FREE ELECTRONIC LIBRARY - Dissertations, online materials

Pages:     | 1 || 3 | 4 |   ...   | 13 |


-- [ Page 2 ] --

The use of PMN quantification to assess periodontal disease status and responses to treatment was first proposed in 1978 (Raeste & Aura, 1978), an idea which seems useful when considering the effect of PMNs on periodontal tissues, and the fact that their levels are naturally elevated during disease (Attstrom, 1970; Schroeder, 1973), and are likely proportional to the extent of disease activity (Attstrom, 1970; Schiött & Löe, 1970).

A simple method for measurement of oral PMNs has been developed and involves the use of a non-invasive oral rinse assay. This was validated at the University of Toronto‟s Department of Periodontology in 2006, and demonstrates promise in allowing the clinician to monitor the activity and severity of periodontal disease as well as its progression (Bender, Thang, & Glogauer, 2006). However, the use of the oral rinse assay is impractical in patients who lack the cooperation and/or coordination required to reliably rinse and expectorate.

This research study will evaluate a novel technique for oral neutrophil quantification, using a PMN assay, as a quantitative measure of periodontal inflammatory load in uncooperative patients with special needs.


1. To correlate oral neutrophil counts obtained by the PMN assay with conventional clinical parameters of periodontal health status in uncooperative patients with special

–  –  –

2. To assess the feasibility of using the PMN assay to provide objective and quantitative data so that gingival inflammation can be quantified and monitored in uncooperative patients with special needs.

–  –  –

Definitions and Prevalence of Disability Patients with special health care needs are defined as those with a, “physical, developmental, mental, sensory, behavioural, cognitive, or emotional impairment or limiting condition that requires medical management, health care intervention, and/or use of specialized services or programs” (American Academy of Pediatric Dentistry Council on Clinical Affairs [AAPD], 2011/12). Disabilities can be congenital or acquired, as well as either visible (i.e. physical), or invisible (e.g. mental). The International Classification of Functioning, Disability, and Health (ICF), defines disability as a broad term that looks at the interaction of health conditions, environmental, and personal factors on body functions, individual activities, and participation in society (World Health Organization [WHO], 2011). Developmental disability is defined as a mental or physical impairment with onset during the developmental period from birth to 22 years of age, and results in significant functional limitations in three or more areas of major life activities, such as self-care, language, mobility, or capacity for independent living (Accardo & Whitman, 2012). Approximately 1.85 million people or about 15% of the population in Ontario have a disability (Ontario Government, 2010), and disability is reported by about 4.4 million Canadians (14.3%; Government of Canada, 2010).

The World Health Organization estimates that over one billion people, or 15% of the world‟s population, have some form of disability (WHO, 2011).

Oral Health Care Needs for Patients with Special Needs Oral disease, including caries and periodontal disease, is significantly prevalent in the special needs population (Scott, March, & Stokes, 1998; Lopez del Valle, Waldman, & Perlman, 2007; Dellavia, Allievi, Pallavera, Rosati, & Sforza, 2009; Anders & Davis, 2010). Oral health is noted to be especially poor in patients who are unable to cooperate for routine dental care (Anders & Davis, 2010), due to movement disorders, cognitive problems or any number of disabilities. Data are limited regarding oral health care in patients with severe developmental delays. These patients need more supervision and are reliant on caregivers for their daily oral hygiene routine. Further, they are dependent on dentists who are comfortable in treating them despite their special needs, medical health complexity, and lack of cooperation (de Jongh, van Houtem, van der Schoof, Resida, & Broers, 2008).

Unfortunately, persons with disabilities experience significant disparities and unmet oral health care needs from dental professionals (Scott, March, & Stokes, 1998; Loeppky & Sigal, 2007; Sigal, 2009). Reasons cited for this disparity include lack of training in the dental curriculum leading to lack of familiarity with this population, belief that special equipment is required, lack of cooperation or communication leading to difficulty in diagnosis, increased time involvement for treatment, or lack of reimbursement for dental services provided through government programs (Fenton, Hood, Holder, May, & Mouradian, 2003; Loeppky & Sigal, 2007; Lopez del Valle, Waldman, & Perlman, 2007; Koneru & Sigal, 2009). The demands for oral health care are only going to increase in this population with the average lifespan increasing due to advances in medical care, and continued deinstitutionalization and integration of persons with special needs into the community (Scott, March, & Stokes, 1998;

Sigal, 2009). Thus, appropriate diagnosis and provision of dental treatment to adult patients that are uncooperative due to varying degrees of developmental delay is a persistent challenge in dentistry (Ananthanarayan, Sigal, & Godlewski, 1998).

The Mount Sinai Hospital Dental Program for Persons with Disabilities The Mount Sinai Hospital Dental Program for Persons with Disabilities, the largest of its kind in Canada, was established in 1975 and provides comprehensive oral health care to patients with special needs in a hospital setting (Sigal, 2010). Patients are referred by their family physician, dentist, case support worker, or allied institution. The hospital based program plays a vital role in providing dental care to patients who are unable to receive treatment in their local community. The overall need for this program is reflected by the current waiting list for dental treatment under GA, which is approximately twelve months following the initial consultation (Park & Sigal, 2008). The Program also serves to educate undergraduate and graduate students attending the University of Toronto‟s Faculty of Dentistry in conjunction with the Department of Paediatric Dentistry, to familiarize students with this population so that they are comfortable in treating patients with special needs in their future community practice (Sigal, 2010). Dental recall examinations for patients with special needs are provided by dental students supervised by staff, as well as hospital dental residents. Dental treatment is provided by hospital dental staff and residents in the ambulatory dental clinic as well as under GA in the operating room. However, despite attempts to manage behaviour in the clinical setting, many patients with special needs still require dental treatment under GA due to poor cooperation (Hennequin, Faulks, & Roux, 2000; Petrovic, Markovic, & Peric, 2011). The Mount Sinai Hospital Dental Clinic has provisions for uncooperative patients to have comprehensive dental care safely and predictably in one treatment session (Ananthanarayan, Sigal, & Godlewski, 1998), followed by de-sensitization to the dental clinic via subsequent dental recalls without sedation.

However, there are still important limitations related to examination, diagnosis, and treatment in this population that will be described later.

Classification of Periodontal Diseases Periodontal diseases are a group of inflammatory disorders that may be inherited or acquired, and are characterized by progressive destruction of the tissues that surround and support the teeth, known as the periodontium (Armitage, 1999). The periodontium is comprised of root cementum, the periodontal ligament, alveolar bone, and its overlying mucosa (Nanci & Bosshardt, 2006). The prevalence of periodontal diseases as reported in the literature varies between 14 to 65% depending on the definitions used and the population studied (Costa et al., 2009). The most common periodontal diseases are grouped under two broad categories of conditions, called gingivitis and periodontitis (Armitage, 1999).

Gingivitis is defined as inflammation of the gingiva associated with teeth that do not demonstrate attachment loss. Gingivitis is further divided into those conditions which are plaque-induced and those that are not (Armitage, 1999). „Plaque-induced‟ gingivitis is a consequence of the interaction between the pathogens within the dental plaque or biofilm at the tooth/gingival interface, and the host tissues and inflammatory cells within them (Armitage, 2004). This interaction between the plaque and host is influenced by local and epigenetic factors such as smoking and plaque, medical problems including but not limited to diseases such as diabetes mellitus, medications including anticonvulsants, immunosuppressants, oral contraceptives, and calcium channel blockers, and malnutrition (Armitage, 1999; Mariotti, 1999; Kinane & Marshall, 2001). „Non-plaque-induced‟ gingival conditions are caused by specific bacterial, viral, fungal, or genetic factors, or can imply the presence of an underlying medical condition (Armitage, 1999). Clinical signs of gingivitis include enlarged gingival contours due to edema or fibrosis, change in color (erythema), elevated sulcular temperature, bleeding on stimulation, and increased gingival exudate.

These signs are associated with stable attachment levels on a periodontium that may or may not be reduced (Mariotti, 1999). In gingivitis, inflammation is limited to the gingiva and may be reversed by removing the etiological factors (i.e. plaque; Löe, Theilade, & Jensen, 1965).

Persistent inflammation may have a role in the progression to periodontal attachment loss (Mariotti, 1999).

Periodontitis is a condition characterized by gingival inflammation of the periodontium, as with gingivitis, but is also associated with the irreversible destruction of connective tissue apical to the cemento-enamel junction, referred to as periodontal attachment loss (Ranney, 1991). Periodontitis is divided into other categories including chronic, aggressive, or as a manifestation of systemic (i.e. non-oral) disease. These categories are distinguished further based on the extent and severity of disease as follows. Chronic periodontitis can be localized (less than 30% of sites are involved), or generalized (more than 30% of sites are affected).

Severity is characterized by the amount of clinical attachment loss (CAL) as measured by a periodontal probe, as slight (1-2 mm CAL), moderate (3-4 mm CAL), or severe (≥ 5 mm CAL; Armitage, 1999). The primary etiological agent appears to be gram negative bacteria, though the exact spectrum of pathogens contained within the biofilm which initiates periodontitis is not firmly established. Moreover, it has been suggested that these suspected pathogenic bacteria are necessary but not sufficient to trigger periodontitis (Socransky & Haffajee, 1992; Van Dyke, 2008). The tissue destruction in periodontitis is a consequence of an imbalance in the homeostatic relationship between tissue resorption and tissue genesis, such that tissue resorption is favoured under the influence of an unregulated inflammatory response to the pathogenic bacteria within the periodontal crevicular space and as alluded to above, other non-microbial factors (Deas, Mackey, & McDonnell, 2003; Van Dyke, 2008;

Sanz & van Winkelhoff, 2011). Susceptibility to disease, progression, severity, and response to treatment are determined mostly by host-based factors (Kinane, Peterson, & Stathopoulou, 2006). The clinical presentation of chronic periodontitis includes loss of alveolar bone, bleeding upon probing, tooth mobility, and ultimately, if the disease is left untreated, tooth loss (Pihlstrom, Michalowicz, & Johnson, 2005). In addition to effects on the periodontium caused by periodontitis, it is also noteworthy that as a consequence of the disease and its treatment, those with periodontal disease have an increased risk for root caries (Boehm & Scannapieco, 2007). Therefore, periodontitis increases the risk for loss of teeth due to the disease itself, but in the longer term tooth loss is also due to an increased risk for root caries, a form of tooth decay that proceeds rapidly and can have rather devastating effects on the teeth. Premature loss of teeth can lead to several problems including but not limited to the following: loss of masticatory function, malnutrition that could worsen the general health, speech difficulties, and an overall decrease in quality of life (Boehm & Scannapieco, 2007;

Brennan, Spencer, & Roberts-Thomson, 2007).

The Oral and Systemic Health Connection The importance of oral health with respect to overall health and well-being has been recognized by an increasing body of literature illustrating the association between periodontal health and general health in conditions such as diabetes mellitus, cardiovascular disease, and pulmonary infections (Scannapieco, 1999; Rutkauskas, 2000; Kinane & Marshall, 2001; Teng et al., 2002; Scannapieco, 2005a; Azarpazhooh & Leake, 2006;

Raghavendran, Mylotte, & Scannapieco, 2007; Kuo, Polson, & Kang, 2008; Azarpazhooh & Tenenbaum, 2012a). The connection lies at the thin and permeable gingival sulcus, which serves as a barrier between the oral environment and underlying tissues. In fact, this is the only area in the human body where the integumentary system is actually penetrated by another structure. The junctional epithelium is highly porous, as epithelial cells are connected by desmosomes and few gap junctions, resulting in large fluid-filled intracellular spaces (Bosshardt & Lang, 2005). In the presence of inflammation, this barrier may be penetrated easily by microorganisms that enter the underlying vasculature, thereby presenting a biological challenge to other parts of the body (Scannapieco, 2005a). Efforts to establish a causal link between oral and systemic diseases appear to be fading in favor of research focusing on the likely similar inflammatory mechanisms which underlie both oral and nonoral disease pathways (Kantarci & Van Dyke, 2005; Teles & Wang, 2011; Vaishnava, Narayan, & Fuster, 2011), where the term „Inflammatory Syndrome‟ may better and more appropriately describe the connection and commonalities between oral and general health and disease mechanisms (Azarpazhooh & Tenenbaum, 2012b).

Pages:     | 1 || 3 | 4 |   ...   | 13 |

Similar works:

«The Association of Indian Management Scholars International Twelfth AIMS International Conference on Management January 2-5, 2015 IIM, Kozhikode Theme: Management Challenges in Uncertain Environment PLENARY SESSIONS Session 1: Friday, January 2, 2015, 2:00-2:40 Session Chair: Speaker: R. C. Natarajan TAPMI, Manipal Pedagogical Experiments in Education of Potential Managers to Face Uncertain Environment Management education in India is at a point of inflection. Thanks to the magnanimity of the...»

«JAERI-Conf 2005-001 JP0550165 2*7 Physics teachers9 nuclear In-service training in Hungary Sandor Ujvari Cornelius Lanczos Gymnasium, Szekesfehervar, Hungary When I was a child, at school we had to make pictures or school compositions with the title,,What will the year 2000 be like? We had futuristic ideas: many people will live in Mars, our cars will fly, there will be eternal peace on the Earth, the cancer wont dangerous any more, we'll be able to produce pure unlimited energy, all the...»

«Georgia State University MBA 8135 – Corporate Finance Course Syllabus Spring Semester 2010 Instructors: C. Hodges, M. Shrikhande, A. Mettler (course coordinator) NOTE: It is your responsibility to read, understand and abide by all of the course information and policies listed below. Failure to do so could result in your failing of this course or of your being administratively withdrawn from the course by your instructor, by the Department of Finance, or by the Robinson College of Business....»

«Jennifer Esposito & Shayla Smith Teacher Education Quarterly, Summer 2006 From Reluctant Teacher to Empowered Teacher-Researcher One Educator’s Journey toward Action Research By Jennifer Esposito & Shayla Smith Yet another role, another hat to wear on a daily basis. I am now to wear the hat of a researcher. Nurse, educator, parent, comforter, encourager, etc. My hat pile is getting high. First as a mother and wife, next as an elementary public school teacher to 23 third graders, and now as a...»

«GCE Business Studies Advanced GCE A2 H430 Advanced Subsidiary GCE AS H030 OCR Report to Centres January 2013 Oxford Cambridge and RSA Examinations OCR (Oxford Cambridge and RSA) is a leading UK awarding body, providing a wide range of qualifications to meet the needs of candidates of all ages and abilities. OCR qualifications include AS/A Levels, Diplomas, GCSEs, OCR Nationals, Functional Skills, Key Skills, Entry Level qualifications, NVQs and vocational qualifications in areas such as IT,...»

«The Writing Revolution For years, nothing seemed capable of turning around New Dorp High School’s dismal performance—not firing bad teachers, not flashy education technology, not after-school programs. So, faced with closure, the school’s principal went all-in on a very specific curriculum reform, placing an overwhelming focus on teaching the basics of analytic writing, every day, in virtually every class. What followed was an extraordinary blossoming of student potential, across nearly...»

«Creative Education, 2016, 7, 1656-1675 Published Online July 2016 in SciRes. http://www.scirp.org/journal/ce http://dx.doi.org/10.4236/ce.2016.711169 Education to Theatricality and Neutral Mask: Psycho-Pedagogical Approach Gaetano Oliva Faculty of Education, Italian Department, Catholic University, Milan, Italy Received 14 June 2016; accepted 24 July 2016; published 27 July 2016 Copyright © 2016 by author and Scientific Research Publishing Inc. This work is licensed under the Creative Commons...»

«ISSN-L: 2223-9553, ISSN: 2223-9944 Academic Research International Vol. 4 No. 6 November 2013 HOW TEACHERS CONTRIBUTE TO PRODUCE THE PHENOMENON OF CULTURAL REPRODUCTION: THE FACTOR OF NORMALIZED PEDAGOGY Tien-Hui Chiang Department of Education, National University of Tainan; President, Taiwan Association for Sociology of Education, TAIWAN, & Guest Professor, Beijing Normal University, CHINA. thchiang@mail.nutn.edu.tw ABSTRACT In terms of implementing social justice, education is imposed the...»

«Hyatt Regency Santa Clara & Santa Clara Convention Center WEST 2016 Santa Clara, CA FEB. 18-21, 2016 2-3 THURSDAY No Strings Attached Working the fiber arts into your wardrobe Teachers à la Carte Luncheon sses Cla nts 4 FRiDAY Fashion Show & Dinner Eve Pajama Party & 5 SATURDAY From KNiTTER'S Pages With Rick Mondragon Student Banquet & Style Show 6 The Key 7–8 Class Schedule Teachers & Classes 9–65 66 Schedule of Events 66 Hotel info 67 Registration Form OPENING DAY CHALLENGE! Attached o...»

«Childhood in the Past 3, 2010, 79–106 Learning ‘From Nobody’: The Limited Role of Teaching in Folk Models of Children’s Development David F. Lancy Abstract Among the Western intelligentsia, parenting is synonymous with teaching. We are cajoled into beginning our child’s education in the womb and feel guilty whenever a ‘teaching moment’ is squandered. This paper will argue that this reliance on teaching generally, and especially on parents as teachers, is quite recent historically...»

«SCHOOL PSYCHOLOGISTS’ EXPERIENCES WITH TEACHER-TO-STUDENT MISTREATMENT by Sharon R. Brown Lyles Liberty University A Dissertation Presented in Partial Fulfillment Of the Requirements for the Degree Doctor of Education Liberty University April, 2014 SCHOOL PSYCHOLOGISTS’ EXPERIENCES WITH TEACHER-TO-STUDENT MISTREATMENT by Sharon R. Brown Lyles A Dissertation Presented in Partial Fulfillment Of the Requirements for the Degree Doctor of Education Liberty University, Lynchburg, VA April, 2014...»

«Духовність особистості: методологія, теорія і практика 2 (61) 2014 accentuates that in legislative documents there is no well-defined problem of reproduction of intelligentsia through higher education system, at the same time, this problem is put forward in the concepts of educational work of a considerable part of higher educational institutions, the qualities of the intelligent person that should be brought up at students and the duties of the...»

<<  HOME   |    CONTACTS
2016 www.dissertation.xlibx.info - Dissertations, online materials

Materials of this site are available for review, all rights belong to their respective owners.
If you do not agree with the fact that your material is placed on this site, please, email us, we will within 1-2 business days delete him.