often involve the orofacial complex.

Ethnic disparities also exist in many oral diseases/disorders. Overall, oral cancer occurs twice as often in the black population as in whites. For example, black men have the highest rates of oral and pharyngeal cancer of any group. Oral cancer is the fourth most common cancer seen in black men as compared with the sixth most common cancer seen in white men. Destructive periodontal disease occurs in 59% of Native Americans as compared with 33% of blacks, 25% of Mexican Americans and 20% of whites.

Dental caries is the most frequent childhood disease, and is concentrated among poor, minority children. Of the youngsters who have experienced dental decay, African-American and Mexican-American children and adolescents have higher percentages of decay than Caucasian youth. Poverty-level African American and Mexican children aged two-to-nine are the most likely to suffer with large amounts of untreated tooth decay. (NIH, 2001) Latino preschoolers, the fastest growing child population in the US, experience 2.5 times more tooth decay than white children. African American children experience 1.5 times more tooth decay than white children. Ethnic disparities continue throughout the lifespan. For example, among retirees, 34% of Black older American have lost all of their teeth as compared to 23% of whites and 20% of Hispanic older adults.

To emphasize the importance of oral health as it relates to general health, the Surgeon General has released two landmark reports. In 2000, Oral Health in America, the first report was released, and in 2003, The National Call to Action once again acknowledged that oral health is a key interrelated component of general health.

The Report of the Surgeon General emphasizes the oral facial area as a “mirror of health and disease” because many viral, bacterial and fungal diseases frequently show lesions in and around the mouth and face. Recent research has uncovered early and intriguing associations between oral infections and cardiovascular disease, stroke, diabetes and low birth weight/preterm delivery. In the past, the oral systemic link as part of oral medicine focused primarily on the oral manifestations of systemic diseases. However, in recent years, research has demonstrated that oral changes may significantly influence extra-oral problems. Therefore, it is clear that the oral systemic link is a two way street backed by scientific literature.

It is our goal to reduce the gap in knowledge regarding oral health and improve the interface of general health and oral health. The recent emergence of new information as a result of research in the area of oral health has mandated that both physicians and dentists be aware of these findings in their efforts to provide optimal care. It is our intention to provide all healthcare providers with the knowledge and skills to effectively include a complete oral examination as part of every general physical examination. The term oral health is used to indicate a broad view of health of the entire orofacial complex, rather than just the health of the teeth. Health care professionals must realize the critical, interrelated role of oral health care within general health care. Consideration must be given to gender and ethnic disparities in oral health as well. In closing, to quote C. Everett Koop, former Surgeon General, “You are not healthy without good oral health.”

videos - introduction - links - anatomy - disease - systemics - additional references

Links

  1. Society of Teachers of Family Medicine National Oral Health Curriculum for Family Medicine
    http://www.stfm.org/oralhealth/

  2. Barbara Steinberg, DDS
    DUCoM Women's Health Seminar Series about Women’s Oral Health
    View Seminar part 1 - View Seminar part 2 (you need a Drexel ID to see these seminars)

videos - introduction - links - anatomy - disease - systemics - additional references

Table of learning objectives and references

Learning objectives

References

I: Normal Oral Anatomy

Describe the normal anatomical structures of the oral cavity

Woelfel, JB, Scheid, RC. Dental Anatomy – Its Relevance to Dentistry. Williams & Wilkins, 6th edition, 2003

Ash, MM. Wheeler's Dental Anatomy, Physiology and Occlusion. WB Saunders Company, 1993

Liebgott, B. Anatomical Basis of Dentistry, 2nd edition, CV Mosby, 2001

Demonstrate competency in performing an oral assessment

Bickley, LB. Bates' guide to physical examination and history taking, 7th ed. Lippincott, 1999

“Detecting Oral Cancer: A Guide for Health Care Professionals”: http://www.nidcr.nih.gov/HealthInformation/DiseasesAndConditions/OralCancer/DetectingOralCancer.htm

Differentiate normal variations of normal and abnormal oral findings

“Detecting Oral Cancer: A Guide for Health Care Professionals”: http://www.nidcr.nih.gov/HealthInformation/DiseasesAndConditions/OralCancer/DetectingOralCancer.htm

Robinson, HBG and Miller, A, Colby, Kerr and Robinson's Color Atlas of Oral Pathology. Lippincott, 1990

Value the importance of oral assessment as an integral part of physical examination

Bickley, LB. Bates' guide to physical examination and history taking, 7th ed. Lippincott, 1999

“Detecting Oral Cancer: A Guide for Health Care Professionals”: http://www.nidcr.nih.gov/HealthInformation/DiseasesAndConditions/OralCancer/DetectingOralCancer.htm

Robinson, HBG and Miller, A, Colby, Kerr and Robinson's Color Atlas of Oral Pathology. Lippincott, 1990.

Describe gender and ethnic variations where applicable

Bickley, LB. Bates' guide to physical examination and history taking, 7th ed. Lippincott, 1999

“Detecting Oral Cancer: A Guide for Health Care Professionals”: http://www.nidcr.nih.gov/HealthInformation/DiseasesAndConditions/OralCancer/DetectingOralCancer.htm

Robinson, HBG and Miller, A, Colby, Kerr and Robinson's Color Atlas of Oral Pathology. Lippincott, 1990

II: Oral Diseases/ Disorders:

Discuss the pathophysiology, etiology, differential diagnosis, prevention, and treatment options, as well as age gender and ethnic disparities where present, for the following:

 

National Call to Action to Promote Oral Health. U.S. Department of Health and Human Services, Rockville MD: U.S. Department of Health and Human Services, Public Health Service, National Institutes of Health, National Institute of Dental and Craniofacial Research. NIH Publication No. 03-5303, Spring 2003: http://www.surgeongeneral.gov/library/oralhealth/nationalcalltoaction.htm

Oral Health In America: A Report of the Surgeon General. U.S. Department of Health and Human Services, Rockville MD: U.S. Department of Health and Human Services, Public Health Service, National Institutes of Health, National Institute of Dental and Craniofacial Research. 2000: http://www.surgeongeneral.gov/library/oralheatlh/

Healthy People 2010. U.S. Department of Health and Human Services, Rockville MD: U.S. Department of Health and Human Services, Public Health Service, National Institutes of Health, National Institute of Dental and Craniofacial Research. 2000: http://www.healthypeople.gov

Neville BW, Damm DD. Oral and Maxillofacial Pathology. WB Saunders, 2nd edition, 2001.

Little J, Falace D, Miller C, Rhodus N. Dental Management of Medically Compromised Patients. 6th edition. 2002. St. Louis, CV Mosby Co.

Siegel MA, Silverman S, Sollecito TP. Clinician's Guide to Treatment of Common Oral Conditions, 5th edition, 2003.

Oral cancer

“Detecting Oral Cancer: A Guide for Health Care Professionals”: http://www.nidcr.nih.gov/HealthInformation/DiseasesAndConditions/OralCancer/DetectingOralCancer.htm

Neville BW, Damm DD. Oral and Maxillofacial Pathology. WB Saunders, 2nd edition, 2001

Tyler MT, Lozada-Nur F, Glick M. Clinician's Guide to Treatment of Medically Complex Dental Patients. 2nd edition, BC Decker, 2001

Dental caries

Harris, N.O., Garcia Godoy (2004). Primary preventive dentistry (6th ed.). Upper Saddle River, NJ: Pearson Prentice Hall

Gluch, JI, Giorgio, SK, Steinberg BJ , Oral Health, in Gorin, SS and Arnold,J. Health Promotion in Practice. Jossey Bass 2006, p. 257-264, 271-276

Beltran, ED, et al, “Surveillance for Dental Caries, Dental Sealants, Tooth Retention, Edentulism and Enamel Fluorosis – US 1988-1994 and 1999-2002. Morbidity and Mortality Weekly. 54 (03); 1-44, August 26, 2005

http://www.cdc.gov/mmwr/preview/mmwrhtml/ss5403a1.htm

Periodontal disease

Periodontics: Medicine, Surgery, and Implants. Rose LF; Mealey BL; Genco RJ; Cohen DW editors; Elsevier – Mosby; St. Louis 2004

Temporo mandibular disorder (TMD)

Okeson, JP. Management of Temporomandibular Disorders. Mosby Year Book, 5th edition, 2003.

Oral lesions (including HSV, aphthous ulcers)

Little J, Falace D, Miller C, Rhodus N. Dental Management of Medically Compromised Patients. 6th edition. 2002. St. Louis, CV Mosby

Siegel, MA, Silverman, S, Sollecito, TP. Clinician's Guide to Treatment of Common Oral Conditions, 5th edition, 2003.

Neville,BW, Damm, DD. Oral and Maxillofacial Pathology. WB Saunders, 2nd edition, 2001.

Oral Trauma/ Emergencies for teeth, hard, and soft tissues

Fonseca, RJ, Walker, RV, Betts, NJ. Oral and Maxillofacial Trauma. 3rd edition, Elsevier, 2004

Fonseca, RJ. Oral and Maxillofacial Surgery, Trauma, Volume 3. CV Mosby, 2000

Peterson, L, Ellis, E, Hupp, J, Tucker, M. Contemporary Oral and Maxillofacial Surgery, CV Mosby, 2003.

Cleft lip / cleft palate

Murray, JC. Face facts: genes, environments, and clefts. Am J Hum Genetics 1995, 57 (2), 227-232

Salivary gland disorder

Neville,BW, Damm, DD. Oral and Maxillofacial Pathology. WB Saunders, 2nd edition, 2001

Little J, Falace D, Miller C, Rhodus N. Dental Management of Medically Compromised Patients. 6th edition. 2002. St. Louis, CV Mosby

Siegel, MA, Silverman, S, Sollecito, TP. Clinician's Guide to Treatment of Common Oral Conditions, 5th edition, 2003

Disease Prevention/Health Promotion

Gluch, JI, Giorgio, SK, Steinberg BJ, Oral Health, in Gorin, SS and Arnold,J. Health Promotion in Practice. Jossey Bass 2006, p. 254 – 286

Harris, N.O., Garcia Godoy (2004). Primary preventive dentistry (6th ed.). Upper Saddle River, NJ: Pearson Prentice Hall.

III: Oral – Systemic Link

A: Describe the potential relationship and oral manifestations of the following systemic diseases/conditions, as well as age gender and ethnic disparities where present

 

Little J, Falace D, Miller C, Rhodus N. Dental Management of Medically Compromised Patients. 6th edition. 2002. St. Louis, CV Mosby

1997 Sunstar-Chapel Hill symposium on periodontal diseases and human health: new directions in periodontal medicine. Annals of Periodontology. 1998 3(1)

Mealey BL, Rees TD, Rose LF, Grossi SG: Systemic factors impacting the periodontium - Chapter 31 in: Periodontics: Medicine, Surgery, and Implants. Rose LF; Mealey BL; Genco RJ; Cohen DW editors; Elsevier – Mosby; St. Louis 2004

Steinberg BJ, Minsk L, Gluch JI, Giorgio SK: Women's Oral Health Issues. Women's Health in Clinical Practice. Clouse A, Sherif K, editors, Philadelphia: Human Press, in press

Garfunkel AA: Recognizing the dental-medical symbiosis: back to basic sciences. Compendium of Continuing Education in Dentistry. 2006; 27 (7), 390-394

Diabetes

Mealey BL. Diabetes Mellitus. In: Rose LF, Genco RJ, Mealey BL, and Cohen DW, eds. Periodontal Medicine. Toronto, Ontario, 2000, BC Decker, Inc. Publishers.

Loe H. Periodontal disease. The sixth complication of diabetes mellitus. Diabetes Care 16 (suppl 1): 329-334, 1993.

 

Cardiovascular disease

Scannapieco FA, Bush RB, Paju S: Associations between periodontal disease and risk for atherosclerosis, cardiovascular disease, and stroke. A systematic review. Annals of Periodontology, 2003; 8(1) 38-53

 

The American Academy of Periodontology. Periodontal management of cardiovascular-risk patients (position paper). J.Periodontol. 2001

Rose LF, Mealy B, Minsk L, Cohen DW: Oral Care for patients with cardiovascular disease and stroke: Journal of the American Dental Association, 133 (6); 37s-44s, 2002

Osteoporosis

Kribbs PJ. Comparison of mandibular bone in normal and osteoporotic women. J Prosthet Dent 1992; 63:218-222.

Krall E, Garcia R, Dawson-Hughes B. Increased risk of tooth loss is related to bone loss at the whole body, hip, and spine. Calcif Tisue Int 1996; 59:433-437.

Grodstein F, Colditz G, Stamfer G. Post-menopausal hormone use and tooth loss: a prospective study. Journal American Dental Association 1996; 127:370-377.

Von Wowern N, Klausen B, Kollerup G. Osteoporosis: a risk factor in periodontal disease. Journal Periodontology 1994; 65:1134-1138.

Grossi S, Nishida M, Wactawski-Wende J, et al. Skeletal osteopenia increases the risk for periodontal disease. J Dent Res 77. 1998. Ref Type: Abstract

 

Pregnancy

Scannapieco FA, Bush RB, Paju S: Periodontal disease as a risk factor for adverse pregnancy outcomes. A systematic review. Annals of Periodontology, 2003; 8(1) 70-78

Loe H. Periodontal changes in pregnancy. Journal Periodontology 1965; 36:209-216.

Amar S, Chung K. Influence of hormonal variation on the periodontium in women. Periodontol 2000 1994; 6:78-87.

Offenbacher S, Katz V, Fertik G, Collins J, Boyd D, Maynor G et al. Periodontal disease as a possible risk factor for preterm low birth weight. Journal Periodontology 1996; 67 (suppl):1103-1113.

Menopause

Zachariasen R. Oral manifestations of menopause. Compend Contin Educ Dent 1993; 14:275-280

American Dental Association. Women's oral health issue. Oral Health Care Series , 22-25. 1995. Ref Type: Serial (Book,Monograph)

Hormonal fluctuations

Mealey B, Rees T, Rose L, Grossi S. Systemic factors impacting the periodontium. In: Rose L, Mealey B, Genco R, Cohen D, editors. Periodontics: medicine, surgery and implants. St. Louis: Elsevier Mosby, 2004: 790-845.

Respiratory diseases

Scannapieco FA, Bush RB, Paju S: Associations between periodontal diseases and risk for nosocomial bacterial pneumonia and chronic obstructive pulmonary disease. A systematic review. Annals of Periodontology, 2003; 8(1) 54-69

 

HIV/AIDS

Patton, L, Glick, M. Clinician's Guide to the Treatment of HIV infected Patients. 3rd edition, LC Becker, 2001

Little J, Falace D, Miller C, Rhodus N. Dental Management of Medically Compromised Patients. 6th edition. 2002. St. Louis, CV Mosby Co.

Sjogren syndrome and other autoimmune disease (i.e. lupus)

Little J, Falace D, Miller C, Rhodus N. Dental Management of Medically Compromised Patients. 6th edition. 2002. St. Louis, CV Mosby Co.

 

Psychosocial disorders (stress, domestic violence, eating disorders)

Stress & Depression:

Croucher R, Marcenes WS, Torres MC, et al. The relationship between life events and periodontitis. A case control study. J Clin Periodontol 24: 39-43, 1997

Monteiro da Silva AM, Oakley DA, Newman HN, et al. Psychosocial factors and adult onset rapidly progressive periodontitis. J Clin Periodontol 23: 789-794, 1996

Linden GJ, Mullally BH, Freeman R. Stress and the progression of periodontal disease. J Clin Periodontol 23: 675-680, 1996

Domestic Violence:

Tjaden P, Thoennes N. Prevalence, incidence and consequences of violence against women: findings from the National Violence Against Women Survey. Department of Justice, editor. Research in Brief. 1998. Washington, DC.

Eating Disorder:

Brown S, Bonifaz D. An overview of anorexia and bulimia nervosa and the impact of eating disorders on the oral cavity. Compend Contin Educ Dent 1993; 14(12):1594-1608.

American Dental Association. Women's oral health issue. Oral Health Care Series , 22-25. 1995. Ref Type: Serial (Book,Monograph)

Obesity

Dalla Vecchia CF, Susin C, Rosing CK, Oppermann RV, Albandar JM: Overweight and obesity as risk indicators for periodontitis in adults. J Periodontol. 2005 Oct;76(10):1721-8

 

B: Describe the effects of pharmacologic agents on the oral cavity and explain the prevention and treatment for these conditions:

gingival hyperplasia, xerostomia, burning mouth, candida, bruxism

Little J, Falace D, Miller C, Rhodus N. Dental Management of Medically Compromised Patients. 6th edition. 2002. St. Louis, CV Mosby

Yagiela J, Niedle E, Dowd F: Pharmacology and therapeutics in dentistry. 5th edition. 2004. St. Louis CV Mosby Co.

Osteonecrosis

Migliorati CA, Casiglia J, Epstein J, Jacobsen PL, Siegel MA, Woo S-B: Managing the care of patients with bisphosphonate-associated osteonecrosis: An American Academy of Oral Medicine position paper. J Am Dent Assoc 2005, Vol 136, No 12, 1658-1668

Markiewicz M, Margarone III J, Campbell JH, Aguirre A: Bisphosphonate-associated osteonecrosis of the jaws. A review of current knowledge. Am Dent Assoc 2005, Vol 136, No 12, 1669-1674

Ruggiero S, Mehrotra B, Rosenberg T, Engroff S. Osteonecrosis of the jaws associated with the use of bisphosphonates: a review of 63 cases. Journal Oral Maxillofacial Surgery 2004; 62(5):527-534

videos - introduction - links - anatomy - disease - systemics - additional references

Additional References

Learning objectives

ADDITIONAL References

I: Normal Oral Anatomy

Describe the normal anatomical structures of the oral cavity

 

Demonstrate competency in performing an oral assessment

 

Differentiate normal variations of normal and abnormal oral findings

 

Value the importance of oral assessment as an integral part of physical examination

 

Describe gender and ethnic variations where applicable

 

II: Oral Diseases/ Disorders:

Discuss the pathophysiology, etiology, differential diagnosis, prevention, and treatment options, as well as age gender and ethnic disparities where present, for the following:

 

 

“Oral Diseases and Conditions”: http://www.nidcr.nih.gov/HealthInformation/DiseasesAndConditions/default

 

“Open Wide: Oral Health Training for Health Care Professionals”: http://www.mchoralhealth.org/OpenWide/index.htm

 

“A Health Professional's Guide to Pediatric Oral Health Care Management”: http://www.mchoralhealth.org/PediatricOH/index.htm

Oral cancer

 

Dental caries

 

 

Periodontal disease

 

Temporal mandibular disorder (TMD)

 

Oral lesions (including HSV, aphthous ulcers)

 

Oral Trauma/ Emergencies for teeth, hard, and soft tissues

 

Cleft lip / cleft palate

 

Salivary gland disorder

 

Disease Prevention/Health Promotion

 

III: Oral – Systemic Link

A: Describe the potential relationship and oral manifestations of the following systemic diseases/conditions, as well as age gender and ethnic disparities where present

 

Rose LF, Steinberg BJ, Minsk L: The Relationship between Periodontal Disease and Systemic Conditions. Compendium of Continuing Education in Dentistry, 21(10A); 870-877, 2000

Cohen DW, Rose LF, Minsk L: Potential Effects of Oral Infections on Systemic Health. Alpha Omegan, 94(1):24-31, 2001

Diabetes

Iacopino AM. Periodontitis and diabetes interrelationships: role of inflammation. Ann Periodontol 6: 125-137, 2001.

Lalla E, Lamster IB, Stern DM, Schmidt AM. Receptor for advanced glycation end products, inflammation, and accelerated periodontal disease in diabetes: mechanisms and insights into therapeutic modalities. Ann Periodontol 6: 113-118, 2001.

Lalla E, Lamster IB, Drury S, et al. Hyperglycemia, glycoxidation and receptor for advanced glycation end products: potential mechanisms underlying diabetic complications, including diabetes-associated periodontitis. Periodontology 2000 23: 50-62, 2000.

Tavares M, DePaola P, Soparkar P, Joshipura K. Prevalence of root caries in a diabetic population. J Dent Res 70:979-983, 1991.

Collin HL, Uusitupa M, Niskanen L, et al. Caries in patients with non-insulin-dependent diabetes mellitus. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 85:680-685, 1998.

Taylor GW. Bidirectional interrelationships between diabetes and periodontal diseases: an epidemiologic perspective. Ann Periodontol 6: 99-112, 2001.

Ervasti T, Knuuttila M, Pohjamo L, Haukipuro K. Relation between control of diabetes and gingival bleeding. J Periodontol 56:154-157, 1985.

Karjalainen KM, Knuuttila MLE. The onset of diabetes and poor metabolic control increases gingival bleeding in children and adolescents with insulin-dependent diabetes mellitus. J Clin Periodontol 23:1060-1067, 1996.

Shlossman M, Knowler WC, Pettitt DJ, Genco RJ. Type 2 diabetes mellitus and periodontal disease. J Am Dent Assoc 121:532-536, 1990.

Emrich LJ, Shlossman M, Genco RJ. Periodontal disease in non-insulin-dependent diabetes mellitus. J Periodontol 62:123-130, 1991.

Taylor GW, Burt BA, Becker MP, et al. Non-insulin dependent diabetes mellitus and alveolar bone loss progression over 2 years. J Periodontol 69:76-83, 1998.

Sastrowijoto SH, Hillemans P, van Steenbergen TJ, Abraham-Inpijn L, de Graff J. Periodontal condition and microbiology of healthy and diseased periodontal pockets in type 1 diabetes mellitus patients. J Clin Periodontol 16:316-322, 1989.

Zambon JJ, Reynolds H, Fisher JG, et al. Microbiological and immunological studies of adult periodontitis in patients with non-insulin dependent diabetes mellitus. J Periodontol 59:23-31, 1988.

Ficara AJ, Levin MP, Grower MF, Kramer GD. A comparison of the glucose and protein content of gingival crevicular fluid from diabetics and nondiabetics. J Periodont Res 10:171-175, 1975.

Nishimura F, Takahashi K, Kurihara M, et al. Periodontal disease as a complication of diabetes mellitus. Ann Periodontol 3:20-29, 1998.

Frantzis TG, Reeve CM, Brown AL. The ultrastructure of capillary basement membranes in the attached gingiva of diabetic and non-diabetic patients with periodontal disease. J Periodontol 42:406-411, 1971.

Seppala B, Sorsa T, Ainamo J. Morphometric analysis of cellular and vascular changes in gingival connective tissue in long-term insulin-dependent diabetes. J Periodontol 68:1237-1245, 1997.

Schmidt AM, Weidman E, Lalla E, et al. Advanced glycation endproducts (AGEs) induce oxidant stress in the gingiva: a potential mechanism underlying accelerated periodontal disease associated with diabetes. J Periodont Res 31:508-515, 1996.

Salvi GE, Collins JG, Yalda B, et al. Monocytic TNF-a secretion patterns in IDDM patients with periodontal diseases. J Clin Periodontol 24:8-16, 1997.

Salvi GE, Yalda B, Collins JG, et al. Inflammatory mediator response as a potential risk marker for periodontal diseases in insulin-dependent diabetes mellitus patients. J Periodontol 68:127-135, 1997.

Ryan ME, Ramamurthy NS, Golub LM. Matrix metalloproteinases and their inhibition in periodontal treatment. Curr Opin Periodont 3:85-96, 1996.

Golub LM, Lee H-M, Ryan ME. Tetracyclines inhibit connective tissue breakdown by multiple non-antimicrobial mechanisms. Adv Dent Res 12:12-26, 1998.

Cardiovascular disease

Mattila K, Nieminen m, Valtonene V, et al. Association between dental health and acute myocardial infarction. Br Med J 1989;298:779-782

Mattila KJ, Valle MS, Nieminen MS, Valtonen VV, Hietaniemi KL. Dental infections and coronary atherosclerosis. Atherosclerosis 1993;103:205-211

Grau AJ, Buggle F, Siegler C. Association between acute cerebrovascular ischemia and chronic and recurrent infection. Stroke 1997:28:1724-1729

DeStefano F, Anda RF, Kahn HS, Williamson DF, Russell CM. Dental disease and risk of coronary heart disease and mortality. Br Med J 1993;306:688-691

Haraszthy VI, Zambon JJ, Trevisan M, et al: Identification of pathogens in atheromatous plaques. J Dent Res, Vol 77 [IADR abstract 666], 1998

Osteoporosis

Kribbs P, Smith D, Chestnut C. Oral findings in osteoporosis. Part II. Relationship between residual ridge and alveolar bone resorption and generalized skeletal osteopenia. Journal Prorthetic Dentistry 1983; 50:719-724.

Kribbs P, Chesnut C, Ott S, Kilcyne R. Relationships between mandibular and skeletal bone in a population of normal women. J Prosthet Dent 1990; 63:86-89

Daniell H. Postmenopausal tooth loss. Contributions to edentulism by osteoporosis and cigarette smoking. Arch Intern Med 1983; 143:1678-1682

Paganini-Hill A. Benefits of estrogen replacement therapy on oral health: the leisure world cohort. Arch Intern Med 1995; 155(2325):2329.

Krall E, Dawson-Hughes B, Hannan M, et al. Post-menopausal estrogen replacement and tooth retention. Am J Med 1997; 102:536-542

Wactawski-Wende J, Grossi SG, Trevisan M, Genco RJ, Tezal M, Dunford RG et al. The Role of Osteopenia in oral Bone Loss and Periodontal Disease. J Periodontol 1996; 67(10):1076-1084

Norderyd O, Grossi S, Machtei E, et al. Periodontal status of women taking post-menopausal estrogen supplementation. Journal Periodontology 1993; 64:957-962.

Payne J, Zachs N, Reinhardt R, et al. The association between estrogen status and alveolar bone density changes in postmenopausal women with a history of periodontitis. Journal Periodontology 1997; 68:24-31

Jeffcoat MK, Lewis C, Reddy M, et al. Post-menopausal bone loss and its relationship to oral bone loss. Periodontol 2000 2000; 23:94-102

Pregnancy

Loe H, Siness J. Periodontal disease in pregnancy I. Prevalence and severity. Acta Odontol Scand 1963; 21:533-551

Cohen D, Shapiro J, Friedman L, Kyle G, Franklin S. A longitudinal investigation of the periodontal changes during pregnancy and fifteen months post-partum. (Part II). Journal Periodontology 1971; 42:653-657.

Sooriyamoorthy M, Gower D. Hormonal influences on gingival tissue: Relationship to periodontal disease. Journal of Clinical Periodontology 1989; 16:201-208

Ferris G. Alteration in female sex hormones: Their effect on oral tissues and dental treatment. Compend Contin Educ Dent 1993; 14:1558-1570.

Zachariasen R. The effect of elevated ovarian hormones on periodontal health: Oral contraceptives and pregnancy. Women Health 1993; 20:21-30.

Raber-Durlacher J, Zeijlemaker W, Meinesz A, Abraham-Inpijn L. CD4 to CD8 ratio and invitro lymphoproliferative responses during experimental gingivitis in pregnancy and post-partum. Journal Periodontology 1991; 62:663-667.

Raber-Durlacher J, Leene W, Palmer-Bouva C, Raber J, Abraham-Inpijn L. Experimental gingivitis during pregnancy and post-partum: Immunohistochemical aspects. Journal Periodontology 1993; 64:211-218.

Mariotti A. Sex steroid hormones and cell dynamics in the periodontium. Crit Rev Oral Biol Med 1994; 5:27-53.

O'Neil T. Plasma female sex-hormone levels and gingivitis in pregnancy. Journal Periodontology 1979; 50:279-282.

Thomson M, Pack A. Effects of extended systemic and topical folate supplementation on gingivitis in pregnancy. Journal of Clinical Periodontology 1982; 9:275-280.

Kornman K, Loesche W. The subgingival microflora during pregnancy. J Periodont Res 1980; 15:111-122.

Jensen J, Liljemark W, Bloomquist C. The effect of female sex hormones on subgingival plaque. Journal Periodontology 1981; 52:599-602.

Kornman K, Loesche W. Effects of estradiol and progesterone on Bacterioides melaninogenicus. Infect Immun 1982; 35:256-263.

Arafat A. The prevalence of pyogenic granuloma in pregnant women. J Baltimore Coll Dent Surg 1974; 29:64-70.

El-Ashiry G, et al. Comparative study of the influence of pregnancy and oral contraceptives on the gingivae. Oral Surgery 1970; 30:472-475.

Rateitschak K. Tooth mobility changes in pregnancy. Journal Periodontology 1967; 2:199-206.

Jeffcoat M, Hauth J, Geurs N, Reddy M, Cliver S, Hodgkins P et al. Periodontal disease and preterm birth: results of a pilot intervention study. Journal Periodontology 2003; 74:1214-1218

Offenbacher S, Boggess KA, Murtha AP, Jared HL, Lieff S, McKaig RG, Mauriello SM, Moss KL, Beck JD: Progressive periodontal disease and risk of very preterm delivery. Obstet Gynecol. 2006 Jan;107(1):29-36. Erratum in: Obstet Gynecol. 2006 May;107(5):1171

Lopez NJ, Smith PC, Gutierrez J: Periodontal therapy may reduce the risk of preterm low birth weight in women with periodontal disease: a randomized controlled trial. J Periodontol. 2002 Aug;73(8):911-24

Lopez NJ, Da Silva I, Ipinza J, Gutierrez J: Periodontal therapy reduces the rate of preterm low birth weight in women with pregnancy-associated gingivitis. J Periodontol. 2005 Nov;76(11 Suppl):2144-53

Oettinger-Barak O, Barak S, Ohel G, Oettinger M, Kreutzer H, Peled M, Machtei EE: Severe pregnancy complication (preeclampsia) is associated with greater periodontal destruction. J Periodontol. 2005 Jan;76(1):134-7

Menopause

Jacobs R, Ghyselen J, Koninckx P, vanSteenberghe D. Long-term bone mass evaluation of mandible and lumbar spine in a group of women receiving hormone replacement therapy. Eur J Oral Sci 1996; 104:10-16.

Hormonal fluctuations

Sweet J, Butler D. Increased incidence of postoperative localized osteitis in mandibular 3rd molar surgery associated with patients using oral contraceptives. Am J Obset Gynecol 1977; 127(5):518-519.

Castellini J, Harvey D, Erickson S, Cherkin D. Effect of oral contraceptive cycle on dry socket (localized alveolar osteitis). J Am Dent Assoc 1980; 101(5):777-780.

Vittek J, Hernandez M, Wenk E, Rappaport S, Southren A. Specific estrogen receptors in human gingiva. Journal of Clinical Endocrinology & Metabolism 1982; 54:608-612

Respiratory diseases

Okuda K, Kimizuka R, Abe S, Kato T, Ishihara K. Involvement of periodontopathic anaerobes in aspiration pneumonia. J Perio, 2005 Nov;76(11 Suppl):2154-60

Acachi M, Ishihara K, Abe S, Okuda K, Ishikawa T: Effect of professional oral health care on the elderly living in nursing homes. OOO 2002 94(2) 191-5

Okuda M, Kaneko Y, Ichinohe T, Ishihara K, Okuda K: Reduction of potential respiratory pathogens by oral hygienic treatment in patients undergoind endotracheal anesthesia. J Anesth 2003; 17(2): 84-91

HIV/AIDS

 

Sjogren syndrome and other autoimmune disease (i.e. lupus)

 

Psychosocial disorders (stress, domestic violence, eating disorders)

Stress & Depression:

Giddon DB, Goldhaber P, Dunning JM. Prevalence of reported cases of acute necrotizing ulcerative gingivitis in a university population. J Periodontol 34: 66-70, 1963.

Shields WD. Acute necrotizing ulcerative gingivitis: a study of some of the contributing factors and their validity in an army population. J Periodontol 48: 346-349, 1977

Marcenes WS, Sheiham A. The relationship between work stress and oral health status. Soc Sci Med 35: 1511-1520, 1992.

Genco RJ, Ho AW, Kopman J, et al. Models to evaluate the role of stress in periodontal disease. Ann Periodontol 3: 288-302, 1998

Genco RJ, Ho AW, Grossi SG, et al. Relationship of stress, distress, and inadequate coping behaviors to periodontal diseases. J Periodontol 70: 711-732, 1999

Elter JR, Alex White B, Gaynes BN, Bader JD. Relationship of clinical depression to periodontal treatment outcome. J Periodontol 73: 441-449, 2002

Rozlog LA, Kiecolt-Glaser JK, Marucha PT, et al. Stress and immunity: implications for viral disease and wound healing. J Periodontol 70: 786-792, 1999

Domestic Violence:

Paulozzi L, Saltzman L, Thompson M, Holmgreen P. Surveillance for homicide among intimate partners - United States 1981-1998. MMWR CDC Surveillance Summary 2001; 50(3):1-15.

Love C, Gerbert B, Caspers N. Dentists attitudes and behaviors regarding domestic violence. Journal American Dental Association 2001; 132:85-93.

Eating Disorder:

Mandel L, Kaynar A. Bulimia and parotid swelling: a review and case report. J Oral Maxillofac Surg 1992; 50:1122-1125.

Ruff J, Koch M, Perkins S. Bulimia: dentomedical complications. General Dentistry 1992; 40:22-25.

Halmi K. Anorexia nervosa - recent investigations. Annual Review in Medicine 1970; 29:137-148

Obesity

 

B: Describe the effects of pharmacologic agents on the oral cavity and explain the prevention and treatment for these conditions:

gingival hyperplaxia, xerostomia, burning mouth, candida, bruxism:

NIDCR.org

ADA.org

Osteonecrosis

 

videos - introduction - links - anatomy - disease - systemics - additional references