Biomedical subjects

Karen B Williams

Publications and source records attributed to Karen B Williams.

17 recordsLinked to original sources

PubMed2006

Dental restorations: a risk factor for periodontal attachment loss?

BACKGROUND: Dental caries and restorations in proximal tooth surfaces often impinge upon the periodontal biological width. AIM: This study examines whether these factors may contribute to risk for periodontal attachment loss at these sites. METHODS: The study is based upon data from the Dunedin Multidisciplinary Health and Development Study, a long-standing cohort study. Approximal tooth surfaces of 884 study members were evaluated for restorations and caries at age 26 and again at 32 years, and probing depth and gingival recession were recorded in millimetres at age 32. Attachment loss was computed as the sum of pocket depth and gingival recession. Data were analysed using generalized estimating equations. RESULTS: Where a caries/restorative event had occurred on an inter-proximal tooth surface before age 26, the age-32 attachment loss at the corresponding periodontal site was approximately twice more likely to be >or=3 mm than if the adjacent tooth surface had remained sound to age 32. This was also true where a caries/restorative event had occurred subsequent to age 26. The association remained after controlling for potential confounders, including smoking. CONCLUSIONS: Site-specific periodontal attachment loss due to dental caries or restorative events occurs in adults in their third and fourth decades of life.

Adult↗

PubMed2006

Differences between herbal and nonherbal users in dental practice.

PURPOSE: The purposes of this study were to describe basic demographics and health belief differences between herb users and nonherb users, any potential herb-drug interactions, and examine the association between dental chart noted and questionnaire self-reported use of herbal remedies. METHODS: A 3-part survey instrument was administered to a convenience sample of 149 individuals at a dental clinic and two dental practices. The first part ascertained demographic information and prescription drug use using open-ended and closed-ended questions. The second part listed 51 individual/combination herbs and the third part assessed healthcare behavior using a 5-point Likert scale. A chart audit compared written responses between a patient's medical/dental history chart and his/her survey on herbal use. Descriptive analyses and MANOVA were used to examine the relationship between herbal users and nonusers. RESULTS: Eighty participants (54%) reported using some form of herbs. They were characterized as mostly female (71%), who were less likely to disclose herbal usage to practitioners (p< .05), believed in herbal effectiveness (p< .05), and reported a more positive perceived level of health status compared to nonusers (p= .02). Although herb users reported a willingness to disclose use of herbs to health practitioners, only three patients had any written documentation of their herb use in their medical/dental health chart (p= .0001). Fifty-five herb users were also taking prescription drugs (69%) that could potentially lead to herb-drug interactions. CONCLUSION: The findings provide supportive evidence that dental hygiene practitioners need to be aware of their patients' use of herbs. Knowing potential risks, side effects, and possible drug interactions is necessary for patient management and each patient's oral health.

Adolescent↗

PubMed2006

Relationship between prereferral periodontal care and periodontal status at time of referral.

BACKGROUND: According to a recent study, the severity of periodontal disease of individuals referred for periodontal care is greater now than in 1980. Variability in the standard of periodontal care in general dental practices may result in less than desirable outcomes and consequences of poorer periodontal health. METHODS: A sample of 100 newly referred dental patients from three separate periodontal practices in the greater Kansas City, Missouri area participated in this study. Data were collected from three sources: 1) a clinical chart audit, 2) current periodontal disease status as determined by clinical examination, and 3) a patient response questionnaire on past professional care and personal oral care habits. Bivariate analyses were performed using a statistical package. RESULTS: Of the 100 subjects, 74 were diagnosed as periodontal case type IV at the point of referral, of which 29.8% were treatment planned by the periodontist for two or more extractions. Teeth treatment planned for extraction were significant as a function of disease severity (P = 0.0001). Periodontal treatment provided in general dental practices did not vary because of disease severity. The incidence of deep cleanings (scaling and root planing) was reported slightly higher (32.4%) for case type IV than for case type III (26.9%), but this difference was not statistically significant. The average number of cleanings received in the general dental office was less than the standard of care according to the severity of the disease. CONCLUSION: If one assumes that the data obtained in the Kansas City practices are representative of a larger geographic area, it indicates that dentistry may be failing to address issues of the timely diagnosis of periodontal disease, appropriate treatment, and/or timely referral for treatment.

Dental Audit↗

PubMed2006

The effect of an oral health promotion program for people with psychiatric disabilities.

Oral health programs for people with psychiatric disabilities are rare. This study examined the feasibility efficacy of an oral health intervention for people with psychiatric disabilities. Fifty individuals were recruited and randomly assigned to receive education, reminder system and mechanical toothbrush or just the mechanical toothbrush. 42 completed the study. Plaque index scores recorded at baseline and after 4 weeks indicate a statistically significant improvement for both groups but those in the enhanced intervention improved significantly more. The results suggest the mechanical toothbrush improves the oral hygiene of people with psychiatric disabilities. The combination of mechanical toothbrush, dental instructions and reminders result in additional improvements.

Adult↗

PubMed2006

Predictive validity of critical thinking skills and disposition for the national board dental hygiene examination: a preliminary investigation.

The objective of this study was to determine if preexisting critical thinking skills and critical thinking disposition predict student performance on the National Board Dental Hygiene Examination (NBDHE). The predictive value of critical thinking skills scores and disposition (habits of mind, attitudes, and character attributes) scores were examined above that provided by traditional predictors: entering grade point average, age, and total number of college hours at entry into the dental hygiene program. Seventy-six first-year dental hygiene students from three baccalaureate dental hygiene programs participated in this study. Participants' preexisting general critical thinking skills and disposition were assessed during the first week of classes in their respective baccalaureate level programs using the California Critical Thinking Skills Test (CCTST) and California Critical Thinking Disposition Inventory (CCTDI). At the completion of their two-year educational program, the CCTST and CCTDI were administered a final time, and students' scores on the multiple-choice and case-based NBDHE were obtained. A series of hierarchical multiple regression analyses demonstrated that CCTST scores explained a statistically significant (p<.05) proportion of variance in students' multiple-choice and case-based NBDHE scores, above and beyond that explained by other predictor variables. Although CCTDI scores were not a significant predictor of either outcome measure, CCTST is a good predictor of student performance on high-stakes qualifying examinations and may have utility for student selection and retention.

Adult↗

PubMed2006

Using a multifaceted approach including community-based service-learning to enrich formal ethics instruction in a dental school setting.

The purpose of this investigation was to examine the degree to which a multifaceted approach to formal ethics instruction including community-based service-learning can enrich the learning environment and how it influences students' attitudes and perceptions about their role as oral health care providers, access to care, disparity, and working in a diverse community. Students' attitudes were evaluated prior to and following the seven-week course to determine if community-based service-learning had any impact on their perceptions. Factor analysis was conducted; and based on the identified factor structure, subscales were computed and used for subsequent analyses of change in attitude over time (pre- and post-test results) and to compare assessment of experience between discipline groups (dental and dental hygiene) as well as gender. There was a statistically significant difference in student attitudes from the beginning of the course to the end about volunteering in the community (p=.036). Additionally, there was a statistically significant difference (p<.01) between male and female students related to course impact on career choice and personal ability. Female students reported the course had a greater impact on their career choice and personal ability than did males. Students were required to complete a reflection paper on their service-learning experience. Reflective papers were analyzed using the qualitative constant comparative method. Reflective papers served as a rich source of information for understanding student perceptions related to their role as oral health care providers, access to oral health care, disparity, and cultural competence. Both dental and dental hygiene students indicated a desire for additional opportunities to participate in community-based service-learning activities and a desire for addressing the current access to care issues in their curricula. We found that a multifaceted approach to ethics instruction incorporating a community-based service-learning component provided an enriched environment for the discussion of several ethical issues facing oral health care providers today.

Adult↗

PubMed2005

Influence of environmental conditions on dental composite flexural properties.

OBJECTIVE: To determine if increased relative humidity and temperature simulating intraoral environmental conditions adversely affect flexural properties of dental composites. METHODS: Specimen fabrication followed ANSI/ADA specification 27 for resin-based filling materials, except that ambient laboratory conditions (47% relative humidity at 22 degrees C) or simulated intraoral conditions (90% relative humidity at 35 degrees C) were used when fabricating and polymerizing specimens. Ten specimens were made of each of three commercially available composites at each condition. As per the specification, after aging specimens in 10 ml of deionized water at 37 degrees C for 24 h, flexural properties were measured using a 3-point bend test. RESULTS: A two-factor ANOVA and Fisher's least significant difference (LSD) post hoc (alpha=0.05) indicated there were significant differences in flexural modulus and strength as a function of material, with Z250=TPH>Prodigy. However, neither flexural modulus nor flexural strength of any material was adversely influenced by fabrication conditions. SIGNIFICANCE: Although the flexural properties did not decrease with respect to fabrication conditions, the flexural modulus of some of the materials (TPH Spectrum and Z250) increased when specimens were fabricated at simulated intraoral temperature and relative humidity. Thus, simulation of these factors may be important in laboratory testing, since the resultant properties may better reflect flexural properties associated with dental composite restorations placed clinically.

Body Temperature↗

PubMed2005

DNA probe identification of bacteria colonizing internal surfaces of the implant-abutment interface: a preliminary study.

BACKGROUND: Currently, there is limited knowledge concerning the specific genus and species of bacteria that may colonize internal surfaces of the implant-abutment interface (IAI) of two-stage dental implants. The purpose of this study was to use DNA probe analysis to identify those periodontopathic bacteria that may inhabit the internal surfaces and healing abutment screw-threads of the IAI of dental implants in situ. METHODS: Following osseointegration, bacterial samples for DNA probe analysis were obtained from 54 two-stage hydroxyapatite plasma spray-coated implants in 32 patients. Using sterile paper points, samples were obtained from the IAI of 43 implants and the screw-threads of healing abutments in the other 11 implants. DNA probes were available to detect the following microbes: Actinobacillus actinomycetemcomitans, Tannerella forsythensis, Campylobacter rectus, Eikenella corrodens, Fusobacterium nucleatum, Porphyromonas gingivalis, Prevotella intermedia, and Treponema denticola. RESULTS: All samples taken from healing abutment screw-threads were negative for all target microbes. The aggregate percentage of positive results for each target microbe for samples from internal surfaces of the IAI were: 41.9%, A. actinomycetemcomitans, 60.5%, T. forsythensis; 44.2%, C rectus; 60.5%, E. corrodens; 48.8%, F. nucleatum; 46.5%, P. gingivalis; 55.8%, P. intermedia; and 51.2%, T. denticola. In addition, no significant differences were noted between colonization of individual microbial species when comparing anterior to posterior and maxillary to mandibular implant sites. CONCLUSIONS: Moderate to high levels of eight different periodontopathic microbes inhabiting the internal surfaces of the IAI of 43 two-stage implants in partially edentulous patients were identified by DNA probe analysis. The microbes colonized these surfaces within 25 days following the second stage surgery and placement of the healing abutment. In contrast, all samples obtained from screw-threads of 11 healing abutments were DNA probe negative. These findings appear to support those of other investigations demonstrating the translocation of bacteria from residual dentition to implants.

Bacteria↗

PubMed2005

Predictive validity of dental hygiene competency assessment measures on one-shot clinical licensure examinations.

The purpose of this study was to examine the predictive validity of traditional and nontraditional dental hygiene competency assessment measures on one-shot clinical licensure examinations in a baccalaureate dental hygiene program. Traditional assessment data including overall grade point average (GPA), Clinical GPA, National Board Dental Hygiene Examination (NBDHE) scores, and Central Regional Dental Testing Service (CRDTS) scores along with nontraditional assessment data in the form of Portfolio scores were collected from seventy-four students. Factor analysis and subsequent linear regression modeling were used to explore the ability of four variables (Overall GPA, NBDHE, Portfolios, and Clinical GPA) to predict one-shot clinical licensure examination (CRDTS) scores. A two-factor solution was obtained with one factor defined as dental hygiene cognition and the second factor defined as dental hygiene clinical performance. Factor scores were subsequently used in a linear predictive model to assess the shared and unique contribution of factors to the one-shot clinical licensure examination score. The shared contribution of both factors only accounted for 13.9 percent of variance in the outcome measure of one-shot clinical licensure examination scores. The lack of concordance between previously validated measures of dental hygiene student competency or predictors of student success (Overall GPA, NBDHE, and Portfolios) and a one-shot clinical licensure examination (CRDTS) raises serious concern about the validity of our current dental hygiene licensing procedure which uses the CRDTS clinical examination to make decisions about granting licenses to practice.

Adult↗

PubMed2004

Current practice and knowledge of oral care for cancer patients: a survey of supportive health care providers.

BACKGROUND: The Oral Care Study Section of the Multinational Association of Supportive Care in Cancer (MASCC) and the International Society for Oral Oncology (ISOO) conducted a survey on clinical practices of oral/dental management of cancer patients among supportive health care providers. The main purpose was to evaluate the knowledge and current practice for preventing and managing oral side effects associated with intensive chemotherapy (ICT), hematopoietic cell transplant (HCT), and radiation therapy to the head and neck (H&N RT). MATERIALS AND METHODS: A questionnaire designed and pretested was sent to 212 MASCC/ISOO members around the world with different dental and medical backgrounds. MAIN RESULTS: Seventy-four individuals (35%) responded. The majority of respondents were aware of possible oral complications and provided patients with clinical strategies and recommendations although there was considerable variability among the respondents. Approximately 75% stated that patients were referred for oral/dental care prior to H&N RT and ICT including HCT. However, integrated dental and medical services were reported available in only about 25% of the institutions, and most patients were referred to community-based dental professionals. MAIN CONCLUSIONS: The survey represents a first review of current, international oral care practices. It suggests a need to develop evidence-based clinical guidelines to support effective oral/dental interventions and management strategies for this population. Furthermore, strategies for implementation of oral care protocols and better integration of dental and medical services should be developed. Caution in interpreting these findings is urged due to the limited response rate.

Antineoplastic Agents↗

PubMed2004

Comparison of probes for microbial contamination following use in periodontal pockets of various depths.

BACKGROUND: It has been speculated that periodontal probes can transmit periodontal pathogens from site to site. The purpose of this study was to evaluate the potential for bacterial transmission as a function of periodontal probe design. METHODS: Four different periodontal probes were used to measure probing depths ranging from 0 to 3 mm and > or = 4 mm. Following measurement of each pocket, probes were transported to a laboratory and cultured on blood agar, and colony forming units (CFUs) were determined for total aerobic, anaerobic, and dark-pigmented colonies (DPCs). Eight randomly selected probe tips, representing each probe type and probing depth category, were selected for examination by scanning electron microscopy (SEM) to determine distribution and morphotypes of adhering microbes. RESULTS: Results showed no statistically significant main effect for probes with respect to CFUs. However, there was a statistically significant increase in CFUs for deeper pockets when compared to pockets 0 to 3 mm. SEM observations were consistent among groups, regardless of probe design or probing depth. All probes exhibited a rough surface texture. Microbes were observed as single organisms or in aggregates and were adherent along the entire length of the probe up to the maximum probing depth. CONCLUSIONS: There was no difference in CFUs obtained as a function of periodontal probes. The rough surfaces of the probes used in this study likely promoted bacterial adherence through two different mechanisms: through scraping of the pocket walls by the roughened surfaces of the probe and by the high surface-free energy of the metal probes, facilitating bacterial adherence.

Alloys↗

PubMed2003

Periodontal referral patterns, 1980 versus 2000: a preliminary study.

BACKGROUND: A review of the periodontal literature offers little information concerning trends in referral patterns of patients for periodontal therapy. Over the last 2 decades, there has been a significant increase in the knowledge base concerning inflammatory periodontal disease. It might be assumed that the collective advances in knowledge have impacted periodontal referral patterns. Thus, the purpose of this study was to examine the differences in periodontal referral patterns in the same offices separated by a 20-year interval (i.e., 1980 and 2000). METHODS: A retrospective chart analysis was conducted on a total of 782 patient charts from three conveniently selected periodontal practices. Charts were randomly selected from two time periods: 1980-1981 and 2000-2001. The following information was obtained from each patient record: gender, age at time of initial examination, tobacco smoking status at time of initial examination, periodontal case type, number of missing teeth at initial examination (not including third molars), and number of teeth scheduled for extraction per periodontal treatment plan. Descriptive data were analyzed using frequency distributions, measures of central tendency, and measures of dispersion. Non-parametric statistics were used to examine the relationship of disease severity as a function of site, time period, and patient age. RESULTS: The following trends were noted: 1) an increase in the average age of patients at the time of the initial examination; 2) a decrease in the percentage of patients using tobacco at the time of the initial interview; 3) an increase in the percentage of periodontal Case Type IV patients with a concomitant decrease in the number of periodontal Case Type II patients; 4) an increase in the average number of missing teeth per patient at the initial examination; and 5) an increase in the average number of teeth scheduled for extraction per periodontal treatment plan. CONCLUSIONS: Characteristics of patients referred in 1980 compared to those referred in the year 2000 indicate that, although fewer patients used tobacco, there were several noteworthy trends. At referral, patients exhibited a greater loss of teeth, had more severe disease, and required extraction of a greater number of teeth in 2000 compared to 1980. Possible reasons for these trends are discussed.

Adult↗

PubMed2003

A preliminary study on oxygen saturation levels of patients during periodontal surgery with and without oral conscious sedation using diazepam.

BACKGROUND: Stress and anxiety alter respiratory rate and thereby alter oxygen saturation in the blood. Management of psychological stress in the dental office may help maintain blood gas homeostasis. One method of stress management is through the use of preoperative oral sedation. METHODS: The study population consisted of 13 patients scheduled to receive two quadrants of periodontal surgery at two different appointments. A randomized split-mouth crossover design was used with one quadrant of surgery involving preoperative oral sedation (diazepam) and local anesthetic, and the second using local anesthetic only. Oxygen saturation was monitored by pulse oximetry, which recorded the number of times saturation dropped below 95% in a given time period. Data were recorded at 5 time periods: 1) baseline; 2) from time of anesthetic administration to 20 minutes into surgery; 3) 21 to 40 minutes; 4) 41 to 60 minutes; and 5) 61 to 80 minutes into the surgery. Data were analyzed by a two-factor repeated measures ANOVA. The two within-group factors were treatment group and time. RESULTS: Results indicated no significant interaction between time and treatment (P > .05). However, data for groups over time suggested a trend supporting an interaction. The eta2 value of 0.124 suggested a moderate effect favoring the diazepam treatment. No significant difference was noted for the main effect of treatment and time. However, the eta2 value of 0.24 for treatment effect (diazepam versus no diazepam) suggested a meaningful difference between groups. Similarly the eta2 value of 0.135 for time suggested a moderate effect over time within-subjects. CONCLUSIONS: This study indicates that diazepam given orally in adult dosages does not cause significant respiratory depression, and is generally safe for those healthy patients who may require slight to mild sedation during periodontal surgery.

Administration, Oral↗

PubMed2003

Predictive validity of critical thinking skills for initial clinical dental hygiene performance.

This study collected validity evidence on the utility of critical thinking skills and critical thinking disposition in predicting initial clinical performance. The predictive value of critical thinking skills scores and disposition scores was examined to determine their unique contribution beyond that provided by traditional predictors: grade point average, age, and number of college hours. The study involved three phases: establishing content validity of three outcome measures; assessing students' baseline critical thinking skills and disposition using the California Critical Thinking Skills Test (CCTST) and the California Critical Thinking Dispositions Inventory (CCTDI); and assessing students' initial clinical competence, clinical reasoning, and clinical knowledge. All baccalaureate-level dental hygiene programs in the United States affiliated with a dental school (N=22) were invited to participate; of those, seven volunteered. A convenience sample of 207 first-year dental hygiene students was obtained. A series of hierarchical multiple regression analyses demonstrated that CCTST scores explained a statistically significant (p<.05) proportion of variance in students' initial clinical reasoning scores, acquired knowledge scores, and faculty ratings, above and beyond that explained by other predictor variables. CCTDI scores were not significant predictors of any outcome measure. It was concluded that CCTST is a good predictor of initial student outcomes and may have utility for student selection and retention.

Clinical Competence↗

PubMed2002

Can application of exogenous fibronectin enhance periodontal regeneration?

BACKGROUND: Although fibronectin (FN) is an important extracellular glycoprotein involved in periodontal wound healing, it is not clear whether the application of exogenous fibronectin (ExoFN) offers any clinical benefit. The purpose of this preliminary in vitro study was to determine the binding of FN from three different sources, viz. endogenous EDTA-plasma, endogenous serum and exogenous commercial purified human fibronectin in PBS buffer, to demineralized and non-demineralized root powder. METHOD: The binding of FN to a known quantity of mineralized and non-demineralized root powder by overnight incubation at 15 degrees C was studied by enzyme immunoassay (EIA) technique. The criteria for optimal performance of EIA procedure for the determination of FN was established. Particle size of powdered root structure was standardized using a Vibratory Sieve Shaker. RESULTS: The EDTA-plasma and the serum FN exhibited binding of (17.8 +/- 2.1 microg) and (6.5 +/- 4.5 microg), respectively, to the non-demineralized root powder. However, the binding was only significant for the EDTA-plasma FN (p < 0.01) when compared to controls. In the demineralized group there was no ascertainable binding of FN from either endogenous or exogenous sources. ExoFN in buffer exhibited no binding at all to the non-demineralized or demineralized root powder. CONCLUSION: The preliminary data suggest that additional plasma and serum factors may facilitate the binding of FN to root powder. High levels of FN in blood do not necessarily indicate that FN is available for binding to the root surface during periodontal surgery.

Analysis of Variance↗

PubMed2002

Controlled local delivery of tetracycline with polymer strips in the treatment of periodontitis.

BACKGROUND: Several antibacterial agents have been studied as a means to produce bactericidal or bacteriostatic activity as an adjunct to mechanical treatment of periodontal disease. The primary purpose of this study was to evaluate the efficacy of tetracycline strips administered singly or in multiples in conjunction with root planing, versus root planing alone, or to an untreated control. Secondary purposes were to compare gingival crevicular fluid (GCF) volume and GCF concentrations of tetracycline in pockets treated with strips; to evaluate strip insertion time; and to compare ease of placement for single or multiple strips. METHODS: Using a 4-quadrant design, 4 test teeth in 24 patients were treated with either root planing and single strip application; root planing and multiple strip application; root planing alone; or an untreated control. RESULTS: Single and multiple strip placement resulted in a significant reduction in probing depth (P = 0.033) compared to root planing and untreated groups. The multiple strip group significantly decreased bleeding on probing (P = 0.05) compared to all other treatment groups. There was no treatment effect on GCF; however, there was a significant reduction in the GCF volume over time (P = 0.001). The time required for placement was, on average, 1.9 minutes for single strips and 3.25 minutes for multiple strips. CONCLUSIONS: Our data suggest that multiple strips are superior to a single strip in reducing bleeding on probing, and that local delivery of tetracycline is superior to root planing alone in reducing probing depth.

Adult↗

PubMed2002

Validity and reliability of a dental operator posture assessment instrument (PAI).

PURPOSE: Basic operating posture is considered an important occupational health issue for oral health care clinicians. It is generally agreed that the physical posture of the operator, while providing care, should be such that all muscles are in a relaxed, well-balanced, and neutral position. Postures outside of this neutral position are likely to cause musculoskeletal discomfort. To date, the range of the neutral operator position has not been well-defined; nor have any specific instruments been identified that can quantitatively or semi-quantitatively assess dental operator posture. This paper reports on the development of an instrument that can be used to semi-quantitatively evaluate postural components. METHODS: During the first phase of the study, an expert panel defined the basic parameters for acceptable, compromised, and harmful operator postures and established face validity of a posture assessment instrument (PAI). During the second phase, the PAI was tested for reliability using generalizability theory. Four raters tested the instrument for reliability. RESULTS: Overall, total PAI scores were similar amongst three of the raters, with the fourth rater's scores being slightly greater than the other three. The main effect of the rater on individual postural components was moderate, indicating that rater variance contributed to 11.9% of total variance. CONCLUSIONS: The PAI measures posture as it occurs and will have numerous applications when evaluating operator performance in the dental and dental hygiene education setting. Also, the PAI will prove useful when examining the effects of operator posture and musculoskeletal disorders.

Dental Staff↗