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Biomedical subjects

B L Mealey

Publications and source records attributed to B L Mealey.

At least 19 recordsLinked to original sources
PubMed2000

Diabetes and periodontal disease: two sides of a coin.

Diabetes and periodontal disease are two seemingly unrelated disorders whose complex interrelationship is only now being clarified. How does diabetes, a metabolic disease, affect the periodontium? Perhaps even more interesting for the diabetic patient: How does periodontal disease, a bacterial infection that results in inflammation and tissue destruction in the oral cavity, impact the metabolic control of diabetes? Evidence clearly supports diabetes as a risk factor for periodontal disease. The mechanisms by which diabetes adversely influences the periodontium are in many ways similar to the mechanisms responsible for the classic complications of diabetes. In recent years, research has demonstrated that the relationship between periodontal disease and diabetes is more complex than previously realized. Not only does diabetes affect the periodontium, but periodontal infection can adversely impact glycemic control in diabetes. Periodontal treatment that decreases the bacterial challenge and the resulting inflammatory periodontal destruction can improve glycemia in some diabetic patients. These research findings are of importance to diabetic patients and their health care providers, because the findings support the need for examination, diagnosis, treatment, and prevention of periodontal infection.

Blood Glucose↗
PubMed1998

Hydroxyapatite cement implant for regeneration of periodontal osseous defects in humans.

A newly developed calcium phosphate cement used to promote bone regeneration in craniofacial defects was examined to determine its potential for treatment of periodontal osseous defects. Sixteen patients with moderate to severe periodontal disease and 2 bilaterally similar vertical bony defects received initial therapy including scaling and root planing followed by treatment with either calcium phosphate cement, flap curettage (F/C) or debridement plus demineralized freeze-dried bone allograft (DFDBA). Standardized radiographs were exposed at baseline and 12 months postsurgery for computer assisted densitometric image analysis (CADIA). The extent of the bony defect was determined during initial and 12 month re-entry surgery. Within 6 months of implant placement, 11 of 16 patients treated with calcium phosphate cement exfoliated all or most of the implant through the gingival sulcus. At all 16 test sites, a narrow radiolucent gap formed by 1 month postsurgery at the initially tight visual interface between the radiopaque calcium phosphate cement and the walls of the bony defect. Mean probing depth reduction and clinical attachment gain at sites treated with calcium phosphate cement were 1.6 mm and 1.3 mm, respectively at 1 year. Minimal bony defect fill was accompanied by mean crestal resorption of 1.4 mm. Alveolar crestal resorption at sites with calcium phosphate cement was statistically significant (P=0.001). These findings contrasted with the more favorable outcomes for controls treated with DFDBA or F/C. DFDBA sites exhibited probing depth reduction of 3.1 mm, clinical attachment gain of 2.9 mm, and defect fill of 2.4 mm. Respective clinical changes at F/C sites were 2.4 mm, 1.4 mm, and 1.1 mm. CADIA revealed clinically significant trends between the three treatment modalities at various areas-of-interest. Based on the findings of this study, there is no rationale available to support the use of hydroxyapatite cement implant in its current formulation for the treatment of vertical intrabony periodontal defects.

Absorptiometry, Photon↗
PubMed1998

How does diabetes alter treatment in the dental office?

Diabetes mellitus affects approximately seven percent of the American population; thus, patients with diabetes are seen in every dental practice. Advances in medical management of diabetes have resulted in intensification of treatment regimens, with a resulting decrease in long-term complications of the eyes, kidneys, and nervous system. This intensified treatment may place the diabetic patient at increased risk of hypoglycemic emergencies during dental appointments. Dental practitioners should understand methods of preventing hypoglycemia and must be able to recognize and treat hypoglycemia, should it occur in the office.

Dental Care for Chronically Ill↗
PubMed1998

Impact of advances in diabetes care on dental treatment of the diabetic patient.

In medicine and dentistry, studies are published periodically that have a potentially wide-ranging impact on patient health and management. One such study is the Diabetes Control and Complications Trial (DCCT), which offers new hope for millions of individuals with diabetes and has begun to significantly alter medical management of these patients. Advances in the medical treatment of diabetes require a heightened awareness by dental practitioners of the various treatment regimens of their patients with diabetes, especially because of potential complications associated with diabetes care. Intensive medical treatment with oral agents and exogenous insulin injection promises to decrease the long-term risks of major complications of diabetes, but these treatments increase the risk of medical emergencies, especially hypoglycemia. This article reviews the findings of the DCCT, diabetes treatment regimens that might be encountered in a dental practice, and potential alterations to dental treatment protocols.

Blood Glucose Self-Monitoring↗
PubMed1997

Effects of guided bone regeneration around commercially pure titanium and hydroxyapatite-coated dental implants. II. Histologic analysis.

The purpose of this study was to determine which treatment of a large osseous defect adjacent to an endosseous dental implant would produce the greatest regeneration of bone and degree of osseointegration: barrier membrane therapy plus demineralized freeze-dried bone allograft (DFDBA), membrane therapy alone, or no treatment. The current study histologically assessed changes in bone within the healed peri-implant osseous defect. In a split-mouth design, 6 implants were placed in edentulous mandibular ridges of 10 mongrel dogs after preparation of 6 cylindrical mid-crestal defects, 5 mm in depth, and 9.525 mm in diameter. An implant site was then prepared in the center of each defect to a depth of 5 mm beyond the apical extent of the defect. One mandibular quadrant received three commercially pure titanium (Ti) screw implants (3.75 x 10 mm), while the contralateral side received three hydroxyapatite (HA) coated root-form implants (3.3 x 10 mm). Consequently, the coronal 5 mm of each implant was surrounded by a circumferential defect approximately 3 mm wide and 5 mm deep. The three dental implants in each quadrant received either DFDBA (canine source) and an expanded polytetrafluoroethylene membrane (ePTFE), ePTFE membrane alone, or no treatment which served as the control. Clinically, the greatest increase in ridge height and width was seen with DFDBA/ePTFE. Histologically, statistically significant differences in defect osseointegration were seen between treatment groups (P < 0.0001: DFDBA/ePTFE > ePTFE alone > control). HA-coated implants had significantly greater osseointegration within the defect than Ti implants (P < 0.0001). Average trabeculation of newly formed bone in the defect after healing was significantly greater for HA-coated implants than for titanium (P < 0.0001), while the effect on trabeculation between treatments was not significantly different (P = 0.14). Finally, there were significantly less residual allograft particles in defect areas adjacent to HA-coated implants than Ti implants (P = 0.0355). The use of HA-coated implants in large size defects with DFDBA and ePTFE membranes produced significantly more osseointegration histologically than other treatment options and more than Ti implants with the same treatment combinations. The results of this study indicate that, although the implants appeared osseointegrated clinically after 4 months of healing, histologic data suggest that selection of both the implant type and the treatment modality is important in obtaining optimum osseointegration in large size defects.

Alveolar Bone Loss↗
PubMed1997

Effects of guided bone regeneration around commercially pure titanium and hydroxyapatite-coated dental implants. I. Radiographic analysis.

The purpose of this study was to determine which treatment of a large osseous defect adjacent to an endosseous dental implant would produce the greatest regeneration of bone and degree of osseointegration: barrier membrane therapy plus demineralized freeze-dried bone allograft (DFDBA), membrane therapy alone, or no treatment. The current study assessed radiographic density changes in bone within the healed peri-implant osseous defect. In a split-mouth design, 6 implants were placed in edentulous mandibular ridges of 10 mongrel dogs after preparation of 6 cylindrical mid-crestal defects, 5 mm in depth and 9.525 mm in diameter. An implant site was then prepared in the center of each defect to a depth of 5 mm beyond the apical extent of the defect. One mandibular quadrant received three commercially pure titanium (Ti) screw implants (3.75 X 10 mm), while the contralateral side received three hydroxyapatite (HA) coated root-form implants (3.3 X 10 mm). Consequently, the coronal 5 mm of each implant was surrounded by a circumferential defect approximately 3 mm wide and 5 mm deep. The three dental implants in each quadrant received either DFDBA (canine source) and an expanded polytetrafluoroethylene membrane (ePTFE), ePTFE membrane alone, or no treatment (control). Standardized radiographs were taken at 1 week and 4 months post-implant placement. Computer-assisted densitometric image analysis (CADIA) was performed at 6 areas of interest (coronal, middle, and apical defect areas mesial and distal to each implant) for each of the implant sites. Significantly greater increase in bone density was obtained using DFDBA/ePTFE compared to ePTFE alone or the controls; likewise, ePTFE alone resulted in greater bone density change than the controls. There were no significant differences in radiographic bone density adjacent to Ti versus HA-coated implants. When 3 dogs having postoperative membrane complications were eliminated from the analysis, the results were similar with the exception that defects adjacent to Ti implants had significantly less density gain when compared to HA-coated implants. The results of this study indicate the use of DFDBA/ePTFE in large surgically-created defects promotes a denser healing of bone adjacent to implants when measured radiographically than either ePTFE alone or no treatment.

Absorptiometry, Photon↗
PubMed1996

Periodontal implications: medically compromised patients.

The presence of systemic disease in patients requiring periodontal therapy creates challenges for management. Alteration of treatment plans, with emphasis on physician consultation and preventive periodontal care, is frequently needed to minimize the impact of periodontal disease on the systemic condition. Conversely, detection and treatment of systemic disorders may impact upon the status of the periodontium and the success of periodontal therapy. The goal of holistic patient management is facilitated by a free flow of information between the patients and their medical and dental health care providers.

Adolescent↗
PubMed1996

Clinical evaluation of demineralized-unicortical-ilium-strips for guided tissue regeneration.

This study compared demineralized-unicortical-ilium-strips (DUIS) and an expanded polytetrafluoroethylene (ePTFE) physical barrier in combination with decalcified freeze-dried bone allograft (DFDBA) for treatment of Class II mandibular furcations. Twenty patients with adult periodontitis and at least 2 furcation invasions participated in this study. Probing depth (PD), clinical attachment level (CAL), and bone fill were measured at 6 and 12 months. Standardized radiographs were analyzed using computer assisted densitometric image analysis (CADIA). Fifteen of 20 patients completed the 12-month evaluation. At 6 months both control and test groups showed significant reductions in PD from baseline (P < 0.01). PD reduction for the ePTFE + DFDBA sites was 2.13 mm +/- 1.25, and the DUIS + DFDBA, 1.77 mm +/- 1.21. CAL at 6 months was sustained to 12 months when the net gains in CAL for ePTFE + DFDBA being 1.30 mm +/- 1.45 (P < 0.01) and for DUIS + DFDBA sites 1.13 mm +/- 1.68 (P < 0.02). The horizontal furcation PD decreased 2.87 mm +/- 1.68 (P < 0.01) in the ePTFE + DFDBA and 1.70 mm +/- 1.69 (P < 0.01) for DUIS + DFDBA sites over 12 months. The evaluation of the hard tissue response at the 12-month re-entry demonstrated a bone fill of 2.37 mm (75%) +/- 2.04 (P < 0.01) with ePTFE + DFDBA and 1.83 mm (79%) +/- 1.57 (P < 0.01) with DUIS + DFDBA. DUIS material and ePTFE showed significant improvements in clinical parameters and neither material proved to be significantly better. However, a larger sample size may have permitted us to demonstrate statistically significant differences between the materials. The positive results from the utilization of DUIS for GTR and the advantage of its bioresorbability warrant further investigation. The study found limitations in the use of CADIA for evaluation of guided tissue regeneration in furcations.

Absorptiometry, Photon↗
PubMed1995

Molecular heterogeneity of PAF in normal human mixed saliva: quantitative mass spectral analysis after direct derivatization of PAF with pentafluorobenzoic anhydride.

Platelet-activating factor (PAF), a family of phospholipid autacoids with potent pro-inflammatory activities, is present in saliva. The current study has quantitated various species of PAF isolated from normal human mixed saliva. Choline-containing, sn-2 acetylated phospholipids with sn-1 ether- or ester-linked fatty alcohol/acid moieties (alkyl-PAF or acyl-PAF, respectively) were evaluated after direct derivatization with pentafluorobenzoic (PFB) anhydride. Individual species of PFB-derivatized PAF were separated by gas chromatography prior to mass spectral analysis; quantitative estimates of six different species of PAF in saliva were made by comparison to corresponding authentic, synthetic PAF standards. In each saliva sample, all six species of PAF were readily detected by this facile procedure. The predominant PAF was 1-O-hexadecyl-2-acetyl-sn-glycero-3-phosphocholine or 16:0-alkyl-PAF (0.75 +/- 0.09 pmol/ml saliva; mean +/- S.E.; n = 5) which represented only 30.4 +/- 1.5% of the total PAF. Substantial amounts of 18:1- and 18:0-alkyl-PAF and 16:0-acyl-PAF were also identified (0.52 +/- 0.07, 0.35 +/- 0.06, and 0.35 +/- 0.02 pmol/ml saliva, respectively). In summary, mass spectrometric analysis of PAF after direct derivatization with PFB anhydride has revealed that at least six different species of PAF are present in normal human mixed saliva. This structural diversity may represent an important aspect of homeostasis in the healthy oral cavity.

Anhydrides↗
PubMed1995

Observations of root surfaces from patients with early-onset periodontitis and leukocyte adhesion deficiency.

The purpose of this investigation was to report observations of the root surfaces of teeth from 2 siblings with leukocyte adhesion deficiency (LAD). In previous publications, the clinical, radiographic and immunologic findings in the family were presented. 38 permanent teeth from the 2 siblings were prepared for microscopic examination, 11 for light microscopy (LM), and 27 for scanning electron microscopy (SEM). In addition, 8 healthy teeth obtained from 2 patients requiring extractions for orthodontic treatment served as controls. LM observations on healthy teeth revealed cementum with normal structural appearance which exhibited a mosaic or mogul-like pattern with SEM. In LAD specimens, cementum apical to the dentogingival junction exhibited resorption lacunae and areas of poor structural definition characterized by aplasia and hypoplasia (hypomineralization). Areas of hypoplasia presented as distinct irregular surfaces with a pebbly or globular-like appearance. Alteration in cementum formation and maturation may play a role in the etiology of early-onset periodontitis.

Adolescent↗
PubMed1995

Periodontitis in the baboon: a potential model for human disease.

Advances in periodontics with respect to disease activity, microbiology and immunology have demonstrated the multifactorial nature of periodontal diseases. This serves to underscore the need for an ideal animal model for periodontal research. Non-human primates are most similar to man in comparison to other animal models. The baboon is an Old World monkey that has infrequently been used in periodontal research. Periodontal exams were accomplished on 116 baboons (Papio anubis, P. cynocephalus) ages 5 to 30 years with one baboon year being roughly equivalent to 3 to 4 human years. The study population consisted of 29 males and 87 females. Clinical parameters including probing depth, attachment level, mobility, plaque index and gingival index were collected. Radiographs were taken on 25 animals and correlated to clinical findings. Results showed a significant increase in mean probing depth and mean attachment level with age (p = 0.0001). Disease prevalence and severity were not significantly different between genders. Mobility was uncommon; however, the prevalence and severity of furcation involvement increased with age. Radiographs suggested horizontal and isolated vertical bone loss. Plaque and gingival indices were at sustained high levels for all age groups and showed a statistically significant increase with age. Some baboons were found to develop a naturally-occurring periodontitis that increased in severity with age. This primate may be a suitable model for studies in human periodontal disease.

Age Factors↗
PubMed1995

The effect of initial periodontal therapy on salivary platelet-activating factor levels in chronic adult periodontitis.

Platelet-activating factor (PAF), a potent phospholipid inflammatory mediator, is increased in the mixed saliva of subjects with periodontal disease and correlates with the extent of oral inflammation. The present study was designed to provide a longitudinal evaluation of the effect of initial periodontal therapy (home care instruction, prophylaxis, and scaling/root planing) on salivary PAF levels in chronic adult periodontitis patients (n = 15). Mixed saliva was collected prior to, during, and after initial therapy and was utilized to assess PAF levels after lipid extraction and fractionation as well as to histologically assess the number of polymorphonuclear leukocytes (PMN). PAF activity was determined in bioassay relative to authentic PAF (1-O-hexadecyl-2-acetyl-sn-glycero-3-phosphocholine; 16:0-alkyl-PAF). Initial salivary PAF levels (12.1 +/- 2.8 pmole equivalents of 16:0-alkyl-PAF/ml saliva; mean +/- SE) decreased following supragingival plaque control (9.6 +/- 2.4) and were further reduced following scaling and root planing (5.7 +/- 1.4). In parallel, salivary PMN levels were significantly reduced and clinical estimates of periodontal disease were significantly improved; i.e., there was a decrease in the percentage of sites with both bleeding on probing (from 46.1 +/- 4.6% of sites at pretreatment to 25.9 +/- 2.6% after scaling and root planing) and probing depths > or = 4 mm (from 16.7 +/- 1.9% of sites to 10.3 +/- 1.2%). Thus, initial periodontal therapy reduced salivary PAF levels in concert with improvements in clinical estimates of marginal and submarginal periodontal inflammation suggesting that PAF may participate in inflammatory events during periodontal tissue injury and disease.

Adult↗
PubMed1995

Multidisciplinary restoration of fused maxillary incisors: a case report.

This case report describes the endodontic, periodontal, and restorative treatment of a maxillary incisor with unusual external and internal anatomy. The right central and lateral incisors had fused, resulting in an oversized unaesthetic central incisor. A small diastema was present between the fused central incisor and the canine. Since overpreparation of the tooth during restoration was anticipated, endodontic therapy was accomplished. Periodontal flap surgery provided an opportunity to reduce the root diameter and narrow the emergence profile of the tooth and to eliminate a plaque-retentive palatogingival groove. A cast post and core rigidly obturated the canal space and provided a preparation on which to fabricate a metal-ceramic restoration simulating the replacement of the right lateral incisor. The final restoration provided significant aesthetic improvement. The learning objective of this article is to familiarize the reader with multidisciplinary restorations.

Adult↗
PubMed1994

Bilateral gustatory sweating as a sign of diabetic neuropathy.

Gustatory sweating is a relatively common sequela to parotidectomy and is almost always unilateral in nature. This article presents a case of bilateral gustatory sweating in a patient with no history of facial trauma or surgery who was undergoing periodontal therapy. A thorough examination determined the cause of diaphoresis to be autonomic neuropathy as a result of a 26-year history of Type II diabetes mellitus. Few cases of this rare complication of diabetes have been described, and the current case represents the first report in the dental literature.

Aged↗
PubMed1994

Use of furcal bone sounding to improve accuracy of furcation diagnosis.

Accurate diagnosis of periodontal destruction in the furcation region of multi-rooted teeth is a critical component of treatment planning, with different therapeutic approaches chosen based upon clinical determination of the severity of involvement. The current study assessed both vertical and horizontal depths of 274 furcations from 67 patients at three separate time points: by probing prior to anesthesia, by bone sounding after administration of anesthesia, and by direct measurement at the time of surgery. All measurements were made to the nearest millimeter. The mean vertical (1.8 mm) and horizontal (2.16 mm) furcation depths determined prior to anesthesia were significantly less than surgical measurements (2.79 mm and 3.65 mm, respectively). Use of sounding significantly improved the mean accuracy of vertical (2.40 mm) and horizontal (3.11 mm) furcation depth measurements relative to surgical determinations (P = 0.000). Surgical vertical depth was exactly the same as pre-anesthesia probing in 42% of furcations, within +/- 1 mm in 72.3% and within +/- 2 mm in 83.6%. Use of post-anesthesia sounding improved agreement in vertical measurements to 59.5%, 85.7%, and 93.1%, respectively. Surgical horizontal depth was exactly the same as pre-anesthesia probing measurements in 47.1% of furcations, within +/- 1 mm in 68.3% and within +/- 2 mm in 77.4%. Sounding improved agreement of horizontal measurements to 64.2%, 83.6%, and 88.3%, respectively. Underestimation of surgical furcation depths by pre-anesthesia probing was much more common than overestimation. Sounding reduced the percent and degree of underestimation in all furcation types. The data demonstrate the ability of post-anesthesia bone sounding to significantly improve the diagnostic accuracy of furcation invasions.

Adult↗
PubMed1994

Dentistry and the cancer patient: Part 2--Oral health management of the chemotherapy patient.

The increase in the incidence of head and neck cancer has been accompanied by a more widespread use of chemotherapy. As a result, the dental community has frequent contact with patients who are undergoing or have undergone chemotherapy. In many of these patients, immunosuppression leads to an increased risk of infection, and the chemotherapeutic agents themselves can cause a variety of oral complications. The dentist must be familiar with available treatments for managing these conditions and for preventing further deterioration of oral and systemic health.

Antineoplastic Agents↗
PubMed1994

Dentistry and the cancer patient: Part 1--Oral manifestations and complications of chemotherapy.

Chemotherapy is frequently used as a primary or adjunctive modality in the treatment of patients with cancer. As the incidence of cancer in the population increases, the ability to properly detect, diagnose, and treat oral side effects of chemotherapy becomes ever more important. Depending on the types and dosages of chemotherapeutic agents used, a wide range of oral complications may appear. This article, in two parts, reviews the potential oral manifestations associated with cancer chemotherapy and appropriate management techniques.

Antineoplastic Agents↗