- Email: [email protected]
Internet information
Discussion.—DM, HT, and CAD were independent risk factors for having teeth extracted after NSRCT. Having two of these systemic diseases significantly increased the risk of tooth extraction after NSRCT.
Clinical Significance.—Systemic disease once again causes problems in the oral cavity. It is important to understand these influences so that they can be considered along with other confounding factors when determining a patient’s
prognosis. Further research is needed to confirm and further explain these findings.
Wang C-H, Chueh L-H, Chen S-C, et al: Impact of diabetes mellitus, hypertension, and coronary artery disease on tooth extraction after nonsurgical endodontic treatment. J Endod 37:1-5, 2011 Reprints available from C-P Chiang, Dept of Dentistry, National Taiwan Univ Hosp, No 1 Chang-Te St, Taipei 10048, Taiwan; e-mail: [email protected]
Orthodontics Internet information Background.—Successful orthodontic treatment depends on the establishment of a good relationship between the patient and the orthodontist. This begins with the consultation and treatment planning stages and continues throughout the process. Both patients and parents are more informed about orthodontics at present than in previous times. Extractions are done to provide space to accommodate a crowded dentition or to achieve orthodontic camouflage. The range of extraction frequencies between practitioners varies considerably, although generally, the frequency is diminishing. During informed consent, patients are offered all alternative treatments and may seek further information on the Internet to help them in choosing among the options, such as extraction or nonextraction. The quality of health information available on the Internet is problematic. To help users discriminate between sites, several organizations have developed methods and tools to assess and rate the quality of the health information presented. The LIDA instrument is a validated method of assessing the design and content of healthcare Web sites, measuring accessibility, usability, and reliability. Readability has been assessed using the Flesch reading ease score. A study was conducted to analyze the quality of information available on the Internet for persons interested in orthodontic extractions. Methods.—The first 50 Web links for the term ‘‘orthodontic extractions’’ on Google and Yahoo were pooled and examined. Repetitions, sites requiring registration or login, and those accessing scientific articles were excluded from the evaluation. The LIDA instrument was used to assess accessibility, usability, and reliability. The Flesch reading ease score was used to evaluate readability. Results.—Twenty-one sites were assessed. The mean total LIDA score overall was 93 out of a possible 144
50
Dental Abstracts
(65%), with a range of 71 to 116. The gold standard, a score of 129 out of R144 (90%), was not attained by any of the sites. Twenty of the 21 sites were between 50% and 81%. Accessibility score averaged 44 out of a possible 63 (70%). The lowest score on accessibility was 33 and the highest was 54. The average usability score was 39 out of a possible 54 (72%). The highest score was 50 and the lowest was 29. Reliability results decreased far below the expected standard, with an average of 11 out of a possible 27 (41%). The highest score was 19. The Flesch reading ease score averaged 58.3. Fortythree percent of the Web sites scored R60, 38% scored 50 to 60, and 19% scored 40 to 50. The highest score was 70.7 and the lowest was 45.4. Discussion.—This study found that sites with the highest LIDA and Flesch scores were not necessarily those ranked highest by the search engines. The overall quality of information available on the Internet regarding orthodontic extractions varied considerably. Readability was usually good, but reliability was of concern. Patients should interpret the information they obtain through the Internet with caution.
Clinical Significance.—The quality of information available on the Internet with respect to orthodontic extractions varies between sites. Reliability is an area that has raised great concern. Search engines do not rank the sites based on
their quality or readability; thus, their ranking is not an indication that they were a good source of information. Patients should be advised to use caution when obtaining information from the Internet on oral health-related matters.
Patel U, Cobourne MT: Orthodontic extractions and the Internet: Quality of online information available to the public. Am J Orthod Dentofacial Orthop 139:e103-e109, 2011 Reprints available from MT Cobourne, Dept of Orthodontics, Flr 22, King’s College London Dental Inst, Guy’s Hosp, London SE19RT, United Kingdom; e-mail: [email protected]
Periodontal Disease Antimicrobials for aggressive periodontitis Background.—In generalized aggressive periodontitis (GAgP), there is severe destruction of the supporting structures of the teeth that can cause edentulism early in life. This is a relatively rare disorder and little studied. Treatment approaches begin with a cause-related treatment phase aimed at reducing and/or eliminating pathogenic microorganisms. Systemic antimicrobials may also prove beneficial. A 7-day adjunctive course of systemic metronidazole and amoxicillin significantly improved the short-term clinical outcomes in patients with GAgP who underwent nonsurgical debridement. However, in clinical practice, antimicrobials are more likely to be used for retreatment than for initial therapy. An investigation was undertaken to determine whether retreatment with adjunctive antimicrobials achieves the same benefit in patients who received instrumentation alone (placebo group), as was seen in patients receiving antimicrobials initially (test group). Methods.—The initial study lasted 6 months, and 38 of the 41 patients with GAgP in the original study completed the retreatment phase. The focus was on sites with pockets that remained R5 mm in depth. Full-mouth root surface debridement was performed to reduce the load of pathogens quickly and prevent cross-contamination of treated sites. Patients were then given chlorhexidine mouth rinses to use for 2 weeks. Subjects in the placebo group in the first phase were given adjunctive antibiotics for 7 days. Two months after retreatment began (8 months from the beginning of the initial study), clinical parameters (probing pocket depth [PPD], lifetime cumulative attachment loss, and recession of the gingival margin) were measured. Results.—Both of the patient groups had improvements in mean PPD and lifetime cumulative attachment
loss. The maximum improvement was noted at 8 months. Patients who received antibiotics in the initial 6-month study had significant improvements in PPD and in the percentage of sites that improved beyond clinically relevant thresholds as compared with the patients whose antibiotic regimen began with the retreatment phase. The mean difference was 0.9 mm for deep pockets (R7 mm) and 0.4 mm for moderate pockets (4 to 6 mm). Discussion.—Having antimicrobials added to the regimen during initial therapy of GAgP conferred greater benefits than reserving antimicrobials for retreatment after 6 months of nonsurgical debridement alone.
Clinical Significance.—Patients who received antibiotics as part of their initial treatment for GAgP benefited significantly more than patients who were given the antibiotics later. Thus, it seems that for severe, aggressive periodontitis, it is best to eliminate causative organisms as well as provide mechanical treatment immediately.
Griffiths GS, Ayob R, Guerrero A, et al: Amoxicillin and metronidazole as an adjunctive treatment in generalized aggressive periodontitis at initial therapy or re-treatment: A randomized controlled clinical trial. J Clin Periodontol 38:42-49, 2011 Reprints available from GS Griffiths, Univ of Sheffield, Academic Unit of Restorative Dentistry, Claremont Crescent, Sheffield S10 2TA, UK; e-mail: [email protected]
Volume 57
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2012
51
Clinical Significance.—Systemic disease once again causes problems in the oral cavity. It is important to understand these influences so that they can be considered along with other confounding factors when determining a patient’s
prognosis. Further research is needed to confirm and further explain these findings.
Wang C-H, Chueh L-H, Chen S-C, et al: Impact of diabetes mellitus, hypertension, and coronary artery disease on tooth extraction after nonsurgical endodontic treatment. J Endod 37:1-5, 2011 Reprints available from C-P Chiang, Dept of Dentistry, National Taiwan Univ Hosp, No 1 Chang-Te St, Taipei 10048, Taiwan; e-mail: [email protected]
Orthodontics Internet information Background.—Successful orthodontic treatment depends on the establishment of a good relationship between the patient and the orthodontist. This begins with the consultation and treatment planning stages and continues throughout the process. Both patients and parents are more informed about orthodontics at present than in previous times. Extractions are done to provide space to accommodate a crowded dentition or to achieve orthodontic camouflage. The range of extraction frequencies between practitioners varies considerably, although generally, the frequency is diminishing. During informed consent, patients are offered all alternative treatments and may seek further information on the Internet to help them in choosing among the options, such as extraction or nonextraction. The quality of health information available on the Internet is problematic. To help users discriminate between sites, several organizations have developed methods and tools to assess and rate the quality of the health information presented. The LIDA instrument is a validated method of assessing the design and content of healthcare Web sites, measuring accessibility, usability, and reliability. Readability has been assessed using the Flesch reading ease score. A study was conducted to analyze the quality of information available on the Internet for persons interested in orthodontic extractions. Methods.—The first 50 Web links for the term ‘‘orthodontic extractions’’ on Google and Yahoo were pooled and examined. Repetitions, sites requiring registration or login, and those accessing scientific articles were excluded from the evaluation. The LIDA instrument was used to assess accessibility, usability, and reliability. The Flesch reading ease score was used to evaluate readability. Results.—Twenty-one sites were assessed. The mean total LIDA score overall was 93 out of a possible 144
50
Dental Abstracts
(65%), with a range of 71 to 116. The gold standard, a score of 129 out of R144 (90%), was not attained by any of the sites. Twenty of the 21 sites were between 50% and 81%. Accessibility score averaged 44 out of a possible 63 (70%). The lowest score on accessibility was 33 and the highest was 54. The average usability score was 39 out of a possible 54 (72%). The highest score was 50 and the lowest was 29. Reliability results decreased far below the expected standard, with an average of 11 out of a possible 27 (41%). The highest score was 19. The Flesch reading ease score averaged 58.3. Fortythree percent of the Web sites scored R60, 38% scored 50 to 60, and 19% scored 40 to 50. The highest score was 70.7 and the lowest was 45.4. Discussion.—This study found that sites with the highest LIDA and Flesch scores were not necessarily those ranked highest by the search engines. The overall quality of information available on the Internet regarding orthodontic extractions varied considerably. Readability was usually good, but reliability was of concern. Patients should interpret the information they obtain through the Internet with caution.
Clinical Significance.—The quality of information available on the Internet with respect to orthodontic extractions varies between sites. Reliability is an area that has raised great concern. Search engines do not rank the sites based on
their quality or readability; thus, their ranking is not an indication that they were a good source of information. Patients should be advised to use caution when obtaining information from the Internet on oral health-related matters.
Patel U, Cobourne MT: Orthodontic extractions and the Internet: Quality of online information available to the public. Am J Orthod Dentofacial Orthop 139:e103-e109, 2011 Reprints available from MT Cobourne, Dept of Orthodontics, Flr 22, King’s College London Dental Inst, Guy’s Hosp, London SE19RT, United Kingdom; e-mail: [email protected]
Periodontal Disease Antimicrobials for aggressive periodontitis Background.—In generalized aggressive periodontitis (GAgP), there is severe destruction of the supporting structures of the teeth that can cause edentulism early in life. This is a relatively rare disorder and little studied. Treatment approaches begin with a cause-related treatment phase aimed at reducing and/or eliminating pathogenic microorganisms. Systemic antimicrobials may also prove beneficial. A 7-day adjunctive course of systemic metronidazole and amoxicillin significantly improved the short-term clinical outcomes in patients with GAgP who underwent nonsurgical debridement. However, in clinical practice, antimicrobials are more likely to be used for retreatment than for initial therapy. An investigation was undertaken to determine whether retreatment with adjunctive antimicrobials achieves the same benefit in patients who received instrumentation alone (placebo group), as was seen in patients receiving antimicrobials initially (test group). Methods.—The initial study lasted 6 months, and 38 of the 41 patients with GAgP in the original study completed the retreatment phase. The focus was on sites with pockets that remained R5 mm in depth. Full-mouth root surface debridement was performed to reduce the load of pathogens quickly and prevent cross-contamination of treated sites. Patients were then given chlorhexidine mouth rinses to use for 2 weeks. Subjects in the placebo group in the first phase were given adjunctive antibiotics for 7 days. Two months after retreatment began (8 months from the beginning of the initial study), clinical parameters (probing pocket depth [PPD], lifetime cumulative attachment loss, and recession of the gingival margin) were measured. Results.—Both of the patient groups had improvements in mean PPD and lifetime cumulative attachment
loss. The maximum improvement was noted at 8 months. Patients who received antibiotics in the initial 6-month study had significant improvements in PPD and in the percentage of sites that improved beyond clinically relevant thresholds as compared with the patients whose antibiotic regimen began with the retreatment phase. The mean difference was 0.9 mm for deep pockets (R7 mm) and 0.4 mm for moderate pockets (4 to 6 mm). Discussion.—Having antimicrobials added to the regimen during initial therapy of GAgP conferred greater benefits than reserving antimicrobials for retreatment after 6 months of nonsurgical debridement alone.
Clinical Significance.—Patients who received antibiotics as part of their initial treatment for GAgP benefited significantly more than patients who were given the antibiotics later. Thus, it seems that for severe, aggressive periodontitis, it is best to eliminate causative organisms as well as provide mechanical treatment immediately.
Griffiths GS, Ayob R, Guerrero A, et al: Amoxicillin and metronidazole as an adjunctive treatment in generalized aggressive periodontitis at initial therapy or re-treatment: A randomized controlled clinical trial. J Clin Periodontol 38:42-49, 2011 Reprints available from GS Griffiths, Univ of Sheffield, Academic Unit of Restorative Dentistry, Claremont Crescent, Sheffield S10 2TA, UK; e-mail: [email protected]
Volume 57
Issue 1
2012
51