THE OFFICIAL PATIENT’S SOURCEBOOK
on
INGIVITIS J AMES N. P ARKER , M.D. AND P HILIP M. P ARKER , P H .D., E DITORS
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ICON Health Publications ICON Group International, Inc. 4370 La Jolla Village Drive, 4th Floor San Diego, CA 92122 USA Copyright Ó2002 by ICON Group International, Inc. Copyright Ó2002 by ICON Group International, Inc. All rights reserved. This book is protected by copyright. No part of it may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, without written permission from the publisher. Printed in the United States of America. Last digit indicates print number: 10 9 8 7 6 4 5 3 2 1
Publisher, Health Care: Tiffany LaRochelle Editor(s): James Parker, M.D., Philip Parker, Ph.D. Publisher's note: The ideas, procedures, and suggestions contained in this book are not intended as a substitute for consultation with your dentist or oral surgeon. All matters regarding your health require medical supervision. As new medical or scientific information becomes available from academic and clinical research, recommended treatments and drug therapies may undergo changes. The authors, editors, and publisher have attempted to make the information in this book up to date and accurate in accord with accepted standards at the time of publication. The authors, editors, and publisher are not responsible for errors or omissions or for consequences from application of the book, and make no warranty, expressed or implied, in regard to the contents of this book. Any practice described in this book should be applied by the reader in accordance with professional standards of care used in regard to the unique circumstances that may apply in each situation, in close consultation with a qualified dentist or oral surgeon. The reader is advised to always check product information (package inserts) for changes and new information regarding dose and contraindications before taking any drug or pharmacological product. Caution is especially urged when using new or infrequently ordered drugs, herbal remedies, vitamins and supplements, alternative therapies, complementary therapies and medicines, and integrative medical treatments. Cataloging-in-Publication Data Parker, James N., 1961Parker, Philip M., 1960The Official Patient’s Sourcebook on Gingivitis: Revised and Updated for the Internet Age/James N. Parker and Philip M. Parker, editors p. cm. Includes bibliographical references, glossary and index. ISBN: 0-597-83142-4 1. Gingivitis-Popular works. I. Title.
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Disclaimer This publication is not intended to be used for the diagnosis or treatment of a health problem or as a substitute for consultation with licensed medical professionals. It is sold with the understanding that the publisher, editors, and authors are not engaging in the rendering of medical, psychological, financial, legal, or other professional services. References to any entity, product, service, or source of information that may be contained in this publication should not be considered an endorsement, either direct or implied, by the publisher, editors or authors. ICON Group International, Inc., the editors, or the authors are not responsible for the content of any Web pages nor publications referenced in this publication.
Copyright Notice If a dentist or oral surgeon wishes to copy limited passages from this sourcebook for patient use, this right is automatically granted without written permission from ICON Group International, Inc. (ICON Group). However, all of ICON Group publications are copyrighted. With exception to the above, copying our publications in whole or in part, for whatever reason, is a violation of copyright laws and can lead to penalties and fines. Should you want to copy tables, graphs or other materials, please contact us to request permission (e-mail:
[email protected]). ICON Group often grants permission for very limited reproduction of our publications for internal use, press releases, and academic research. Such reproduction requires confirmed permission from ICON Group International Inc. The disclaimer above must accompany all reproductions, in whole or in part, of this sourcebook.
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Dedication To the healthcare professionals dedicating their time and efforts to the study of gingivitis.
Acknowledgements The collective knowledge generated from academic and applied research summarized in various references has been critical in the creation of this sourcebook which is best viewed as a comprehensive compilation and collection of information prepared by various official agencies which directly or indirectly are dedicated to gingivitis. All of the Official Patient’s Sourcebooks draw from various agencies and institutions associated with the United States Department of Health and Human Services, and in particular, the Office of the Secretary of Health and Human Services (OS), the Administration for Children and Families (ACF), the Administration on Aging (AOA), the Agency for Healthcare Research and Quality (AHRQ), the Agency for Toxic Substances and Disease Registry (ATSDR), the Centers for Disease Control and Prevention (CDC), the Food and Drug Administration (FDA), the Healthcare Financing Administration (HCFA), the Health Resources and Services Administration (HRSA), the Indian Health Service (IHS), the institutions of the National Institutes of Health (NIH), the Program Support Center (PSC), and the Substance Abuse and Mental Health Services Administration (SAMHSA). In addition to these sources, information gathered from the National Library of Medicine, the United States Patent Office, the European Union, and their related organizations has been invaluable in the creation of this sourcebook. Some of the work represented was financially supported by the Research and Development Committee at INSEAD. This support is gratefully acknowledged. Finally, special thanks are owed to Tiffany LaRochelle for her excellent editorial support.
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About the Editors James N. Parker, M.D. Dr. James N. Parker received his Bachelor of Science degree in Psychobiology from the University of California, Riverside and his M.D. from the University of California, San Diego. In addition to authoring numerous research publications, he has lectured at various academic institutions. Dr. Parker is the medical editor for the Official Patient’s Sourcebook series published by ICON Health Publications.
Philip M. Parker, Ph.D. Philip M. Parker is the Eli Lilly Chair Professor of Innovation, Business and Society at INSEAD (Fontainebleau, France and Singapore). Dr. Parker has also been Professor at the University of California, San Diego and has taught courses at Harvard University, the Hong Kong University of Science and Technology, the Massachusetts Institute of Technology, Stanford University, and UCLA. Dr. Parker is the associate editor for the Official Patient’s Sourcebook series published by ICON Health Publications.
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About ICON Health Publications In addition to gingivitis, Official Patient’s Sourcebooks are available for the following related topics: ·
The Official Patient's Sourcebook on Diabetes-related Periodontal Disease
·
The Official Patient's Sourcebook on Dry Mouth
·
The Official Patient's Sourcebook on Oral Cancer
·
The Official Patient's Sourcebook on Periodontitis
·
The Official Patient's Sourcebook on Temporomandibular Joint Syndrome
·
The Official Patient's Sourcebook on Tooth Decay
To discover more about ICON Health Publications, simply check with your preferred online booksellers, including Barnes & Noble.com and Amazon.com which currently carry all of our titles. Or, feel free to contact us directly for bulk purchases or institutional discounts: ICON Group International, Inc. 4370 La Jolla Village Drive, Fourth Floor San Diego, CA 92122 USA Fax: 858-546-4341 Web site: www.icongrouponline.com/health
Contents vii
Table of Contents INTRODUCTION ................................................................................................................. 1 Overview .................................................................................................................................... 1 Organization ............................................................................................................................. 3 Scope ............................................................................................................................................ 3 Moving Forward ...................................................................................................................... 4
PART I: THE ESSENTIALS ..................................................................... 7 CHAPTER 1. THE ESSENTIALS ON GINGIVITIS: GUIDELINES . 9 Overview .................................................................................................................................... 9 What Is Periodontal Disease? ............................................................................................ 10 How Does Periodontal Disease Develop?....................................................................... 11 Who Gets Gingivitis? ........................................................................................................... 12 What Can I Do to Prevent Gingivitis? ........................................................................... 12 Risk Factors ............................................................................................................................. 12 How Do I Know If I Have Gingivitis? ............................................................................ 13 How Is Gingivitis Treated? ................................................................................................ 13 Surgical Treatments.............................................................................................................. 16 Second Opinion ...................................................................................................................... 16 Can Periodontal Disease Cause Health Problems Beyond the Mouth?................. 17 More Guideline Sources....................................................................................................... 17 Vocabulary Builder ............................................................................................................... 26
CHAPTER 2. SEEKING GUIDANCE ................................................................. 31 Overview .................................................................................................................................. 31 Associations and Gingivitis ................................................................................................ 31 Finding More Associations ................................................................................................. 33 Finding Dentists .................................................................................................................... 35 Selecting Your Dentist......................................................................................................... 36 Working with Your Dentist ............................................................................................... 36 Broader Health-Related Resources.................................................................................... 38 Vocabulary Builder ............................................................................................................... 38
CHAPTER 3. CLINICAL TRIALS AND GINGIVITIS ............................. 39 Overview .................................................................................................................................. 39 Recent Trials on Gingivitis ................................................................................................. 42 Benefits and Risks .................................................................................................................. 43 Keeping Current on Clinical Trials .................................................................................. 46 General References................................................................................................................. 47
PART II: ADDITIONAL RESOURCES AND ADVANCED MATERIAL ....................................................................... 49
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CHAPTER 4. STUDIES ON GINGIVITIS ......................................................... 51 Overview .................................................................................................................................. 51 The Combined Health Information Database ................................................................ 51 Federally-Funded Research on Gingivitis ...................................................................... 57 E-Journals: PubMed Central .............................................................................................. 70 The National Library of Medicine: PubMed.................................................................. 70 Vocabulary Builder ............................................................................................................... 74
CHAPTER 5. BOOKS ON GINGIVITIS ............................................................. 81 Overview .................................................................................................................................. 81 Book Summaries: Federal Agencies .................................................................................. 81 Book Summaries: Online Booksellers............................................................................... 85 The National Library of Medicine Book Index .............................................................. 85 Chapters on Gingivitis ......................................................................................................... 87 General Home References .................................................................................................... 89 Vocabulary Builder ............................................................................................................... 90
CHAPTER 6. MULTIMEDIA ON GINGIVITIS ........................................... 95 Overview .................................................................................................................................. 95 Video Recordings ................................................................................................................... 95 Bibliography: Multimedia on Gingivitis ........................................................................ 96
CHAPTER 7. PERIODICALS AND NEWS ON GINGIVITIS ............ 99 Overview .................................................................................................................................. 99 News Services & Press Releases ........................................................................................ 99 Newsletter Articles .............................................................................................................. 101 Academic Periodicals covering Gingivitis .................................................................... 103 Vocabulary Builder ............................................................................................................. 104
CHAPTER 8. PHYSICIAN GUIDELINES AND DATABASES ....... 105 Overview ................................................................................................................................ 105 NIH Guidelines .................................................................................................................... 105 NIH Databases ..................................................................................................................... 106 Other Commercial Databases ........................................................................................... 114 The Genome Project and Gingivitis ............................................................................... 114 Specialized References ........................................................................................................ 119 Vocabulary Builder ............................................................................................................. 121
CHAPTER 9. DISSERTATIONS ON GINGIVITIS ................................... 123 Overview ................................................................................................................................ 123 Dissertations on Gingivitis............................................................................................... 123 Keeping Current................................................................................................................... 124
PART III. APPENDICES .......................................................................... 125 APPENDIX A. RESEARCHING YOUR MEDICATIONS .................. 127 Overview ................................................................................................................................ 127 Your Medications: The Basics.......................................................................................... 128
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Learning More about Your Medications ...................................................................... 129 Commercial Databases ....................................................................................................... 132 Contraindications and Interactions (Hidden Dangers) ........................................... 134 A Final Warning.................................................................................................................. 135 General References............................................................................................................... 135 Vocabulary Builder ............................................................................................................. 136
APPENDIX B. RESEARCHING ALTERNATIVE MEDICINE ........ 139 Overview ................................................................................................................................ 139 What Is CAM? ..................................................................................................................... 139 What Are the Domains of Alternative Medicine? ..................................................... 140 Can Alternatives Affect My Treatment?...................................................................... 143 Finding CAM References on Gingivitis ....................................................................... 144 Additional Web Resources ................................................................................................ 147 General References............................................................................................................... 155
APPENDIX C. RESEARCHING NUTRITION ........................................... 157 Overview ................................................................................................................................ 157 Food and Nutrition: General Principles ....................................................................... 158 Finding Studies on Gingivitis ......................................................................................... 162 Federal Resources on Nutrition ....................................................................................... 166 Additional Web Resources ................................................................................................ 167 Vocabulary Builder ............................................................................................................. 168
APPENDIX D. FINDING MEDICAL LIBRARIES ................................... 171 Overview ................................................................................................................................ 171 Preparation ............................................................................................................................ 171 Finding a Local Medical Library ..................................................................................... 172 Medical Libraries Open to the Public ............................................................................ 172
APPENDIX E. YOUR RIGHTS AND INSURANCE ............................... 179 Overview ................................................................................................................................ 179 Your Rights as a Patient.................................................................................................... 179 Patient Responsibilities ...................................................................................................... 183 Choosing an Insurance Plan............................................................................................. 184 Medicare and Medicaid ...................................................................................................... 186 NORD’s Medication Assistance Programs ................................................................. 189 Additional Resources .......................................................................................................... 190 Vocabulary Builder ............................................................................................................. 191
ONLINE GLOSSARIES............................................................................. 193 Online Dictionary Directories ......................................................................................... 196
GINGIVITIS GLOSSARY ..................................................................... 197 General Dictionaries and Glossaries .............................................................................. 212
INDEX ................................................................................................................................... 215
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Contents
Introduction
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INTRODUCTION Overview Dr. C. Everett Koop, former U.S. Surgeon General, once said, “The best prescription is knowledge.”1 The Agency for Healthcare Research and Quality (AHRQ) of the National Institutes of Health (NIH) echoes this view and recommends that every patient incorporate education into the treatment process. According to the AHRQ: Finding out more about your condition is a good place to start. By contacting groups that support your condition, visiting your local library, and searching on the Internet, you can find good information to help guide your treatment decisions. Some information may be hard to find—especially if you don't know where to look.2 As the AHRQ mentions, finding the right information is not an obvious task. Though many healthcare providers and public officials had thought that the emergence of the Internet would do much to assist patients in obtaining reliable information, in March 2001 the National Institutes of Health issued the following warning: The number of Web sites offering health-related resources grows every day. Many sites provide valuable information, while others may have information that is unreliable or misleading.3
Quotation from http://www.drkoop.com. The Agency for Healthcare Research and Quality (AHRQ): http://www.ahcpr.gov/consumer/diaginfo.htm. 3 From the NIH, National Cancer Institute (NCI): http://cancertrials.nci.nih.gov/beyond/evaluating.html. 1 2
2
Gingivitis
Since the late 1990s, healthcare providers have seen a general increase in patient Internet usage rates. Patients frequently enter their dentists’ offices with printed Web pages of home remedies in the guise of latest medical research. This scenario is so common that dentists often spend more time dispelling misleading information than guiding patients through sound therapies. The Official Patient’s Sourcebook on Gingivitis has been created for patients who have decided to make education and research an integral part of the treatment process. The pages that follow will tell you where and how to look for information covering virtually all topics related to gingivitis, from the essentials to the most advanced areas of research. The title of this book includes the word “official.” This reflects the fact that the sourcebook draws from public, academic, government, and peerreviewed research. Selected readings from various agencies are reproduced to give you some of the latest official information available to date on gingivitis. Given patients’ increasing sophistication in using the Internet, abundant references to reliable Internet-based resources are provided throughout this sourcebook. Where possible, guidance is provided on how to obtain free-ofcharge, primary research results as well as more detailed information via the Internet. E-book and electronic versions of this sourcebook are fully interactive with each of the Internet sites mentioned (clicking on a hyperlink automatically opens your browser to the site indicated). Hard copy users of this sourcebook can type cited Web addresses directly into their browsers to obtain access to the corresponding sites. Since we are working with ICON Health Publications, hard copy Sourcebooks are frequently updated and printed on demand to ensure that the information provided is current. In addition to extensive references accessible via the Internet, every chapter presents a “Vocabulary Builder.” Many health guides offer glossaries of technical or uncommon terms in an appendix. In editing this sourcebook, we have decided to place a smaller glossary within each chapter that covers terms used in that chapter. Given the technical nature of some chapters, you may need to revisit many sections. Building one’s vocabulary of medical terms in such a gradual manner has been shown to improve the learning process. We must emphasize that no sourcebook on gingivitis should affirm that a specific diagnostic procedure or treatment discussed in a research study, patent, or doctoral dissertation is “correct” or your best option. This sourcebook is no exception. Each patient is unique. Deciding on appropriate
Introduction
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options is always up to the patient in consultation with their dentist and other healthcare providers.
Organization This sourcebook is organized into three parts. Part I explores basic techniques to researching gingivitis (e.g. finding guidelines on diagnosis, treatments, and prognosis), followed by a number of topics, including information on how to get in touch with organizations, associations, or other patient networks dedicated to gingivitis. It also gives you sources of information that can help you find a dentist or oral surgeon in your local area specializing in treating gingivitis. Collectively, the material presented in Part I is a complete primer on basic research topics for patients with gingivitis. Part II moves on to advanced research dedicated to gingivitis. Part II is intended for those willing to invest many hours of hard work and study. It is here that we direct you to the latest scientific and applied research on gingivitis. When possible, contact names, links via the Internet, and summaries are provided. It is in Part II where the vocabulary process becomes important as authors publishing advanced research frequently use highly specialized language. In general, every attempt is made to recommend “free-to-use” options. Part III provides appendices of useful background reading for all patients with gingivitis or related disorders. The appendices are dedicated to more pragmatic issues faced by many patients with gingivitis. Accessing materials via medical libraries may be the only option for some readers, so a guide is provided for finding local medical libraries which are open to the public. Part III, therefore, focuses on advice that goes beyond the biological and scientific issues facing patients with gingivitis.
Scope While this sourcebook covers gingivitis, your dentist, research publications, and specialists may refer to your condition using a variety of terms. Therefore, you should understand that gingivitis is often considered a synonym or a condition closely related to the following: ·
Denture Sore Mouth
·
Mild Gum Disease
4
Gingivitis
·
Mild Gum Inflammation
In addition to synonyms and related conditions, healthcare providers may refer to gingivitis using certain coding systems. The International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) is the most commonly used system of classification for the world's illnesses. Your dentist may use this coding system as an administrative or tracking tool. The following classification is commonly used for gingivitis:4 ·
523 gingival and periodontal diseases
·
523.0 acute gingivitis
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523.1 chronic gingivitis
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523.2 gingival recession
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523.9 unspecified gingival and periodontal disease
For the purposes of this sourcebook, we have attempted to be as inclusive as possible, looking for official information for all of the synonyms relevant to gingivitis. You may find it useful to refer to synonyms when accessing databases or interacting with healthcare professionals and medical librarians.
Moving Forward Since the 1980s, the world has seen a proliferation of healthcare guides covering most illnesses. Some are written by patients or their family members. These generally take a layperson's approach to understanding and coping with an illness or disorder. They can be uplifting, encouraging, and highly supportive. Other guides are authored by dentists or other healthcare providers who have a more clinical outlook. Each of these two styles of guide has its purpose and can be quite useful. As editors, we have chosen a third route. We have chosen to expose you to as many sources of official and peer-reviewed information as practical, for the purpose of educating you about basic and advanced knowledge as recognized by medical science today. You can think of this sourcebook as your personal Internet age reference librarian. 4 This list is based on the official version of the World Health Organization's 9th Revision, International Classification of Diseases (ICD-9). According to the National Technical Information Service, “ICD-9CM extensions, interpretations, modifications, addenda, or errata other than those approved by the U.S. Public Health Service and the Health Care Financing Administration are not to be considered official and should not be utilized. Continuous maintenance of the ICD-9-CM is the responsibility of the federal government.”
Introduction
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Why “Internet age”? All too often, patients diagnosed with gingivitis will log on to the Internet, type words into a search engine, and receive several Web site listings which are mostly irrelevant or redundant. These patients are left to wonder where the relevant information is, and how to obtain it. Since only the smallest fraction of information dealing with gingivitis is even indexed in search engines, a non-systematic approach often leads to frustration and disappointment. With this sourcebook, we hope to direct you to the information you need that you would not likely find using popular Web directories. Beyond Web listings, in many cases we will reproduce brief summaries or abstracts of available reference materials. These abstracts often contain distilled information on topics of discussion. While we focus on the more scientific aspects of gingivitis, there is, of course, the emotional side to consider. Later in the sourcebook, we provide a chapter dedicated to helping you find peer groups and associations that can provide additional support beyond research produced by medical science. We hope that the choices we have made give you the most options available in moving forward. In this way, we wish you the best in your efforts to incorporate this educational approach into your treatment plan. The Editors
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PART I: THE ESSENTIALS
ABOUT PART I Part I has been edited to give you access to what we feel are “the essentials” on gingivitis. The essentials of a disease typically include the definition or description of the disease, a discussion of who it affects, the signs or symptoms associated with the disease, tests or diagnostic procedures that might be specific to the disease, and treatments for the disease. Your dentist or oral surgeon may have already explained the essentials of gingivitis to you or even given you a pamphlet or brochure describing gingivitis. Now you are searching for more in-depth information. As editors, we have decided, nevertheless, to include a discussion on where to find essential information that can complement what your dentist or oral surgeon has already told you. In this section we recommend a process, not a particular Web site or reference book. The process ensures that, as you search the Web, you gain background information in such a way as to maximize your understanding.
Guidelines
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CHAPTER 1. THE ESSENTIALS ON GINGIVITIS: GUIDELINES Overview Official agencies, as well as federally-funded institutions supported by national grants, frequently publish a variety of guidelines on gingivitis. These are typically called “Fact Sheets” or “Guidelines.” They can take the form of a brochure, information kit, pamphlet, or flyer. Often they are only a few pages in length. The great advantage of guidelines over other sources is that they are often written with the patient in mind. Since new guidelines on gingivitis can appear at any moment and be published by a number of sources, the best approach to finding guidelines is to systematically scan the Internet-based services that post them.
The National Institutes of Health (NIH)5 The National Institutes of Health (NIH) is the first place to search for relatively current patient guidelines and fact sheets on gingivitis. Originally founded in 1887, the NIH is one of the world's foremost medical research centers and the federal focal point for medical research in the United States. At any given time, the NIH supports some 35,000 research grants at universities, medical schools, and other research and training institutions, both nationally and internationally. The rosters of those who have conducted research or who have received NIH support over the years include the world's most illustrious scientists and physicians. Among them are 97 scientists who have won the Nobel Prize for achievement in medicine.
5
Adapted from the NIH: http://www.nih.gov/about/NIHoverview.html.
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There is no guarantee that any one Institute will have a guideline on a specific disease, though the National Institutes of Health collectively publish over 600 guidelines for both common and rare diseases. The best way to access NIH guidelines is via the Internet. Although the NIH is organized into many different Institutes and Offices, the following is a list of key Web sites where you are most likely to find NIH clinical guidelines and publications dealing with gingivitis and associated conditions: ·
Office of the Director (OD); guidelines consolidated across agencies available at http://www.nih.gov/health/consumer/conkey.htm
·
National Library of Medicine (NLM); extensive encyclopedia (A.D.A.M., Inc. ) with guidelines available at http://www.nlm.nih.gov/medlineplus/healthtopics.html
·
National Institute of Dental and Craniofacial Research (NIDCR); guidelines available at http://www.nidr.nih.gov/health/
Among these, the National Institute of Dental and Craniofacial Research (NIDCR) is particularly noteworthy.6 Its mission is to promote the general health of the American people by improving their oral, dental, and craniofacial health. Through nurturing fundamental research and the development of researchers, the NIDCR aims to promote health, to prevent diseases and conditions, and to develop new diagnostics and therapeutics. Knowledge acquisition through science and effective and efficient science transfer are the means used to contribute to improved quality of health. The following is NIDCR’s patient guideline on gingivitis.
What Is Periodontal Disease?7 If you have been told you have periodontal (gum) disease, you're not alone. An estimated 80 percent of American adults currently have some form of the disease. Periodontal diseases range from simple gum inflammation to serious disease that results in major damage to the soft tissue and bone that support the teeth. In the worst cases, teeth are lost.
6 Adapted from the NIDCR: http://www.nidr.nih.gov/about/mission.asp. For the remainder of the book, “adapted” indicates reproduction with attribution, with minor editorial adjustments, as needed. 7 Adapted from the National Institute of Dental and Craniofacial Research (NIDCR): http://www.nidcr.nih.gov/health/newsandhealth/gumDiseasesPub.asp.
Guidelines 11
Gum disease is a threat to your oral health. Research is also pointing to possible health effects of periodontal diseases that go well beyond your mouth (more about this later). Whether it is stopped, slowed, or gets worse depends a great deal on how well you care for your teeth and gums every day, from this point forward.
How Does Periodontal Disease Develop? Plaque and Tartar Our mouths are full of bacteria. These bacteria, along with mucus and other particles, constantly form a sticky, colorless “plaque” on teeth. Brushing and flossing help get rid of plaque. Plaque that is not removed can harden and form bacteria-harboring “tartar” that brushing doesn't clean. Only a professional cleaning by a dentist or dental hygienist can remove tartar.
Gingivitis The longer plaque and tartar are on teeth, the more harmful they become. The bacteria cause inflammation of the gums that is called “gingivitis.” In gingivitis, the gums become red, swollen and can bleed easily. Gingivitis is a mild form of gum disease that can usually be reversed with daily brushing and flossing, and cleaning by a dentist or dental hygienist. This form of gum disease does not include any loss of bone and tissue that hold teeth in place. Periodontitis When gingivitis is not treated, it can advance to “periodontitis” (which means “inflammation around the tooth.”) In periodontitis, gums pull away from the teeth and form “pockets” that are infected. The body's immune system fights the bacteria as the plaque spreads and grows below the gum line. Bacterial toxins and the body's enzymes fighting the infection actually start to break down the bone and connective tissue that hold teeth in place. If not treated, the bones, gums, and connective tissue that support the teeth are destroyed. The teeth may eventually become loose and have to be removed.
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Who Gets Gingivitis? People usually don't show signs of gum disease until they are in their 30s or 40s. Men are more likely to have periodontal disease than women. Although teenagers rarely develop periodontitis, they can develop gingivitis, the milder form of gum disease. Most commonly, gum disease develops when plaque is allowed to build up along and under the gum line.
What Can I Do to Prevent Gingivitis? Here are some things you can do to prevent periodontal diseases: ·
Brush your teeth twice a day (with a fluoride toothpaste)
·
Floss once a day
·
Visit the dentist routinely for a check-up and professional cleaning
·
Eat a well balanced diet
·
Don't use tobacco products
Risk Factors Risk factors of developing periodontal disease include the following: ·
Smoking. Need another reason to quit smoking? Smoking is one of the most significant risk factors associated with the development of periodontitis. Additionally, smoking can lower the chances of success of some treatments.
·
Hormonal changes in girls/women. These changes can make gums more sensitive and make it easier for gingivitis to develop.
·
Diabetes. People with diabetes are at higher risk for developing infections, including periodontal disease.
·
Stress. Research shows that stress can make it more difficult for our bodies to fight infection, including periodontal disease.
·
Medications. Some drugs, such as oral contraceptives, antidepressants, and some heart medicines can affect oral health because they lessen the flow of saliva. (Saliva has a protective effect on teeth and gums.)
·
Poor nutrition. A poor diet, especially one low in calcium, can lower your resistance to gum disease.
Guidelines 13
·
Illnesses. Diseases like cancer or AIDS and their treatments can also affect the health of gums.
·
Genetic susceptibility. Some people are more prone to severe periodontal disease than others.
How Do I Know If I Have Gingivitis? Symptoms are often not noticeable until the disease is advanced. They include: ·
Bad breath that won't go away
·
Red or swollen gums
·
Tender or bleeding gums
·
Painful chewing
·
Loose teeth
·
Sensitive teeth
Any of these symptoms may signal a serious problem, which should be checked by a dentist. At your dental visit: ·
The dentist will ask about your medical history to identify underlying conditions or risk factors (such as smoking) that may contribute to periodontal disease.
·
The dentist or hygienist will examine your gums and note any signs of inflammation.
·
The dentist or hygienist will use a probe to check for periodontal pockets and to measure any pockets. In a healthy mouth, the depth of these pockets is usually between 1 and 3 millimeters.
·
The dentist or hygienist may take an x-ray to see whether there is any bone loss.
·
The dentist may refer you to a periodontist, a specialist who treats gum diseases.
How Is Gingivitis Treated? The main goal of treatment is to control the infection. Treatment will vary, depending on the extent of the gum disease. Any type of treatment requires
14 Gingivitis
that the patient keep up good daily care at home. Additionally, modifying certain behaviors, such as quitting tobacco use, might also be suggested as a way to improve treatment outcome. Deep Cleaning (Scaling and Root Planing) The dentist, periodontist, or dental hygienist removes the plaque through a deep-cleaning method called scaling and root planing. Scaling means scraping off the tartar from above and below the gum line. Root planing gets rid of rough spots on the tooth root where the germs gather, and helps remove bacteria that contribute to the disease.
Medications A number of medications are now available to control the infection and reduce inflammation. Medications are generally used with treatment that includes scaling and root planing. Long-term studies will be needed to determine whether using medications reduces the need for surgery and whether they are effective over a long period of time. Here are some that are currently used: ·
Antimicrobial mouthrinse What is it? A prescription mouthrinse containing an antimicrobial called chlorhexidine. Why is it used? To control bacteria when treating gingivitis and after gum surgery. How is it used? It's used like a regular mouthwash.
·
Antiseptic “chip” What is it? A tiny piece of gelatin filled with the medicine chlorhexidine. Why is it used? To control bacteria and reduce the size of periodontal pockets. How is it used?
Guidelines 15
After root planing, it's placed in the pockets where the medicine is slowly released over time. ·
Antibiotic gel What is it? A gel that contains the antibiotic doxycycline. Why is it used? To control bacteria and reduce the size of periodontal pockets. How is it used? The periodontist puts it in the pockets after scaling and root planing. The antibiotic is released slowly over a period of about seven days.
·
Antibiotic fiber What is it? Thread-like fiber that contains the antibiotic tetracycline. Why is it used? To control bacteria and reduce the size of periodontal pockets. How is it used? These fibers are placed in the pockets. The medicine is released slowly over 10 days. The fibers are then removed.
·
Antibiotic microspheres What is it? Tiny, round particles that contain the antibiotic minocycline. Why is it used? To control bacteria and reduce the size of periodontal pockets. How is it used? The periodontist puts the microspheres into the pockets after scaling and root planing. The particles release minocycline slowly over time.
·
Enzyme suppressant What is it? A low dose of the medication doxycycline that keeps destructive enzymes in check. Why is it used?
16 Gingivitis
To hold back the body's enzyme response -- If not controlled, certain enzymes can break down gum tissue. How is it used? This medication is in pill form. It is used in combination with scaling and root planing.
Surgical Treatments Flap Surgery Surgery might be necessary if inflammation and deep pockets remain following treatment with deep cleaning and medications. A periodontist may perform flap surgery to remove tartar deposits in deep pockets or to reduce the periodontal pocket and make it easier for the patient, dentist, and hygienist to keep the area clean. This common surgery involves lifting back the gums and removing the tartar. The gums are then sutured back in place so that the tissue fits snugly around the tooth again.
Bone and Tissue Grafts In addition to flap surgery, your periodontist may suggest placing bone or tissue grafts. Grafting is a way to replace or encourage new growth of bone or gum tissue destroyed by periodontitis. A technique that can be used with bone grafting is called guided tissue regeneration, in which a small piece of mesh-like fabric is inserted between the bone and gum tissue. This keeps the gum tissue from growing into the area where the bone should be, allowing the bone and connective tissue to regrow. Since each case is different, it is not possible to predict with certainty which grafts will be successful over the long-term. Treatment results depend on many things, including severity of the disease, ability to maintain oral hygiene at home, and certain risk factors, such as smoking, which may lower the chances of success. Ask your periodontist what the level of success might be in your particular case.
Second Opinion When considering any extensive dental or medical treatment options, you should think about getting a second opinion. To find a dentist or
Guidelines 17
periodontist for a second opinion, call your local dental society. They can provide you with names of practitioners in your area. Dental schools are also a good source for getting a second opinion.
Can Periodontal Disease Cause Health Problems Beyond the Mouth? Maybe. But so far the research is inconclusive. Studies are ongoing to try to determine whether there is a cause-and-effect relationship between periodontal disease and: ·
An increased risk of heart attack or stroke
·
An increased risk of delivering preterm, low birth weight babies
·
Difficulty controlling blood sugar levels in people with diabetes
In the meantime, it's a fact that controlling periodontal disease can save your teeth -- a very good reason to take care of your teeth and gums.
Participating in Research Studies To find out about participating in research studies on periodontal diseases go to clinicaltrials.gov.
More Guideline Sources The guideline above on gingivitis is only one example of the kind of material that you can find online and free of charge. The remainder of this chapter will direct you to other sources which either publish or can help you find additional guidelines on topics related to gingivitis. Many of the guidelines listed below address topics that may be of particular relevance to your specific situation or of special interest to only some patients with gingivitis. Due to space limitations these sources are listed in a concise manner. Do not hesitate to consult the following sources by either using the Internet hyperlink provided, or, in cases where the contact information is provided, contacting the publisher or author directly.
18 Gingivitis
Topic Pages: MEDLINEplus For patients wishing to go beyond guidelines published by specific Institutes of the NIH, the National Library of Medicine has created a vast and patientoriented healthcare information portal called MEDLINEplus. Within this Internet-based system are “health topic pages.” You can think of a health topic page as a guide to patient guides. To access this system, log on to http://www.nlm.nih.gov/medlineplus/healthtopics.html. If you do not find topics of interest when browsing health topic pages, then you can choose to use the advanced search utility of MEDLINEplus at the following:http://www.nlm.nih.gov/medlineplus/advancedsearch.html. This utility is similar to the NIH Search Utility, with the exception that it only includes material linked within the MEDLINEplus system (mostly patientoriented information). It also has the disadvantage of generating unstructured results. We recommend, therefore, that you use this method only if you have a very targeted search. The Combined Health Information Database (CHID) CHID Online is a reference tool that maintains a database directory of thousands of journal articles and patient education guidelines on gingivitis and related conditions. One of the advantages of CHID over other sources is that it offers summaries that describe the guidelines available, including contact information and pricing. CHID’s general Web site is http://chid.nih.gov/. To search this database, go to http://chid.nih.gov/detail/detail.html. In particular, you can use the advanced search options to look up pamphlets, reports, brochures, and information kits. The following was recently posted in this archive: ·
Mouth Care and Diabetes: Managing Periodontal Disease Source: San Bruno, CA: StayWell Company. 2000. [2 p.]. Contact: Available from StayWell Company. Order Department, 1100 Grundy Lane, San Bruno, CA 94066-9821. (800) 333-3032. Fax (650) 2444512. E-mail:
[email protected]. Website: www.staywell.com. PRICE: $17.95 for a pack of 50; plus shipping and handling. Summary: This pamphlet provides people who have diabetes with tips for preventing and treating periodontal disease. People who have diabetes are at increased risk for periodontal disease. Periodontal disease occurs in three stages: gingivitis, periodontitis, and advanced periodontitis. Steps that people can take to prevent periodontal disease
Guidelines 19
include using good oral hygiene, visiting the dentist every 3 to 4 months for examinations and cleanings, and keeping blood glucose at a healthy level. Treatment of periodontal disease involves scaling and root planing, taking antibiotics, and undergoing gum surgery. 13 figures. ·
Periodontal Diseases: What You Need to Know Source: Chicago, IL: American Academy of Periodontology. 1996. 10 p. Contact: Available from American Academy of Periodontology. 737 North Michigan Avenue, Suite 800, Chicago, IL 60611-2690. (312) 7875518. Fax (312) 787-3670. Website: www.perio.org. PRICE: Single copy free; bulk orders available. Summary: This brochure uses a question and answer format to provide information on periodontal diseases, which are bacterial gum infections that destroy the attachment fibers and supporting bone that hold the teeth in the mouth. The most common forms of periodontal disease are gingivitis, mild periodontitis, and moderate-advanced periodontitis. Although plaque is the main cause of periodontal disease, other factors such as smoking or tobacco use, pregnancy and puberty, stress, medications, clenching or grinding the teeth, diabetes, poor nutrition, and systemic diseases, can affect gum health. The brochure lists the symptoms of periodontal disease and discusses their prevention and treatment. It also includes four inserts that explain the relationship between periodontal disease and respiratory disease, pregnancy outcomes, diabetes, and heart disease. 6 figures.
·
Diabetes and Dental Care Source: New York, NY: Juvenile Diabetes Foundation International. 199x. [4 p.]. Contact: Available from Juvenile Diabetes Foundation International. 120 Wall Street, New York, NY 10005-4001. (800) 533-2873 or (212) 785-9500. Website: www.jdfcure.com. PRICE: Single copy free; bulk copies available. Summary: This brochure discusses the impact of diabetes on the teeth. People with diabetes have a higher than average risk of developing periodontal disease. When dental plaque, the main cause of periodontal disease, builds up, it creates toxic byproducts that inflame and infect the gums. This condition is known as gingivitis. If dental plaque continues to build up, the irritated gums pull away from the teeth, forming pockets that trap more plaque. Untreated, the inflammation will affect the underlying bone structure and cause its destruction. Diabetes makes people more susceptible to periodontal disease because they accumulate
20 Gingivitis
more plaque, have high sugar levels in their oral fluids, tend to lose collagen in the gum tissue, and have reduced circulation in the blood vessels in the gums. Periodontal disease may be prevented through good blood sugar control, proper oral hygiene, and attention to warning signs. Treatments such as root planing and periodontal surgery may be needed if gum inflammation occurs. It is important for people who have diabetes to prevent or treat periodontal disease because it can interfere with diabetes management. ·
Consumer Products: ADA Seal of Acceptance Source: Chicago, Illinois: American Dental Association. 2000. [9]. Contact: Available from American Dental Association. 211 East Chicago Avenue, Chicago, Illinois 6011-2678. (312) 440-2534. Website: www.ada.org. PRICE: Single copy free, plus shipping and handling. Summary: Dentists and consumers have long recognized the American Dental Association (ADA) Seal of Acceptance as an important symbol of a dental product's safety and effectiveness. Although it is strictly voluntary, about 350 companies participate in the Seal program, which has early roots in 1866, with the first seal being awarded in 1934. Participating manufacturers commit significant resources to evaluate, test, and market products in the Seal program. Some 1,300 dental products carry the Seal of Acceptance. Of these, about 40 percent are products sold to consumers, such as toothpaste, dental floss, manual and electric toothbrushes, and mouthrinses. The rest are products prescribed or used by dentists, such as antibiotics or dental restorative materials. This pamphlet lists the manufacturer and brand name of ADA approved consumer products. In each category, the pamphlet also reprints the consumer label information asserting the Seal of Acceptance. Items listed are: manual toothbrushes, powered toothbrushes, fluoride toothpaste, antigingivitis tartar control fluoride toothpaste, desensitizing fluoride toothpaste, tartar control fluoride toothpaste, whitening tartar control fluoride toothpaste, gingivitis mouthrinses, fluoride mouthrinses, floss, oral irrigators, and dentist-dispensed whiteners or bleachers for home use.
·
Treating Periodontal Disease: Restoring the Health of Your Teeth and Gums. [Como Tratar las Enfermedades Periodontales: Recupere la Salud de Sus Dientes y Encias] Source: San Bruno, CA: Staywell Company. 1999. 16 p.
Guidelines 21
Contact: Available from Staywell Company. 1100 Grundy Lane, San Bruno, CA 94066-3030. (800) 333-3032. PRICE: $2.50 per brochure plus shipping and handling. Order Number 1415 (English) or 1678 (Spanish). Summary: This booklet provides readers with an overview of periodontal disease and its treatment. Topics covered include the signs of periodontal disease; the need for a lifelong commitment to fighting periodontal disease; the role and training of the periodontist; the anatomy and physiology of healthy gums and teeth; how periodontal disease can progress from gingivitis, to periodontitis, to advanced periodontitis; the periodontal evaluation; steps for the home care aspects of periodontal therapy, notably flossing and brushing; nonsurgical options for treating periodontal disease, including scaling and root planing, antibiotics, bite correction, and splinting; surgical options for periodontal therapy, including flap surgery, gingivectomy, bone surgery, guided tissue regeneration, bone graft, and soft tissue graft; what to expect during and after the surgical experience; and the importance of regular monitoring and ongoing care to prevent periodontal disease. The brochure is illustrated with full-color line drawings of patients, as well as medical illustrations of the procedures discussed. This brochure is available in English and Spanish. ·
Preventing and Treating Periodontal Diseases Source: Chicago, IL: American Dental Association (ADA). 1998. [4 p.]. Contact: Available from American Dental Association (ADA). Catalog Sales, P.O. Box 776, St. Charles, IL 60174. (800) 947-4746. Fax (888) 4761880 or (630) 443-9970. Website: www.ada.org. PRICE: $19.00 for 50; nonmembers add 50 percent; bulk rates available. Item number W646. Summary: Periodontal (gum) disease is a condition in which bacteria attack the tissues that surround and support teeth. This brochure describes the use of scaling and root planing to prevent or treat the early stages of periodontal diseases. The brochure begins with a list of the common warning signs of periodontal diseases. The brochure then discusses the causes of periodontal diseases, how periodontal diseases are diagnosed, and prevention and treatment options. Scaling is used to remove plaque and tartar beneath the gumline with a small scaler or ultrasonic cleaner. The tooth's root surfaces are then smoothed or planed to allow the gum tissue to heal and reattach to the tooth. Once the scaling and root planing treatment is complete, another appointment will be made so the dentist can check how the gums have healed and how the periodontal pockets have decreased. When pockets greater than 3 mm persist after root planing and scaling, additional treatment may be
22 Gingivitis
needed. The brochure is illustrated with line drawings and full color photographs of gingivitis and of healthy gums. 10 figures. ·
Taking Care of Your Teeth and Gums Source: Chicago, IL: American Dental Association (ADA). 1998. [6 p.]. Contact: Available from American Dental Association (ADA). Catalog Sales, P.O. Box 776, St. Charles, IL 60174. (800) 947-4746. Fax (888) 4761880 or (630) 443-9970. Website: www.ada.org. PRICE: $21.00 for 50; nonmembers add 50 percent; bulk rates available. Item number W135 (English version); W239 (Spanish version). Summary: This brochure from the American Dental Association (ADA) reminds readers that a simple routine of brushing and cleaning between the teeth every day, establishing good eating habits, and having regular dental visits can prevent many dental problems. Topics include the problem of plaque and how it contributes to tooth decay and gingivitis; the ADA Seal of Acceptance (used on dental products); choosing oral hygiene products (toothpaste, toothbrushes, oral irrigating devices, mouthwashes, mouth rinses); the basics of toothbrushing; how to floss; and the importance of a regular routine of oral hygiene. The flossing and toothbrushing sections each provide black and white photographs of each step of the processes described. The brochure is available in English or Spanish. 16 figures.
·
Mouth: Owner's Manual: Preventing and Controlling Gum Disease Source: San Bruno, CA: Staywell Company. 1998. 16 p. Contact: Available from Staywell Company. Order Department, 1100 Grundy Lane, San Bruno, CA 94066-3030. (800) 333-3032. PRICE: $1.35 plus shipping and handling; quantity discounts available. Order Number 1315. Summary: This full-color, illustrated patient education brochure presents a guide to preventing and controlling periodontal (gum) disease. Topics covered include a guide to diagnosing gum disease, including a patient checklist of symptoms; the anatomy of the mouth and the physiology of bacteria, plaque, and periodontal disease; the three stages of gum disease: gingivitis, periodontitis, and advanced periodontitis; the full dental evaluation, including dental history, exam, and pocket charting; a how-to guide to self-care, especially flossing and toothbrushing; and professional treatment options for periodontal disease. The brochure concludes with an overview of proper dental hygiene and a blank space for the dentist to record recommendations for the patient.
Guidelines 23
·
Pregnancy and Oral Health Source: Chicago, IL: American Dental Association (ADA). 1998. [4 p.]. Contact: Available from American Dental Association (ADA). Catalog Sales, P.O. Box 776, St. Charles, IL 60174. (800) 947-4746. Fax (630) 4439970. Website: www.ada.org. PRICE: $21.00 for 50 copies; nonmembers add 50 percent; bulk orders available. Order Number W100. Summary: This brochure reviews pregnancy and oral health. Topics include dental caries, gingivitis, nutritional considerations, dental visits, drugs and medications, and X-rays during pregnancy. The brochure concludes with a review of good dental health guidelines designed to help ensure a lifetime of healthy smiles for the whole family.
·
Diabetes and Periodontal Disease: A Guide for Patients Source: Bethesda, MD: National Institute of Dental and Craniofacial Research (NIDCR). 1997. [7 p.]. Contact: Available from National Oral Health Information Clearinghouse (NOHIC). 1 NOHIC Way, Bethesda, MD 20892-3500. Voice (301) 4027364. TTY (301) 656-7581. Fax (301) 907-8830. E-mail:
[email protected]. Website: www.nohic.nidcr.nih.gov. PRICE: Single copy free, limit 25 copies. Item Number OP-07 (English). Summary: This brochure discusses periodontal disease (gum disease) in people with diabetes mellitus. Topics include the link between diabetes and periodontal disease, including the factors of diabetic control, blood vessel changes, bacteria, and smoking; how periodontal disease develops, including the conditions of gingivitis and periodontitis; how periodontal disease is treated, including plaque removal and periodontal surgery; other oral problems that are linked to diabetes, including cavities, thrush, and dry mouth; the importance of keeping natural teeth; and protecting teeth and gums with proper brushing and flossing and regular dental checkups.
·
What Every Expectant Mother Should Know: How Your Dental Health Can Affect the Well-Being of Your Unborn Baby Source: Bellevue, WA: Sonicare, Optiva Corporation. 1997. 2 p. Contact: Available from Sonicare. Optiva Corporation, 13222 South East 30th Street, Bellevue, WA 98005. (800) 682-7664. PRICE: Single copy free. Summary: This brochure educates pregnant women about their oral health during pregnancy. The brochure describes pregnancy gingivitis, a condition that commonly occurs in the second or third month of pregnancy and can become more severe throughout the pregnancy. The
24 Gingivitis
brochure cautions that new research suggests a link between gum disease and premature low birth-weight babies. The bacteria P. gingivalis, the primary cause of gum infection, can travel throughout the body and can trigger the production of prostaglandins in the reproductive tract. These prostaglandins are suspected to induce premature labor. The brochure reiterates the importance of paying close attention to oral health during pregnancy and the need for regular dental care and meticulous daily oral care. Early identification of oral health problems such as gum disease may help reduce the risk of premature labor. ·
Gum Disease: The Warning Signs Source: Chicago, IL: American Dental Association (ADA). 1996. [2 p.]. Contact: Available from American Dental Association (ADA). Catalog Sales, P.O. Box 776, St. Charles, IL 60174. (800) 947-4746; Fax (630) 4439970; http://www.ada.org. PRICE: Single copy free; bulk orders available. Order Number W105. Summary: This mini-brochure, from the American Dental Association, provides basic information about the warning signs of gum disease. Illustrated with colorful line drawings, the brochure discusses the forms of gum disease, including gingivitis, and periodontitis; the causes of gum disease; what happens during a dental care examination and how the dentist determines if gum disease is present; and the role of good oral hygiene in preventing gum disease.
The National Guideline Clearinghouse™ The National Guideline Clearinghouse™ offers hundreds of evidence-based clinical practice guidelines published in the United States and other countries. You can search their site located at http://www.guideline.gov by using the keyword “gingivitis” or synonyms. The following was recently posted: ·
Parameter on plaque-induced gingivitis. Source: American Academy of Periodontology.; 1996 October (revised 2000 May); 2 pages http://www.guideline.gov/FRAMESETS/guideline_fs.asp?guideline=00 1550&sSearch_string=gingivitis
Guidelines 25
Healthfinder™ Healthfinder™ is an additional source sponsored by the U.S. Department of Health and Human Services which offers links to hundreds of other sites that contain healthcare information. This Web site is located at http://www.healthfinder.gov. Again, keyword searches can be used to find guidelines. The following was recently found in this database: ·
Diabetes and Periodontal Disease -- A Guide for Patients Summary: If you have diabetes, you know the disease can harm your eyes, nerves, kidneys, heart and other important systems in the body. Source: National Institute of Dental and Craniofacial Research, National Institutes of Health http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&R ecordID=1145
·
Gum Disease (Periodontal Disease) Summary: An online consumer mini-fact sheet, this document produced by the ADA discusses gum disease causes, treatment and prevention. Source: American Dental Association http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&R ecordID=2214
The NIH Search Utility After browsing the references listed at the beginning of this chapter, you may want to explore the NIH Search Utility. This allows you to search for documents on over 100 selected Web sites that comprise the NIH-WEBSPACE. Each of these servers is “crawled” and indexed on an ongoing basis. Your search will produce a list of various documents, all of which will relate in some way to gingivitis. The drawbacks of this approach are that the information is not organized by theme and that the references are often a mix of information for professionals and patients. Nevertheless, a large number of the listed Web sites provide useful background information. We can only recommend this route, therefore, for relatively rare or specific disorders, or when using highly targeted searches. To use the NIH search utility, visit the following Web page: http://search.nih.gov/index.html.
26 Gingivitis
NORD (The National Organization of Rare Disorders, Inc.) NORD provides an invaluable service to the public by publishing, for a nominal fee, short yet comprehensive guidelines on over 1,000 diseases. NORD primarily focuses on rare diseases that might not be covered by the previously listed sources. NORD’s Web address is www.rarediseases.org. To see if a recent fact sheet has been published on gingivitis, simply go to the following hyperlink: http://www.rarediseases.org/cgi-bin/nord/alphalist. A complete guide on gingivitis can be purchased from NORD for a nominal fee.
Additional Web Sources A number of Web sites that often link to government sites are available to the public. These can also point you in the direction of essential information. The following is a representative sample: ·
AOL: http://search.aol.com/cat.adp?id=168&layer=&from=subcats
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drkoop.comÒ: http://www.drkoop.com/conditions/ency/index.html
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Family Village: http://www.familyvillage.wisc.edu/specific.htm
·
Google: http://directory.google.com/Top/Health/Conditions_and_Diseases/
·
Med Help International: http://www.medhelp.org/HealthTopics/A.html
·
Open Directory Project: http://dmoz.org/Health/Conditions_and_Diseases/
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Yahoo.com: http://dir.yahoo.com/Health/Diseases_and_Conditions/
·
WebMDÒHealth: http://my.webmd.com/health_topics
Vocabulary Builder The material in this chapter may have contained a number of unfamiliar words. The following Vocabulary Builder introduces you to terms used in this chapter that have not been covered in the previous chapter: Antibiotic: A chemical substance produced by a microorganism which has the capacity, in dilute solutions, to inhibit the growth of or to kill other microorganisms. Antibiotics that are sufficiently nontoxic to the host are used as chemotherapeutic agents in the treatment of infectious diseases of
Guidelines 27
man, animals and plants. [EU] Antibiotics: Substances produced by microorganisms that can inhibit or suppress the growth of other microorganisms. [NIH] Antidepressant: An agent that stimulates the mood of a depressed patient, including tricyclic antidepressants and monoamine oxidase inhibitors. [EU] Antimicrobial: Killing microorganisms, or suppressing their multiplication or growth. [EU] Antiseptic: A substance that inhibits the growth and development of microorganisms without necessarily killing them. [EU] Bacteria: Unicellular prokaryotic microorganisms which generally possess rigid cell walls, multiply by cell division, and exhibit three principal forms: round or coccal, rodlike or bacillary, and spiral or spirochetal. [NIH] Cardiovascular: Pertaining to the heart and blood vessels. [EU] Cataract: An opacity, partial or complete, of one or both eyes, on or in the lens or capsule, especially an opacity impairing vision or causing blindness. The many kinds of cataract are classified by their morphology (size, shape, location) or etiology (cause and time of occurrence). [EU] Chlorhexidine: Disinfectant and topical anti-infective agent used also as mouthwash to prevent oral plaque. [NIH] Collagen: The protein substance of the white fibres (collagenous fibres) of skin, tendon, bone, cartilage, and all other connective tissue; composed of molecules of tropocollagen (q.v.), it is converted into gelatin by boiling. collagenous pertaining to collagen; forming or producing collagen. [EU] Contraceptive: conception. [EU]
An agent that diminishes the likelihood of or prevents
Dentists: Individuals licensed to practice dentistry. [NIH] Doxycycline: A synthetic tetracycline derivative with a range of antimicrobial activity and mode of action similar to that of tetracycline, but more effective against many species. Animal studies suggest that it may cause less tooth staining than other tetracyclines. [NIH] Enzyme: A protein molecule that catalyses chemical reactions of other substances without itself being destroyed or altered upon completion of the reactions. Enzymes are classified according to the recommendations of the Nomenclature Committee of the International Union of Biochemistry. Each enzyme is assigned a recommended name and an Enzyme Commission (EC) number. They are divided into six main groups; oxidoreductases, transferases, hydrolases, lyases, isomerases, and ligases. [EU] Gelatin: A product formed from skin, white connective tissue, or bone collagen. It is used as a protein food adjuvant, plasma substitute, hemostatic,
28 Gingivitis
suspending agent in pharmaceutical preparations, and in the manufacturing of capsules and suppositories. [NIH] Gingivitis: Inflammation of the gingivae. Gingivitis associated with bony changes is referred to as periodontitis. Called also oulitis and ulitis. [EU] Glucose: D-glucose, a monosaccharide (hexose), C6H12O6, also known as dextrose (q.v.), found in certain foodstuffs, especially fruits, and in the normal blood of all animals. It is the end product of carbohydrate metabolism and is the chief source of energy for living organisms, its utilization being controlled by insulin. Excess glucose is converted to glycogen and stored in the liver and muscles for use as needed and, beyond that, is converted to fat and stored as adipose tissue. Glucose appears in the urine in diabetes mellitus. [EU] Hormonal: Pertaining to or of the nature of a hormone. [EU] Inflammation: A pathological process characterized by injury or destruction of tissues caused by a variety of cytologic and chemical reactions. It is usually manifested by typical signs of pain, heat, redness, swelling, and loss of function. [NIH] Microspheres: Small uniformly-sized spherical particles frequently labeled with radioisotopes or various reagents acting as tags or markers. [NIH] Minocycline: A semisynthetic antibiotic effective against tetracyclineresistant staphylococcus infections. [NIH] Mucus: The free slime of the mucous membranes, composed of secretion of the glands, along with various inorganic salts, desquamated cells, and leucocytes. [EU] Nephropathy: Disease of the kidneys. [EU] Neuropathy: A general term denoting functional disturbances and/or pathological changes in the peripheral nervous system. The etiology may be known e.g. arsenical n., diabetic n., ischemic n., traumatic n.) or unknown. Encephalopathy and myelopathy are corresponding terms relating to involvement of the brain and spinal cord, respectively. The term is also used to designate noninflammatory lesions in the peripheral nervous system, in contrast to inflammatory lesions (neuritis). [EU] Oral: Pertaining to the mouth, taken through or applied in the mouth, as an oral medication or an oral thermometer. [EU] Particle: A tiny mass of material. [EU] Prostaglandins: A group of compounds derived from unsaturated 20carbon fatty acids, primarily arachidonic acid, via the cyclooxygenase pathway. They are extremely potent mediators of a diverse group of physiological processes. [NIH]
Guidelines 29
Puberty: The period during which the secondary sex characteristics begin to develop and the capability of sexual reproduction is attained. [EU] Regeneration: The natural renewal of a structure, as of a lost tissue or part. [EU]
Respiratory: Pertaining to respiration. [EU] Retinopathy: 1. retinitis (= inflammation of the retina). 2. retinosis (= degenerative, noninflammatory condition of the retina). [EU] Saliva: The clear, viscous fluid secreted by the salivary glands and mucous glands of the mouth. it contains mucins, water, organic salts, and ptylin. [NIH] Surgical: Of, pertaining to, or correctable by surgery. [EU] Systemic: Pertaining to or affecting the body as a whole. [EU] Tetracycline: An antibiotic originally produced by Streptomyces viridifaciens, but used mostly in synthetic form. It is an inhibitor of aminoacyl-tRNA binding during protein synthesis. [NIH] Toxic: Pertaining to, due to, or of the nature of a poison or toxin; manifesting the symptoms of severe infection. [EU] Toxin: A poison; frequently used to refer specifically to a protein produced by some higher plants, certain animals, and pathogenic bacteria, which is highly toxic for other living organisms. Such substances are differentiated from the simple chemical poisons and the vegetable alkaloids by their high molecular weight and antigenicity. [EU] Toxins: Specific, characterizable, poisonous chemicals, often proteins, with specific biological properties, including immunogenicity, produced by microbes, higher plants, or animals. [NIH]
Seeking Guidance 31
CHAPTER 2. SEEKING GUIDANCE Overview Some patients are comforted by the knowledge that a number of organizations dedicate their resources to helping people with gingivitis. These associations can become invaluable sources of information and advice. Many associations offer aftercare support, financial assistance, and other important services. Furthermore, healthcare research has shown that support groups often help people to better cope with their conditions.8 In addition to support groups, your dentist can be a valuable source of guidance and support. Therefore, finding a dentist that can work with your unique situation is a very important aspect of your care. In this chapter, we direct you to resources that can help you find patient organizations and medical specialists. We begin by describing how to find associations and peer groups that can help you better understand and cope with gingivitis. The chapter ends with a discussion on how to find a dentist or oral surgeon that is right for you.
Associations and Gingivitis As mentioned by the Agency for Healthcare Research and Quality, sometimes the emotional side of an illness can be as taxing as the physical side.9 You may have fears or feel overwhelmed by your situation. Everyone has different ways of dealing with disease or physical injury. Your attitude, your expectations, and how well you cope with your condition can all Churches, synagogues, and other houses of worship might also have groups that can offer you the social support you need. 9 This section has been adapted from http://www.ahcpr.gov/consumer/diaginf5.htm. 8
32 Gingivitis
influence your well-being. This is true for both minor conditions and serious illnesses. For example, a study on female breast cancer survivors revealed that women who participated in support groups lived longer and experienced better quality of life when compared with women who did not participate. In the support group, women learned coping skills and had the opportunity to share their feelings with other women in the same situation. In addition to associations or groups that your dentist might recommend, we suggest that you consider the following list (if there is a fee for an association, you may want to check with your insurance provider to find out if the cost will be covered): ·
American Academy of Periodontology Address: 737 N. Michigan Ave., Ste 800 Chicago, IL 60611-2690 Telephone: (312) 787-5518 Fax: (32) 787-3670 Web Site: http://www.perio.org Background: Primary interests of the American Academy of Periodontology (AAO) include basic and clinical science as they apply to periodontics (treatment of supporting and surrounding tissues of the teeth). The Academy staff answers inquiries; provides consulting services, mainly to American Dental Association and other professional groups; provides dental referral services; makes referrals to other sources of information. Publication(s): Journal of Periodontology (monthly); AAP Newsletter (bimonthly); Registry of Graduate and Postgraduate Education in Periodontics (annual); International Conference on Research in the Biology of Periodontal Disease (1977); Periodontal Procedural Codes (1977); Current Procedural Terminology for Periodontics (manual); pamphlets; newspaper reprint series; slide-script series (slides and booklets or tapes); third-party/insurance aids; publications list. Relevant area(s) of interest: Gingival diseases; Oral hygiene; Periodontics
·
Dental Research Institute University of California, Los Angeles Address: 10833 Le Conte Ave. Los Angeles, CA 90095-1668 Telephone: (310) 206-6063 Web Site: http://www.dent.ucla.edu/dri Background: The Dental Research Institute (DRI) is an independent Organized Research Unit at the University of California, Los Angeles. The Institute's interests and programs include Oral Cancer/Molecular
Seeking Guidance 33
Oncology, Viral Oncology Molecular Mechanisms of Periodontal Diseases, Dental Implantology, TMJ Disorders and Orofacial Pain, Neuroimmunology, Molecular Immunology, AIDS, HIV Immunology, Pain Control/Pharmacology, and Wound Repair/Keloid Tissue Formation Mechanisms. Institute staff answer inquiries, provide advisory services, provide information on research in progress, conduct seminars and workshops, and distribute publications. Services are free and available to everyone. Publication(s): International Journal of Oral Biology. Relevant area(s) of interest: Craniofacial abnormalities; Dentistry; Gingival diseases; Oral AIDS; Oral immunology; Oral molecular biology; Pain control; Temporomandibular Joint; Viral oncology; Wound healing
Finding More Associations There are a number of directories that list additional medical associations that you may find useful. While not all of these directories will provide different information than what is listed above, by consulting all of them, you will have nearly exhausted all sources for patient associations.
The National Health Information Center (NHIC) The National Health Information Center (NHIC) offers a free referral service to help people find organizations that provide information about gingivitis. For more information, see the NHIC’s Web site at http://www.health.gov/NHIC/ or contact an information specialist by calling 1-800-336-4797. DIRLINE A comprehensive source of information on associations is the DIRLINE database maintained by the National Library of Medicine. The database comprises some 10,000 records of organizations, research centers, and government institutes and associations which primarily focus on health and biomedicine. DIRLINE is available via the Internet at the following Web site: http://dirline.nlm.nih.gov/. Simply type in “gingivitis” (or a synonym) or the name of a topic, and the site will list information contained in the database on all relevant organizations.
34 Gingivitis
The Combined Health Information Database Another comprehensive source of information on healthcare associations is the Combined Health Information Database. Using the “Detailed Search” option, you will need to limit your search to “Organizations” and “gingivitis”. Type the following hyperlink into your Web browser: http://chid.nih.gov/detail/detail.html. To find associations, use the drop boxes at the bottom of the search page where “You may refine your search by.” For publication date, select “All Years.” Then, select your preferred language and the format option “Organization Resource Sheet.” By making these selections and typing in “gingivitis” (or synonyms) into the “For these words:” box, you will only receive results on organizations dealing with gingivitis. You should check back periodically with this database since it is updated every 3 months. The National Organization for Rare Disorders, Inc. The National Organization for Rare Disorders, Inc. has prepared a Web site that provides, at no charge, lists of associations organized by specific diseases. You can access this database at the following Web site: http://www.rarediseases.org/cgi-bin/nord/searchpage. Select the option called “Organizational Database (ODB)” and type “gingivitis” (or a synonym) in the search box.
Online Support Groups In addition to support groups, commercial Internet service providers offer forums and chat rooms for people with different illnesses and conditions. WebMDÒ, for example, offers such a service at their Web site: http://boards.webmd.com/roundtable. These online self-help communities can help you connect with a network of people whose concerns are similar to yours. Online support groups are places where people can talk informally. If you read about a novel approach, consult with your dentist or other healthcare providers, as the treatments or discoveries you hear about may not be scientifically proven to be safe and effective.
Seeking Guidance 35
Finding Dentists One of the most important aspects of your treatment will be the relationship between you and your dentist or specialist. All patients with gingivitis must go through the process of selecting a dentist. While this process will vary from person to person, the Agency for Healthcare Research and Quality makes a number of suggestions, including the following:10 ·
If you are in a managed care plan, check the plan's list of dentists first.
·
Ask dentists or other health professionals who work with dentists, such as dental assistants and oral surgeons, for referrals.
·
Call a dentist referral service, but keep in mind that these services refer you to dentists who pay to be members. The services do not have information on the quality of care that these dentists provide.
·
Some local dental societies offer lists of member dentists. Again, these lists do not have information on the quality of care that these dentists provide.
Additional steps you can take to locate dentists include the following: ·
Check with the associations listed earlier in this chapter.
·
You can log on to the American Dental Association’s “Find a Dentist” Web site at http://www.ada.org/public/disclaimer.html.
·
Contact the dental organization in your State. Information on how to find the dental organization in your State is available on the ADA’s Web site: http://www.ada.org/ada/resources/societies/searchconst.asp.
If the previous sources did not meet your needs, you may want to log on to the Web site of the National Organization for Rare Disorders (NORD) at http://www.rarediseases.org/. NORD maintains a database of physicians with expertise in various rare diseases. The Metabolic Information Network (MIN), 800-945-2188, also maintains a database of physicians with expertise in various metabolic diseases.
10
This section is adapted from the AHRQ: www.ahrq.gov/consumer/qntascii/qntdr.htm.
36 Gingivitis
Selecting Your Dentist11 When you have compiled a list of prospective dentists, call each of their offices. First, ask if the dentist accepts your health insurance plan and if he or she is taking new patients. If the dentist is not covered by your plan, ask yourself if you are prepared to pay the extra costs. The next step is to schedule a visit with your chosen dentist. During the first visit you will have the opportunity to evaluate your dentist and to find out if you feel comfortable with him or her. Ask yourself, did the dentist: ·
Give me a chance to ask questions about gingivitis?
·
Really listen to my questions?
·
Answer in terms I understood?
·
Show respect for me?
·
Ask me questions?
·
Make me feel comfortable?
·
Address the health problem(s) I came with?
·
Ask me my preferences about different kinds of treatments for gingivitis?
·
Spend enough time with me?
Trust your instincts when deciding if the dentist is right for you. But remember, it might take time for the relationship to develop. It takes more than one visit for you and your dentist to get to know each other.
Working with Your Dentist12 Research has shown that patients who have good relationships with their dentists tend to be more satisfied with their care and have better results. Here are some tips to help you and your dentist become partners: ·
You know important things about your symptoms and your health history. Tell your dentist what you think he or she needs to know.
·
It is important to tell your dentist personal information, even if it makes you feel embarrassed or uncomfortable.
11 This
section has been adapted from the AHRQ: www.ahrq.gov/consumer/qntascii/qntdr.htm. 12 This section has been adapted from the AHRQ: www.ahrq.gov/consumer/qntascii/qntdr.htm.
Seeking Guidance 37
·
Bring a “health history” list with you (and keep it up to date).
·
Always bring any medications you are currently taking with you to the appointment, or you can bring a list of your medications including dosage and frequency information. Talk about any allergies or reactions you have had to your medications.
·
Tell your dentist about any natural or alternative medicines you are taking.
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Bring other medical information, such as x-ray films, test results, and medical records.
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Ask questions. If you don't, your dentist will assume that you understood everything that was said.
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Write down your questions before your visit. List the most important ones first to make sure that they are addressed.
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Consider bringing a friend with you to the appointment to help you ask questions. This person can also help you understand and/or remember the answers.
·
Ask your dentist to draw pictures if you think that this would help you understand.
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Take notes. Some dentists do not mind if you bring a tape recorder to help you remember things, but always ask first.
·
Let your dentist know if you need more time. If there is not time that day, perhaps you can speak to a nurse or dental assistant on staff or schedule a telephone appointment.
·
Take information home. Ask for written instructions. Your dentist may also have brochures and audio and videotapes that can help you.
·
After leaving the dentist's office, take responsibility for your care. If you have questions, call. If your symptoms get worse or if you have problems with your medication, call. If you had tests and do not hear from your dentist, call for your test results. If your dentist recommended that you have certain tests, schedule an appointment to get them done. If your dentist said you should see an additional specialist, make an appointment.
By following these steps, you will enhance the relationship you will have with your dentist.
38 Gingivitis
Broader Health-Related Resources In addition to the references above, the NIH has set up guidance Web sites that can help patients find healthcare professionals. These include:13 ·
Caregivers: http://www.nlm.nih.gov/medlineplus/caregivers.html
·
Choosing a Oral Surgeon or Healthcare Service: http://www.nlm.nih.gov/medlineplus/choosingadoctororhealthcareserv ice.html
·
Hospitals and Health Facilities: http://www.nlm.nih.gov/medlineplus/healthfacilities.html
Vocabulary Builder The following vocabulary builder provides definitions of words used in this chapter that have not been defined in previous chapters: Keloid: A sharply elevated, irregularly- shaped, progressively enlarging scar due to the formation of excessive amounts of collagen in the corium during connective tissue repair. [EU] Molecular: Of, pertaining to, or composed of molecules : a very small mass of matter. [EU] Orofacial: Of or relating to the mouth and face. [EU] Periodontics: A dental specialty concerned with the histology, physiology, and pathology of the tissues that support, attach, and surround the teeth, and of the treatment and prevention of disease affecting these tissues. [NIH] Viral: Pertaining to, caused by, or of the nature of virus. [EU]
You can access this information at: http://www.nlm.nih.gov/medlineplus/healthsystem.html.
13
Clinical Trials 39
CHAPTER 3. CLINICAL TRIALS AND GINGIVITIS Overview Very few medical conditions have a single treatment. The basic treatment guidelines that your healthcare provider has discussed with you, or those that you have found using the techniques discussed in Chapter 1, may provide you with all that you will require. For some patients, current treatments can be enhanced with new or innovative techniques currently under investigation. In this chapter, we will describe how clinical trials work and show you how to keep informed of trials concerning gingivitis.
What Is a Clinical Trial?14 Clinical trials involve the participation of people in medical research. Most medical research begins with studies in test tubes and on animals. Treatments that show promise in these early studies may then be tried with people. The only sure way to find out whether a new treatment is safe, effective, and better than other treatments for gingivitis is to try it on patients in a clinical trial.
The discussion in this chapter has been adapted from the NIH and the NEI: www.nei.nih.gov/netrials/ctivr.htm.
14
40 Gingivitis
What Kinds of Clinical Trials Are There? Clinical trials are carried out in three phases: ·
Phase I. Researchers first conduct Phase I trials with small numbers of patients and healthy volunteers. If the new treatment is a medication, researchers also try to determine how much of it can be given safely.
·
Phase II. Researchers conduct Phase II trials in small numbers of patients to find out the effect of a new treatment on gingivitis.
·
Phase III. Finally, researchers conduct Phase III trials to find out how new treatments for gingivitis compare with standard treatments already being used. Phase III trials also help to determine if new treatments have any side effects. These trials--which may involve hundreds, perhaps thousands, of people--can also compare new treatments with no treatment. How Is a Clinical Trial Conducted?
Various organizations support clinical trials at medical centers, hospitals, universities, and oral surgeons' offices across the United States. The “principal investigator” is the researcher in charge of the study at each facility participating in the clinical trial. Most clinical trial researchers are medical doctors, academic researchers, and specialists. The “clinic coordinator” knows all about how the study works and makes all the arrangements for your visits. All oral surgeons and researchers who take part in the study on gingivitis carefully follow a detailed treatment plan called a protocol. This plan fully explains how the healthcare providers will treat you in the study. The “protocol” ensures that all patients are treated in the same way, no matter where they receive care. Clinical trials are controlled. This means that researchers compare the effects of the new treatment with those of the standard treatment. In some cases, when no standard treatment exists, the new treatment is compared with no treatment. Patients who receive the new treatment are in the treatment group. Patients who receive a standard treatment or no treatment are in the “control” group. In some clinical trials, patients in the treatment group get a new medication while those in the control group get a placebo. A placebo is a harmless substance, a “dummy” pill, that has no effect on gingivitis. In other clinical trials, where a new surgery or device (not a medicine) is being tested, patients in the control group may receive a “sham treatment.” This
Clinical Trials 41
treatment, like a placebo, has no effect on gingivitis and does not harm patients. Researchers assign patients “randomly” to the treatment or control group. This is like flipping a coin to decide which patients are in each group. If you choose to participate in a clinical trial, you will not know which group you will be appointed to. The chance of any patient getting the new treatment is about 50 percent. You cannot request to receive the new treatment instead of the placebo or sham treatment. Often, you will not know until the study is over whether you have been in the treatment group or the control group. This is called a “masked” study. In some trials, neither researchers nor patients know who is getting which treatment. This is called a “double masked” study. These types of trials help to ensure that the perceptions of the patients or researchers will not affect the study results. Natural History Studies Unlike clinical trials in which patient volunteers may receive new treatments, natural history studies provide important information to researchers on how gingivitis develops over time. A natural history study follows patient volunteers to see how factors such as age, sex, race, or family history might make some people more or less at risk for gingivitis. A natural history study may also tell researchers if diet, lifestyle, or occupation affects how a disease or disorder develops and progresses. Results from these studies provide information that helps answer questions such as: How fast will a disease or disorder usually progress? How bad will the condition become? Will treatment be needed? What Is Expected of Patients in a Clinical Trial? Not everyone can take part in a clinical trial for a specific disease or disorder. Each study enrolls patients with certain features or eligibility criteria. These criteria may include the type and stage of disease or disorder, as well as, the age and previous treatment history of the patient. You or your dentist can contact the sponsoring organization to find out more about specific clinical trials and their eligibility criteria. If you are interested in joining a clinical trial, your dentist must contact one of the trial's investigators and provide details about your diagnosis and medical history. If you participate in a clinical trial, you may be required to have a number of medical tests. You may also need to take medications and/or undergo
42 Gingivitis
surgery. Depending upon the treatment and the examination procedure, you may be required to receive inpatient hospital care. Or, you may have to return to the medical facility for follow-up examinations. These exams help find out how well the treatment is working. Follow-up studies can take months or years. However, the success of the clinical trial often depends on learning what happens to patients over a long period of time. Only patients who continue to return for follow-up examinations can provide this important long-term information.
Recent Trials on Gingivitis The National Institutes of Health and other organizations sponsor trials on various diseases and disorders. Because funding for research goes to the medical areas that show promising research opportunities, it is not possible for the NIH or others to sponsor clinical trials for every disease and disorder at all times. The following lists recent trials dedicated to gingivitis.15 If the trial listed by the NIH is still recruiting, you may be eligible. If it is no longer recruiting or has been completed, then you can contact the sponsors to learn more about the study and, if published, the results. Further information on the trial is available at the Web site indicated. Please note that some trials may no longer be recruiting patients or are otherwise closed. Before contacting sponsors of a clinical trial, consult with your dentist who can help you determine if you might benefit from participation. ·
Trials To Enhance Elders Tooth/Oral Health (TEETH) Condition(s): Tooth Loss; Dental Caries; Periodontal Disease; Gingivitis Study Status: This study is currently recruiting patients. Sponsor(s): National Institute of Dental and Craniofacial Research (NIDCR) Purpose - Excerpt: The purpose of this trial is to determine whether or not the use of two mouth rinses, one containing an anti-bacterial agent and the other fluoride, can prevent tooth loss and oral disease morbidity in community dwelling elderly at high risk for oral disease. The trial involves a collaboration between sites at the University of Washington in Seattle and the University of British Columbia in Vancouver. A total of 900 individuals between the ages of 60 and 75 years at enrollment will be randomized to one of two treatment conditions. One-half of the individuals will be asked to use the anti-bacterial, chlorhexidine, and fluoride mouth rinses at home while the other half will be given placebo rinses. Participants will be followed for 5 years.
15
These are listed at www.ClinicalTrials.gov.
Clinical Trials 43
Phase(s): Phase III Study Type: Interventional Contact(s): Dr. Asuman Kiyak 1-206-543-8727
[email protected]; British Columbia, Canada; University of British Columbia, Vancouver, British Columbia, V6T 1Z3, Canada; Recruiting; Dr. Michael I. MacEntee 604-822-3564
[email protected]; Washington; University of Washington, Seattle, Washington, 98195, United States; Recruiting; Dr. Asuman Kiyak 206-543-8727
[email protected] Web Site: http://clinicaltrials.gov/ct/gui/c/a1b/show/NCT00004640
Benefits and Risks16 What Are the Benefits of Participating in a Clinical Trial? If you are interested in a clinical trial, it is important to realize that your participation can bring many benefits to you and society at large: ·
A new treatment could be more effective than the current treatment for gingivitis. Although only half of the participants in a clinical trial receive the experimental treatment, if the new treatment is proved to be more effective and safer than the current treatment, then those patients who did not receive the new treatment during the clinical trial may be among the first to benefit from it when the study is over.
·
If the treatment is effective, then it may improve health or prevent diseases or disorders.
·
Clinical trial patients receive the highest quality of medical care. Experts watch them closely during the study and may continue to follow them after the study is over.
·
People who take part in trials contribute to scientific discoveries that may help other people with gingivitis. In cases where certain diseases or disorders run in families, your participation may lead to better care or prevention for your family members.
This section has been adapted from ClinicalTrials.gov, a service of the National Institutes of Health: http://www.clinicaltrials.gov/ct/gui/c/a1r/info/whatis?JServSessionIdzone_ct=9jmun6f291. 16
44 Gingivitis
The Informed Consent Once you agree to take part in a clinical trial, you will be asked to sign an “informed consent.” This document explains a clinical trial's risks and benefits, the researcher’s expectations of you, and your rights as a patient. What Are the Risks? Clinical trials may involve risks as well as benefits. Whether or not a new treatment will work cannot be known ahead of time. There is always a chance that a new treatment may not work better than a standard treatment. There is also the possibility that it may be harmful. The treatment you receive may cause side effects that are serious enough to require medical attention. How Is Patient Safety Protected? Clinical trials can raise fears of the unknown. Understanding the safeguards that protect patients can ease some of these fears. Before a clinical trial begins, researchers must get approval from their hospital's Institutional Review Board (IRB), an advisory group that makes sure a clinical trial is designed to protect patient safety. During a clinical trial, researchers will closely watch you to see if the treatment is working and if you are experiencing any side effects. All the results are carefully recorded and reviewed. In many cases, experts from the Data and Safety Monitoring Committee carefully monitor each clinical trial and can recommend that a study be stopped at any time. You will only be asked to take part in a clinical trial as a volunteer giving informed consent.
What Are a Patient's Rights in a Clinical Trial? If you are eligible for a clinical trial, you will be given information to help you decide whether or not you want to participate. As a patient, you have the right to: ·
Information on all known risks and benefits of the treatments in the study.
·
Know how the researchers plan to carry out the study, for how long, and where.
·
Know what is expected of you.
Clinical Trials 45
·
Know any costs involved for you or your insurance provider.
·
Know before any of your medical or personal information is shared with other researchers involved in the clinical trial.
·
Talk openly with healthcare providers and ask any questions.
After you join a clinical trial, you have the right to: ·
Leave the study at any time. Participation is strictly voluntary. However, you should not enroll if you do not plan to complete the study.
·
Receive any new information about the new treatment.
·
Continue to ask questions and get answers.
·
Maintain your privacy. Your name will not appear in any reports based on the study.
·
Know whether you participated in the treatment group or the control group (once the study has been completed).
What about Costs? In some clinical trials, the research facility pays for treatment costs and other associated expenses. You or your insurance provider may have to pay for costs that are considered standard care. These things may include inpatient hospital care, laboratory and other tests, and medical procedures. You also may need to pay for travel between your home and the clinic. You should find out about costs before committing to participation in the trial. If you have health insurance, find out exactly what it will cover. If you don't have health insurance, or if your insurance company will not cover your costs, talk to the clinic staff about other options for covering the cost of your care. What Questions Should You Ask before Deciding to Join a Clinical Trial? Questions you should ask when thinking about joining a clinical trial include the following: ·
What is the purpose of the clinical trial?
·
What are the standard treatments for gingivitis? Why do researchers think the new treatment may be better? What is likely to happen to me with or without the new treatment?
46 Gingivitis
·
What tests and treatments will I need? Will I need surgery? Medication? Hospitalization?
·
How long will the treatment last? How often will I have to come back for follow-up exams?
·
What are the treatment's possible benefits to my condition? What are the short- and long-term risks? What are the possible side effects?
·
Will the treatment be uncomfortable? Will it make me feel sick? If so, for how long?
·
How will my health be monitored?
·
Where will I need to go for the clinical trial? How will I get there?
·
How much will it cost to be in the study? What costs are covered by the study? How much will my health insurance cover?
·
Will I be able to see my own dentist? Who will be in charge of my care?
·
Will taking part in the study affect my daily life? Do I have time to participate?
·
How do I feel about taking part in a clinical trial? Are there family members or friends who may benefit from my contributions to new medical knowledge?
Keeping Current on Clinical Trials Various government agencies maintain databases on trials. The U.S. National Institutes of Health, through the National Library of Medicine, has developed ClinicalTrials.gov to provide patients, family members, and healthcare providers with current information about clinical research across the broadest number of diseases and conditions. The site was launched in February 2000 and currently contains approximately 5,700 clinical studies in over 59,000 locations worldwide, with most studies being conducted in the United States. ClinicalTrials.gov receives about 2 million hits per month and hosts approximately 5,400 visitors daily. To access this database, simply go to their Web site (www.clinicaltrials.gov) and search by “gingivitis” (or synonyms). While ClinicalTrials.gov is the most comprehensive listing of NIH-supported clinical trials available, not all trials are in the database. The database is updated regularly, so clinical trials are continually being added. The
Clinical Trials 47
following is a list of specialty databases affiliated with the National Institutes of Health that offer additional information on trials: ·
For clinical studies at the Warren Grant Magnuson Clinical Center located in Bethesda, Maryland, visit their Web site: http://clinicalstudies.info.nih.gov/
·
For clinical studies conducted at the Bayview Campus in Baltimore, Maryland, visit their Web site: http://www.jhbmc.jhu.edu/studies/index.html
General References The following references describe clinical trials and experimental medical research. They have been selected to ensure that they are likely to be available from your local or online bookseller or university medical library. These references are usually written for healthcare professionals, so you may consider consulting with a librarian or bookseller who might recommend a particular reference. The following includes some of the most readily available references (sorted alphabetically by title; hyperlinks provide rankings, information and reviews at Amazon.com): ·
A Guide to Patient Recruitment : Today's Best Practices & Proven Strategies by Diana L. Anderson; Paperback - 350 pages (2001), CenterWatch, Inc.; ISBN: 1930624115; http://www.amazon.com/exec/obidos/ASIN/1930624115/icongroupinter na
·
A Step-By-Step Guide to Clinical Trials by Marilyn Mulay, R.N., M.S., OCN; Spiral-bound - 143 pages Spiral edition (2001), Jones & Bartlett Pub; ISBN: 0763715697; http://www.amazon.com/exec/obidos/ASIN/0763715697/icongroupinter na
·
The CenterWatch Directory of Drugs in Clinical Trials by CenterWatch; Paperback - 656 pages (2000), CenterWatch, Inc.; ISBN: 0967302935; http://www.amazon.com/exec/obidos/ASIN/0967302935/icongroupinter na
·
The Complete Guide to Informed Consent in Clinical Trials by Terry Hartnett (Editor); Paperback - 164 pages (2000), PharmSource Information Services, Inc.; ISBN: 0970153309; http://www.amazon.com/exec/obidos/ASIN/0970153309/icongroupinter na
48 Gingivitis
·
Dictionary for Clinical Trials by Simon Day; Paperback - 228 pages (1999), John Wiley & Sons; ISBN: 0471985961; http://www.amazon.com/exec/obidos/ASIN/0471985961/icongroupinter na
·
Extending Medicare Reimbursement in Clinical Trials by Institute of Medicine Staff (Editor), et al; Paperback 1st edition (2000), National Academy Press; ISBN: 0309068886; http://www.amazon.com/exec/obidos/ASIN/0309068886/icongroupinter na
·
Handbook of Clinical Trials by Marcus Flather (Editor); Paperback (2001), Remedica Pub Ltd; ISBN: 1901346293; http://www.amazon.com/exec/obidos/ASIN/1901346293/icongroupinter na
49
PART II: ADDITIONAL RESOURCES AND ADVANCED MATERIAL
ABOUT PART II In Part II, we introduce you to additional resources and advanced research on gingivitis. All too often, patients who conduct their own research are overwhelmed by the difficulty in finding and organizing information. The purpose of the following chapters is to provide you an organized and structured format to help you find additional information resources on gingivitis. In Part II, as in Part I, our objective is not to interpret the latest advances on gingivitis or render an opinion. Rather, our goal is to give you access to original research and to increase your awareness of sources you may not have already considered. In this way, you will come across the advanced materials often referred to in pamphlets, books, or other general works. Once again, some of this material is technical in nature, so consultation with a professional familiar with gingivitis is suggested.
Studies 51
CHAPTER 4. STUDIES ON GINGIVITIS Overview Every year, academic studies are published on gingivitis or related conditions. Broadly speaking, there are two types of studies. The first are peer reviewed. Generally, the content of these studies has been reviewed by scientists or healthcare providers. Peer-reviewed studies are typically published in scientific journals and are usually available at medical libraries. The second type of studies is non-peer reviewed. These works include summary articles that do not use or report scientific results. These often appear in the popular press, newsletters, or similar periodicals. In this chapter, we will show you how to locate peer-reviewed references and studies on gingivitis. We will begin by discussing research that has been summarized and is free to view by the public via the Internet. We then show you how to generate a bibliography on gingivitis and teach you how to keep current on new studies as they are published or undertaken by the scientific community.
The Combined Health Information Database The Combined Health Information Database summarizes studies across numerous federal agencies. To limit your investigation to research studies and gingivitis, you will need to use the advanced search options. First, go to http://chid.nih.gov/index.html. From there, select the “Detailed Search” option (or go directly to that page with the following hyperlink: http://chid.nih.gov/detail/detail.html). The trick in extracting studies is found in the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer, and the
52 Gingivitis
format option “Journal Article.” At the top of the search form, select the number of records you would like to see (we recommend 100) and check the box to display “whole records.” We recommend that you type in “gingivitis” (or synonyms) into the “For these words:” box. Consider using the option “anywhere in record” to make your search as broad as possible. If you want to limit the search to only a particular field, such as the title of the journal, then select this option in the “Search in these fields” drop box. The following is a sample of what you can expect from this type of search: ·
Effects of an Instructional-Motivational Program on Plaque and Gingivitis in Adolescents Source: Journal of Public Health Dentistry. 37(4):281-289, Fall 1977. Summary: A 3-year study of 1,500 students from 33 schools chosen at random from all public and private elementary schools in Buffalo, New York, investigated the efficacy of preventive dental treatment given along with an innovative program of instruction and motivational activities. For 3 years, students in group A received annual dental prophylaxes, fluoride applications, application of sealant on occlusal surfaces, and referral for restorative work, if necessary. Group B received the same treatment, plus brushing and flossing instruction and (for a subgroup) weekly rewards by parents for good dental behavior. In addition, group B participated in a belief consistency program, which employed values clarification, peer leadership, and group competition techniques. Group C, the control, received dental prophylaxes and referral, if necessary. Examinations for plaque and gingivitis were conducted every 6 months, and examinations for caries were made at the beginning and end of each treatment year. A gingivitis assessment method and the Kobayashi and Ash method of scoring plaque were employed to evaluate the efficacy of the interventions. Data were subjected to analysis of variance and covariance and indicated that after 30 months, group B had a significantly lower mean plaque score than groups A or C, but the gingivitis scores of experimental subjects were not significantly lower than those of control subjects. Further studies incorporating costeffectiveness assessments should be done to determine the best combination of instructional and motivational components. 13 references.
·
Review of Efficacy Studies of an Antiplaque-Antigingivitis EssentialOil-Containing Dentifrice Source: Journal of Practical Hygiene. 10(2): 29-33. March-April 2001. Contact: Available from Montage Media Corporation. 1000 Wyckoff Avenue, Mahwah, NJ 07430-3164. (201) 891-3200.
Studies 53
Summary: This article reviews the efficacy studies that investigated an antiplaque antigingivitis dentifrice (a mouthrinse) that contained essential oils. The effectiveness of a new essential oil containing (EOC) dentifrice in the control of plaque and gingivitis (gum infection) was initially evaluated in multiple short term human studies and later confirmed in a definitive six month clinical trial conducted according to guidelines established by the American Dental Association (ADA). The addition of zinc salts provided desired anticalculus benefits as demonstrated in two long term human clinical studies, while the bactericidal, anticaries, and stain reduction properties were verified utilizing accepted scientific testing methods. The authors conclude that the research demonstrates that a dentifrice containing a fixed combination of essential oils is effective against dental plaque and gingivitis and is consistent with the body of published long term clinical trials on essential oil mouthrinses (Listerine). The authors briefly discuss the use of these dentifrices in a program of oral hygiene. Increasing confidence in the value of dentifrices containing chemotherapeutic agents has resulted in their expanded use by people affected by gingivitis and acceptance by the professional dental community. 1 figure. 3 tables. 22 references. ·
Influence of Toothbrush Wear on the Variables of Plaque and Gingivitis in Clinical Trials Source: Journal of Dental Hygiene. 75(2): 150-155. Spring 2001. Contact: Available from American Dental Hygienists' Association. 444 North Michigan Avenue, Chicago, IL 60611. (312) 440-8900. Website: www.adha.org. Summary: Although toothbrush wear has been shown not to be critical in ensuring optimal plaque removal, the degree of toothbrush wear occurring in a clinical trial may influence the results of the trial. This article reports on a study undertaken to determine the effects of toothbrush wear on the clinical variables of dental plaque and gingivitis (inflamed gums). There were 107 subjects who participated in the six month clinical trial in which plaque and gingivitis scores were assessed in relation to toothbrush wear at 2, 4, 12, and 24 weekly intervals. At each appointment, the toothbrushes being used were assessed for wear and replaced if necessary. The researchers found that 58 percent of the group were 'rapid' and 42 percent were 'slow' wearers. Of the group, 18.6 percent required replacement toothbrushes within two weeks from baseline with 50.9 percent of replacement toothbrushes being issued within four weeks of the start of the trial. Two subjects required as many as 10 replacement toothbrushes over the six month trial period. 'Slow'
54 Gingivitis
wearers had significantly lower plaque scores than 'rapid' wearers at weeks 4 and 12, whereas the 'rapid' wearers had significantly lower gingivitis scores than 'slow' wearers at weeks 2 and 4. The author concludes that significant toothbrush wear patterns of people participating in clinical trials should be taken into account when designing clinical trials assessing plaque and gingivitis scores. It may be necessary to exclude 'rapid' toothbrush wearers from clinical trials that assess plaque and its removal. In addition, as the rate of toothbrush wear varied considerably among subjects, the simple classification of subjects into 'rapid' and 'slow' wearers may require further subgrouping. 4 tables. 11 references. ·
Evidence of a Substantial Genetic Basis for Risk of Adult Periodontitis Source: Journal of Periodontology. 71(11): 1699-1707. November 2000. Contact: Available from American Academy of Periodontology. Suite 800, 737 North Michigan Avenue, Chicago, IL 60611-2690. (312) 573-3220. Fax (312) 573-3225. Summary: A few previous studies have suggested that risk for adult periodontitis (AP) has a genetic (inherited) component. This article reports on a study in which the authors estimated genetic and environmental variances and heritability for gingivitis and adult periodontitis using data from twins reared together. One hundred seventeen (117) pairs of adult twins (64 monozygotic or MZ and 53 dizygotic or DZ pairs) were recruited. Probing depth (PD), attachment loss (AL), plaque, and gingivitis (GI) were assessed on all teeth by two examiners. Measurements were averaged over all sites, teeth, and examiners. Genetic and environmental variances and heritability were estimated using path models with maximum likelihood estimation techniques. Results showed that MZ twins were more similar than DZ twins for all clinical measures. Statistically significant genetic variance was found for both the severity and extent of disease. AP was estimated to have approximately 50 percent heritability, which was unaltered following adjustments for behavioral variables including smoking. In contrast, while MZ twins were also more similar than DZ twins for gingivitis scores, there was no evidence of heritability for gingivitis after behavioral covariates such as utilization of dental care and smoking were incorporated into the analyses. The authors conclude that the basis for the heritability of periodontitis appears to be biological and not behavioral in nature. 1 figure. 7 tables. 37 references.
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Role of Pharmacotherapeutics in the Reduction of Plaque and Gingivitis Source: Journal of Practical Hygiene. 9(6): 46-50. November-December 2000. Contact: Available from Montage Media Corporation. 1000 Wyckoff Avenue, Mahwah, NJ 07430-3164. (201) 891-3200. Summary: This article reviews the role of pharmacotherapeutics in the reduction of dental plaque and gingivitis (gum infection). The author notes that while mechanical aids (e.g., toothbrushes, floss, and interdental devices) are widely used to achieve proper oral hygiene, they occasionally fail to meet this goal and to reduce the bacteria below the patient's threshold for disease. In these patients, drug therapy may be indicated. The author discusses selection, research, and delivery considerations; and specific drugs including phenolic related essential oils, triclosan, bisbiguanides (including chlorhexidine), quaternary ammonium compounds, herbal extracts, and oxygenating agents. The author concludes that the ineffectiveness of mechanical plaque control is based largely on the fact that people do not brush or floss effectively or regularly. Several antimicrobial products have demonstrated safety and range of efficacy. Recommendations should be based on level of infection, research, expected outcomes, and patient input. Mouthrinses should be used as adjuncts and not replacements for traditional plaque control. 2 tables. 60 references.
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Comparison of the Efficacy of a Novel Electric Toothbrush and a Manual Toothbrush in the Treatment of Gingivitis Source: American Journal of Dentistry. 11(Special Issue): S23-S28. September 1998. Contact: Available from American Journal of Dentistry. Subscription Department, 9859 IH-10 West, Suite 107/489, San Antonio, TX 782302236. Summary: This article reports on a study undertaken to compare the efficiency of a new electric toothbrush featuring a novel three dimensional brush head action, with a manual toothbrush, in resolving gingivitis which had been allowed to develop in a group of subjects prior to the treatment phase of the study. This randomized split mouth study includes a total of 35 healthy non dental students who refrained from any oral hygiene on the lower jaw for a period of 21 days in order to develop gingivitis (inflamed gums). They then brushed one quadrant of the lower jaw with the Braun Oral B 3D Plaque Remover and the other with a manual toothbrush for a period of 4 weeks. Plaque and gingivitis were
56 Gingivitis
evaluated at the start of the study, after the 21 days of no oral hygiene, and after 1, 2, 3, and 4 weeks of brushing twice a day. At the end of the study, the 3D was found to be significantly more effective at reducing bleeding on probing for all sites combined and all individual sites. Plaque removal was also significantly more effective with the 3D. Subjects in the study reported that they preferred the 3D to the manual toothbrush and said that it would encourage them to brush for longer. The authors conclude that the new Braun Oral B 3D Plaque Remover offers advantages over a manual toothbrush in terms of plaque control and improvement of gingival condition. 3 figure. 2 tables. 18 references. ·
Gingivitis: A Prelude to Periodontitis? Source: Journal of Clinical Dentistry. 6(Special Issue): 41-45. 1995. Summary: This article explores the role of gingivitis in the progression of periodontitis. Topics covered include therapeutic intervention in gingival disease, the progression from gingival health to gingival disease, agerelated gingival microbiology, predictive patterns of destructive periodontal disease, the host response to pathogenic bacteria, predicting disease progression, the management of gingival health, and the benefits of stannous fluoride. The author concludes that the reduction of gingivitis in the general population results in more than merely cosmetic improvement following the reduction of gingival bleeding and some forms of halitosis. There is overwhelming evidence that gingivitis is linked to periodontitis and that the elimination of gingivitis will result in the reduction of attachment loss in the majority of the population. 59 references.
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Painful Gingivitis May Be an Early Sign of Infection with the Human Immunodeficiency Virus Source: Clinical Infectious Diseases. 16(3): 233-236. February 1993. Summary: Anecdotal reports have suggested that painful gingivitis may be associated with infection due to the human immunodeficiency virus (HIV). This article reports on a study of 20 patients who came to the emergency room and complained about gum pain. They were then evaluated for HIV infection. Seven of the 20 patients (35 percent) were seropositive for HIV. Three of the seven HIV-seropositive patients were unaware of their HIV infection until tested in this study. Regardless of HIV serological status, all patients demonstrated a severely depressed mitogenic response when compared with control subjects. The authors conclude that identification of clinical presentations that reflect an early stage of HIV infection such as painful gingivitis, could aid in the timing
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of therapy and prevention of the spread of HIV infection. 1 table. 19 references. (AA-M). ·
Postscaling Bacteremia in HIV-Associated Gingivitis and Periodontitis Source: Oral Surgery, Oral Medicine, Oral Pathology. 73(5): 550-554. May 1992. Summary: This article reports on a study that assessed the incidence of postscaling bacteremias in patients seropositive for HIV who have unequivocal evidence of periodontal infection. In addition, the authors tried to ascertain whether the posttreatment febrile episode reported by HIV-positive patients is a predictable sequela to the temporary presence of microorganisms in the peripheral circulation. Aseptive venipuncture was used to obtain samples of blood from 22 HIV-positive patients with gingivitis (HIV-G) and 19 HIV-positive patients with periodontitis (HIVP), 15 and 30 minutes after the initiation of routine dental scaling and root planing. Six of the samples from HIV-G subjects were positive for colony-forming units 15 minutes after scaling but not at 30 minutes. Similar evidence of bacteremia was found in seven of the HIV-P patients 15 minutes after scaling, with no microbial growth detectable in samples obtained at 30 minutes. In two HIV-G and three HIV-P patients with demonstrable bacteremias a postoperative fever developed. For both HIV-G and HIV-P groups, no significant difference was found between the absolute CD4 T-cell counts of nonbacteremic versus bacteremic patients. The authors conclude that special provisions for antibiotic prophylaxis in this patient group may be unnecessary. 3 tables. 12 references. (AA-M).
Federally-Funded Research on Gingivitis The U.S. Government supports a variety of research studies relating to gingivitis and associated conditions. These studies are tracked by the Office of Extramural Research at the National Institutes of Health.17 CRISP (Computerized Retrieval of Information on Scientific Projects) is a searchable database of federally-funded biomedical research projects conducted at universities, hospitals, and other institutions. Visit the CRISP Web site at http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket. You can Healthcare projects are funded by the National Institutes of Health (NIH), Substance Abuse and Mental Health Services (SAMHSA), Health Resources and Services Administration (HRSA), Food and Drug Administration (FDA), Centers for Disease Control and Prevention (CDCP), Agency for Healthcare Research and Quality (AHRQ), and Office of Assistant Secretary of Health (OASH).
17
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perform targeted searches by various criteria including geography, date, as well as topics related to gingivitis and related conditions. For most of the studies, the agencies reporting into CRISP provide summaries or abstracts. As opposed to clinical trial research using patients, many federally-funded studies use animals or simulated models to explore gingivitis and related conditions. In some cases, therefore, it may be difficult to understand how some basic or fundamental research could eventually translate into medical practice. The following sample is typical of the type of information found when searching the CRISP database for gingivitis: ·
Project Title: A NOVEL PERIODONTAL DISEASE
AGENT
FOR
THE
THERAPY
OF
Principal Investigator & Institution: Szabo, Csaba; Vice President for Research; Inotek Corporation 100 Cummings Ctr, Ste 419E Beverly, Ma 01915 Timing: Fiscal Year 1999; Project Start 1-AUG-1998; Project End 1-DEC2002 Summary: The current application represents the Phase 2 continuation of the Phase I NIH SBIR Grant number R43 DE12686, entitled A novel agent for the therapy of gingivitis . In the Phase I application, we have presented evidence that mercaptoethylguanidine (MEG) is a promising nitric oxide synthase (NOS) inhibitor with selectivity for the inducible nitric oxide synthase isoform (iNOS), and with an additional free radical scavenger activity, and proposed to perform pre-clinical studies in the rat to demonstrate its efficacy in periodontal disease. The studies performed in the Phase I studies confirmed iNOS expression and peroxynitrite generation in periodontitis, and demonstrated the potent antiinflammatory effects of MEG in a rat model of ligature-induced periodontitis. In the current application, we propose to inform preclinical studies with a MEG in order to develop it as a treatment for periodontal disease. The specific aims of the present proposal are to synthesize large quantities of MEG, and perform studies in beagle dog models of gingivitis and periodontitis in order to obtain definitive proof of principle that this agent can reduce the tissue injury and inflammation. Additional aims of the current submission are to complete the on-going pre-clinical pharmaceutical testing (advanced toxicity determinations, pathology, stability, pharmacokinetics, local irritation tests), to reach the stage of investigational drug application to the FDA, and conduct a Phase I/II human clinical trial with MEG for the treatment of gingivitis. PROPOSED COMMERCIAL APPLICATION Worldwide the market for an effective, safe pharmaceutical for periodontal diseases is estiamted to
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be over 20 billion dollars per year. Current market entrants are marginally effective. MEG may represent a highly potent and successful candidate therapy; funding of SBIR Phase II will allow for market entry in 3-4 years. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket ·
Project Title: CLINICAL/MICROBIAL EVALUATION OF TOPICAL P113 GELS IN HUMANS WITH GINGIVITIS Principal Investigator & Institution: Paquette, David; ; University of North Carolina Chapel Hill Chapel Hill, Nc 27514 Timing: Fiscal Year 2000 Summary: This abstract is not available. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket
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Project Title: DEVELOPMENT OF A MARINE ANTI-PLAQUE COMPOUND Principal Investigator & Institution: Castor, Trevor P.; President & Chief Executive Officer; Aphios Corporation 3-E Gill St Woburn, Ma 01801 Timing: Fiscal Year 2000; Project Start 5-SEP-2000; Project End 4-MAR2001 Summary: Epidemiological surveys indicate that an average of 50% of the adult population of the United States (US) has gingivitis and that gingivitis can lead to a number of life threatening illnesses such as heart disease. Since gingivitis is caused by plaque and plaque is composed of various kinds of bacteria, in theory antimicrobial agents should be effective against gingivitis. Most anti-plaque compounds, e.g. triclosan, chlorohexidene and fluorine, are halogenated. Marine microorganisms, which can generate compounds that integrate halogens such as chlorine and bromine, can thus be an important resource for the discovery of antiplaque compounds. Recently 4,800 extracts derived from 150 marine microorganisms were screened for anti-microbial activity against Haemophilus actinomycetemcomitans, Actinomyces viscosus, and Streptococcus mutans. The extract of one organism, APP214, was found to have excellent inhibitory and bactericidal activity against these microorganisms. The specific aims of this proposal are to isolate, identify and characterize (in terms of antimicrobial efficacy and toxicity) the bioactive components derived from APP214. In Phase II, medicinal and combinatorial chemistry will be performed on the candidate compound(s) to maximize effectiveness and substantivity against orallyrelevant microorganisms. In Phase III, the lead anti-plaque compound will be commercialized with an industrial partner, such as Tom's of
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Maine, Gillette or Colgate-Palmolive. PROPOSED COMMERCIAL APPLICATIONS: There is currently no truly efficacious anti-gingivitis product that is also both convenient to use and appealing to the consumer. A product that is effective and substantive against oral biofilms (dental plaque) will have a significant market potential in the United States and internationally. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket ·
Project Title: DIAGNOSTIC PERIODONTAL TISSUES
OPITCAL
IMAGING
OF
Principal Investigator & Institution: Otis, Linda L.; Associate Professor; Oral Medicine; University of Pennsylvania 1 College Hall Philadelphia, Pa 19104 Timing: Fiscal Year 2000; Project Start 0-SEP-1994; Project End 1-JUL-2003 Summary: (Adapted from Applicant's Abstract): Optical Coherence Tomography (OCT) is a non-invasive optical technique for cross-sectional imaging of biologic tissues which permits identification of both internal structure and surface contour of hard and soft tissues without ionizing radiation. Based on previously sponsored efforts, the authors have designed and constructed an OCT instrument for imaging teeth and periodontal tissues. Initial human studies demonstrate the feasibility of this method. The goal of this proposal is to construct a small, compact clinical instrument that will allow access to all tooth-bearing regions within the oral cavity. The capacity of OCT to characterize morphology, localize structures and quantify sub-gingival calculus will be determined in a small patient study. The authors hope to identify OCT signals associated with periodontitis and/or gingivitis. In order to make the device clinically relevant., the authors propose to optimize the instrument and evaluate its performance in comparison to standard techniques. The specific aims of the proposal are to (1) construct an improved, miniaturized intraoral OCT imaging hand piece; (2) miniaturize OCT imaging system components; (3) image and characterize healthy and diseased periodontal tissue and optimize OCT imaging parameters; (4) compare OCT imaging to standard assessment methods; and (5) investigate the potential of OCT to quantify gingival inflammation. Images produced to date suggest that OCT may delineate pathological changes in gingival fiber groups based on changes in optical properties. Finally operating OCT systems at multiple wavelengths may be used for quantification of blood and fluid content in tissue. This project is carried out in conjunction with Lawrence Livermore National Laboratory. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket
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Project Title: EDUCATION
EFFICACY
OF
TAILORED
ORAL
HEALTH
Principal Investigator & Institution: Pallonen, Unto E.; Associate Research Scientist; University of Michigan at Ann Arbor Ann Arbor, Mi 48109 Timing: Fiscal Year 2001; Project Start 0-SEP-2001; Project End 1-JUL-2008 Summary: (Provided by the applicant): The long-term objective of this project is to develop an effective tailored behavior change expert system (ES) education program to promote and maintain good oral health and prevent oral diseases among low-income children and their caregivers. To achieve this, the proposed multimedia-based, self-help intervention is designed to be easy to use and easy to diffuse for large-scale use through personal computers. Due to the current lack of tailored self-help behavior change dental interventions, substantial time and resources are needed to develop the content and to test the instruments and feasibility of the proposed interventions. This project has five specific aims: 1) To design and produced two interventions to promote oral health and prevent oral disease among caregivers and their children: (i) an interactive, tailored, theory-driven, behavior change ES education program, and (ii) an untailored health information HI comparison program. 2) To assess the feasibility and usability of these unique interventions with a small-scale feasibility study prior to their final implementation. 3) To revise the interventions based on the findings of the feasibility study and implement the efficacy trial. 4) To evaluate the efficacy of the interventions with two clinical outcomes: gingivitis among caregivers and untreated tooth decay among caregivers and their children. 5) To examine the extent to which the clinical outcomes are mediated by the affective, evaluative, and situational individual factors influenced by the tailored intervention, or by broader psychosocial factors addressed in other center projects. The efficacy of the tailored ES intervention, whether it results in better oral health than the untailored HI intervention, will be tested by the randomized controlled trial. In year 4 of the course of the longitudinal center research, the participating caregivers, low income African Americans recruited from the poorest 39 census tracks in the city of Detroit, will be randomly assigned to one of the two education programs at the beginning of the multimedia intervention session. The oral follow-up examination at year four will be the baseline measurement of this trial, and changes in the outcomes will be assessed in the followup examination in year 6. Both the participants and examiners will be blinded from the intervention regimens. Production and evaluation of a state of the science, interactive, tailored multimedia self-help ES program for oral health will provide an opportunity to obtain currently
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nonexistent information about the ability to influence behaviors that determine oral health status among low SES African Americans caregivers and their children. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket ·
Project Title: LYSIS OF CARIOGENIC BACTERIA BY PHAGEENCODED ENZYMES Principal Investigator & Institution: Delisle, Allan L.; Oral & Craniofacial Biol Scis; University of Maryland Balt Prof School Professional Schools Baltimore, Md 21201 Timing: Fiscal Year 2000; Project Start 5-SEP-2000; Project End 1-AUG2003 Summary: The long-range, health-related goal of this proposal is to develop species-specific, cell wall-hydrolyzing enzymes encoded in the genomes of phages specific for Streptococcus mutans and Actinomyces naeslundii as new therapeutic treatments for dental caries. S. mutans is the primary etiological agent of human enamel caries, whereas A. naeslundii (A. viscosus), an early colonizer of dental plaque, has long been believed to be involved in gingivitis and root surface (cementum) caries. The major objective of the research proposed herein is to isolate, purify and characterize the enzymes which enable phages specific for these species to lyse their host cells. The lysis genes of two previously studied phages which are specific for S. mutans and A. naeslundii will be isolated, cloned and sequenced. To accomplish this, the complete genomes of these two phages will be sequenced, which will allow direct PCR subcloning of their holin and endolysin genes and characterization of their respective products. The DNA sequences of these holin/lysin gene pairs will provide information on their regulatory mechanisms and further our knowledge of the evolutionary relatedness of these viral proteins. Comparative analyses of their deduced primary amino acid sequences may also reveal conserved protein domains that are important in determining their structural and functional properties. Additional cloning experiments will be employed to isolate holin genes, and nearby endolysin genes, from these two phages and three additional oral phages, in order to develop a generally applicable method for directly isolating oral phage lysis genes. Phage DNA libraries will be constructed in a phage vector having a defective holin gene, which will allow recombinants expressing oral phage holins to be selected by complementation (plaque formation) of the defect in the phage vector. Inserts will then be sequenced to identify the phage holin genes and primers complementary to the ends of these genes will then be used to sequence, directly from the phage genomes, the adjacent, downstream
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endolysin genes. Selected endolysin genes will be subcloned, by PCR, from phage genomic DNAs, or from recombinant phage vectors, into expression vectors and introduced into E. coli in order to isolate and purify their gene products. The enzymatic activities of these proteins will then be extensively characterized, including determining the specific bonds which they cleave in the cell walls of their respective hosts. Purified preparations of these lytic enzymes might ultimately be used to kill, in a species-specific manner, S. mutans and A. naeslundii in dental plaque. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket ·
Project Title: MOLECULAR MICROBIAL DIVERSITY
ANALYSIS
OF
SUBGINGIVAL
Principal Investigator & Institution: Relman, David A.; Assistant Professor; Medicine; Stanford University Stanford, Ca 94305 Timing: Fiscal Year 2000; Project Start 1-SEP-2000; Project End 1-AUG2004 Summary: (Adapted from the Investigator's Abstract): Bacteria are the primary cause of plaque-associated gingivitis and chronic adult periodontitis. It is unclear, however, whether the microorganisms responsible for gingivitis also contribute to the development of adult periodontitis or whether a unique assemblage of microorganisms is responsible for periodontitis. Studies indicate that plaque-associated gingivitis progresses to chronic adult periodontitis in only a subset of individuals. Previous work on this topic has been hampered by the limitations of cultivation-based methods, taxonomic inconsistencies, insufficient microbial characterization and inter-patient heterogeneity. The proposed work relies upon sensitive molecular methods to identify predictive associations between specific bacterial and archaeal species and the onset of adult periodontitis. The short-term objectives are to determine the subgingival microbial markers of gingival health, plaqueassociated gingivitis and chronic adult periodontitis. The long-term objectives are to understand oral microbial ecology, to determine its relationship with local and systemic disease, and by so doing, to identify healthy individuals with increased risk of disease who would benefit from early intervention. The Specific Aims of this proposal are: Aim 1. Identify the bacterial and archaeal species within subgingival plaque from healthy sites in periodontitis patients. Phylogenetic analysis of 16S ribosomal DNA sequences and high density DNA microarrays will be used to identify the microbial species composition of subgingival plaque. Aim 2. Identify the bacteria and archaea from plaque-associated gingivitis and chronic adult periodontitis sites using the approach in Aim
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1. Aim 3. Quantify differences in bacterial and archaeal contribution to the total microbial population within subgingival plaque associated with healthy gingiva, plaque-associated gingivitis and chronic adult periodontitis. Slot-blot and in situ hybridization methods will be applied with group- and species-specific 16S rDNA probes. Targeted organisms will include those implicated in the development of disease from the work in the above aims. Among the expected long-term benefits of this work will be the identification of organisms that can serve as predictors of intra-oral health and disease, and the development of broadly useful DNA microarray for microbial surveys and diagnostic studies. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket ·
Project Title: NEWLY GAMMA/DELTA T CELLS
IDENTIFIED
ANTIGENS
FOR
Principal Investigator & Institution: Bukowski, Jack F.; ; Brigham and Women's Hospital 75 Francis St Boston, Ma 02115 Timing: Fiscal Year 2000; Project Start 1-AUG-1998; Project End 1-JUL2003 Summary: (Adapted from Investigator's abstract): It is becoming evident that gamma/delta (gd) T cells play an important role in defense against bacterial and viral infections as well as in autoimmunity. gd T cells are expanded in humans with infectious diseases such as tuberculosis, salmonellosis, brucellosis, ehlichiosis, tularemia, malaria, leishmaniasis, mononucleosis, and in HIV (early stages). They are expanded in the synovium of patients with sarcoidosis. In contrast to alpha/beta (ab) T cells, which recognize peptide antigens in the context of MHC molecules, the predominant subset of gd T cells in human peripheral blood, termed Vg2Vd2 T cells, having no homologue in rodents, recognize unprocessed nonpeptide phosphate antigens in the absence of professional APC or known antigen presenting molecules. Abundant data describing in detail the interactions of the ab TCR with MHC-bound peptide have deepened our understanding of their role in infectious disease and in autoimmunity. In contrast, there is little information regarding the nature of interaction between the gd TCRs and their ligands. In fact, the identities of most microbial and autoimmune antigens reactive with gd T cells is unknown. Preliminary evidence in the investigator's laboratory shows that the TCR g junctional region is of crucial importance for the recognition of phosphate antigens by Vg2Vd2 T cells, arguing against a superantigen-like recognition of such antigens. The laboratory recently has found that alkylamines, which are major products of certain bacteria that cause gingivitis and many other diseases and are also found in plant foods and human body fluids, cause proliferation of Vg2Vd2 T cells in a
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TCR-specific manner. Alkylamine antigens are the first phosphate-free antigens described for Vg2Vd2 T cells and thus represent a distinct chemical class of ligand for Vg2Vd2 T cells. The investigator proposes to 1) Define the structural characteristics necessary for bioactivity of alkylamine antigens by testing a panel of naturally occurring alkylamine antigens for reactivity to gd T cells; 2) Identify specific domains and residues in the gd TCR important for recognition of alkylamine and phosphate antigens; 3) Determine the requirements of alkylamine antigens for antigen presentation and processing; 4) Define the phenotypes and alkylamine antigen reactivities of gingival gd T cells from patients with chronic gingivitis. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket ·
Project Title: NON TOXIC ANTIMICROBIAL RINSE FOR ORAL BACTERIA Principal Investigator & Institution: Norbury, Kenneth C.; Research Scientist; Biomedical Development Corporation 500 Sandau, Ste 200 San Antonio, Tx 78216 Timing: Fiscal Year 2000; Project Start 1-SEP-2000; Project End 8-FEB-2002 Summary: Biomedical Development Corporation is developing a unique antimicrobial mouth rinse to treat oral bacteria. Antimicrobial mouth rinses are valuable supplements to oral hygiene and used as preventives before and after surgery. The disinfectant is biocidal against a broad spectrum of organisms including waterborne bacteria and viruses. It also operates as a biofilm reducing and prevention agent. Plaque, a living biofilm, plays a critical role in the development of caries, gingivitis and periodontal disease. Preventing the formation of plaque, eliminating the presence of plaque, and decreasing the amount of oral bacteria in the mouth are essential factors in preventing dental disease. In this grant, we will demonstrate the antimicrobial rinse's biocidal activity and effect on color stability of composite resins. PROPOSED COMMERCIAL APPLICATION: Over 18 billion dollars in 1992 was spent on dental services in the U.S. on prevention of tooth decay, single-tooth restoration, and the replacement of teeth. Chlorhexidine is available and is an effective antimicrobial mouth rinse but due to its side effects can only be used in acute settings. Other currently available mouth rinses can be used over longer periods of time but are less effective than chlorhexidine in reducing oral bacteria. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket
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Project Title: NOVEL ANTIOXIDANTS PERIODONTAL DISEASE
FOR
THERAPY
OF
Principal Investigator & Institution: Marton, Anita; ; Inotek Corporation 100 Cummings Ctr, Ste 419E Beverly, Ma 01915 Timing: Fiscal Year 2000; Project Start 5-SEP-2000; Project End 4-SEP-2001 Summary: In recent studies, our group have presented evidence that mercaptoethylguanidine (MEG) and related agents such as its dimeric form guanidinoethyldisulfide (GED) are promising inducible nitric oxide synthase (iNOS) inhibitors with selectivity for the inducible isoform (iNOS). In addition, we have obtained data, which demonstrated that these compounds are scavengers of the cytotoxic oxidant peroxynitrite. Based on the role NO and peroxynitrite plays in the pathogenesis of periodontal disease, we are currently developing a first-generation candidate of the MEG class for periodontal diseases. Recent in vivo data demonstrated that MEG and GED are effective in suppressing the course of inflammation in the ligature-induced gingivitis/periodontitis model in the rat. Furthermore, we present data demonstrating the appropriate therapeutic ratio of MEG and GED. Inotek Corporation is in the process of the development of mercaptoalkylguanidines for the experimental therapy of periodontal disease. Inotek is now also developing a "second generation" class of iNOS inhibitor/peroxynitrite scavenger compounds, exemplified by selenoethylguanidine and selenopropylguanidine. Preliminary in vitro data suggest that substitution of the sulfur group to selenium increases the reactivity of the compound with peroxynitrite by about 100-fold. In addition, selenoethylguanidine maintains its iNOS inhibitory effects. The first aim of the current study is to synthesize selenoguanidines, and perform in vitro studies to characterize its effects as NOS inhibitor, determine their isoform selectivity, and their peroxynitrite scavenging activity. The second aim of the study is to test selenoguanidines in a rat model of periodontal disease, where NO and peroxynitrite play a key role in disease development. The results of the present application will permit application for Phase 2 SBIR funding to support: pre-clinical pharmaceutical testing (further testing in animal models, advanced toxicity determinations, pathology, stability, pharmacokinetics, in vivo efficacy), IND application to the FDA, and Phase 1 clinical trial). PROPOSED COMMERCIAL APPLICATIONS: The annual anticipated revenues for an effective therapeutic to prevent and treat periodontal disease is over $30 billion in the US alone. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket
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Project Title: ORAL ANTIMICROBIAL PEPTIDES IN HEALTH AND DISEASE Principal Investigator & Institution: Dale-Crunk, Beverly A.; ; University of Washington 3935 University Way Ne Seattle, Wa 98195 Timing: Fiscal Year 2000 Summary: Children have excellent defenses against oral infections. They lose deciduous teeth and erupt permanent teeth without infections and rarely get periodontal disease even in the presence of plaque. This project will investigate the role without infections and rarely get periodontal disease even in the presence of plaque. This project will investigate the role of beta- defensins, a newly recognized family of small, cationic peptides with anti- microbial activity, in oral health and disease susceptibility. Oral epithelia are constantly exposed to microbial challenges that lead to bacterially induced gingivitis, periodontal diseases and other infections. Recent findings show that mucosal epithelial cells, including gingival epithelial are the source of beta-defensins. These peptides are predicted to function as a first line of host defense against microbial pathogens and are now recognized as part of the innate or nonadaptive hot defense system. Two beta-defensin peptides, hBD-1 and hBD-2, are expressed and differentially regulated in gingival epithelial cells. This proposal is based on the hypotheses that (1) beta- defensin peptides produced by oral epithelial cells play an important role in determining the outcome of the host pathogen interaction at the oral mucosal barrier, (2) these peptides may be important in the normal protective function of the oral mucosa during development, and (3) variation in individual expression of these peptides may be a contributing factor to susceptibility to specific oral disorders in children and adults. These peptides have future potential for prevention and treatment of oral microbial disorders, including periodontal disease, caries, recurrent candidal infections, and oral mucositis. The goals of this study encompass basic investigations and applied studies. We seek to understand the regulation of beta-defensin mRNA expression emphasizing epithelial differentiation and cell signaling pathways for expression upon stimulation by examples of commensal and pathogenic organisms, and by a two-component biofilm; to explore the relationship of beta-defensin expression and that of inflammatory cytokines; to determine beta-defensin expression in non- invasively collected oral samples from children, and to explore variation in defensin expression as a function of age and to test the hypothesis that defensin expression has correlated with oral health status in test populations in collaboration with other Comprehensive Center investigators. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket
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Project Title: ORAL TREPONEMES IN PERIODONTAL DISEASES Principal Investigator & Institution: Ebersole, Jeffrey L.; Professor; Periodontics; University of Texas Hlth Sci Ctr San Ant 7703 Floyd Curl Dr San Antonio, Tx 78229 Timing: Fiscal Year 2000; Project Start 0-SEP-1994; Project End 0-APR2001 Summary: (adapted from the Investigator's abstract): There is a growing awareness that oral treponemes play a role in the progression from health to periodontitis. Despite the interest in the relationship of this genus to periodontitis, only a few Treponema spp. have been isolated and grown. Substantial literature has implicated Treponema denticola as an oral pathogen: however, few investigations have examined other species. These investigators have discovered that the predominant cultivable oral spirochete in subgingival These investigators propose to investigate T. pectinovorum virulence components and its potential contribution to the tissue and cellular destruction observed vitro and in vivo models which have been developed during the initial phases of the grant. The hypothesis to be tested is that T. pectinovorum is a major this organism presents unique outer membrane proteins and an LPS-like molecule distinctive from other oral treponemes, the hypothesis to be tested is that the 42 kDa major outer membrane protein (MompA) and the LPS like molecule (LPSL) have characteristics of virulence components in in vitro and in vivo models of disease. Successful testing of these hypotheses would imply that T. pectinovorum utilizes these components in subgingival plaque ecology to contribute to the soft tissue destructive and bone resorptive manifestations of functions of the 42 kDa major outer membrane protein (MompA) of T. pectinovorum including i) cloning and sequencing the MompA gene, ii) developing Abs to localize the molecule and determine its distribution among T. pectinovorum isolates, and iii) determining functional characteristics of MompA including its role as an adhesin for epithelial cells and fibroblasts, its activity as a ligand in eliciting host cell cytokine responses, and determination of its antigens capacity in a murine model. A highly innovative aspect of these studies will investigate variations in binding and effects on host cell functions following interaction of T. pectinovorum with fibroblasts derived from normal and HIV-infected individuals; 2) To isolate and characterize the LPSL molecule from T. pectinovorum including: i) biochemical characterization of the LPSL, ii) determining the endotoxic activity in vitro and in vivo, and iii) examining its biological functions in vitro and in vivo; and 3) To evaluate the presence and level of T. pectinovorum in human plaque samples using molecular and immunologic probes, including i) species-specific probes for T. pectinovorum and other oral
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treponemes, ii)MompA probes: iii) intragenic probes for pectinovorum; iv) Antibody to the MompA, and v) Ab to the LPSL.
T.
Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket ·
Project Title: SALIVARY PROTEINS IN DENTAL INTEGUMENTS Principal Investigator & Institution: Oppenheim, Frank G.; Professor and Chairman; Periodontology; Boston University 121 Bay State Rd Boston, Ma 02215 Timing: Fiscal Year 2001; Project Start 1-JAN-1983; Project End 1-MAY2005 Summary: The acquired enamel pellicle is a protein film readily formed on tooth mineral surfaces in the oral environment. It has been established that its formation is driven by the adsorption of proteins and peptides derived from oral fluid. Most of these proteins originate from either parotid or submandibular/ sublingual secretions which undergo modifications in the oral cavity before or after adsorption to the hydroxyapatite crystallites of tooth enamel. The composition and the structure of this acquired enamel pellicle are still largely unknown but play functionally a vital role with important physiological/clinical implications. A major thrust of this application is to use state-of-the-art proteomics to identify and characterize the major components of the invivo formed pellicle. Since the pellicle has an inner aspect facing the tooth surface and an outer aspect connected to the bacterial biofilm known as Dental plaque the functions of pellicle are multifaceted and complex. Another major goal is to investigate the protective functions of the pellicle vis-a-vis the maintenance of the mineral phase of enamel and the interplay between molecular entities of the pellicle and those bacteria which constitute the early colonizers of the biofilm forming on the tooth surface. The nature of the pellicle with respect to the early attachment of bacteria including those which are known periodontal pathogens will be studied in vitro and in vivo. The Specific Aims of the project are to: 1) Characterize components from pellicles formed in vivo by a variety of isolation techniques including 2D-electrophoresis followed by proteomic analyses comprising MALDI-TOF MS. LC-ESI MS and LC-MS/MS; 2) Explore the protective functions of the enamel pellicle by determining the affinity of its components to hydroxyapatite, the inhibitory potential of pellicle proteins/peptides of calcium phosphate precipitation from supersaturated solutions, and the capacity to retard demineralization; 3) Determine in vitro binding parameters of individual early pellicle colonizers, assess the role of transglutaminase in pellicle-bacterial interactions and employ biomimetic approaches to modify functional aspects of pellicle components; 4) Investigate with the checkerboard
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DNA-DNA hybridization assay the in vivo binding of early pellicle colonizers in healthy individuals and gingivitis patients, assess the relative role of exocrine and serum derived proteins/peptides on pellicle colonization in vivo and explore effects of different local environments in the oral cavity on these processes. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket
E-Journals: PubMed Central18 PubMed Central (PMC) is a digital archive of life sciences journal literature developed and managed by the National Center for Biotechnology Information (NCBI) at the U.S. National Library of Medicine (NLM).19 Access to this growing archive of e-journals is free and unrestricted.20 To search, go to http://www.pubmedcentral.nih.gov/index.html#search, and type “gingivitis” (or synonyms) into the search box. This search gives you access
The National Library of Medicine: PubMed One of the quickest and most comprehensive ways to find academic studies in both English and other languages is to use PubMed, maintained by the National Library of Medicine. The advantage of PubMed over previously mentioned sources is that it covers a greater number of domestic and foreign references. It is also free to the public.21 If the publisher has a Web site that offers full text of its journals, PubMed will provide links to that site, as well as to sites offering other related data. User registration, a subscription fee, or some other type of fee may be required to access the full text of articles in some journals. Adapted from the National Library of Medicine: http://www.pubmedcentral.nih.gov/about/intro.html. 19 With PubMed Central, NCBI is taking the lead in preservation and maintenance of open access to electronic literature, just as NLM has done for decades with printed biomedical literature. PubMed Central aims to become a world-class library of the digital age. 20 The value of PubMed Central, in addition to its role as an archive, lies the availability of data from diverse sources stored in a common format in a single repository. Many journals already have online publishing operations, and there is a growing tendency to publish material online only, to the exclusion of print. 21 PubMed was developed by the National Center for Biotechnology Information (NCBI) at the National Library of Medicine (NLM) at the National Institutes of Health (NIH). The PubMed database was developed in conjunction with publishers of biomedical literature as a search tool for accessing literature citations and linking to full-text journal articles at Web sites of participating publishers. Publishers that participate in PubMed supply NLM with their citations electronically prior to or at the time of publication. 18
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To generate your own bibliography of studies dealing with gingivitis, simply go to the PubMed Web site at www.ncbi.nlm.nih.gov/pubmed. Type “gingivitis” (or synonyms) into the search box, and click “Go.” The following is the type of output you can expect from PubMed for “gingivitis” (hyperlinks lead to article summaries): ·
Clinical and histological evaluation of gingival massage in the treatment of chronic gingivitis. Author(s): Simaan C, Skach M. Source: J Periodontol. 1966 September-October; 37(5): 383-90. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=4161925&dopt=Abstract
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Clinical effect of a Mexican sanguinaria extract (Polygonum aviculare L.) on gingivitis. Author(s): Gonzalez Begne M, Yslas N, Reyes E, Quiroz V, Santana J, Jimenez G. Source: Journal of Ethnopharmacology. 2001 January; 74(1): 45-51. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11137347&dopt=Abstract
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Comparative clinical trial with natural herbal mouthwash versus chlorhexidine in gingivitis. Author(s): Serfaty R, Itic J. Source: J Clin Dent. 1988 Summer; 1 Suppl A: A34-7. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=3076781&dopt=Abstract
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Comparative clinical trials of a European herbal sodium bicarbonate dentifrice and a widely-used dentifrice containing MFP, in braceinduced gingivitis. Author(s): Bellet L, Bellet A. Source: J Clin Dent. 1988 Summer; 1 Suppl A: A25-6. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=2855713&dopt=Abstract
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Comparison of an herbal toothpaste with a fluoride toothpaste on plaque and gingivitis. Author(s): Moran J, Addy M, Newcombe R. Source: Clin Prev Dent. 1991 May-June; 13(3): 12-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=1860291&dopt=Abstract
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Double-blind evaluation of the clinical efficacy of an herbal dentifrice against gingivitis and periodontitis. Author(s): Emling RC. Source: J Clin Dent. 1988 Summer; 1 Suppl A: A27-9. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=2855714&dopt=Abstract
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Effects of extended systemic and topical folate supplementation on gingivitis of pregnancy. Author(s): Thomson ME, Pack AR. Source: Journal of Clinical Periodontology. 1982 May; 9(3): 275-80. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=7047579&dopt=Abstract
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Effects of topical and systemic folic acid supplementation on gingivitis in pregnancy. Author(s): Pack AR, Thomson ME. Source: Journal of Clinical Periodontology. 1980 October; 7(5): 402-14. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=7007454&dopt=Abstract
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Experimental gingivitis in ODU plaque-susceptible rats. V. The presence of bradykinin in the gingival tissue and the bradykinin inactivating factor in rat dental plaque. Author(s): Iga K, Kobayashi H, Mori M. Source: J Periodontol. 1980 June; 51(6): 348-54. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=6930475&dopt=Abstract
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Holistic care concepts, bruxism and necrotizing ulcerative gingivitis. Author(s): Pear JH.
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Source: Dent Hyg (Chic). 1982 September; 56(9): 24-9. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=6958589&dopt=Abstract ·
Increase of free collagenase and neutral protease activities in the gingival crevice during experimental gingivitis in man. Author(s): Kowashi Y, Jaccard F, Cimasoni G. Source: Archives of Oral Biology. 1979; 24(9): 645-50. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=231957&dopt=Abstract
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Meswak versus chlorhexidine and a commercial toothpaste in plaque formation and gingivitis. Author(s): Gazi MI, Lambourne A, Chagla AH. Source: Odontostomatol Trop. 1987 March; 10(1): 29-38. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=3474596&dopt=Abstract
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Notes on treating a case of acute lymphocytic leukemia resembling necrotizing ulcerative gingivitis: a case history. Author(s): Aker F, Magera J, Vernino A. Source: Quintessence Int. 1978 March; 9(3): 51-2. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=287120&dopt=Abstract
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Plasma cell gingivitis of unusual origin. A case report. Author(s): Serio FG, Siegel MA, Slade BE. Source: J Periodontol. 1991 June; 62(6): 390-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=1870070&dopt=Abstract
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Plasma cell gingivitis related to the use of herbal toothpaste. Author(s): Macleod RI, Ellis JE. Source: Br Dent J. 1989 May 20; 166(10): 375-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=2736170&dopt=Abstract
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The effect of herbal extracts in an experimental mouthrinse on established plaque and gingivitis.
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Author(s): Van der Weijden GA, Timmer CJ, Timmerman MF, Reijerse E, Mantel MS, van der Velden U. Source: Journal of Clinical Periodontology. 1998 May; 25(5): 399-403. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=9650877&dopt=Abstract ·
The effects of megadoses of ascorbic acid on PMN chemotaxis and experimental gingivitis. Author(s): Vogel RI, Lamster IB, Wechsler SA, Macedo B, Hartley LJ, Macedo JA. Source: J Periodontol. 1986 August; 57(8): 472-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=3462380&dopt=Abstract
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The efficacy of a herbal-based toothpaste on the control of plaque and gingivitis. Author(s): Mullally BH, James JA, Coulter WA, Linden GJ. Source: Journal of Clinical Periodontology. 1995 September; 22(9): 686-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=7593698&dopt=Abstract
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The relationship between chewing sticks (Miswak) and periodontal health. 2. Relationship to plaque, gingivitis, pocket depth, and attachment loss. Author(s): Eid MA, al-Shammery AR, Selim HA. Source: Quintessence Int. 1990 December; 21(12): 1019-22. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=2082419&dopt=Abstract
Vocabulary Builder Actinomyces: A genus of gram-positive, rod-shaped bacteria whose organisms are nonmotile. Filaments that may be present in certain species are either straight or wavy and may have swollen or clubbed heads. [NIH] Adsorption: The attachment of one substance to the surface of another; the concentration of a gas or a substance in solution in a liquid on a surface in contact with the gas or liquid, resulting in a relatively high concentration of the gas or solution at the surface. [EU] Antibody: An immunoglobulin molecule that has a specific amino acid sequence by virtue of which it interacts only with the antigen that induced its synthesis in cells of the lymphoid series (especially plasma cells), or with
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antigen closely related to it. Antibodies are classified according to their ode of action as agglutinins, bacteriolysins, haemolysins, opsonins, precipitins, etc. [EU] Antigen: Any substance which is capable, under appropriate conditions, of inducing a specific immune response and of reacting with the products of that response, that is, with specific antibody or specifically sensitized Tlymphocytes, or both. Antigens may be soluble substances, such as toxins and foreign proteins, or particulate, such as bacteria and tissue cells; however, only the portion of the protein or polysaccharide molecule known as the antigenic determinant (q.v.) combines with antibody or a specific receptor on a lymphocyte. Abbreviated Ag. [EU] Antigens: Substances that are recognized by the immune system and induce an immune reaction. [NIH] Antioxidant: One of many widely used synthetic or natural substances added to a product to prevent or delay its deterioration by action of oxygen in the air. Rubber, paints, vegetable oils, and prepared foods commonly contain antioxidants. [EU] Antioxidants: Naturally occurring or synthetic substances that inhibit or retard the oxidation of a substance to which it is added. They counteract the harmful and damaging effects of oxidation in animal tissues. [NIH] Assay: Determination of the amount of a particular constituent of a mixture, or of the biological or pharmacological potency of a drug. [EU] Autoimmunity: Process whereby the immune system reacts against the body's own tissues. Autoimmunity may produce or be caused by autoimmune diseases. [NIH] Bacteremia: The presence of viable bacteria circulating in the blood. Fever, chills, tachycardia, and tachypnea are common acute manifestations of bacteremia. The majority of cases are seen in already hospitalized patients, most of whom have underlying diseases or procedures which render their bloodstreams susceptible to invasion. [NIH] Bacteroides: A genus of gram-negative, anaerobic, rod-shaped bacteria. Its organisms are normal inhabitants of the oral, respiratory, intestinal, and urogenital cavities of humans, animals, and insects. Some species may be pathogenic. [NIH] Biochemical: Relating to biochemistry; characterized by, produced by, or involving chemical reactions in living organisms. [EU] Bradykinin: A nonapeptide messenger that is enzymatically produced from kallidin in the blood where it is a potent but short-lived agent of arteriolar dilation and increased capillary permeability. Bradykinin is also released from mast cells during asthma attacks, from gut walls as a gastrointestinal
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vasodilator, from damaged tissues as a pain signal, and may be a neurotransmitter. [NIH] Brucellosis: Infection caused by bacteria of the genus brucella mainly involving the reticuloendothelial system. This condition is characterized by fever, weakness, malaise, and weight loss. [NIH] Bruxism: A disorder characterized by grinding and clenching of the teeth. [NIH]
Candidiasis: Infection with a fungus of the genus Candida. It is usually a superficial infection of the moist cutaneous areas of the body, and is generally caused by C. albicans; it most commonly involves the skin (dermatocandidiasis), oral mucous membranes (thrush, def. 1), respiratory tract (bronchocandidiasis), and vagina (vaginitis). Rarely there is a systemic infection or endocarditis. Called also moniliasis, candidosis, oidiomycosis, and formerly blastodendriosis. [EU] Chemotaxis: The movement of cells or organisms toward or away from a substance in response to its concentration gradient. [NIH] Chlorine: A greenish-yellow, diatomic gas that is a member of the halogen family of elements. It has the atomic symbol Cl, atomic number 17, and atomic weight 70.906. It is a powerful irritant that can cause fatal pulmonary edema. Chlorine is used in manufacturing, as a reagent in synthetic chemistry, for water purification, and in the production of chlorinated lime, which is used in fabric bleaching. [NIH] Chronic: Persisting over a long period of time. [EU] Commensal: 1. living on or within another organism, and deriving benefit without injuring or benefiting the other individual. 2. an organism living on or within another, but not causing injury to the host. [EU] Cytokines: Non-antibody proteins secreted by inflammatory leukocytes and some non-leukocytic cells, that act as intercellular mediators. They differ from classical hormones in that they are produced by a number of tissue or cell types rather than by specialized glands. They generally act locally in a paracrine or autocrine rather than endocrine manner. [NIH] Cytotoxic: Pertaining to or exhibiting cytotoxicity. [EU] Defensins: Family of antimicrobial peptides that have been identified in humans, animals, and plants. They are thought to play a role in host defenses against infections, inflammation, wound repair, and acquired immunity. Based on the disulfide pairing of their characteristic six cysteine residues, they are divided into alpha-defensins and beta-defensins. [NIH] Dentifrices: Any preparations used for cleansing teeth; they usually contain an abrasive, detergent, binder and flavoring agent and may exist in the form of liquid, paste or powder; may also contain medicaments and caries
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preventives. [NIH] Disinfectant: An agent that disinfects; applied particularly to agents used on inanimate objects. [EU] Electrophoresis: An electrochemical process in which macromolecules or colloidal particles with a net electric charge migrate in a solution under the influence of an electric current. [NIH] Endotoxic: Of, relating to, or acting as an endotoxin (= a heat-stable toxin, associated with the outer membranes of certain gram-negative bacteria. Endotoxins are not secreted and are released only when the cells are disrupted). [EU] Epidemiological: Relating to, or involving epidemiology. [EU] Ethnopharmacology: The study of the actions and properties of drugs, usually derived from medicinal plants, indigenous to a population or ethnic group. [NIH] Exocrine: 1. secreting outwardly, via a duct;. [EU] Febrile: Pertaining to or characterized by fever. [EU] Fibroblasts: Connective tissue cells which secrete an extracellular matrix rich in collagen and other macromolecules. [NIH] Gels: Colloids with a solid continuous phase and liquid as the dispersed phase; gels may be unstable when, due to temperature or other cause, the solid phase liquifies; the resulting colloid is called a sol. [NIH] Genotype: The genetic constitution of the individual; the characterization of the genes. [NIH] Haemophilus: A genus of pasteurellaceae that consists of several species occurring in animals and humans. Its organisms are described as gramnegative, facultatively anaerobic, coccobacillus or rod-shaped, and nonmotile. [NIH] Halitosis: An offensive, foul breath odor resulting from a variety of causes such as poor oral hygiene, dental or oral infections, or the ingestion of certain foods. [NIH] Hybridization: The genetic process of crossbreeding to produce a hybrid. Hybrid nucleic acids can be formed by nucleic acid hybridization of dna and rna molecules. protein hybridization allows for hybrid proteins to be formed from polypeptide chains. [NIH] Invasive: 1. having the quality of invasiveness. 2. involving puncture or incision of the skin or insertion of an instrument or foreign material into the body; said of diagnostic techniques. [EU] Lymphocytic: Pertaining to, characterized by, or of the nature of lymphocytes. [EU]
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Lytic: 1. pertaining to lysis or to a lysin. 2. producing lysis. [EU] Membrane: A thin layer of tissue which covers a surface, lines a cavity or divides a space or organ. [EU] Microbiology: The study of microorganisms such as fungi, bacteria, algae, archaea, and viruses. [NIH] Microorganism: A microscopic organism; those of medical interest include bacteria, viruses, fungi and protozoa. [EU] Mononucleosis: The presence of an abnormally large number of mononuclear leucocytes (monocytes) in the blood. The term is often used alone to refer to infectious mononucleosis. [EU] Pharmacokinetics: The action of drugs in the body over a period of time, including the processes of absorption, distribution, localization in tissues, biotransformation, and excretion. [EU] Phenotype: The outward appearance of the individual. It is the product of interactions between genes and between the genotype and the environment. This includes the killer phenotype, characteristic of yeasts. [NIH] Porphyromonas: A genus of gram-negative, anaerobic, nonsporeforming, nonmotile rods or coccobacilli. Organisms in this genus had originally been classified as members of the bacteroides genus but overwhelming biochemical and chemical findings indicated the need to separate them from other Bacteroides species, and hence, this new genus was created. [NIH] Postoperative: Occurring after a surgical operation. [EU] Precipitation: The act or process of precipitating. [EU] Prevalence: The total number of cases of a given disease in a specified population at a designated time. It is differentiated from incidence, which refers to the number of new cases in the population at a given time. [NIH] Prevotella: A genus of gram-negative, anaerobic, nonsporeforming, nonmotile rods. Organisms of this genus had originally been classified as members of the bacteroides genus but overwhelming biochemical and chemical findings in 1990 indicated the need to separate them from other Bacteroides species, and hence, this new genus was established. [NIH] Prophylaxis: The prevention of disease; preventive treatment. [EU] Protease: Proteinase (= any enzyme that catalyses the splitting of interior peptide bonds in a protein). [EU] Proteins: Polymers of amino acids linked by peptide bonds. The specific sequence of amino acids determines the shape and function of the protein. [NIH]
Quaternary: 1. fourth in order. 2. containing four elements or groups. [EU] Recombinant: 1. a cell or an individual with a new combination of genes not
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found together in either parent; usually applied to linked genes. [EU] Sarcoidosis: An idiopathic systemic inflammatory granulomatous disorder comprised of epithelioid and multinucleated giant cells with little necrosis. It usually invades the lungs with fibrosis and may also involve lymph nodes, skin, liver, spleen, eyes, phalangeal bones, and parotid glands. [NIH] Secretion: 1. the process of elaborating a specific product as a result of the activity of a gland; this activity may range from separating a specific substance of the blood to the elaboration of a new chemical substance. 2. any substance produced by secretion. [EU] Sequela: Any lesion or affection following or caused by an attack of disease. [EU]
Serum: The clear portion of any body fluid; the clear fluid moistening serous membranes. 2. blood serum; the clear liquid that separates from blood on clotting. 3. immune serum; blood serum from an immunized animal used for passive immunization; an antiserum; antitoxin, or antivenin. [EU] Species: A taxonomic category subordinate to a genus (or subgenus) and superior to a subspecies or variety, composed of individuals possessing common characters distinguishing them from other categories of individuals of the same taxonomic level. In taxonomic nomenclature, species are designated by the genus name followed by a Latin or Latinized adjective or noun. [EU] Spectrum: A charted band of wavelengths of electromagnetic vibrations obtained by refraction and diffraction. By extension, a measurable range of activity, such as the range of bacteria affected by an antibiotic (antibacterial s.) or the complete range of manifestations of a disease. [EU] Streptococcus: A genus of gram-positive, coccoid bacteria whose organisms occur in pairs or chains. No endospores are produced. Many species exist as commensals or parasites on man or animals with some being highly pathogenic. A few species are saprophytes and occur in the natural environment. [NIH] Sublingual: Located beneath the tongue. [EU] Tomography: The recording of internal body images at a predetermined plane by means of the tomograph; called also body section roentgenography. [EU]
Topical: Pertaining to a particular surface area, as a topical anti-infective applied to a certain area of the skin and affecting only the area to which it is applied. [EU] Toxicity: The quality of being poisonous, especially the degree of virulence of a toxic microbe or of a poison. [EU] Treponema: A genus of microorganisms of the order spirochaetales, many
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of which are pathogenic and parasitic for man. [NIH] Triclosan: A diphenyl ether derivative used in cosmetics and toilet soaps as an antiseptic. It has some bacteriostatic and fungistatic action. [NIH] Tuberculosis: Any of the infectious diseases of man and other animals caused by species of mycobacterium. [NIH] Tularemia: A plague-like disease of rodents, transmissible to man. It is caused by Francisella Tularensis and is characterized by fever, chills, headache, backache, and weakness. [NIH] Virulence: The degree of pathogenicity within a group or species of microorganisms or viruses as indicated by case fatality rates and/or the ability of the organism to invade the tissues of the host. [NIH] Viruses: Minute infectious agents whose genomes are composed of DNA or RNA, but not both. They are characterized by a lack of independent metabolism and the inability to replicate outside living host cells. [NIH]
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CHAPTER 5. BOOKS ON GINGIVITIS Overview This chapter provides bibliographic book references relating to gingivitis. You have many options to locate books on gingivitis. The simplest method is to go to your local bookseller and inquire about titles that they have in stock or can special order for you. Some patients, however, feel uncomfortable approaching their local booksellers and prefer online sources (e.g. www.amazon.com and www.bn.com). In addition to online booksellers, excellent sources for book titles on gingivitis include the Combined Health Information Database and the National Library of Medicine. Once you have found a title that interests you, visit your local public or medical library to see if it is available for loan.
Book Summaries: Federal Agencies The Combined Health Information Database collects various book abstracts from a variety of healthcare institutions and federal agencies. To access these summaries, go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. You will need to use the “Detailed Search” option. To find book summaries, use the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer. For the format option, select “Monograph/Book.” Now type “gingivitis” (or synonyms) into the “For these words:” box. You will only receive results on books. You should check back periodically with this database which is updated every 3 months. The following is a typical result when searching for books on gingivitis:
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Oral Medicine and Hospital Practice Source: Chicago, IL: Special Care Dentistry. 1997. 362 p. Contact: Available from Special Care Dentistry. 211 East Chicago Avenue, Chicago, IL 60611. (312) 440-2660. Fax (312) 440-2824. PRICE: $27.00 (member) or $30.00 (nonmember), plus shipping and handling; institutional prices and bulk orders available. ISBN: 0965719103. Summary: This manual is designed to help dental residents, students, and practitioners engaged in the care of both ambulatory and nonambulatory patients. The ten chapters provide information on questions that arise concerning a patient's medical history, medications, lab values, risk assessment, and clinical management. Topics include hospital structure and function, in-hospital care of dental patients, outpatient management of medically compromised patients, consultations, dental emergencies, medical emergencies, problems of the oral mucosa, treatment protocol, principles of drug therapy and formulary, and laboratory tests. The chapter on dental emergencies covers intraoral emergencies, postoperative emergencies, odontogenic infections, salivary gland emergencies, maxillofacial trauma, and temporomandibular joint emergencies. The chapter on problems of the oral mucosa covers angular cheilitis, bleeding, burning mouth, desquamative gingivitis, dry mouth, erythema of the mucosa, glossitis, odor, pain, pigmented lesions, ulcers, vesiculobullous disorders, and white patches. Most information is presented in outline format, for ease of access.
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Blue Book: Dental Prescription Handbook Source: Cleveland, OH: American Academy of Oral Pharmacology. 1996. 32 p. Contact: Available from Academy of Oral Pharmacology. 24200 Chagrin Boulevard, Cleveland, OH 44122. (216) 292-0229; E-mail:
[email protected]. PRICE: $15.00 plus shipping and handling. Summary: This handbook includes over 50 dental product categories and more than 500 dental product entries. The chapters are alphabetical listings of dental conditions. Each chapter contains numerous listings of dental products in categories. These dental products are positioned as potential solutions to the dental conditions. Nineteen chapters are included: allergies, anxiety, aphthous ulcers and minor oral trauma, caries, dentinal hypersensitivity, diagnosis, nicotine addiction, gingivitis, halitosis, hepatitis B, infection control, infections, medical emergencies, oral surgery, pain, periodontitis, sinusitis, stained teeth, and xerostomia. Appendices cover infective endocarditis, AHA prophylactic regimens
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and guidelines, adult hypertension classifications, adult hematology and complete blood counts, gingival hyperplastic agents, metric weight and volume, the Blue Book Top-30 drug key, xerostomic agents, and 19961997 major dental meetings. (AA-M). ·
Atlas of Diseases of the Oral Cavity in HIV Infection Source: Copenhagen, Denmark: Munksgaard. 1995. 152 p. Contact: Available from Munksgaard. 35 Norre Sogade, P.O. Box 2148, DK-1016, Copenhagen K, Denmark. Telephone +45 33 12 70 30; Fax +45 33 12 93 87; E-mail:
[email protected]; http://www.munksgaard.dk/publishers/. PRICE: DKK 400,000 plus postage; contact directly for current price in US dollars. ISBN: 8716115090. Summary: This atlas of oral diseases in HIV infection depicts and describes the oral manifestations of HIV in three sections. The authors stress that oral manifestations are often the key to an initial clinical diagnosis of HIV infection. The introductory material discusses epidemiology, the global aspects of HIV seropositivity, predictions for the future, and the classification of oral lesions associated with HIV infection. The first section covers lesions strongly associated with HIV infection including candidiasis, hyperplasia, angular cheilitis, hairy leukoplakia, periodontal diseases, linear gingival erythema, necrotizing gingivitis, stomatitis and periodontitis, Kaposi's sarcoma, and nonHodgkin's lymphoma. The second section covers lesions less commonly associated with HIV infection including tuberculosis, hyperpigmentation, pigmentation of the nails, enlargement of major salivary glands, lymphoepithelial lesion, thrombocytopenia, atypical ulceration, herpes labialis, herpetic stomatitis, herpes zoster, varicella, condyloma acuminatum, focal epithelial hyperplasis, and verruca vulgaris. The third section outlines lesions seen in HIV infection, notably Klebsiella pneumonia infection, bacillar epithelioid angiomatosis, toxic epidermal necrolysis, drug-induced ulcerations, cryptococcoses, mucormycosis, penicilliosis, facial nerve paralysis, aphthous ulceration, cytomegalovirus-induced oral ulceration, and molluscum contagiosum. A final section describes other lesions, including exfoliative cheilitis, impetigo contagiosa, secondary syphilis, lichenoid lesions of buccal mucosa, and oral cancer. The atlas depicts each manifestation with a fullcolor photograph and provides brief descriptions. The book concludes with a list of references, coding according to the international classification of diseases, and a subject index. 111 figures. 193 references.
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Impact of Tobacco Use on Nonmalignant and Precancerous Oral and Dental Diseases and Conditions: An Indiana University School of Dentistry Teaching Monograph. A Comprehensive Review Source: Indianapolis, IN: Department of Preventive and Community Dentistry, Indiana School of Dentistry. June 1991. 80 p. Contact: Available from Indiana University School of Dentistry. Department of Preventive and Community Dentistry, 1121 West Michigan Street, Indianapolis, IN 46202-5186. Website: www.iusd.iupui.edu. PRICE: Single copy free. Summary: In addition to a number of intraoral malignancies (cancer), a wide variety of precancerous and nonmalignant oral and perioral diseases and conditions are also directly or indirectly linked to the use of smoked and smokeless (spit) tobacco (ST). This monograph is designed to help the reader understand the etiology, scope, and physical impact of these abnormalities as they relate to tobacco use. This document presents a comprehensive literature review on this topic. The authors reviewed over 800 scientific works and used 426 of these published articles as the basis for this document. The authors emphasize the oral effects of cigarette smoking, but they also review oral problems related to ST use. The literature review demonstrates how tobacco cessation benefits oral health, particularly regarding leukoplakia, stomatitis nicotina, impaired gingival bleeding, periodontitis, gingival (gum) recession, acute necrotizing ulcerative gingivitis, dental calculus, halitosis (bad breath) and dental staining, dental caries, delayed oral wound healing, smoker's melanosis, oral candidiasis, recurrent aphthous ulcers, and altered taste and smell. Information from this report can be used by oral health team members as they learn to recognize and deal with the tobacco related conditions which they diagnose in their patients. A subject index concludes the document. 4 tables. 426 references.
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Instructions for Patients. 5th ed Source: Orlando, FL: W.B. Saunders Company. 1994. 598 p. Contact: Available from W.B. Saunders Company. Order Fulfillment, 6277 Sea Harbor Drive, Orlando, FL 32887-4430. (800) 545-2522 (individuals) or (800) 782-4479 (schools); Fax (800) 874-6418 or (407) 3523445; http://www.wbsaunders.com. PRICE: $52.00 (English); $49.95 (Spanish); plus shipping and handling. ISBN: 0721649300 (English); 0721669972 (Spanish). Summary: This book is a compilation of instructions for patients, published in paperback format. The fact sheets each provide information in three sections: basic information, including a description of the
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condition, frequent signs and symptoms, causes, risk factors, preventive measures, expected outcome, and possible complications; treatment, including general measures, medication, activity guidelines, and diet; and when to contact one's health care provider. Fact sheets are available on oral health topics including: herpangina, leukoplakia, lichen planus, salivary gland infection, benign mouth or tongue tumors, oral cancer, periodontitis, salivary gland tumors, Sjogren's syndrome, stomatitis, teething, temporomandibular joint syndrome (TMJ), oral candidiasis (thrush), thumbsucking, glossitis (tongue inflammation), bruxism (tooth grinding), necrotizing ulcerative gingivitis (trench mouth), and trigeminal neuralgia (tic douloureux). The fact sheets are designed to be photocopied and distributed to patients as a reinforcement of oral instructions and as a teaching tool.
Book Summaries: Online Booksellers Commercial Internet-based booksellers, such as Amazon.com and Barnes & Noble.com, offer summaries which have been supplied by each title’s publisher. Some summaries also include customer reviews. Your local bookseller may have access to in-house and commercial databases that index all published books (e.g. Books in PrintÒ). The following have been recently listed with online booksellers as relating to gingivitis (sorted alphabetically by title; follow the hyperlink to view more details at Amazon.com): ·
Gingivitis by William George Cross; ISBN: 0723604525; http://www.amazon.com/exec/obidos/ASIN/0723604525/icongroupin terna
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The Borderland between caries and periodontal disease : proceedings of a conference sponsored by the Royal Society of Medicine, 28 February 1977 ; ISBN: 0808910817; http://www.amazon.com/exec/obidos/ASIN/0808910817/icongroupin terna
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The Dental Implant : Clinical and Biological Response of Oral Tissues by Ralph V. McKinney, Jack E. Lemons (Editor); ISBN: 0884164918; http://www.amazon.com/exec/obidos/ASIN/0884164918/icongroupin terna
The National Library of Medicine Book Index The National Library of Medicine at the National Institutes of Health has a massive database of books published on healthcare and biomedicine. Go to
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the following Internet site, http://locatorplus.gov/, and then select “Search LOCATORplus.” Once you are in the search area, simply type “gingivitis” (or synonyms) into the search box, and select “books only.” From there, results can be sorted by publication date, author, or relevance. The following was recently catalogued by the National Library of Medicine:22 ·
Caries in deciduous teeth and public dental care in Finland. Author: Milén, Anneli. Studies on immunologic and inflammatory factors in the saliva and gingiva in patients with asthma / Hyyppä, Tuula; Year: 1984; Helsinki: Suomen Hammaslääkäriseura, 1984
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Chlorhexidine in the prevention and treatment of gingivitis. Author: Harald Löe (editor); Year: 1986; Copenhagen: Munksgaard, [1986]; ISBN: 8716063678 (pbk.) Clinical guide to periodontology. Author: Richard M. Palmer, Peter D. Floyd; foreword by William Becker; Year: 1996; London: British Dental Association, 1996; ISBN: 0904588483
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Development of experimental gingivitis at different ages in young individuals: clinical, light microscopy and transmission electron microscopy studies. Author: by Lars Matsson; Year: 1979; Malmö: Departments of Pedodontics and Periodontology, School of Denistry, University of Lund, 1979
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Electron microscopic study of chronic desquamative gingivitis [by] Hiromasa Nikai, George G. Rose, and Martin Cattoni. Author: Nikai, Hiromasa, 1937-; Year: 1971; Copenhagen, Munksgaard, 1971
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Gingival inflammation and female sex hormones; a clinical investigation of pregnant women and experimental studies in dogs. Author: Hugoson, Anders; Year: 1970; Copenhagen, Munksgaard, 1970; ISBN: 8716001354 Gingivectomy. Author: Beube, Frank E; Year: 1957; Chicago, Year Book Publishers, 1957 Gingivitis. Author: W. G. Cross; Year: 1977; Bristol: Wright, 1977; ISBN: 0723604525
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In addition to LOCATORPlus, in collaboration with authors and publishers, the National Center for Biotechnology Information (NCBI) is adapting biomedical books for the Web. The books may be accessed in two ways: (1) by searching directly using any search term or phrase (in the same way as the bibliographic database PubMed), or (2) by following the links to PubMed abstracts. Each PubMed abstract has a “Books” button that displays a facsimile of the abstract in which some phrases are hypertext links. These phrases are also found in the books available at NCBI. Click on hyperlinked results in the list of books in which the phrase is found. Currently, the majority of the links are between the books and PubMed. In the future, more links will be created between the books and other types of information, such as gene and protein sequences and macromolecular structures. See http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Books.
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http://www.amazon.com/exec/obidos/ASIN/0723604525/icongroupin terna ·
Gingivitis. Author: Cross, W. G. (William George); Year: 1965; Bristol, Wright, 1965
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Interstitial gingivitis and pyorrhoea alveolaris. Author: Talbot, Eugene Solomon, 1847-1924; Year: 1913; Toledo, Ransom & Randolph, 1913
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Longitudinal study of the use of chlorhexidine in the prevention of dental plaque, caries and gingivitis. Author: Löe, Harald; Year: 1974; Springfield, VA.: NTIS, 1974
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Neutrophil leukocyte enzymes in gingival inflammation. Author: Gunilla Tynelius-Bratthall; Year: 1973; Göteborg, Sweden: [s.n.], 1973; ISBN: 9172220376 Periodontal therapy. Author: Claude L. Nabers, William H. Stalker; Year: 1990; Toronto; Philadelphia: B.C. Decker, 1990; ISBN: 1556642199 http://www.amazon.com/exec/obidos/ASIN/1556642199/icongroupin terna
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Vincent's infection; necrotizing ulcerative gingivitis. Author: Ivancie, Gerald P., 1923-; Year: 1958; Chicago, Year Book Publishers, 1958
Chapters on Gingivitis Frequently, gingivitis will be discussed within a book, perhaps within a specific chapter. In order to find chapters that are specifically dealing with gingivitis, an excellent source of abstracts is the Combined Health Information Database. You will need to limit your search to book chapters and gingivitis using the “Detailed Search” option. Go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. To find book chapters, use the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer, and the format option “Book Chapter.” By making these selections and typing in “gingivitis” (or synonyms) into the “For these words:” box, you will only receive results on chapters in books. The following is a typical result when searching for book chapters on gingivitis: ·
Gingivitis and Periodontal Disease Source: in McDonald, R.E. and Avery, D.A., eds. Dentistry for the Child and Adolescent. 7th ed. St. Louis, MO: Mosby, Inc. 2000. p. 440-484. Contact: Available from Harcourt Health Sciences. 11830 Westline Industrial Drive, St. Louis, MO 63146. (800) 325-4177. Fax (800) 874-6418.
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Website: www.harcourthealth.com. PRICE: $72.00 plus shipping and handling. ISBN: 0815190174. Summary: Gingivitis, a type of periodontal disease, is an inflammation involving only the gingival (gum) tissues next to the tooth. This chapter on gingivitis and periodontal disease is from a textbook on dentistry for the child and adolescent that is designed to help undergraduate dental students and postdoctoral pediatric dentistry students provide comprehensive oral health care for infants, children, teenagers, and individuals with various disabilities. The authors cover simple gingivitis, including eruption gingivitis, gingivitis associated with poor oral hygiene, and allergy and gingival inflammation; acute gingival disease, including that due to herpes simplex virus infection, recurrent aphthous ulcer (canker sore), acute necrotizing ulcerative gingivitis (ANUG), acute candidiasis (thrush, a fungal infection), and acute bacterial infections; chronic nonspecific gingivitis; chlorhexidine as a therapeutic plaque control agent; conditioned gingival enlargement, including puberty gingivitis, fibromatosis, and phenytoin (Dilantin) induced gingival overgrowth; scorbutic gingivitis (associated with vitamin C deficiency); periodontal diseases in children, including periodontitis, premature bone loss in primary dentition, Papillon Lefevre syndrome (precocious periodontosis), gingival recession, the differential diagnosis of self mutilation, abnormal frenum attachment, and frenectomy; the clinical assessment of oral cleanliness and periodontal disease; extrinsic stains and deposits on teeth; and dental calculus (seen with low frequency in children). 44 figures. 93 references. ·
Gingivitis Source: in Soderman, W.A., Jr. Instructions for Geriatric Patients. Orlando, FL: W.B. Saunders Company. 1995. p. 95-96. Contact: Available from W.B. Saunders Company. Book Orders Fulfillment Department, 6277 Sea Harbor Drive, Orlando, FL 32821-9854. (800) 545-2522; Fax (800) 874-6418 or (407) 352-3445; http://www.wbsaunders.com. PRICE: $38.95 plus shipping and handling. ISBN: 0721643353. Summary: This chapter on gingivitis is from a book of strategies to help caregivers provide better care to geriatric patients. The book provides simple, direct aids to improve communication between physicians, other health care providers, caregivers, and patients. Gingivitis, like dental caries, is a result of mouth bacteria infecting normal tissues. The author focuses on the importance of regular oral hygiene to prevent problems like gingivitis, particularly in this patient population. The chapter covers important points in treatment, including control and reversal of gingivitis
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and the associated periodontal disease and diseases that may cause or exacerbate gingivitis (e.g., diabetes), regular toothbrushing and flossing, and contacting a health care provider. ·
Trench Mouth (Necrotizing Ulcerative Gingivitis; Vincent's Disease) Source: in Griffith, H.W. Instruction for Patients. 5th ed. Orlando, FL: W.B. Saunders Company. 1994. p. 476. Contact: Available from W.B. Saunders Company. Order Fulfillment, 6277 Sea Harbor Drive, Orlando, FL 32887-4430. (800) 545-2522 (individuals) or (800) 782-4479 (schools); Fax (800) 874-6418 or (407) 3523445; http://www.wbsaunders.com. PRICE: $52.00 (English); $49.95 (Spanish); plus shipping and handling. ISBN: 0721649300 (English); 0721669972 (Spanish). Summary: This fact sheet on necrotizing ulcerative gingivitis (trench mouth) is from a compilation of instructions for patients, published in book format. Also known as Vincent's Disease, necrotizing ulcerative gingivitis is an infection of the tissue between the teeth. The fact sheet provides information in three sections: basic information, including a description of the condition, frequent signs and symptoms, causes, risk factors, preventive measures, expected outcome, and possible complications; treatment, including general measures, medication, activity guidelines, and diet; and when to contact one's health care provider. The fact sheet is designed to be photocopied and distributed to patients as a reinforcement of oral instructions and as a teaching tool.
General Home References In addition to references for gingivitis, you may want a general home medical guide that spans all aspects of home healthcare. The following list is a recent sample of such guides (sorted alphabetically by title; hyperlinks provide rankings, information, and reviews at Amazon.com): ·
Dental Terminology by Charline M. Dofka, et al; Paperback - 312 pages, 1st edition (July 12, 1999), Delmar Publishers; ISBN: 0827390688; http://www.amazon.com/exec/obidos/ASIN/0827390688/icongroupinter na
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Oral Medicine Secrets by Sonis; Paperback (August 15, 2002), Hanley & Belfus; ISBN: 1560534192; http://www.amazon.com/exec/obidos/ASIN/1560534192/icongroupinter na
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·
The Perfect Smile: A Consumer's Guide to Dental Health and Cosmetic Dentistry by James Doundoulakis, Warren Strugatch; Paperback - 160 pages (May 2002), Hatherleigh Press; ISBN: 1578260957; http://www.amazon.com/exec/obidos/ASIN/1578260957/icongroupinter na
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Prentice Hall Health: Complete Review of Dental Hygiene by Jacqueline N. Brian, Mary Danusis Cooper; Paperback - 612 pages, 1st edition (July 10, 2001), Prentice Hall; ISBN: 0130833282; http://www.amazon.com/exec/obidos/ASIN/0130833282/icongroupinter na
Vocabulary Builder Anesthesia: A state characterized by loss of feeling or sensation. This depression of nerve function is usually the result of pharmacologic action and is induced to allow performance of surgery or other painful procedures. [NIH]
Angioedema: A vascular reaction involving the deep dermis or subcutaneous or submucal tissues, representing localized edema caused by dilatation and increased permeability of the capillaries, and characterized by development of giant wheals. [EU] Anxiety: The unpleasant emotional state consisting of psychophysiological responses to anticipation of unreal or imagined danger, ostensibly resulting from unrecognized intrapsychic conflict. Physiological concomitants include increased heart rate, altered respiration rate, sweating, trembling, weakness, and fatigue; psychological concomitants include feelings of impending danger, powerlessness, apprehension, and tension. [EU] Atypical: Irregular; not conformable to the type; in microbiology, applied specifically to strains of unusual type. [EU] Benign: Not malignant; not recurrent; favourable for recovery. [EU] Buccal: Pertaining to or directed toward the cheek. In dental anatomy, used to refer to the buccal surface of a tooth. [EU] Cheilitis: Inflammation of the lips. It is of various etiologies and degrees of pathology. [NIH] Condyloma: C. acuminatum; a papilloma with a central core of connective tissue in a treelike structure covered with epithelium, usually occurring on the mucous membrane or skin of the external genitals or in the perianal region. [EU] Cutaneous: Pertaining to the skin; dermal; dermic. [EU]
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Cyst: Any closed cavity or sac; normal or abnormal, lined by epithelium, and especially one that contains a liquid or semisolid material. [EU] Cytomegalovirus: A genus of the family herpesviridae, subfamily betaherpesvirinae, infecting the salivary glands, liver, spleen, lungs, eyes, and other organs, in which they produce characteristically enlarged cells with intranuclear inclusions. Infection with Cytomegalovirus is also seen as an opportunistic infection in AIDS. [NIH] Dentition: The teeth in the dental arch; ordinarily used to designate the natural teeth in position in their alveoli. [EU] Dermatitis: Inflammation of the skin. [EU] Dermatosis: Any skin disease, especially one not characterized by inflammation. [EU] Endocarditis: Exudative and proliferative inflammatory alterations of the endocardium, characterized by the presence of vegetations on the surface of the endocardium or in the endocardium itself, and most commonly involving a heart valve, but sometimes affecting the inner lining of the cardiac chambers or the endocardium elsewhere. It may occur as a primary disorder or as a complication of or in association with another disease. [EU] Epidermal: Pertaining to or resembling epidermis. Called also epidermic or epidermoid. [EU] Erythema: A name applied to redness of the skin produced by congestion of the capillaries, which may result from a variety of causes, the etiology or a specific type of lesion often being indicated by a modifying term. [EU] Fibrosis: The formation of fibrous tissue; fibroid or fibrous degeneration [EU] Fissure: Any cleft or groove, normal or otherwise; especially a deep fold in the cerebral cortex which involves the entire thickness of the brain wall. [EU] Geriatric: Pertaining to the treatment of the aged. [EU] Glossitis: Inflammation of the tongue. [EU] Hematology: A subspecialty of internal medicine concerned with morphology, physiology, and pathology of the blood and blood-forming tissues. [NIH] Hemorrhage: Bleeding or escape of blood from a vessel. [NIH] Hepatitis: Inflammation of the liver. [EU] Herpes: Any inflammatory skin disease caused by a herpesvirus and characterized by the formation of clusters of small vesicles. When used alone, the term may refer to herpes simplex or to herpes zoster. [EU] Hormones: Chemical substances having a specific regulatory effect on the activity of a certain organ or organs. The term was originally applied to substances secreted by various endocrine glands and transported in the
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bloodstream to the target organs. It is sometimes extended to include those substances that are not produced by the endocrine glands but that have similar effects. [NIH] Hyperpigmentation: Excessive pigmentation of the skin, usually as a result of increased melanization of the epidermis rather than as a result of an increased number of melanocytes. Etiology is varied and the condition may arise from exposure to light, chemicals or other substances, or from a primary metabolic imbalance. [NIH] Hyperplasia: The abnormal multiplication or increase in the number of normal cells in normal arrangement in a tissue. [EU] Hypersensitivity: A state of altered reactivity in which the body reacts with an exaggerated immune response to a foreign substance. Hypersensitivity reactions are classified as immediate or delayed, types I and IV, respectively, in the Gell and Coombs classification (q.v.) of immune responses. [EU] Hypertension: Persistently high arterial blood pressure. Various criteria for its threshold have been suggested, ranging from 140 mm. Hg systolic and 90 mm. Hg diastolic to as high as 200 mm. Hg systolic and 110 mm. Hg diastolic. Hypertension may have no known cause (essential or idiopathic h.) or be associated with other primary diseases (secondary h.). [EU] Impetigo: A common superficial bacterial infection caused by staphylococcus aureus or group A beta-hemolytic streptococci. Characteristics include pustular lesions that rupture and discharge a thin, amber-colored fluid that dries and forms a crust. This condition is commonly located on the face, especially about the mouth and nose. [NIH] Keratosis: Any horny growth such as a wart or callus. [NIH] Klebsiella: A genus of gram-negative, facultatively anaerobic, rod-shaped bacteria whose organisms arrange singly, in pairs, or short chains. This genus is commonly found in the intestinal tract and is an opportunistic pathogen that can give rise to bacteremia, pneumonia, urinary tract and several other types of human infection. [NIH] Lesion: Any pathological or traumatic discontinuity of tissue or loss of function of a part. [EU] Lupus: A form of cutaneous tuberculosis. It is seen predominantly in women and typically involves the nasal, buccal, and conjunctival mucosa. [NIH]
Lymphoma: Any neoplastic disorder of the lymphoid tissue, the term lymphoma often is used alone to denote malignant lymphoma. [EU] Malformation: A morphologic defect resulting from an intrinsically abnormal developmental process. [EU] Melanosis: A disorder caused by a disturbance in melanin pigmentation;
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melanism. [EU] Microscopy: The application of microscope magnification to the study of materials that cannot be properly seen by the unaided eye. [NIH] Necrolysis: Separation or exfoliation of tissue due to necrosis. [EU] Neuralgia: Paroxysmal pain which extends along the course of one or more nerves. Many varieties of neuralgia are distinguished according to the part affected or to the cause, as brachial, facial, occipital, supraorbital, etc., or anaemic, diabetic, gouty, malarial, syphilitic, etc. [EU] Nicotine: Nicotine is highly toxic alkaloid. It is the prototypical agonist at nicotinic cholinergic receptors where it dramatically stimulates neurons and ultimately blocks synaptic transmission. Nicotine is also important medically because of its presence in tobacco smoke. [NIH] Paralysis: Loss or impairment of motor function in a part due to lesion of the neural or muscular mechanism; also by analogy, impairment of sensory function (sensory paralysis). In addition to the types named below, paralysis is further distinguished as traumatic, syphilitic, toxic, etc., according to its cause; or as obturator, ulnar, etc., according to the nerve part, or muscle specially affected. [EU] Parasitic: Pertaining to, of the nature of, or caused by a parasite. [EU] Perioral: Situated or occurring around the mouth. [EU] Pharmacologic: Pertaining to pharmacology or to the properties and reactions of drugs. [EU] Phenytoin: An anticonvulsant that is used in a wide variety of seizures. It is also an anti-arrhythmic and a muscle relaxant. The mechanism of therapeutic action is not clear, although several cellular actions have been described including effects on ion channels, active transport, and general membrane stabilization. The mechanism of its muscle relaxant effect appears to involve a reduction in the sensitivity of muscle spindles to stretch. Phenytoin has been proposed for several other therapeutic uses, but its use has been limited by its many adverse effects and interactions with other drugs. [NIH] Pneumonia: Inflammation of the lungs with consolidation. [EU] Psoriasis: A common genetically determined, chronic, inflammatory skin disease characterized by rounded erythematous, dry, scaling patches. The lesions have a predilection for nails, scalp, genitalia, extensor surfaces, and the lumbosacral region. Accelerated epidermopoiesis is considered to be the fundamental pathologic feature in psoriasis. [NIH] Sarcoma: A tumour made up of a substance like the embryonic connective tissue; tissue composed of closely packed cells embedded in a fibrillar or homogeneous substance. Sarcomas are often highly malignant. [EU]
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Sialorrhea: Increased salivary flow. [NIH] Sinusitis: Inflammation of a sinus. The condition may be purulent or nonpurulent, acute or chronic. Depending on the site of involvement it is known as ethmoid, frontal, maxillary, or sphenoid sinusitis. [EU] Stomatitis: Inflammation of the oral mucosa, due to local or systemic factors which may involve the buccal and labial mucosa, palate, tongue, floor of the mouth, and the gingivae. [EU] Syphilis: A contagious venereal disease caused by the spirochete treponema pallidum. [NIH] Thrombocytopenia: Decrease in the number of blood platelets. [EU] Ulceration: 1. the formation or development of an ulcer. 2. an ulcer. [EU] Urticaria: Pathology: a transient condition of the skin, usually caused by an allergic reaction, characterized by pale or reddened irregular, elevated patches and severe itching; hives. [EU] Varicella: Chicken pox. [EU] Vesicular: 1. composed of or relating to small, saclike bodies. 2. pertaining to or made up of vesicles on the skin. [EU] Xerostomia: Dryness of the mouth from salivary gland dysfunction, as in Sjögren's syndrome. [EU]
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CHAPTER 6. MULTIMEDIA ON GINGIVITIS Overview Information on gingivitis can come in a variety of formats. Among multimedia sources, video productions, slides, audiotapes, and computer databases are often available. In this chapter, we show you how to keep current on multimedia sources of information on gingivitis. We start with sources that have been summarized by federal agencies, and then show you how to find bibliographic information catalogued by the National Library of Medicine. If you see an interesting item, visit your local medical library to check on the availability of the title.
Video Recordings Most diseases do not have a video dedicated to them. If they do, they are often rather technical in nature. An excellent source of multimedia information on gingivitis is the Combined Health Information Database. You will need to limit your search to “video recording” and “gingivitis” using the “Detailed Search” option. Go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. To find video productions, use the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer, and the format option “Videorecording (videotape, videocassette, etc.).” By making these selections and typing “gingivitis” (or synonyms) into the “For these words:” box, you will only receive results on video productions. The following is a typical result when searching for video recordings on gingivitis: ·
Dental Care Source: Evanston, IL: Altschul Group Corporation. 1994. (videocassette).
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Contact: Available from Altschul Group Corporation. 1560 Sherman Avenue, Suite 100, Evanston, IL 60201-9971. (800) 323-9084 or (828) 3286700; Fax (847) 328-6706; E-mail:
[email protected]; http://www.agcmedia.com. PRICE: $179.00 plus shipping and handling. Order Number 7884. Summary: This videotape program presents an overview of dental health. The composition of the tooth and its role in the body are detailed. Viewers are shown the dental development from birth to old age. The proper care of teeth and preventive devices for sports activities are demonstrated. Orthodontics is explained, and techniques for treating dental abnormalities are shown. Periodontal disease, plaque, tartar, and gingivitis are defined and described. The video program stresses preventive measures, including proper brushing style, use of dental floss, and proper nutrition. The program is one in a series of self-health videos in which, by emphasizing lifestyle and environmental factors that increase the risk of illness, the prevention of disease is motivated. The programs also illustrate the impact of health problems on individuals and society. Each program in the series provides viewers with a better understanding of bodily functions and helps them to detect signs or symptoms of illness. (AA-M).
Bibliography: Multimedia on Gingivitis The National Library of Medicine is a rich source of information on healthcare-related multimedia productions including slides, computer software, and databases. To access the multimedia database, go to the following Web site: http://locatorplus.gov/. Select “Search LOCATORplus.” Once in the search area, simply type in gingivitis (or synonyms). Then, in the option box provided below the search box, select “Audiovisuals and Computer Files.” From there, you can choose to sort results by publication date, author, or relevance. The following multimedia has been indexed on gingivitis. For more information, follow the hyperlink indicated: ·
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Apically positioned partial thickness flap to eliminate periodontal pockets. Source: Veterans Administration Dental Training Center; Year: 1968; Format: Motion picture; Washington: The Center: [for sale by National Audiovisual Center; Atlanta: for loan by National Medical Audiovisual Center, 1968] Clinic on periodontal surgery. Source: [production company unknown]; sponsored by Crest Professional Services, the Procter & Gamble Company; presented by the University of Pennsylvania, School of
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Dentistry, in consultation with the American De; Year: 1961; Format: Motion picture; United States: Crest Professional Services, [1961] Contiguous osseous tissue autograph in periodontics. Source: Veterans Administration Dental Training Center; Year: 1969; Format: Motion picture; Washington: The Center; [Chicago: for loan by American Dental Assn., Bureau of Audiovisual Services; Washington: for sale by U. S. Veterans Administration Central Office Film Library, 1969] Gingival autograft in periodontics. Source: Veterans Administration Dental Training Center; Year: 1968; Format: Motion picture; Washington: The Center: [for sale by National Audiovisual Center; Atlanta: for loan by National Medical Audiovisual Center, 1968] Gum disease. Source: a presentation of Films for the Humanities & Sciences; ITV, Information Television Network; Year: 2001; Format: Videorecording; Princeton, N.J.: Films for the Humanities & Sciences, c2001 Histopathology of non-specific gingivitis. Source: College of Dentistry, University of Florida; Year: 1973; Format: Slide; [Gainesville, Fla.]: The College: [for loan by J. Hillis Miller Health Center, Learning Resource Center, 1973?] Mouth diseases. Source: [Armed Forces Institute of Pathology]; Year: 1951; Format: Slide; [Washington, D.C.]: The Institute: [for loan by Armed Forces Institute of Pathology Audio-visual Support Center], 1951 Periodontal disease : prevention and early treatment. Source: produced by Low & Associates, Inc; Year: 1963; Format: Motion picture; United States: Dept. of the Navy, 1963 Periodontal implications of orthodontic therapy. Source: American Association of Orthodontists; Year: 1970; Format: Slide; St. Louis: The Association, [1970] Plaque and oral disease. Source: Catherine J. Spence; produced by the Visual Education Dept., Virginia Commonwealth University, Medical College of Virginia Campus; Year: 1979; Format: Slide; Richmond: Spence; [Chapel Hill, N.C.: for sale by Health Sciences Consortium], c1979 Plaque diseases. Source: Irwin D. Mandel, Robert Gottsegen, Daniel S. Fine; Year: 1971; Format: Slide; New York: Medcom, c1972 Signs & symptoms of non-specific gingival inflammation. Source: College of Dentistry, University of Florida; Year: 1974; Format: Slide; [Gainesville, Fla.]: The College: [for loan by J. Hillis Miller Health Center, Learning Resource Center, 1974?] Signs and symptoms of gingivitis. Source: David J. Mishkin, in cooperation with the Office of Education, College of Dental Medicine, Medical University of South Carolina; Year: 1978; Format: Slide; Atlanta:
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·
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National Medical Audiovisual Center; [Washington: for sale by National Audiovisual Center], 1978 Signs and symptoms of periodontitis. Source: David J. Mishkin, in cooperation with the Office of Education, College of Dental Medicine, Medical University of South Carolina; Year: 1978; Format: Slide; Atlanta: National Medical Audiovisual Center, 1978 Systemic conditions affecting non-specific gingivitis. Source: College of Dentistry, University of Florida; produced by Ron Baughman; Year: 1973; Format: Slide; [Gainesville, Fla.]: The College, [1973] Tooth accumulated deposits: plaque, calculus, stain. Source: College of Dentistry, University of Florida; Year: 1973; Format: Slide; [Gainesville, Fla.]: The College: [for loan by J. Hillis Miller Health Center, Learning Resource Center, 1973?]
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CHAPTER 7. PERIODICALS AND NEWS ON GINGIVITIS Overview Keeping up on the news relating to gingivitis can be challenging. Subscribing to targeted periodicals can be an effective way to stay abreast of recent developments on gingivitis. Periodicals include newsletters, magazines, and academic journals. In this chapter, we suggest a number of news sources and present various periodicals that cover gingivitis beyond and including those which are published by patient associations mentioned earlier. We will first focus on news services, and then on periodicals. News services, press releases, and newsletters generally use more accessible language, so if you do chose to subscribe to one of the more technical periodicals, make sure that it uses language you can easily follow.
News Services & Press Releases Well before articles show up in newsletters or the popular press, they may appear in the form of a press release or a public relations announcement. One of the simplest ways of tracking press releases on gingivitis is to search the news wires. News wires are used by professional journalists, and have existed since the invention of the telegraph. Today, there are several major “wires” that are used by companies, universities, and other organizations to announce new medical breakthroughs. In the following sample of sources, we will briefly describe how to access each service. These services only post recent news intended for public viewing.
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PR Newswire Perhaps the broadest of the wires is PR Newswire Association, Inc. To access this archive, simply go to http://www.prnewswire.com. Below the search box, select the option “The last 30 days.” In the search box, type “gingivitis” or synonyms. The search results are shown by order of relevance. When reading these press releases, do not forget that the sponsor of the release may be a company or organization that is trying to sell a particular product or therapy. Their views, therefore, may be biased.
Reuters The Reuters' Medical News database can be very useful in exploring news archives relating to gingivitis. While some of the listed articles are free to view, others can be purchased for a nominal fee. To access this archive, go to http://www.reutershealth.com/frame2/arch.html and search by “gingivitis” (or synonyms). The following was recently listed in this archive for gingivitis: ·
Salmeterol tied to gingivitis in asthmatic children Source: Reuters Industry Breifing Date: December 12, 2001 http://www.reuters.gov/archive/2001/12/12/business/links/20011212 clin004.html
The NIH Within MEDLINEplus, the NIH has made an agreement with the New York Times Syndicate, the AP News Service, and Reuters to deliver news that can be browsed by the public. Search news releases at http://www.nlm.nih.gov/medlineplus/alphanews_a.html. MEDLINEplus allows you to browse across an alphabetical index. Or you can search by date at the following: http://www.nlm.nih.gov/medlineplus/newsbydate.html. Often, news items are indexed by MEDLINEplus within their search engine.
Business Wire Business Wire is similar to PR Newswire. To access this archive, simply go to http://www.businesswire.com. You can scan the news by industry category or company name.
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Internet Wire Internet Wire is more focused on technology than the other wires. To access this site, go to http://www.internetwire.com and use the “Search Archive” option. Type in “gingivitis” (or synonyms). As this service is oriented to technology, you may wish to search for press releases covering diagnostic procedures or tests that you may have read about.
Search Engines Free-to-view news can also be found in the news section of your favorite search engines (see the health news page at Yahoo: http://dir.yahoo.com/Health/News_and_Media/, or use this Web site’s general news search page http://news.yahoo.com/. Type in “gingivitis” (or synonyms). If you know the name of a company that is relevant to gingivitis, you can go to any stock trading Web site (such as www.etrade.com) and search for the company name there. News items across various news sources are reported on indicated hyperlinks.
BBC Covering news from a more European perspective, the British Broadcasting Corporation (BBC) allows the public free access to their news archive located at http://www.bbc.co.uk/. Search by “gingivitis” (or synonyms).
Newsletter Articles If you choose not to subscribe to a newsletter, you can nevertheless find references to newsletter articles. We recommend that you use the Combined Health Information Database, while limiting your search criteria to “newsletter articles.” Again, you will need to use the “Detailed Search” option. Go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. Go to the bottom of the search page where “You may refine your search by.” Select the dates and language that you prefer. For the format option, select “Newsletter Article.” By making these selections, and typing in “gingivitis” (or synonyms) into the “For these words:” box, you will only receive results on newsletter articles.
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You should check back periodically with this database as it is updated every 3 months. The following is a typical result when searching for newsletter articles on gingivitis: ·
Oral Health and Heart Disease Source: Harvard Health Letter. 11(7): 1-3. March 2001. Contact: Available from Harvard Health Publications. P.O. Box 420300, Palm Coast, FL 32142-0300. (800) 829-9045. Website: www.health.harvard.edu. Summary: This article explores the recent evidence that by averting gum disease, patients might actually be reducing their chances for developing heart disease. The author notes that, at the very least, it seems clear that people with worse dental health have a higher risk of heart attack. Recent findings link periodontal disease to cardiovascular disease. Periodontal disease is any disease, including gingivitis or periodontitis, that affects the gums and associated membranes. However, not all of these studies adequately controlled for other risk factors (for example, socioeconomic status, age, or unhealthy behaviors). Poor dental health may consequently have been an indication of poor personal hygiene or suboptimal health habits. The author cautions that the observed increase in heart disease risk among those with poor dental health may have reflected a general lack of health care, rather than a lack of dental care in particular. The article also reports on present Harvard studies that are evaluating the role of inflammation and diet as potential mediators. For example, periodontal disease and resulting tooth loss may lead to poor dietary habits that, in turn, might increase heart disease risk. The article concludes by hypothesizing the role of inflammation (the body's response to infection or injury) in heart disease. 1 figure.
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Dental Care: How to Help Your Teeth Last a Lifetime Source: Mayo Clinic Health Letter. 15(10): 1-3. October 1997. Contact: Available from Mayo Clinic Health Letter. Subscription Services, P.O. Box 53889, Boulder, CO 80322-3889. (800) 291-1128. Summary: This health newsletter article reviews the basics of good oral hygiene and the role of preventive dental care. Written primarily for an audience of older adults, the article emphasizes that although aging can bring changes that make teeth more vulnerable, with proper care, the teeth can last a lifetime. Topics include dental plaque, gingivitis, periodontitis, dental risk factors associated with aging, and the adverse effects of medications (notably xerostomia, or dry mouth). The article concludes with a brief discussion of the risk factors for cavities and
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periodontal disease in older adults. These factors include co-existing medical conditions or systemic disease, a poor diet, lack of preventive dental care, lack of fluoridated water, and lack of transportation to dental care. One sidebar provides a brief quiz for readers to determine if they need a dental check-up. 1 figure. ·
Gum Disease: You Can Often Prevent This Cause of Tooth Loss Source: Mayo Clinic Health Letter. 10(12): 4-6. December 1992. Contact: Available from Mayo Clinic Health Letter. Subscription Services, P.O. Box 53889, Boulder, CO 80322-3889. (800) 333-9037. Summary: This newsletter article reminds readers of the steps to take in preventing gum disease, including gingivitis and periodontitis. Topics covered include the symptoms of these types of gum disease; how the dentist screens for gum disease; risk factors, including genetics, medications, smoking, pregnancy, and decreased immunity; and treatment options, such as scaling and root planing, antibiotic therapy, and surgery. The article concludes with a brief discussion on research and development of new treatment strategies. One sidebar summarizes daily tooth care recommendations. 6 figures.
Academic Periodicals covering Gingivitis Academic periodicals can be a highly technical yet valuable source of information on gingivitis. We have compiled the following list of periodicals known to publish articles relating to gingivitis and which are currently indexed within the National Library of Medicine's PubMed database (follow hyperlinks to view more information, summaries, etc., for each). In addition to these sources, to keep current on articles written on gingivitis published by any of the periodicals listed below, you can simply follow the hyperlink indicated or go to the following Web site: www.ncbi.nlm.nih.gov/pubmed. Type the periodical's name into the search box to find the latest studies published. If you want complete details about the historical contents of a periodical, you can also visit the Web site: http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi. Here, type in the name of the journal or its abbreviation, and you will receive an index of published articles. At http://locatorplus.gov/ you can retrieve more indexing information on medical periodicals (e.g. the name of the publisher). Select the button “Search LOCATORplus.” Then type in the name of the journal
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and select the advanced search option “Journal Title Search.” The following is a sample of periodicals which publish articles on gingivitis: ·
Archives of Oral Biology. (Arch Oral Biol) http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi?field=0®exp=Archives+of +Oral+Biology&dispmax=20&dispstart=0
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Journal of Clinical Periodontology. (J Clin Periodontol) http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi?field=0®exp=Journal+of+ Clinical+Periodontology&dispmax=20&dispstart=0
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Journal of Ethnopharmacology. (J Ethnopharmacol) http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi?field=0®exp=Journal+of+ Ethnopharmacology&dispmax=20&dispstart=0
Vocabulary Builder Adverse: Harmful. [EU] Mediator: An object or substance by which something is mediated, such as (1) a structure of the nervous system that transmits impulses eliciting a specific response; (2) a chemical substance (transmitter substance) that induces activity in an excitable tissue, such as nerve or muscle; or (3) a substance released from cells as the result of the interaction of antigen with antibody or by the action of antigen with a sensitized lymphocyte. [EU] Membranes: Thin layers of tissue which cover parts of the body, separate adjacent cavities, or connect adjacent structures. [NIH]
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CHAPTER 8. PHYSICIAN GUIDELINES AND DATABASES Overview Healthcare providers and medical researchers rely on a number of information sources to help patients with their conditions. Many will subscribe to journals or newsletters published by their professional associations or refer to specialized textbooks or clinical guides published for the medical profession. In this chapter, we focus on databases and Internetbased guidelines created or written for this professional audience.
NIH Guidelines For the more common diseases, The National Institutes of Health publish guidelines that are frequently consulted by healthcare providers. Publications are typically written by one or more of the various NIH Institutes. For physician guidelines, commonly referred to as “clinical” or “professional” guidelines, you can visit the following Institutes: ·
Office of the Director (OD); guidelines consolidated across agencies available at http://www.nih.gov/health/consumer/conkey.htm
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National Institute of General Medical Sciences (NIGMS); fact sheets available at http://www.nigms.nih.gov/news/facts/
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National Library of Medicine (NLM); extensive encyclopedia (A.D.A.M., Inc.) with guidelines: http://www.nlm.nih.gov/medlineplus/healthtopics.html
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National Institute of Dental and Craniofacial Research (NIDCR); guidelines available at http://www.nidr.nih.gov/health/
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NIH Databases In addition to the various Institutes of Health that publish professional guidelines, the NIH has designed a number of databases for professionals.23 Physician-oriented resources provide a wide variety of information related to the biomedical and health sciences, both past and present. The format of these resources varies. Searchable databases, bibliographic citations, full text articles (when available), archival collections, and images are all available. The following are referenced by the National Library of Medicine:24 ·
Bioethics: Access to published literature on the ethical, legal and public policy issues surrounding healthcare and biomedical research. This information is provided in conjunction with the Kennedy Institute of Ethics located at Georgetown University, Washington, D.C.: http://www.nlm.nih.gov/databases/databases_bioethics.html
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HIV/AIDS Resources: Describes various links and databases dedicated to HIV/AIDS research: http://www.nlm.nih.gov/pubs/factsheets/aidsinfs.html
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NLM Online Exhibitions: Describes “Exhibitions in the History of Medicine”: http://www.nlm.nih.gov/exhibition/exhibition.html. Additional resources for historical scholarship in medicine: http://www.nlm.nih.gov/hmd/hmd.html
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Biotechnology Information: Access to public databases. The National Center for Biotechnology Information conducts research in computational biology, develops software tools for analyzing genome data, and disseminates biomedical information for the better understanding of molecular processes affecting human health and disease: http://www.ncbi.nlm.nih.gov/
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Population Information: The National Library of Medicine provides access to worldwide coverage of population, family planning, and related health issues, including family planning technology and programs, fertility, and population law and policy: http://www.nlm.nih.gov/databases/databases_population.html
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Cancer Information: Access to caner-oriented databases: http://www.nlm.nih.gov/databases/databases_cancer.html
Remember, for the general public, the National Library of Medicine recommends the databases referenced in MEDLINEplus (http://medlineplus.gov/ or http://www.nlm.nih.gov/medlineplus/databases.html). 24 See http://www.nlm.nih.gov/databases/databases.html. 23
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Profiles in Science: Offering the archival collections of prominent twentieth-century biomedical scientists to the public through modern digital technology: http://www.profiles.nlm.nih.gov/
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Chemical Information: Provides links to various chemical databases and references: http://sis.nlm.nih.gov/Chem/ChemMain.html
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Clinical Alerts: Reports the release of findings from the NIH-funded clinical trials where such release could significantly affect morbidity and mortality: http://www.nlm.nih.gov/databases/alerts/clinical_alerts.html
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Space Life Sciences: Provides links and information to space-based research (including NASA): http://www.nlm.nih.gov/databases/databases_space.html
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MEDLINE: Bibliographic database covering the fields of medicine, nursing, dentistry, veterinary medicine, the healthcare system, and the pre-clinical sciences: http://www.nlm.nih.gov/databases/databases_medline.html
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Toxicology and Environmental Health Information (TOXNET): Databases covering toxicology and environmental health: http://sis.nlm.nih.gov/Tox/ToxMain.html
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Visible Human Interface: Anatomically detailed, three-dimensional representations of normal male and female human bodies: http://www.nlm.nih.gov/research/visible/visible_human.html
While all of the above references may be of interest to healthcare providers who study and treat gingivitis, the following are particularly noteworthy.
The Combined Health Information Database A comprehensive source of information on clinical guidelines written for professionals is the Combined Health Information Database. You will need to limit your search to “Brochure/Pamphlet,” “Fact Sheet,” or “Information Package” and gingivitis using the “Detailed Search” option. Go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. To find associations, use the drop boxes at the bottom of the search page where “You may refine your search by.” For the publication date, select “All Years,” select your preferred language, and the format option “Fact Sheet.” By making these selections and typing “gingivitis” (or synonyms) into the “For these words:” box above, you will only receive results on fact sheets dealing with gingivitis. The following is a sample result:
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·
Prevention Methods and Programmes for Oral Diseases: Report of a WHO Expert Committee Source: Geneva, Switzerland, World Health Organization (WHO Technical Report Series; 713), 46 p., 1984. Summary: The World Health Organization (WHO) Expert Committee on Prevention Methods and Programmes for Oral Diseases met in Geneva, Switzerland, September 12-16, 1983, to reaffirm the importance of prevention and control programs that minimizes the need for curative, restorative, and therapeutic treatment of oral diseases. The Committee discussed (1) established methods for the prevention and control of dental caries, (2) methods available for the prevention and especially the control of gingivitis and periodontal diseases, (3) the role of health education and health promotion in the prevention and control of oral diseases, and (4) guidelines for setting priorities in planning and selecting procedures and regimens for preventing oral diseases. The Committee also identified research needs in the following areas: (1) fluoridation and the use of fluorides, (2) oral health education and promotion, (3) public health dentistry, and (4) periodontal health and disease. The Committee formulated a list of recommendations for furthering an initiative aimed at achieving worldwide oral health goals.
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Operational Definitions for Year 2000 Objectives: Priority Area 13, Oral Health Source: Healthy People 2000. Statistical Notes. Number 12: 1-20. May 1997. Contact: Available from National Center for Health Statistics. Centers for Disease Control and Prevention (CDC), U.S. Department of Health and Human Service, 6525 Belcrest Road, Hyattsville, MD 20782. (301) 4368500; E-mail:
[email protected]; http://www.cdc.gov/nchswww/nchshome.htm. PRICE: Single copy free. DHHS Publication Number 97-1237. Summary: This issue of Statistical Notes provides definitions and data collection specifications for objectives in Priority Area 13: Oral Health, one of 22 priority areas of the Healthy People 2000 project. In this publication, the text and operational definitions of the objectives are presented, important data issues are discussed, and references are cited for expanded discussions of the data systems that provide data for the national objectives. Topics covered in the objectives include dental caries (in children and adolescents), untreated dental caries, no tooth loss (tooth retention), complete tooth loss, gingivitis, periodontal diseases, oral cancer deaths, protective sealants, water fluoridation, topical and
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systemic fluorides, baby bottle tooth decay, oral health screening (including referral and follow up), oral health care at institutional facilities, regular dental visits, oral health care for infants with cleft lip or palate, protective equipment in sporting and recreation events, and the reduction of smokeless tobacco (spit tobacco) use. One appendix lists the oral health objectives in total. One chart provides a data comparability worktable with objective definitions, data sources, and issues. This table presents the short text of each objective, the measure, the operational definition, the national data source, and a brief description of data issues. 8 figures. 1 table. (AA-M). ·
Priority Area 13: Oral Health Source: in National Center for Health Statistics. Healthy People 2000 Review, 1993. Hyattsville, MD: Public Health Service. 1994. p. 80-86. Contact: Available from National Technical Information Service (NTIS). Springfield, VA 22161. Voice (703) 487-4650; TDD (703) 487-4639; Fax (703) 321-8547. PRICE: $27 plus shipping and handling. DHHS Publication Number (PHS) 94-1232-1. Summary: This report is a section of the 1993 report on the Healthy People 2000 project of the U.S. Department of Health and Human Services. Priority Area 13, Oral Health, is the focus of this report. Topics covered include background and data summary; data issues, including definition; and proxy measures. A detailed table summarizes the original, present, and target status for each oral health objective, including level of dental caries, untreated dental caries, no tooth loss, complete tooth loss, gingivitis, periodontal diseases, oral cancer deaths, protective sealants, water fluoridation, topical and systemic fluorides, baby bottle tooth decay, oral health screening, oral health care at institutional facilities, regular dental visits, oral health care for infants with cleft lip and/or palate, and protective equipment in sporting and recreation events. 1 figure. 1 table. 8 references.
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Recent Advances in Oral Health: Report of a WHO Expert Committee Source: Albany, NY: World Health Organization (WHO). 1992. 48 p. Contact: Available from World Health Organization (WHO). Publications Center, 49 Sheridan Avenue, Albany, NY 12210. (518) 436-9686; Fax (518) 436-7433. PRICE: $6.30 each; bulk orders available. Summary: This report is from a World Health Organization (WHO) Committee charged to consider advances in the fields of prevention, diagnosis, treatment, and computerization within the oral health profession; to advise on which measures should be implemented now
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and which after further development; to examine the polarity that has developed in oral health between tissue-invasive or other hightechnology interventions and preventive, control, and self care strategies; and to give guidance on the growing need to integrate many activities with different areas of the health profession and other sectors in the search for broader health strategies and involvement. Specific topics include fluoride, sealants, saliva, artificial saliva, diet, antimicrobials, modifying molecules, immunization, risk assessment, gingivitis, microbiology, risk factors for periodontal diseases, oral hygiene, oral cancer, treatment of gingivitis, tissue regeneration, juvenile periodontitis, necrotizing ulcerative gingivitis, malocclusion, dental implants, orofacial lesions, oral manifestations of HIV infection and AIDS, facial pain, oral surgical techniques, advances in technology, personnel issues, work environment and support, and professional education and training. The document concludes with recommendations in five areas: self care and low intervention oral health care; technology transfer; informatics developments in the advancement of oral health; enhancement of scientific research; and broadening the scope of oral health care. One appendix presents a classification of oral lesions associated with HIV infection. 22 references. ·
Healthy smiles, healthy children Source: Des Moines, IA: Iowa Department of Public Health. 1994. 2 pp. Contact: Available from William C. Maurer, D.D.S., M.P.H., Chief, Iowa Department of Public Health, Dental Health Bureau, Lucas State Office Building, Third Floor, 321 East 12th Street, Des Moines, IA 50319. Telephone: (515) 281-4916. Single copies available at no charge. Summary: This brochure provides parents with an overview of the role of dental hygiene in ensuring their children's oral health. Topics include information on primary and permanent teeth, plaque, gingivitis, decay, snacks, fluoride, sealants, dental care visits, and home hygiene.
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Cleaning Between Your Teeth Source: Chicago, IL: American Dental Association (ADA). 1998. [2 p.]. Contact: Available from American Dental Association (ADA). Catalog Sales, P.O. Box 776, St. Charles, IL 60174. (800) 947-4746. Fax (888) 4761880 or (630) 443-9970. Website: www.ada.org. PRICE: $19.00 for 100; nonmembers add 50 percent; bulk rates available. Item number W175. Summary: As calculus forms near the gumline and between teeth, gums may become irritated and inflamed. This leads to swollen and bleeding gums, an early form of periodontal disease called gingivitis. This
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brochure reviews the importance of and strategies for cleaning between the teeth. The best way to remove plaque and to prevent tooth decay and gum disease is to clean the teeth thoroughly every day. Twice daily brushing is essential, but cannot reach between the teeth. Dental floss and interdental cleaners can help loosen and remove the debris and plaque from between the teeth and under the gumline. Interdental cleaners may be helpful for people who have difficulty handling floss or for those who wear braces. The brochure describes how interdental cleaners are used, different types of interdental cleaners, and the use of the American Dental Association's Seal of Acceptance. 3 figures. ·
Stomatology Center, Baylor College of Dentistry Source: Dallas, TX: Baylor College of Dentistry. 199x. 3 p. Contact: Available from Terry Rees, D.D.S., M.S.D., Director, Stomatology Center. Department of Periodontics, Baylor College of Dentistry, 3302 Gaston Avenue, Dallas, TX 75246. (214) 828-8144. Price: Single copy free. Summary: This brochure describes the Stomatology Center of the Baylor College of Dentistry, located in Dallas, Texas. The Stomatology Center was established to serve as a referral site for the treatment of severe mouth problems that are difficult to diagnose and difficult to manage. The stomatopathologic conditions of concern are chronic, painful, ulcerative or debilitating diseases of the oral mucosa. Their focus includes, but is not limited to: lichen planus, pemphigoid, pemphigus, hormonally-mediated desquamative gingivitis, recurrent oral ulcerations, erythema multiforme, candidosis, xerostomia, burning mouth and tongue syndrome, and problems resulting from chemotherapy. The brochure is illustrated with full-color photographs of the Center.
The NLM Gateway25 The NLM (National Library of Medicine) Gateway is a Web-based system that lets users search simultaneously in multiple retrieval systems at the U.S. National Library of Medicine (NLM). It allows users of NLM services to initiate searches from one Web interface, providing “one-stop searching” for many of NLM's information resources or databases.26 One target audience for the Gateway is the Internet user who is new to NLM's online resources and Adapted from NLM: http://gateway.nlm.nih.gov/gw/Cmd?Overview.x. The NLM Gateway is currently being developed by the Lister Hill National Center for Biomedical Communications (LHNCBC) at the National Library of Medicine (NLM) of the National Institutes of Health (NIH).
25 26
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does not know what information is available or how best to search for it. This audience may include dentists and other healthcare providers, researchers, librarians, students, and, increasingly, patients, their families, and the public.27 To use the NLM Gateway, simply go to the search site at http://gateway.nlm.nih.gov/gw/Cmd. Type “gingivitis” (or synonyms) into the search box and click “Search.” The results will be presented in a tabular form, indicating the number of references in each database category. Results Summary Items Found Category Journal Articles 8257 Books / Periodicals / Audio Visual 62 Consumer Health 4 Meeting Abstracts 34 Other Collections 1 Total 8358
HSTAT28 HSTAT is a free, Web-based resource that provides access to full-text documents used in healthcare decision-making.29 HSTAT's audience includes healthcare providers, health service researchers, policy makers, insurance companies, consumers, and the information professionals who serve these groups. HSTAT provides access to a wide variety of publications, including clinical practice guidelines, quick-reference guides for clinicians, consumer health brochures, evidence reports and technology assessments from the Agency for Healthcare Research and Quality (AHRQ), as well as AHRQ's
Other users may find the Gateway useful for an overall search of NLM's information resources. Some searchers may locate what they need immediately, while others will utilize the Gateway as an adjunct tool to other NLM search services such as PubMed® and MEDLINEplus®. The Gateway connects users with multiple NLM retrieval systems while also providing a search interface for its own collections. These collections include various types of information that do not logically belong in PubMed, LOCATORplus, or other established NLM retrieval systems (e.g., meeting announcements and pre-1966 journal citations). The Gateway will provide access to the information found in an increasing number of NLM retrieval systems in several phases. 28 Adapted from HSTAT: http://www.nlm.nih.gov/pubs/factsheets/hstat.html. 29 The HSTAT URL is http://hstat.nlm.nih.gov/. 27
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Put Prevention Into Practice.30 Simply search by “gingivitis” (or synonyms) at the following Web site: http://text.nlm.nih.gov.
Coffee Break: Tutorials for Biologists31 Some patients may wish to have access to a general healthcare site that takes a scientific view of the news and covers recent breakthroughs in biology that may one day assist healthcare providers in developing treatments. To this end, we recommend “Coffee Break,” a collection of short reports on recent biological discoveries. Each report incorporates interactive tutorials that demonstrate how bioinformatics tools are used as a part of the research process. Currently, all Coffee Breaks are written by NCBI staff.32 Each report is about 400 words and is usually based on a discovery reported in one or more articles from recently published, peer-reviewed literature.33 This site has new articles every few weeks, so it can be considered an online magazine of sorts, and intended for general background information. You can access the Coffee Break Web site at the following hyperlink: http://www.ncbi.nlm.nih.gov/Coffeebreak/.
Other important documents in HSTAT include: the National Institutes of Health (NIH) Consensus Conference Reports and Technology Assessment Reports; the HIV/AIDS Treatment Information Service (ATIS) resource documents; the Substance Abuse and Mental Health Services Administration's Center for Substance Abuse Treatment (SAMHSA/CSAT) Treatment Improvement Protocols (TIP) and Center for Substance Abuse Prevention (SAMHSA/CSAP) Prevention Enhancement Protocols System (PEPS); the Public Health Service (PHS) Preventive Services Task Force's Guide to Clinical Preventive Services; the independent, nonfederal Task Force on Community Services Guide to Community Preventive Services; and the Health Technology Advisory Committee (HTAC) of the Minnesota Health Care Commission (MHCC) health technology evaluations. 31 Adapted from http://www.ncbi.nlm.nih.gov/Coffeebreak/Archive/FAQ.html. 32 The figure that accompanies each article is frequently supplied by an expert external to NCBI, in which case the source of the figure is cited. The result is an interactive tutorial that tells a biological story. 33 After a brief introduction that sets the work described into a broader context, the report focuses on how a molecular understanding can provide explanations of observed biology and lead to therapies for diseases. Each vignette is accompanied by a figure and hypertext links that lead to a series of pages that interactively show how NCBI tools and resources are used in the research process. 30
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Other Commercial Databases In addition to resources maintained by official agencies, other databases exist that are commercial ventures addressing medical professionals. Here are a few examples that may interest you: ·
CliniWeb International: Index and table of contents to selected clinical information on the Internet; see http://www.ohsu.edu/cliniweb/.
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Image Engine: Multimedia electronic medical record system that integrates a wide range of digitized clinical images with textual data stored in the University of Pittsburgh Medical Center's MARS electronic medical record system; see the following Web site: http://www.cml.upmc.edu/cml/imageengine/imageEngine.html.
·
Medical World Search: Searches full text from thousands of selected medical sites on the Internet; see http://www.mwsearch.com/.
·
MedWeaver: Prototype system that allows users to search differential diagnoses for any list of signs and symptoms, to search medical literature, and to explore relevant Web sites; see http://www.med.virginia.edu/~wmd4n/medweaver.html.
·
Metaphrase: Middleware component intended for use by both caregivers and medical records personnel. It converts the informal language generally used by caregivers into terms from formal, controlled vocabularies; see the following Web site: http://www.lexical.com/Metaphrase.html.
The Genome Project and Gingivitis With all the discussion in the press about the Human Genome Project, it is only natural that healthcare providers, researchers, and patients want to know about how human genes relate to gingivitis. In the following section, we will discuss databases and references used by healthcare providers and scientists who work in this area.
Online Mendelian Inheritance in Man (OMIM) The Online Mendelian Inheritance in Man (OMIM) database is a catalog of human genes and genetic disorders authored and edited by Dr. Victor A. McKusick and his colleagues at Johns Hopkins and elsewhere. OMIM was developed for the World Wide Web by the National Center for
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Biotechnology Information (NCBI).34 The database contains textual information, pictures, and reference information. It also contains copious links to NCBI's Entrez database of MEDLINE articles and sequence information. To search the database, go to http://www.ncbi.nlm.nih.gov/Omim/searchomim.html. Type “gingivitis” (or synonyms) in the search box, and click “Submit Search.” If too many results appear, you can narrow the search by adding the word “clinical.” Each report will have additional links to related research and databases. By following these links, especially the link titled “Database Links,” you will be exposed to numerous specialized databases that are largely used by the scientific community. These databases are overly technical and seldom used by the general public, but offer an abundance of information. The following is an example of the results you can obtain from the OMIM for gingivitis: ·
Chediak-higashi Syndrome Web site: http://www.ncbi.nlm.nih.gov/htbinpost/Omim/dispmim?214500
·
Cohen Syndrome Web site: http://www.ncbi.nlm.nih.gov/htbinpost/Omim/dispmim?216550
·
Glycogen Storage Disease Ib Web site: http://www.ncbi.nlm.nih.gov/htbinpost/Omim/dispmim?232220
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Immunodeficiency with Hyper-igm, Type 1 Web site: http://www.ncbi.nlm.nih.gov/htbinpost/Omim/dispmim?308230
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Integrin, Beta-2 Web site: http://www.ncbi.nlm.nih.gov/htbinpost/Omim/dispmim?600065
·
Interleukin 2 Receptor, Alpha, Deficiency of Web site: http://www.ncbi.nlm.nih.gov/htbinpost/Omim/dispmim?606367
34 Adapted from http://www.ncbi.nlm.nih.gov/. Established in 1988 as a national resource for molecular biology information, NCBI creates public databases, conducts research in computational biology, develops software tools for analyzing genome data, and disseminates biomedical information--all for the better understanding of molecular processes affecting human health and disease.
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·
Lazy Leukocyte Syndrome Web site: http://www.ncbi.nlm.nih.gov/htbinpost/Omim/dispmim?150550
·
Leukocyte Adhesion Deficiency, Type I Web site: http://www.ncbi.nlm.nih.gov/htbinpost/Omim/dispmim?116920
·
Neutropenia, Chronic Familial Web site: http://www.ncbi.nlm.nih.gov/htbinpost/Omim/dispmim?162700
Genes and Disease (NCBI - Map) The Genes and Disease database is produced by the National Center for Biotechnology Information of the National Library of Medicine at the National Institutes of Health. This Web site categorizes each disorder by the system of the body associated with it. Go to http://www.ncbi.nlm.nih.gov/disease/, and browse the system pages to have a full view of important conditions linked to human genes. Since this site is regularly updated, you may wish to re-visit it from time to time. The following systems and associated disorders are addressed: ·
Cancer: Uncontrolled cell division. Examples: Breast And Ovarian Cancer, Burkitt lymphoma, chronic myeloid leukemia, colon cancer, lung cancer, malignant melanoma, multiple endocrine neoplasia, neurofibromatosis, p53 tumor suppressor, pancreatic cancer, prostate cancer, Ras oncogene, RB: retinoblastoma, von Hippel-Lindau syndrome. Web site: http://www.ncbi.nlm.nih.gov/disease/Cancer.html
·
Muscle and Bone: Movement and growth. Examples: Duchenne muscular dystrophy, Ellis-van Creveld syndrome, Marfan syndrome, myotonic dystrophy, spinal muscular atrophy. Web site: http://www.ncbi.nlm.nih.gov/disease/Muscle.html
·
Nervous System: Mind and body. Examples: Alzheimer disease, Amyotrophic lateral sclerosis, Angelman syndrome, Charcot-Marie-Tooth disease, epilepsy, essential tremor, Fragile X syndrome, Friedreich's ataxia, Huntington disease, NiemannPick disease, Parkinson disease, Prader-Willi syndrome, Rett syndrome, Spinocerebellar atrophy, Williams syndrome. Web site: http://www.ncbi.nlm.nih.gov/disease/Brain.html
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·
Signals: Cellular messages. Examples: Ataxia telangiectasia, Baldness, Cockayne syndrome, Glaucoma, SRY: sex determination, Tuberous sclerosis, Waardenburg syndrome, Werner syndrome. Web site: http://www.ncbi.nlm.nih.gov/disease/Signals.html
·
Transporters: Pumps and channels. Examples: Cystic Fibrosis, deafness, diastrophic dysplasia, Hemophilia A, long-QT syndrome, Menkes syndrome, Pendred syndrome, polycystic kidney disease, sickle cell anemia, Wilson's disease, Zellweger syndrome. Web site: http://www.ncbi.nlm.nih.gov/disease/Transporters.html
Entrez Entrez is a search and retrieval system that integrates several linked databases at the National Center for Biotechnology Information (NCBI). These databases include nucleotide sequences, protein sequences, macromolecular structures, whole genomes, and MEDLINE through PubMed. Entrez provides access to the following databases: ·
PubMed: Biomedical literature (PubMed), Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed
·
Nucleotide Sequence Database (Genbank): Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Nucleotide
·
Protein Sequence Database: Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Protein
·
Structure: Three-dimensional macromolecular structures, Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Structure
·
Genome: Complete genome assemblies, Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Genome
·
PopSet: Population study data sets, Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Popset
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OMIM: Online Mendelian Inheritance in Man, Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=OMIM
·
Taxonomy: Organisms in GenBank, Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Taxonomy
·
Books: Online books, Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=books
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·
ProbeSet: Gene Expression Omnibus (GEO), Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=geo
·
3D Domains: Domains from Entrez Structure, Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=geo
·
NCBI's Protein Sequence Information Survey Results: Web site: http://www.ncbi.nlm.nih.gov/About/proteinsurvey/
To access the Entrez system at the National Center for Biotechnology Information, go to http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?CMD=search&DB=genome, and then select the database that you would like to search. The databases available are listed in the drop box next to “Search.” In the box next to “for,” enter “gingivitis” (or synonyms) and click “Go.”
Jablonski's Multiple Congenital Anomaly/Mental Retardation (MCA/MR) Syndromes Database35 This online resource can be quite useful. It has been developed to facilitate the identification and differentiation of syndromic entities. Special attention is given to the type of information that is usually limited or completely omitted in existing reference sources due to space limitations of the printed form. At the following Web site you can also search across syndromes using an alphabetical index: http://www.nlm.nih.gov/mesh/jablonski/syndrome_toc/toc_a.html. You can search by keywords at this Web site: http://www.nlm.nih.gov/mesh/jablonski/syndrome_db.html. The Genome Database36 Established at Johns Hopkins University in Baltimore, Maryland in 1990, the Genome Database (GDB) is the official central repository for genomic mapping data resulting from the Human Genome Initiative. In the spring of 1999, the Bioinformatics Supercomputing Centre (BiSC) at the Hospital for Sick Children in Toronto, Ontario assumed the management of GDB. The Human Genome Initiative is a worldwide research effort focusing on Adapted from the National Library of Medicine: http://www.nlm.nih.gov/mesh/jablonski/about_syndrome.html. 36 Adapted from the Genome Database: http://gdbwww.gdb.org/gdb/aboutGDB.html#mission. 35
Physician Guidelines and Databases 119
structural analysis of human DNA to determine the location and sequence of the estimated 100,000 human genes. In support of this project, GDB stores and curates data generated by researchers worldwide who are engaged in the mapping effort of the Human Genome Project (HGP). GDB's mission is to provide scientists with an encyclopedia of the human genome which is continually revised and updated to reflect the current state of scientific knowledge. Although GDB has historically focused on gene mapping, its focus will broaden as the Genome Project moves from mapping to sequence, and finally, to functional analysis. To access the GDB, simply go to the following hyperlink: http://www.gdb.org/. Search “All Biological Data” by “Keyword.” Type “gingivitis” (or synonyms) into the search box, and review the results. If more than one word is used in the search box, then separate each one with the word “and” or “or” (using “or” might be useful when using synonyms). This database is extremely technical as it was created for specialists. The articles are the results which are the most accessible to non-professionals and often listed under the heading “Citations.” The contact names are also accessible to non-professionals.
Specialized References The following books are specialized references written for professionals interested in gingivitis (sorted alphabetically by title, hyperlinks provide rankings, information, and reviews at Amazon.com): ·
Advances in Operative Dentistry: Volume 1: Contemporary Clinical Practice by Jean-Francois Roulet (Editor), et al; Hardcover - 263 pages, 1st edition (August 15, 2001), Quintessence Publishing Co.; ISBN: 0867154020; http://www.amazon.com/exec/obidos/ASIN/0867154020/icongroupinter na
·
Behavioural Sciences for Dentistry by Gerry Humphris, Margaret S. Ling; Paperback - 149 pages, 1st edition (October 1, 2005), Churchill Livingstone; ISBN: 0443051909; http://www.amazon.com/exec/obidos/ASIN/0443051909/icongroupinter na
·
Burket's Oral Medicine: Diagnosis and Treatment by Martin S. Greenberg, Michael Glick; Hardcover, 10th edition (July 2002), Decker Periodicals; ISBN: 0781725372; http://www.amazon.com/exec/obidos/ASIN/0781725372/icongroupinter na
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·
Churchill's Pocketbook of Clinical Dentistry by I. G. Chestnutt (Editor), J. Gibson (Editor); Hardcover 2nd edition (April 2002), Churchill Livingstone; ISBN: 0443070849; http://www.amazon.com/exec/obidos/ASIN/0443070849/icongroupinter na
·
A Color Atlas and Text of Oral Anatomy, Histology and Embryology by Berkovitz; Hardcover, 3rd edition (July 26, 2002), Mosby-Year Book; ISBN: 0723431817; http://www.amazon.com/exec/obidos/ASIN/0723431817/icongroupinter na
·
Essential Microbiology for Dentistry by L. P. Samaranayake; Paperback - 293 pages, 2nd edition (January 15, 2002), W B Saunders Co; ISBN: 044306461X; http://www.amazon.com/exec/obidos/ASIN/044306461X/icongroupinter na
·
Essentials of Oral Medicine by Sol Silverman, Jr., et al; Paperback, Book & Cd-Rom edition (October 2001), B C Decker; ISBN: 1550091468; http://www.amazon.com/exec/obidos/ASIN/1550091468/icongroupinter na
·
Fundamentals of Oral Medicine: A Practical Guide by Crispian Scully, M.D., Ph.D.; Paperback (September 2001), Butterworth-Heinemann Medical; ISBN: 0723610746; http://www.amazon.com/exec/obidos/ASIN/0723610746/icongroupinter na
·
Medical Emergencies in Dentistry by Jeffrey D. Bennett, Morton B. Rosenberg; Paperback - 556 pages, 1st edition (January 15, 2002), W B Saunders Co; ISBN: 0721684815; http://www.amazon.com/exec/obidos/ASIN/0721684815/icongroupinter na
·
Oral Development and Histology by James K. Avery, D.D.S., Ph.D. (Editor), Hardcover, 3rd edition (October 2001), Thieme Medical Pub; ISBN: 1588900282; http://www.amazon.com/exec/obidos/ASIN/1588900282/icongroupinter na
·
Year Book of Dentistry 2001 by Lawrence H. Meskin; Hardcover (January 2002), Mosby-Year Book; ISBN: 0323015433; http://www.amazon.com/exec/obidos/ASIN/0323015433/icongroupinter na
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Vocabulary Builder Chemotherapy: The treatment of disease by means of chemicals that have a specific toxic effect upon the disease - producing microorganisms or that selectively destroy cancerous tissue. [EU] Curative: Tending to overcome disease and promote recovery. [EU] Immunization: The induction of immunity. [EU] Neoplasms: New abnormal growth of tissue. Malignant neoplasms show a greater degree of anaplasia and have the properties of invasion and metastasis, compared to benign neoplasms. [NIH] Neutropenia: Leukopenia in which the decrease in white blood cells is chiefly in neutrophils. [EU] Pemphigus: A group of chronic, relapsing, sometimes fatal skin diseases characterized clinically by the development of successive crops of vesicles and bullae, histologically by acantholysis, and immunologically by serum autoantibodies directed against antigens in the intracellular zones of the epidermis. The specific disease is usually indicated by a modifying term; but the term pemphigus is often used alone to designate pemphigus vulgaris. [EU] Proxy: A person authorized to decide or act for another person, for example, a person having durable power of attorney. [NIH] Receptor: 1. a molecular structure within a cell or on the surface characterized by (1) selective binding of a specific substance and (2) a specific physiologic effect that accompanies the binding, e.g., cell-surface receptors for peptide hormones, neurotransmitters, antigens, complement fragments, and immunoglobulins and cytoplasmic receptors for steroid hormones. 2. a sensory nerve terminal that responds to stimuli of various kinds. [EU] Warts: Benign epidermal proliferations or tumors; some are viral in origin. [NIH]
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CHAPTER 9. DISSERTATIONS ON GINGIVITIS Overview University researchers are active in studying almost all known diseases. The result of research is often published in the form of Doctoral or Master's dissertations. You should understand, therefore, that applied diagnostic procedures and/or therapies can take many years to develop after the thesis that proposed the new technique or approach was written. In this chapter, we will give you a bibliography on recent dissertations relating to gingivitis. You can read about these in more detail using the Internet or your local medical library. We will also provide you with information on how to use the Internet to stay current on dissertations.
Dissertations on Gingivitis ProQuest Digital Dissertations is the largest archive of academic dissertations available. From this archive, we have compiled the following list covering dissertations devoted to gingivitis. You will see that the information provided includes the dissertation’s title, its author, and the author’s institution. To read more about the following, simply use the Internet address indicated. The following covers recent dissertations dealing with gingivitis: ·
Foreign Body Gingivitis by Gordon, Sara Christine, Msc from The University of Western Ontario (canada), 1996, 159 pages http://wwwlib.umi.com/dissertations/fullcit/MM09818
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Keeping Current As previously mentioned, an effective way to stay current on dissertations dedicated to gingivitis is to use the database called ProQuest Digital Dissertations via the Internet, located at the following Web address: http://wwwlib.umi.com/dissertations. The site allows you to freely access the last two years of citations and abstracts. Ask your medical librarian if the library has full and unlimited access to this database. From the library, you should be able to do more complete searches than with the limited 2-year access available to the general public.
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PART III. APPENDICES
ABOUT PART III Part III is a collection of appendices on general medical topics which may be of interest to patients with gingivitis and related conditions.
Researching Your Medications 127
APPENDIX A. RESEARCHING YOUR MEDICATIONS Overview There are a number of sources available on new or existing medications which could be prescribed to patients with gingivitis. While a number of hard copy or CD-Rom resources are available to patients and dentists for research purposes, a more flexible method is to use Internet-based databases. In this chapter, we will begin with a general overview of medications. We will then proceed to outline official recommendations on how you should view your medications. You may also want to research medications that you are currently taking for other conditions as they may interact with medications for gingivitis. Research can give you information on the side effects, interactions, and limitations of prescription drugs used in the treatment of gingivitis. Broadly speaking, there are two sources of information on approved medications: public sources and private sources. We will emphasize free-to-use public sources.
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Your Medications: The Basics37 The Agency for Health Care Research and Quality has published extremely useful guidelines on how you can best participate in the medication aspects of gingivitis. Taking medicines is not always as simple as swallowing a pill. It can involve many steps and decisions each day. The AHCRQ recommends that patients with gingivitis take part in treatment decisions. Do not be afraid to ask questions and talk about your concerns. By taking a moment to ask questions early, you may avoid problems later. Here are some points to cover each time a new medicine is prescribed: ·
Ask about all parts of your treatment, including diet changes, exercise, and medicines.
·
Ask about the risks and benefits of each medicine or other treatment you might receive.
·
Ask how often you or your healthcare provider will check for side effects from a given medication.
Do not hesitate to ask what is important to you about your medicines. You may want a medicine with the fewest side effects, or the fewest doses to take each day. You may care most about cost, or how the medicine might affect how you live or work. Or, you may want the medicine your dentist believes will work the best. Do not be afraid to “bother” your dentist or oral surgeon with your concerns and questions about medications for gingivitis. You can also talk to a nurse or a pharmacist. They can help you better understand your treatment plan. Feel free to bring a friend or family member with you when you visit your dentist. Talking over your options with someone you trust can help you make better choices, especially if you are not feeling well. Specifically, ask your dentist the following: ·
The name of the medicine and what it is supposed to do.
·
How and when to take the medicine, how much to take, and for how long.
·
What food, drinks, other medicines, or activities you should avoid while taking the medicine.
·
What side effects the medicine may have, and what to do if they occur.
·
If you can get a refill, and how often.
37
This section is adapted from AHCRQ: http://www.ahcpr.gov/consumer/ncpiebro.htm.
Researching Your Medications 129
·
About any terms or directions you do not understand.
·
What to do if you miss a dose.
·
If there is written information you can take home (most pharmacies have information sheets on your prescription medicines; some even offer large-print or Spanish versions).
Do not forget to tell your dentist about all the medicines you are currently taking (not just those for gingivitis). This includes prescription medicines and the medicines that you buy over the counter. Then your dentist can avoid giving you a new medicine that may not work well with the medications you take now. When talking to your dentist, you may wish to prepare a list of medicines you currently take, the reason you take them, and how you take them. Be sure to include the following information for each: ·
Name of medicine
·
Reason taken
·
Dosage
·
Time(s) of day
Also include any over-the-counter medicines, such as: ·
Laxatives
·
Diet pills
·
Vitamins
·
Cold medicine
·
Aspirin or other pain, headache, or fever medicine
·
Cough medicine
·
Allergy relief medicine
·
Antacids
·
Sleeping pills
·
Others (include names)
Learning More about Your Medications Because of historical investments by various organizations and the emergence of the Internet, it has become rather simple to learn about the medications your dentist has recommended for gingivitis. One such source is
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the United States Pharmacopeia. In 1820, eleven physicians met in Washington, D.C. to establish the first compendium of standard drugs for the United States. They called this compendium the “U.S. Pharmacopeia (USP).” Today, the USP is a non-profit organization consisting of 800 volunteer scientists, eleven elected officials, and 400 representatives of state associations and colleges of medicine and pharmacy. The USP is located in Rockville, Maryland, and its home page is located at www.usp.org. The USP currently provides standards for over 3,700 medications. The resulting USP DIÒ Advice for the PatientÒ can be accessed through the National Library of Medicine of the National Institutes of Health. The database is partially derived from lists of federally approved medications in the Food and Drug Administration's (FDA) Drug Approvals database.38 While the FDA database is rather large and difficult to navigate, the Phamacopeia is both user-friendly and free to use. It covers more than 9,000 prescription and over-the-counter medications. To access this database, simply type the following hyperlink into your Web browser: http://www.nlm.nih.gov/medlineplus/druginformation.html. To view examples of a given medication (brand names, category, description, preparation, proper use, precautions, side effects, etc.), simply follow the hyperlinks indicated within the United States Pharmacopoeia (USP). It is important to read the disclaimer by the USP (http://www.nlm.nih.gov/medlineplus/drugdisclaimer.html) before using the information provided. Of course, we as editors cannot be certain as to what medications you are taking. Therefore, we have compiled a list of medications associated with the treatment of gingivitis. Once again, due to space limitations, we only list a sample of medications and provide hyperlinks to ample documentation (e.g. typical dosage, side effects, drug-interaction risks, etc.). The following drugs have been mentioned in the Pharmacopeia and other sources as being potentially applicable to gingivitis: Chlorhexidine ·
Dental - U.S. Brands: Peridex; PerioGard http://www.nlm.nih.gov/medlineplus/druginfo/chlorhexidinede ntal202131.html
Though cumbersome, the FDA database can be freely browsed at the following site: www.fda.gov/cder/da/da.htm.
38
Researching Your Medications 131
Clindamycin ·
Systemic - U.S. Brands: Cleocin http://www.nlm.nih.gov/medlineplus/druginfo/clindamycinsyst emic202145.html
·
Topical - U.S. Brands: Clinda-Derm http://www.nlm.nih.gov/medlineplus/druginfo/clindamycintopi cal202146.html
·
Vaginal - U.S. Brands: Cleocin http://www.nlm.nih.gov/medlineplus/druginfo/clindamycinvag inal202700.html
Corticosteroids ·
Dental - U.S. Brands: Kenalog in Orabase; Orabase-HCA; Oracort; Oralone http://www.nlm.nih.gov/medlineplus/druginfo/corticosteroidsd ental202010.html
·
Inhalation - U.S. Brands: AeroBid; AeroBid-M; Azmacort; Beclovent; Decadron Respihaler; Pulmicort Respules; Pulmicort Turbuhaler; Vanceril; Vanceril 84 mcg Double Strength http://www.nlm.nih.gov/medlineplus/druginfo/corticosteroidsi nhalation202011.html
·
Nasal - U.S. Brands: Beconase; Beconase AQ; Dexacort Turbinaire; Flonase; Nasacort; Nasacort AQ; Nasalide; Nasarel; Nasonex; Rhinocort; Vancenase; Vancenase AQ 84 mcg; Vancenase pockethaler http://www.nlm.nih.gov/medlineplus/druginfo/corticosteroidsn asal202012.html
·
Ophthalmic - U.S. Brands: AK-Dex; AK-Pred; AK-Tate; Baldex; Decadron; Dexair; Dexotic; Econopred; Econopred Plus; Eflone; Flarex; Fluor-Op; FML Forte; FML Liquifilm; FML S.O.P.; HMS Liquifilm; Inflamase Forte; Inflamase Mild; I-Pred; Lite Pred; Maxidex; Ocu-Dex; Ocu-Pred; Ocu-Pr http://www.nlm.nih.gov/medlineplus/druginfo/corticosteroidso phthalmic202013.html
·
Otic - U.S. Brands: Decadron http://www.nlm.nih.gov/medlineplus/druginfo/corticosteroidso tic202014.html
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·
Rectal - U.S. Brands: Anucort-HC; Anu-Med HC; Anuprep HC; Anusol-HC; Anutone-HC; Anuzone-HC; Cort-Dome; Cortenema; Cortifoam; Hemorrhoidal HC; Hemril-HC Uniserts; Proctocort; Proctosol-HC; Rectosol-HC http://www.nlm.nih.gov/medlineplus/druginfo/corticosteroidsr ectal203366.html
Nystatin ·
Oral - U.S. Brands: Mycostatin; Nilstat; Nystex http://www.nlm.nih.gov/medlineplus/druginfo/nystatinoral202 417.html
·
Topical - U.S. Brands: http://www.nlm.nih.gov/medlineplus/druginfo/nystatintopical2 02418.html
·
Topical - U.S. Brands: Mycostatin; Nilstat; Nystex; Nystop; PediDri http://www.nlm.nih.gov/medlineplus/druginfo/nystatintopical2 02418.html
Commercial Databases In addition to the medications listed in the USP above, a number of commercial sites are available by subscription to dentists and their institutions. You may be able to access these sources from your local medical library or your dentist's office.
Reuters Health Drug Database The Reuters Health Drug Database can be searched by keyword at the hyperlink: http://www.reutershealth.com/frame2/drug.html. The following medications are listed in the Reuters' database as associated with gingivitis (including those with contraindications):39 ·
Chlorhexidine Gluconate http://www.reutershealth.com/atoz/html/Chlorhexidine_Gluconate.ht m
·
Delavirdine Mesylate http://www.reutershealth.com/atoz/html/Delavirdine_Mesylate.htm
39
Adapted from A to Z Drug Facts by Facts and Comparisons.
Researching Your Medications 133
·
Gabapentin http://www.reutershealth.com/atoz/html/Gabapentin.htm
·
Itraconazole http://www.reutershealth.com/atoz/html/Itraconazole.htm
·
Methotrexate http://www.reutershealth.com/atoz/html/Methotrexate.htm
·
Mycophenolate Mofetil http://www.reutershealth.com/atoz/html/Mycophenolate_Mofetil.htm
·
Sildenafil http://www.reutershealth.com/atoz/html/Sildenafil.htm
·
Sirolimus http://www.reutershealth.com/atoz/html/Sirolimus.htm
·
Tiagabine Hydrochloride http://www.reutershealth.com/atoz/html/Tiagabine_Hydrochloride.ht m
·
Topiramate http://www.reutershealth.com/atoz/html/Topiramate.htm Mosby's GenRx
Mosby's GenRx database (also available on CD-Rom and book format) covers 45,000 drug products including generics and international brands. It provides prescribing information, drug interactions, and patient information. Information can be obtained at the following hyperlink: http://www.genrx.com/Mosby/PhyGenRx/group.html.
Physicians Desk Reference The Physicians Desk Reference database (also available in CD-Rom and book format) is a full-text drug database. The database is searchable by brand name, generic name or by indication. It features multiple drug interactions reports. Information can be obtained at the following hyperlink: http://physician.pdr.net/physician/templates/en/acl/psuser_t.htm.
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Other Web Sites A number of additional Web sites discuss drug information. As an example, you may like to look at www.drugs.com which reproduces the information in the Pharmacopeia as well as commercial information. You may also want to consider the Web site of the Medical Letter, Inc. which allows users to download articles on various drugs and therapeutics for a nominal fee: http://www.medletter.com/.
Contraindications and Interactions (Hidden Dangers) Some of the medications mentioned in the previous discussions can be problematic for patients with gingivitis--not because they are used in the treatment process, but because of contraindications, or side effects. Medications with contraindications are those that could react with drugs used to treat gingivitis or potentially create deleterious side effects in patients with gingivitis. You should ask your dentist about any contraindications, especially as these might apply to other medications that you may be taking for common ailments. Drug-drug interactions occur when two or more drugs react with each other. This drug-drug interaction may cause you to experience an unexpected side effect. Drug interactions may make your medications less effective, cause unexpected side effects, or increase the action of a particular drug. Some drug interactions can even be harmful to you. Be sure to read the label every time you use a nonprescription or prescription drug, and take the time to learn about drug interactions. These precautions may be critical to your health. You can reduce the risk of potentially harmful drug interactions and side effects with a little bit of knowledge and common sense. Drug labels contain important information about ingredients, uses, warnings, and directions which you should take the time to read and understand. Labels also include warnings about possible drug interactions. Further, drug labels may change as new information becomes available. This is why it's especially important to read the label every time you use a medication. When your dentist prescribes a new drug, discuss all over-thecounter and prescription medications, dietary supplements, vitamins, botanicals, minerals and herbals you take as well as the foods you eat. Ask your pharmacist for the package insert for each prescription drug you take.
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The package insert provides more information about potential drug interactions.
A Final Warning At some point, you may hear of alternative medications from friends, relatives, or in the news media. Advertisements may suggest that certain alternative drugs can produce positive results for patients with gingivitis. Exercise caution--some of these drugs may have fraudulent claims, and others may actually hurt you. The Food and Drug Administration (FDA) is the official U.S. agency charged with discovering which medications are likely to improve the health of patients with gingivitis. The FDA warns patients to watch out for40: ·
Secret formulas (real scientists share what they know)
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Amazing breakthroughs or miracle cures (real breakthroughs don't happen very often; when they do, real scientists do not call them amazing or miracles)
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Quick, painless, or guaranteed cures
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If it sounds too good to be true, it probably isn't true.
If you have any questions about any kind of medical treatment, the FDA may have an office near you. Look for their number in the blue pages of the phone book. You can also contact the FDA through its toll-free number, 1888-INFO-FDA (1-888-463-6332), or on the World Wide Web at www.fda.gov.
General References In addition to the resources provided earlier in this chapter, the following general references describe medications (sorted alphabetically by title; hyperlinks provide rankings, information and reviews at Amazon.com): ·
Drug Dictionary for Dentistry by J. G. Meechan, R. A. Seymour; Hardcover (March 2002), Oxford University Press; ISBN: 0192632744; http://www.amazon.com/exec/obidos/ASIN/0192632744/icongroupinter na
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Drug Information Handbook for Dentistry, 2001-2002 by Richard L. Wynn, et al; Paperback - 1500 pages, 7th edition (August 15, 2001), Lexi
40
This section has been adapted from http://www.fda.gov/opacom/lowlit/medfraud.html.
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Comp; ISBN: 1930598718; http://www.amazon.com/exec/obidos/ASIN/1930598718/icongroupinter na ·
Handbook of Commonly Prescribed Drugs by G. John Digregorio, Edward J. Barbieri; Paperback 16th edition (2001), Medical Surveillance; ISBN: 0942447417; http://www.amazon.com/exec/obidos/ASIN/0942447417/icongroupinter na
·
Johns Hopkins Complete Home Encyclopedia of Drugs 2nd ed. by Simeon Margolis (Ed.), Johns Hopkins; Hardcover - 835 pages (2000), Rebus; ISBN: 0929661583; http://www.amazon.com/exec/obidos/ASIN/0929661583/icongroupinter na
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Mosby's Dental Drug Reference by Tommy W. Gage, Frieda Atherton Pickett; Paperback - 815 pages, 5th edition (October 2001), Mosby-Year Book; ISBN: 032301710X; http://www.amazon.com/exec/obidos/ASIN/032301710X/icongroupinter na
Vocabulary Builder The following vocabulary builder gives definitions of words used in this chapter that have not been defined in previous chapters: Clindamycin: An antibacterial agent that is a semisynthetic analog of lincomycin. [NIH] Inhalation: The drawing of air or other substances into the lungs. [EU] Itraconazole: An antifungal agent that has been used in the treatment of histoplasmosis, blastomycosis, cryptococcal meningitis, and aspergillosis. [NIH]
Liquifilm: A thin liquid layer of coating. [EU] Methotrexate: An antineoplastic antimetabolite with immunosuppressant properties. It is an inhibitor of dihydrofolate reductase and prevents the formation of tetrahydrofolate, necessary for synthesis of thymidylate, an essential component of DNA. [NIH] Nasal: Pertaining to the nose. [EU] Nystatin: Macrolide antifungal antibiotic complex produced by Streptomyces noursei, S. aureus, and other Streptomyces species. The biologically active components of the complex are nystatin A1, A2, and A3. [NIH]
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Ophthalmic: Pertaining to the eye. [EU] Rectal: Pertaining to the rectum (= distal portion of the large intestine). [EU] Sirolimus: A macrolide compound obtained from Streptomyces hygroscopicus that acts by selectively blocking the transcriptional activation of cytokines thereby inhibiting cytokine production. It is bioactive only when bound to immunophilins. Sirolimus is a potent immunosuppressant and possesses both antifungal and antineoplastic properties. [NIH] Vaginal: 1. of the nature of a sheath; ensheathing. 2. pertaining to the vagina. 3. pertaining to the tunica vaginalis testis. [EU]
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APPENDIX B. RESEARCHING ALTERNATIVE MEDICINE Overview Complementary and alternative medicine (CAM) is one of the most contentious aspects of modern medical practice. You may have heard of these treatments on the radio or on television. Maybe you have seen articles written about these treatments in magazines, newspapers, or books. Perhaps your friends or healthcare providers have mentioned alternatives. In this chapter, we will begin by giving you a broad perspective on complementary and alternative therapies. Next, we will introduce you to official information sources on CAM relating to gingivitis. Finally, at the conclusion of this chapter, we will provide a list of readings on gingivitis from various authors. We will begin, however, with the National Center for Complementary and Alternative Medicine's (NCCAM) overview of complementary and alternative medicine.
What Is CAM?41 Complementary and alternative medicine (CAM) covers a broad range of healing philosophies, approaches, and therapies. Generally, it is defined as those treatments and healthcare practices which are not taught in medical schools, used in hospitals, or reimbursed by medical insurance companies. Many CAM therapies are termed “holistic,” which generally means that the healthcare practitioner considers the whole person, including physical, mental, emotional, and spiritual health. Some of these therapies are also known as “preventive,” which means that the practitioner educates and 41
Adapted from the NCCAM: http://nccam.nih.gov/nccam/fcp/faq/index.html#what-is.
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treats the person to prevent health problems from arising, rather than treating symptoms after problems have occurred. People use CAM treatments and therapies in a variety of ways. Therapies are used alone (often referred to as alternative), in combination with other alternative therapies, or in addition to conventional treatment (sometimes referred to as complementary). Complementary and alternative medicine, or “integrative medicine,” includes a broad range of healing philosophies, approaches, and therapies. Some approaches are consistent with physiological principles of Western medicine, while others constitute healing systems with non-Western origins. While some therapies are far outside the realm of accepted Western medical theory and practice, others are becoming established in mainstream medicine. Complementary and alternative therapies are used in an effort to prevent illness, reduce stress, prevent or reduce side effects and symptoms, or control or cure disease. Some commonly used methods of complementary or alternative therapy include mind/body control interventions such as visualization and relaxation, manual healing including acupressure and massage, homeopathy, vitamins or herbal products, and acupuncture.
What Are the Domains of Alternative Medicine?42 The list of CAM practices changes continually. The reason being is that these new practices and therapies are often proved to be safe and effective, and therefore become generally accepted as “mainstream” healthcare practices. Today, CAM practices may be grouped within five major domains: (1) alternative medical systems, (2) mind-body interventions, (3) biologicallybased treatments, (4) manipulative and body-based methods, and (5) energy therapies. The individual systems and treatments comprising these categories are too numerous to list in this sourcebook. Thus, only limited examples are provided within each. Alternative Medical Systems Alternative medical systems involve complete systems of theory and practice that have evolved independent of, and often prior to, conventional biomedical approaches. Many are traditional systems of medicine that are
42
Adapted from the NCCAM: http://nccam.nih.gov/nccam/fcp/classify/index.html.
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practiced by individual cultures throughout the world, including a number of venerable Asian approaches. Traditional oriental medicine emphasizes the balance or disturbances of qi (pronounced chi) or vital energy in health and disease, respectively. Traditional oriental medicine consists of a group of techniques and methods including acupuncture, herbal medicine, oriental massage, and qi gong (a form of energy therapy). Acupuncture involves stimulating specific anatomic points in the body for therapeutic purposes, usually by puncturing the skin with a thin needle. Ayurveda is India's traditional system of medicine. Ayurvedic medicine (meaning “science of life”) is a comprehensive system of medicine that places equal emphasis on body, mind, and spirit. Ayurveda strives to restore the innate harmony of the individual. Some of the primary Ayurvedic treatments include diet, exercise, meditation, herbs, massage, exposure to sunlight, and controlled breathing. Other traditional healing systems have been developed by the world’s indigenous populations. These populations include Native American, Aboriginal, African, Middle Eastern, Tibetan, and Central and South American cultures. Homeopathy and naturopathy are also examples of complete alternative medicine systems. Homeopathic medicine is an unconventional Western system that is based on the principle that “like cures like,” i.e., that the same substance that in large doses produces the symptoms of an illness, in very minute doses cures it. Homeopathic health practitioners believe that the more dilute the remedy, the greater its potency. Therefore, they use small doses of specially prepared plant extracts and minerals to stimulate the body's defense mechanisms and healing processes in order to treat illness. Naturopathic medicine is based on the theory that disease is a manifestation of alterations in the processes by which the body naturally heals itself and emphasizes health restoration rather than disease treatment. Naturopathic physicians employ an array of healing practices, including the following: diet and clinical nutrition, homeopathy, acupuncture, herbal medicine, hydrotherapy (the use of water in a range of temperatures and methods of applications), spinal and soft-tissue manipulation, physical therapies (such as those involving electrical currents, ultrasound, and light), therapeutic counseling, and pharmacology.
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Mind-Body Interventions Mind-body interventions employ a variety of techniques designed to facilitate the mind's capacity to affect bodily function and symptoms. Only a select group of mind-body interventions having well-documented theoretical foundations are considered CAM. For example, patient education and cognitive-behavioral approaches are now considered “mainstream.” On the other hand, complementary and alternative medicine includes meditation, certain uses of hypnosis, dance, music, and art therapy, as well as prayer and mental healing.
Biological-Based Therapies This category of CAM includes natural and biological-based practices, interventions, and products, many of which overlap with conventional medicine's use of dietary supplements. This category includes herbal, special dietary, orthomolecular, and individual biological therapies. Herbal therapy employs an individual herb or a mixture of herbs for healing purposes. An herb is a plant or plant part that produces and contains chemical substances that act upon the body. Special diet therapies, such as those proposed by Drs. Atkins, Ornish, Pritikin, and Weil, are believed to prevent and/or control illness as well as promote health. Orthomolecular therapies aim to treat disease with varying concentrations of chemicals such as magnesium, melatonin, and mega-doses of vitamins. Biological therapies include, for example, the use of laetrile and shark cartilage to treat cancer and the use of bee pollen to treat autoimmune and inflammatory diseases.
Manipulative and Body-Based Methods This category includes methods that are based on manipulation and/or movement of the body. For example, chiropractors focus on the relationship between structure and function, primarily pertaining to the spine, and how that relationship affects the preservation and restoration of health. Chiropractors use manipulative therapy as an integral treatment tool. In contrast, osteopaths place particular emphasis on the musculoskeletal system and practice osteopathic manipulation. Osteopaths believe that all of the body's systems work together and that disturbances in one system may have an impact upon function elsewhere in the body. Massage therapists manipulate the soft tissues of the body to normalize those tissues.
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Energy Therapies Energy therapies focus on energy fields originating within the body (biofields) or those from other sources (electromagnetic fields). Biofield therapies are intended to affect energy fields (the existence of which is not yet experimentally proven) that surround and penetrate the human body. Some forms of energy therapy manipulate biofields by applying pressure and/or manipulating the body by placing the hands in or through these fields. Examples include Qi gong, Reiki and Therapeutic Touch. Qi gong is a component of traditional oriental medicine that combines movement, meditation, and regulation of breathing to enhance the flow of vital energy (qi) in the body, improve blood circulation, and enhance immune function. Reiki, the Japanese word representing Universal Life Energy, is based on the belief that, by channeling spiritual energy through the practitioner, the spirit is healed and, in turn, heals the physical body. Therapeutic Touch is derived from the ancient technique of “laying-on of hands.” It is based on the premises that the therapist’s healing force affects the patient's recovery and that healing is promoted when the body's energies are in balance. By passing their hands over the patient, these healers identify energy imbalances. Bioelectromagnetic-based therapies involve the unconventional use of electromagnetic fields to treat illnesses or manage pain. These therapies are often used to treat asthma, cancer, and migraine headaches. Types of electromagnetic fields which are manipulated in these therapies include pulsed fields, magnetic fields, and alternating current or direct current fields.
Can Alternatives Affect My Treatment? A critical issue in pursuing complementary alternatives mentioned thus far is the risk that these might have undesirable interactions with your medical treatment. It becomes all the more important to speak with your healthcare provider who can offer advice on the use of alternatives. Official sources confirm this view. Though written for women, we find that the National Women’s Health Information Center’s advice on pursuing alternative medicine is appropriate for patients of both genders and all ages.43
43
Adapted from http://www.4woman.gov/faq/alternative.htm.
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Is It Okay to Want Both Traditional and Alternative or Complementary Medicine? Should you wish to explore non-traditional types of treatment, be sure to discuss all issues concerning treatments and therapies with your healthcare provider, whether a dentist or practitioner of complementary and alternative medicine. Competent healthcare management requires knowledge of both conventional and alternative therapies you are taking for the practitioner to have a complete picture of your treatment plan. The decision to use complementary and alternative treatments is an important one. Consider before selecting an alternative therapy, the safety and effectiveness of the therapy or treatment, the expertise and qualifications of the healthcare practitioner, and the quality of delivery. These topics should be considered when selecting any practitioner or therapy.
Finding CAM References on Gingivitis Having read the previous discussion, you may be wondering which complementary or alternative treatments might be appropriate for gingivitis. For the remainder of this chapter, we will direct you to a number of official sources which can assist you in researching studies and publications. Some of these articles are rather technical, so some patience may be required.
National Center for Complementary and Alternative Medicine The National Center for Complementary and Alternative Medicine (NCCAM) of the National Institutes of Health (http://nccam.nih.gov) has created a link to the National Library of Medicine's databases to allow patients to search for articles that specifically relate to gingivitis and complementary medicine. To search the database, go to the following Web site: www.nlm.nih.gov/nccam/camonpubmed.html. Select “CAM on PubMed.” Enter “gingivitis” (or synonyms) into the search box. Click “Go.” The following references provide information on particular aspects of complementary and alternative medicine (CAM) that are related to gingivitis: ·
Clinical and histological evaluation of gingival massage in the treatment of chronic gingivitis. Author(s): Simaan C, Skach M.
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Source: J Periodontol. 1966 September-October; 37(5): 383-90. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=4161925&dopt=Abstract ·
Clinical effect of a Mexican sanguinaria extract (Polygonum aviculare L.) on gingivitis. Author(s): Gonzalez Begne M, Yslas N, Reyes E, Quiroz V, Santana J, Jimenez G. Source: Journal of Ethnopharmacology. 2001 January; 74(1): 45-51. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11137347&dopt=Abstract
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Comparison of an herbal toothpaste with a fluoride toothpaste on plaque and gingivitis. Author(s): Moran J, Addy M, Newcombe R. Source: Clin Prev Dent. 1991 May-June; 13(3): 12-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=1860291&dopt=Abstract
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Effects of extended systemic and topical folate supplementation on gingivitis of pregnancy. Author(s): Thomson ME, Pack AR. Source: Journal of Clinical Periodontology. 1982 May; 9(3): 275-80. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=7047579&dopt=Abstract
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Effects of topical and systemic folic acid supplementation on gingivitis in pregnancy. Author(s): Pack AR, Thomson ME. Source: Journal of Clinical Periodontology. 1980 October; 7(5): 402-14. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=7007454&dopt=Abstract
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Holistic care concepts, bruxism and necrotizing ulcerative gingivitis. Author(s): Pear JH. Source: Dent Hyg (Chic). 1982 September; 56(9): 24-9. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=6958589&dopt=Abstract
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Increase of free collagenase and neutral protease activities in the gingival crevice during experimental gingivitis in man. Author(s): Kowashi Y, Jaccard F, Cimasoni G. Source: Archives of Oral Biology. 1979; 24(9): 645-50. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=231957&dopt=Abstract
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Meswak versus chlorhexidine and a commercial toothpaste in plaque formation and gingivitis. Author(s): Gazi MI, Lambourne A, Chagla AH. Source: Odontostomatol Trop. 1987 March; 10(1): 29-38. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=3474596&dopt=Abstract
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Notes on treating a case of acute lymphocytic leukemia resembling necrotizing ulcerative gingivitis: a case history. Author(s): Aker F, Magera J, Vernino A. Source: Quintessence Int. 1978 March; 9(3): 51-2. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=287120&dopt=Abstract
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Plasma cell gingivitis of unusual origin. A case report. Author(s): Serio FG, Siegel MA, Slade BE. Source: J Periodontol. 1991 June; 62(6): 390-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=1870070&dopt=Abstract
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Plasma cell gingivitis related to the use of herbal toothpaste. Author(s): Macleod RI, Ellis JE. Source: Br Dent J. 1989 May 20; 166(10): 375-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=2736170&dopt=Abstract
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The effect of herbal extracts in an experimental mouthrinse on established plaque and gingivitis. Author(s): Van der Weijden GA, Timmer CJ, Timmerman MF, Reijerse E, Mantel MS, van der Velden U.
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Source: Journal of Clinical Periodontology. 1998 May; 25(5): 399-403. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=9650877&dopt=Abstract ·
The effects of megadoses of ascorbic acid on PMN chemotaxis and experimental gingivitis. Author(s): Vogel RI, Lamster IB, Wechsler SA, Macedo B, Hartley LJ, Macedo JA. Source: J Periodontol. 1986 August; 57(8): 472-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=3462380&dopt=Abstract
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The efficacy of a herbal-based toothpaste on the control of plaque and gingivitis. Author(s): Mullally BH, James JA, Coulter WA, Linden GJ. Source: Journal of Clinical Periodontology. 1995 September; 22(9): 686-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=7593698&dopt=Abstract
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The relationship between chewing sticks (Miswak) and periodontal health. 2. Relationship to plaque, gingivitis, pocket depth, and attachment loss. Author(s): Eid MA, al-Shammery AR, Selim HA. Source: Quintessence Int. 1990 December; 21(12): 1019-22. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=2082419&dopt=Abstract
Additional Web Resources A number of additional Web sites offer encyclopedic information covering CAM and related topics. The following is a representative sample: ·
Alternative Medicine Foundation, Inc.: http://www.herbmed.org/
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AOL: http://search.aol.com/cat.adp?id=169&layer=&from=subcats
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Chinese Medicine: http://www.newcenturynutrition.com/
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drkoop.comÒ: http://www.drkoop.com/InteractiveMedicine/IndexC.html
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Family Village: http://www.familyvillage.wisc.edu/med_altn.htm
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Google: http://directory.google.com/Top/Health/Alternative/
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·
Healthnotes: http://www.thedacare.org/healthnotes/
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Open Directory Project: http://dmoz.org/Health/Alternative/
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TPN.com: http://www.tnp.com/
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Yahoo.com: http://dir.yahoo.com/Health/Alternative_Medicine/
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WebMDÒHealth: http://my.webmd.com/drugs_and_herbs
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WellNet: http://www.wellnet.ca/herbsa-c.htm
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WholeHealthMD.com: http://www.wholehealthmd.com/reflib/0,1529,,00.html
The following is a specific Web list relating to gingivitis; please note that any particular subject below may indicate either a therapeutic use, or a contraindication (potential danger), and does not reflect an official recommendation: ·
General Overview Gingivitis Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Gingivitis.htm
·
Herbs and Supplements Achillea Alternative names: Yarrow; Achillea millefolium L. Source: Alternative Medicine Foundation, Inc.; www.amfoundation.org Hyperlink: http://www.herbmed.org/ Alpha2-Adrenergic Agonists Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsDepletions/Cardio vascularMedicationsAlpha2AdrenergicAgonistscl.html Beta-Blockers Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsDepletions/Cardio vascularMedicationsBetaBlockerscl.html
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Bloodroot Alternative names: Sanguinaria canadensis Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Herb/Bloodroot.htm Bloodroot Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Gingivitis.htm Bloodroot Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000112.html Caraway Alternative names: Carum carvi Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Herb/Caraway.htm Carnosine Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Supp/Carnosine.htm Chamaemelum nobile Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsHerbs/Chamomile Romanch.html Chamomile Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Gingivitis.htm Chamomile Alternative names: Matricaria recutita Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Herb/Chamomile.htm Chamomile, Roman
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Alternative names: Chamaemelum nobile Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsHerbs/Chamomile Romanch.html Chlorhexidine Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Gingivitis.htm Chlorhexidine Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Drug/Chlorhexidine.htm Coenzyme Q Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Gingivitis.htm Coenzyme Q10 Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Supp/Coenzyme_Q10.htm Coenzyme Q10 Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Gingivitis.htm CoQ10 Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Gingivitis.htm Cranberry Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,100 19,00.html Echinacea
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Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Gingivitis.htm Echinacea Alternative names: Echinacea purpurea, Echinacea angustifolia, Echinacea pallida Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Herb/Echinacea.htm ECHINACEA Source: The Canadian Internet Directory for Holistic Help, WellNet, Health and Wellness Network; www.wellnet.ca Hyperlink: http://www.wellnet.ca/herbsd-f.htm Echinacea purpurea Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Gingivitis.htm Fibric Acid Derivatives Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsDepletions/Cholest erolLoweringMedicationsFibricAcidDerivativescl.html Flavonoids Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Supp/Flavonoids.htm Flavonoids Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Gingivitis.htm Glycyrrhiza1 Alternative names: Licorice; Glycyrrhiza glabra L. Source: Alternative Medicine Foundation, Inc.; www.amfoundation.org Hyperlink: http://www.herbmed.org/ Juniperus
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Alternative names: Juniper; Juniperus sp. Source: Alternative Medicine Foundation, Inc.; www.amfoundation.org Hyperlink: http://www.herbmed.org/ Melaleuca Alternative names: Tea Tree Oil; Melaleuca alternifolia Source: Alternative Medicine Foundation, Inc.; www.amfoundation.org Hyperlink: http://www.herbmed.org/ Myrrh Alternative names: Commiphora molmol Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Herb/Myrrh.htm Myrrh Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Gingivitis.htm MYRRH Source: The Canadian Internet Directory for Holistic Help, WellNet, Health and Wellness Network; www.wellnet.ca Hyperlink: http://www.wellnet.ca/herbsm-o.htm Peppermint Alternative names: Mentha piperita Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Herb/Peppermint.htm Peppermint Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Gingivitis.htm Phenothiazine Derivatives Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsDepletions/Psychot herapeuticMedicationsPhenothiazineDerivativescl.html Phenytoin Source: Healthnotes, Inc.; www.healthnotes.com
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Hyperlink: http://www.thedacare.org/healthnotes/Concern/Gingivitis.htm Potentilla Alternative names: Cinquefoil, Silverweed; Potentilla sp. Source: Alternative Medicine Foundation, Inc.; www.amfoundation.org Hyperlink: http://www.herbmed.org/ Roman Chamomile Alternative names: Chamaemelum nobile Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsHerbs/Chamomile Romanch.html Rosmarinus Alternative names: Rosemary; Rosmarinus officinalis L. Source: Alternative Medicine Foundation, Inc.; www.amfoundation.org Hyperlink: http://www.herbmed.org/ Sage Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Gingivitis.htm Sage Alternative names: Salvia officinalis Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Herb/Sage.htm Sanguinaria Alternative names: Bloodroot; Sanguinaria canadensis L. Source: Alternative Medicine Foundation, Inc.; www.amfoundation.org Hyperlink: http://www.herbmed.org/ Sanguinaria Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Gingivitis.htm Sassafras Alternative names: Sassafras albidum (Nuttall) Source: Alternative Medicine Foundation, Inc.; www.amfoundation.org
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Hyperlink: http://www.herbmed.org/ Sulfonylureas Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsDepletions/Antidia beticMedicationsSulfonylureascl.html Thiazide Diuretics Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsDepletions/Diuretic sThiazideDiureticscl.html Thioxanthene Derivatives Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsDepletions/Psychot herapeuticMedicationsThioxantheneDerivativescl.html Thyme Alternative names: Thymus vulgaris Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Herb/Thyme.htm Tricyclic Antidepressants (TCAs) Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsDepletions/Antide pressantMedicationsTCAscl.html Vasodilators Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsDepletions/Cardio vascularMedicationsVasodilatorscl.html WILD INDIGO Source: The Canadian Internet Directory for Holistic Help, WellNet, Health and Wellness Network; www.wellnet.ca Hyperlink: http://www.wellnet.ca/herbsw-z.htm ·
Related Conditions
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Periodontal Disease Alternative names: Gum Disease Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000290.html
General References A good place to find general background information on CAM is the National Library of Medicine. It has prepared within the MEDLINEplus system an information topic page dedicated to complementary and alternative medicine. To access this page, go to the MEDLINEplus site at: www.nlm.nih.gov/medlineplus/alternativemedicine.html. This Web site provides a general overview of various topics and can lead to a number of general sources. The following additional references describe, in broad terms, alternative and complementary medicine (sorted alphabetically by title; hyperlinks provide rankings, information, and reviews at Amazon.com): ·
Complementary Therapies in Dental Practice by Peter Varley (Editor); Paperback, 1st edition (January 15, 1998), Butterworth-Heinemann Medical; ISBN: 0723610339; http://www.amazon.com/exec/obidos/ASIN/0723610339/icongroupinter na
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Alternative Medicine for Dummies by James Dillard (Author); Audio Cassette, Abridged edition (1998), Harper Audio; ISBN: 0694520659; http://www.amazon.com/exec/obidos/ASIN/0694520659/icongroupinter na
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Complementary and Alternative Medicine Secrets by W. Kohatsu (Editor); Hardcover (2001), Hanley & Belfus; ISBN: 1560534400; http://www.amazon.com/exec/obidos/ASIN/1560534400/icongroupinter na
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Dictionary of Alternative Medicine by J. C. Segen; Paperback-2nd edition (2001), Appleton & Lange; ISBN: 0838516211; http://www.amazon.com/exec/obidos/ASIN/0838516211/icongroupinter na
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Eat, Drink, and Be Healthy: The Harvard Medical School Guide to Healthy Eating by Walter C. Willett, MD, et al; Hardcover - 352 pages (2001), Simon & Schuster; ISBN: 0684863375; http://www.amazon.com/exec/obidos/ASIN/0684863375/icongroupinter na
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Encyclopedia of Natural Medicine, Revised 2nd Edition by Michael T. Murray, Joseph E. Pizzorno; Paperback - 960 pages, 2nd Rev edition (1997), Prima Publishing; ISBN: 0761511571; http://www.amazon.com/exec/obidos/ASIN/0761511571/icongroupinter na
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Integrative Medicine: An Introduction to the Art & Science of Healing by Andrew Weil (Author); Audio Cassette, Unabridged edition (2001), Sounds True; ISBN: 1564558541; http://www.amazon.com/exec/obidos/ASIN/1564558541/icongroupinter na
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New Encyclopedia of Herbs & Their Uses by Deni Bown; Hardcover 448 pages, Revised edition (2001), DK Publishing; ISBN: 078948031X; http://www.amazon.com/exec/obidos/ASIN/078948031X/icongroupinter na
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Textbook of Complementary and Alternative Medicine by Wayne B. Jonas; Hardcover (2003), Lippincott, Williams & Wilkins; ISBN: 0683044370; http://www.amazon.com/exec/obidos/ASIN/0683044370/icongroupinter na
For additional information on complementary and alternative medicine, ask your healthcare provider or write to: National Institutes of Health National Center for Complementary and Alternative Medicine Clearinghouse P. O. Box 8218 Silver Spring, MD 20907-8218
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APPENDIX C. RESEARCHING NUTRITION Overview Since the time of Hippocrates, healthcare providers have understood the importance of diet and nutrition to patients’ health and well-being. Since then, they have accumulated an impressive archive of studies and knowledge dedicated to this subject. Based on their experience, dentists and healthcare providers may recommend particular dietary supplements to patients with gingivitis. Any dietary recommendation is based on a patient's age, body mass, gender, lifestyle, eating habits, food preferences, and health condition. It is therefore likely that different patients with gingivitis may be given different recommendations. Some recommendations may be directly related to gingivitis, while others may be more related to the patient's general health. These recommendations, themselves, may differ from what official sources recommend for the average person. In this chapter we will begin by briefly reviewing the essentials of diet and nutrition that will broadly frame more detailed discussions of gingivitis. We will then show you how to find studies dedicated specifically to nutrition and gingivitis.
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Food and Nutrition: General Principles What Are Essential Foods? Food is generally viewed by official sources as consisting of six basic elements: (1) fluids, (2) carbohydrates, (3) protein, (4) fats, (5) vitamins, and (6) minerals. Consuming a combination of these elements is considered to be a healthy diet: ·
Fluids are essential to human life as 80-percent of the body is composed of water. Water is lost via urination, sweating, diarrhea, vomiting, diuretics (drugs that increase urination), caffeine, and physical exertion.
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Carbohydrates are the main source for human energy (thermoregulation) and the bulk of typical diets. They are mostly classified as being either simple or complex. Simple carbohydrates include sugars which are often consumed in the form of cookies, candies, or cakes. Complex carbohydrates consist of starches and dietary fibers. Starches are consumed in the form of pastas, breads, potatoes, rice, and other foods. Soluble fibers can be eaten in the form of certain vegetables, fruits, oats, and legumes. Insoluble fibers include brown rice, whole grains, certain fruits, wheat bran and legumes.
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Proteins are eaten to build and repair human tissues. Some foods that are high in protein are also high in fat and calories. Food sources for protein include nuts, meat, fish, cheese, and other dairy products.
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Fats are consumed for both energy and the absorption of certain vitamins. There are many types of fats, with many general publications recommending the intake of unsaturated fats or those low in cholesterol.
Vitamins and minerals are fundamental to human health, growth, and, in some cases, disease prevention. Most are consumed in your diet (exceptions being vitamins K and D which are produced by intestinal bacteria and sunlight on the skin, respectively). Each vitamin and mineral plays a different role in health. The following outlines essential vitamins: ·
Vitamin A is important to the health of your eyes, hair, bones, and skin; sources of vitamin A include foods such as eggs, carrots, and cantaloupe.
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Vitamin B1, also known as thiamine, is important for your nervous system and energy production; food sources for thiamine include meat, peas, fortified cereals, bread, and whole grains.
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Vitamin B2, also known as riboflavin, is important for your nervous system and muscles, but is also involved in the release of proteins from
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nutrients; food sources for riboflavin include dairy products, leafy vegetables, meat, and eggs. ·
Vitamin B3, also known as niacin, is important for healthy skin and helps the body use energy; food sources for niacin include peas, peanuts, fish, and whole grains
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Vitamin B6, also known as pyridoxine, is important for the regulation of cells in the nervous system and is vital for blood formation; food sources for pyridoxine include bananas, whole grains, meat, and fish.
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Vitamin B12 is vital for a healthy nervous system and for the growth of red blood cells in bone marrow; food sources for vitamin B12 include yeast, milk, fish, eggs, and meat.
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Vitamin C allows the body's immune system to fight various diseases, strengthens body tissue, and improves the body's use of iron; food sources for vitamin C include a wide variety of fruits and vegetables.
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Vitamin D helps the body absorb calcium which strengthens bones and teeth; food sources for vitamin D include oily fish and dairy products.
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Vitamin E can help protect certain organs and tissues from various degenerative diseases; food sources for vitamin E include margarine, vegetables, eggs, and fish.
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Vitamin K is essential for bone formation and blood clotting; common food sources for vitamin K include leafy green vegetables.
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Folic Acid maintains healthy cells and blood and, when taken by a pregnant woman, can prevent her fetus from developing neural tube defects; food sources for folic acid include nuts, fortified breads, leafy green vegetables, and whole grains.
It should be noted that one can overdose on certain vitamins which become toxic if consumed in excess (e.g. vitamin A, D, E and K). Like vitamins, minerals are chemicals that are required by the body to remain in good health. Because the human body does not manufacture these chemicals internally, we obtain them from food and other dietary sources. The more important minerals include: ·
Calcium is needed for healthy bones, teeth, and muscles, but also helps the nervous system function; food sources for calcium include dry beans, peas, eggs, and dairy products.
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Chromium is helpful in regulating sugar levels in blood; food sources for chromium include egg yolks, raw sugar, cheese, nuts, beets, whole grains, and meat.
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Fluoride is used by the body to help prevent tooth decay and to reinforce bone strength; sources of fluoride include drinking water and certain brands of toothpaste.
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Iodine helps regulate the body's use of energy by synthesizing into the hormone thyroxine; food sources include leafy green vegetables, nuts, egg yolks, and red meat.
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Iron helps maintain muscles and the formation of red blood cells and certain proteins; food sources for iron include meat, dairy products, eggs, and leafy green vegetables.
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Magnesium is important for the production of DNA, as well as for healthy teeth, bones, muscles, and nerves; food sources for magnesium include dried fruit, dark green vegetables, nuts, and seafood.
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Phosphorous is used by the body to work with calcium to form bones and teeth; food sources for phosphorous include eggs, meat, cereals, and dairy products.
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Selenium primarily helps maintain normal heart and liver functions; food sources for selenium include wholegrain cereals, fish, meat, and dairy products.
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Zinc helps wounds heal, the formation of sperm, and encourage rapid growth and energy; food sources include dried beans, shellfish, eggs, and nuts.
The United States government periodically publishes recommended diets and consumption levels of the various elements of food. Again, your healthcare provider may encourage deviations from the average official recommendation based on your specific condition. To learn more about basic dietary guidelines, visit the Web site: http://www.health.gov/dietaryguidelines/. Based on these guidelines, many foods are required to list the nutrition levels on the food’s packaging. Labeling Requirements are listed at the following site maintained by the Food and Drug Administration: http://www.cfsan.fda.gov/~dms/labcons.html. When interpreting these requirements, the government recommends that consumers become familiar with the following abbreviations before reading FDA literature:44 ·
44
DVs (Daily Values): A new dietary reference term that will appear on the food label. It is made up of two sets of references, DRVs and RDIs.
Adapted from the FDA: http://www.fda.gov/fdac/special/foodlabel/dvs.html.
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·
DRVs (Daily Reference Values): A set of dietary references that applies to fat, saturated fat, cholesterol, carbohydrate, protein, fiber, sodium, and potassium.
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RDIs (Reference Daily Intakes): A set of dietary references based on the Recommended Dietary Allowances for essential vitamins and minerals and, in selected groups, protein. The name “RDI” replaces the term “U.S. RDA.”
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RDAs (Recommended Dietary Allowances): A set of estimated nutrient allowances established by the National Academy of Sciences. It is updated periodically to reflect current scientific knowledge.
What Are Dietary Supplements?45 Dietary supplements are widely available through many commercial sources, including health food stores, grocery stores, pharmacies, and by mail. Dietary supplements are provided in many forms including tablets, capsules, powders, gel-tabs, extracts, and liquids. Historically in the United States, the most prevalent type of dietary supplement was a multivitamin/mineral tablet or capsule that was available in pharmacies, either by prescription or “over the counter.” Supplements containing strictly herbal preparations were less widely available. Currently in the United States, a wide array of supplement products are available, including vitamin, mineral, other nutrients, and botanical supplements as well as ingredients and extracts of animal and plant origin. The Office of Dietary Supplements (ODS) of the National Institutes of Health is the official agency of the United States which has the expressed goal of acquiring “new knowledge to help prevent, detect, diagnose, and treat disease and disability, from the rarest genetic disorder to the common cold.”46 According to the ODS, dietary supplements can have an important impact on the prevention and management of disease and on the maintenance of health.47 The ODS notes that considerable research on the This discussion has been adapted from the NIH: http://ods.od.nih.gov/whatare/whatare.html. 46 Contact: The Office of Dietary Supplements, National Institutes of Health, Building 31, Room 1B29, 31 Center Drive, MSC 2086, Bethesda, Maryland 20892-2086, Tel: (301) 435-2920, Fax: (301) 480-1845, E-mail:
[email protected]. 47 Adapted from http://ods.od.nih.gov/about/about.html. The Dietary Supplement Health and Education Act defines dietary supplements as “a product (other than tobacco) intended to supplement the diet that bears or contains one or more of the following dietary ingredients: a vitamin, mineral, amino acid, herb or other botanical; or a dietary substance for use to supplement the diet by increasing the total dietary intake; or a concentrate, 45
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effects of dietary supplements has been conducted in Asia and Europe where the use of plant products, in particular, has a long tradition. However, the overwhelming majority of supplements have not been studied scientifically. To explore the role of dietary supplements in the improvement of health care, the ODS plans, organizes, and supports conferences, workshops, and symposia on scientific topics related to dietary supplements. The ODS often works in conjunction with other NIH Institutes and Centers, other government agencies, professional organizations, and public advocacy groups. To learn more about official information on dietary supplements, visit the ODS site at http://ods.od.nih.gov/whatare/whatare.html. Or contact: The Office of Dietary Supplements National Institutes of Health Building 31, Room 1B29 31 Center Drive, MSC 2086 Bethesda, Maryland 20892-2086 Tel: (301) 435-2920 Fax: (301) 480-1845 E-mail:
[email protected] Finding Studies on Gingivitis The NIH maintains an office dedicated to patient nutrition and diet. The National Institutes of Health’s Office of Dietary Supplements (ODS) offers a searchable bibliographic database called the IBIDS (International Bibliographic Information on Dietary Supplements). The IBIDS contains over 460,000 scientific citations and summaries about dietary supplements and nutrition as well as references to published international, scientific literature on dietary supplements such as vitamins, minerals, and botanicals.48 IBIDS is available to the public free of charge through the ODS Internet page: http://ods.od.nih.gov/databases/ibids.html.
metabolite, constituent, extract, or combination of any ingredient described above; and intended for ingestion in the form of a capsule, powder, softgel, or gelcap, and not represented as a conventional food or as a sole item of a meal or the diet.” 48 Adapted from http://ods.od.nih.gov. IBIDS is produced by the Office of Dietary Supplements (ODS) at the National Institutes of Health to assist the public, healthcare providers, educators, and researchers in locating credible, scientific information on dietary supplements. IBIDS was developed and will be maintained through an interagency partnership with the Food and Nutrition Information Center of the National Agricultural Library, U.S. Department of Agriculture.
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After entering the search area, you have three choices: (1) IBIDS Consumer Database, (2) Full IBIDS Database, or (3) Peer Reviewed Citations Only. We recommend that you start with the Consumer Database. While you may not find references for the topics that are of most interest to you, check back periodically as this database is frequently updated. More studies can be found by searching the Full IBIDS Database. Healthcare professionals and researchers generally use the third option, which lists peer-reviewed citations. In all cases, we suggest that you take advantage of the “Advanced Search” option that allows you to retrieve up to 100 fully explained references in a comprehensive format. Type “gingivitis” (or synonyms) into the search box. To narrow the search, you can also select the “Title” field. The following information is typical of that found when using the “Full IBIDS Database” when searching using “gingivitis” (or a synonym): ·
A comparison of stabilized stannous fluoride dentifrice and triclosan/copolymer dentifrice for efficacy in the reduction of gingivitis and gingival bleeding: six-month clinical results. Author(s): Procter and Gamble Company, Health Care Research Center Mason, Ohio, USA. Source: McClanahan, S F Beiswanger, B B Bartizek, R D Lanzalaco, A C Bacca, L White, D J J-Clin-Dent. 1997; 8(2 Spec No): 39-45 0895-8831
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A short-term brushing model for assessing antiplaque/antigingivitis dentifrice effectiveness: a pilot study. Author(s): Warner-Lambert Co., Morris Plains, NJ, USA. Source: Kohut, B Coelho, J Sharma, N C Galustians, J Proskin, H M J-ClinDent. 1999; 10(4): 119-23 0895-8831
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Caries inhibition efficacy of an antiplaque/antigingivitis dentifrice. Author(s): The Warner-Lambert Consumer Healthcare Division of the Warner-Lambert Consumer Group of Pfizer, Morris Plains, NJ, USA.
[email protected] Source: Yu, D Pearson, S K Bowen, W H Luo, D Kohut, B E Harper, D S Am-J-Dent. 2000 September; 13(Spec No): 14C-17C 0894-8275
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Clinical controlled study on plaque and gingivitis reduction under long-term use of low-dose chlorhexidine solutions in a population exhibiting good oral hygiene. Author(s): Department of Periodontology, Dental School TU Dresden, Germany.
[email protected] Source: Hoffmann, T Bruhn, G Richter, S Netuschil, L Brecx, M Clin-OralInvestig. 2001 June; 5(2): 89-95 1432-6981
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Comparative clinical trial with natural herbal mouthwash versus chlorhexidine in gingivitis. Source: Serfaty, R Itic, J J-Clin-Dent. 1988 Summer; 1 Suppl AA34-7 08958831
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Comparative clinical trials of a European herbal sodium bicarbonate dentifrice and a widely-used dentifrice containing MFP, in braceinduced gingivitis. Source: Bellet, L Bellet, A J-Clin-Dent. 1988 Summer; 1 Suppl AA25-6 0895-8831
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Double-blind evaluation of the clinical efficacy of an herbal dentifrice against gingivitis and periodontitis. Source: Emling, R C J-Clin-Dent. 1988 Summer; 1 Suppl AA27-9 08958831
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Effect of a triclosan/copolymer/fluoride dentifrice on plaque formation and gingivitis: a 7-month clinical study. Author(s): University of Texas Health Science Center at San Antonio. Source: Garcia Godoy, F Garcia Godoy, F DeVizio, W Volpe, A R Ferlauto, R J Miller, J M Am-J-Dent. 1990 September; 3 Spec NoS15-26 0894-8275
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Effect of insulin on naturally occurring gingivitis rats with diabetes. Author(s): Department of Pharmacology, Osaka Dental University, Japan. Source: Hayashi, A Shinohara, M Ohura, K J-Osaka-Dent-Univolume 1999 April; 33(1): 1-7 0475-2058
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Effect of the NSAID piroxicam, topically administered, on the development of gingivitis in beagle dogs. Author(s): Harvard School of Dental Medicine, Boston, MA. Source: Howell, T H Fiorellini, J Weber, H P Williams, R C J-PeriodontalRes. 1991 May; 26(3 Pt 1): 180-3 0022-3484
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Effect of two dietary regimens on gingivitis in the dog. Author(s): Waltham Centre for Pet Nutrition, Melton Mowbray, Leicestershire. Source: Rawlings, J M Gorrel, C Markwell, P J J-Small-Anim-Pract. 1997 April; 38(4): 147-51 0022-4510
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Effects of zirconium silicate chewing gum on plaque and gingivitis. Author(s): University of Texas Health Science Center at Houston 77225. Source: Anderson, G B McLean, T N Caffesse, R G Smith, B A Quintessence-Int. 1990 June; 21(6): 479-89 0033-6572
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Efficacy of a dentifrice containing zinc citrate for the control of plaque and gingivitis: a 6-month clinical study in adults. Author(s): McWill Research Laboratories, Inc. Atlanta, Georgia, USA.
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Source: Williams, C McBride, S Mostler, K Petrone, D M Simone, A J Crawford, R Patel, S Petrone, M E Chaknis, P DeVizio, W Volpe, A R Proskin, H M Compend-Contin-Educ-Dent. 1998; 19(2 Suppl): 4-15 ·
Efficacy of a mouthrinse containing 0.05% cetylpyridinium chloride for the control of plaque and gingivitis: a 6-month clinical study in adults. Author(s): Department of Periodontics, Howard University College of Dentistry, Washington, DC, USA. Source: Allen, D R Davies, R Bradshaw, B Ellwood, R Simone, A J Robinson, R Mukerjee, C Petrone, M E Chaknis, P Volpe, A R Proskin, H M Compend-Contin-Educ-Dent. 1998; 19(2 Suppl): 20-6
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Efficacy of a triclosan/NaF dentifrice in the control of plaque and gingivitis and concurrent oral microflora monitoring. Author(s): Dental Research Center, University of Dentistry and Medicine of New Jersey, Newark 07103, USA. Source: Fine, D H Furgang, D Bonta, Y DeVizio, W Volpe, A R Reynolds, H Zambon, J J Dunford, R G Am-J-Dent. 1998 December; 11(6): 259-70 0894-8275
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Eighteen-month evaluation of the effects of a 0.4% stannous fluoride gel on gingivitis in orthodontic patients. Author(s): Department of Growth and Development, School of Dentistry, University of California at San Francisco. Source: Boyd, R L Chun, Y S Am-J-Orthod-Dentofacial-Orthopage 1994 January; 105(1): 35-41 0889-5406
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Essential oils in an antiplaque and antigingivitis dentifrice: a 6-month study. Author(s): The Warner-Lambert Consumer Healthcare Division of the Warner-Lambert Consumer Group of Pfizer, Morris Plains, NJ 07950, USA.
[email protected] Source: Coelho, J Kohut, B E Mankodi, S Parikh, R Wu, M M Am-J-Dent. 2000 September; 13(Spec No): 5C-10C 0894-8275
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Longitudinal evaluation of the effect of sanguinarine on plaque and gingivitis. Source: Palcanis, K G Sarbin, A G Koertge, T E Brooks, C N Gunsolley, J C Gen-Dent. 1990 Jan-February; 38(1): 17-9 0363-6771
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Long-standing plaque and gingivitis at implants and teeth in the dog. Author(s): Faculty of Odontology, University of Goteborg, Sweden. Source: Ericsson, I Berglundh, T Marinello, C Liljenberg, B Lindhe, J ClinOral-Implants-Res. 1992 September; 3(3): 99-103 0905-7161
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Long-term effects of Listerine antiseptic on dental plaque and gingivitis. Source: Ross, N M Charles, C H Dills, S S J-Clin-Dent. 1989 Spring; 1(4): 92-5 0895-8831
Federal Resources on Nutrition In addition to the IBIDS, the United States Department of Health and Human Services (HHS) and the United States Department of Agriculture (USDA) provide many sources of information on general nutrition and health. Recommended resources include: ·
healthfinder®, HHS's gateway to health information, including diet and nutrition: http://www.healthfinder.gov/scripts/SearchContext.asp?topic=238&pag e=0
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The United States Department of Agriculture's Web site dedicated to nutrition information: www.nutrition.gov
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The Food and Drug Administration's Web site for federal food safety information: www.foodsafety.gov
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The National Action Plan on Overweight and Obesity sponsored by the United States Surgeon General: http://www.surgeongeneral.gov/topics/obesity/
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The Center for Food Safety and Applied Nutrition has an Internet site sponsored by the Food and Drug Administration and the Department of Health and Human Services: http://vm.cfsan.fda.gov/
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Center for Nutrition Policy and Promotion sponsored by the United States Department of Agriculture: http://www.usda.gov/cnpp/
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Food and Nutrition Information Center, National Agricultural Library sponsored by the United States Department of Agriculture: http://www.nal.usda.gov/fnic/
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Food and Nutrition Service sponsored by the United States Department of Agriculture: http://www.fns.usda.gov/fns/
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Additional Web Resources A number of additional Web sites offer encyclopedic information covering food and nutrition. The following is a representative sample: ·
AOL: http://search.aol.com/cat.adp?id=174&layer=&from=subcats
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Family Village: http://www.familyvillage.wisc.edu/med_nutrition.html
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Google: http://directory.google.com/Top/Health/Nutrition/
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Healthnotes: http://www.thedacare.org/healthnotes/
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Open Directory Project: http://dmoz.org/Health/Nutrition/
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Yahoo.com: http://dir.yahoo.com/Health/Nutrition/
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WebMDÒHealth: http://my.webmd.com/nutrition
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WholeHealthMD.com: http://www.wholehealthmd.com/reflib/0,1529,,00.html
The following is a specific Web list relating to gingivitis; please note that any particular subject below may indicate either a therapeutic use, or a contraindication (potential danger), and does not reflect an official recommendation: ·
Vitamins Ascorbic Acid Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Gingivitis.htm Folic Acid Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Supp/Folic_Acid.htm Vitamin C Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Supp/Vitamin_C.htm
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Minerals
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Calcium Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Gingivitis.htm Calcium Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Supp/Calcium.htm Folate Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Gingivitis.htm HMG-CoA Reductase Inhibitors (Statins) Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsDepletions/Cholest erolLoweringMedicationsHMGCoAReductaseInhibitorscl.html Zinc Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Supp/Zinc.htm ·
Food and Diet Water Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Gingivitis.htm
Vocabulary Builder The following vocabulary builder defines words used in the references in this chapter that have not been defined in previous chapters: Capsules: Hard or soft soluble containers used for the oral administration of medicine. [NIH] Carbohydrate: An aldehyde or ketone derivative of a polyhydric alcohol, particularly of the pentahydric and hexahydric alcohols. They are so named because the hydrogen and oxygen are usually in the proportion to form
Researching Nutrition 169
water, (CH2O)n. The most important carbohydrates are the starches, sugars, celluloses, and gums. They are classified into mono-, di-, tri-, poly- and heterosaccharides. [EU] Cetylpyridinium: Cationic bactericidal surfactant used as a topical antiseptic for skin, wounds, mucous membranes, instruments, etc.; and also as a component in mouthwash and lozenges. [NIH] Cholesterol: The principal sterol of all higher animals, distributed in body tissues, especially the brain and spinal cord, and in animal fats and oils. [NIH] Degenerative: Undergoing degeneration : tending to degenerate; having the character of or involving degeneration; causing or tending to cause degeneration. [EU] Diarrhea: Passage of excessively liquid or excessively frequent stools. [NIH] Diuretic: An agent that promotes the excretion of urine. [EU] Diuretics: Agents that promote the excretion of urine through their effects on kidney function. [NIH] Insulin: A protein hormone secreted by beta cells of the pancreas. Insulin plays a major role in the regulation of glucose metabolism, generally promoting the cellular utilization of glucose. It is also an important regulator of protein and lipid metabolism. Insulin is used as a drug to control insulindependent diabetes mellitus. [NIH] Intestinal: Pertaining to the intestine. [EU] Iodine: A nonmetallic element of the halogen group that is represented by the atomic symbol I, atomic number 53, and atomic weight of 126.90. It is a nutritionally essential element, especially important in thyroid hormone synthesis. In solution, it has anti-infective properties and is used topically. [NIH]
Niacin: Water-soluble vitamin of the B complex occurring in various animal and plant tissues. Required by the body for the formation of coenzymes NAD and NADP. Has pellagra-curative, vasodilating, and antilipemic properties. [NIH] Overdose: 1. to administer an excessive dose. 2. an excessive dose. [EU] Piroxicam: 4-Hydroxy-2-methyl-N-2-pyridyl-2H-1,2-benzothiazine-3carboxamide 1,1-dioxide. A non-steroidal anti-inflammatory agent that is well established in the treatment of rheumatoid arthritis and osteoarthritis. Its usefulness has also been demonstrated in the treatment of musculoskeletal disorders, dysmenorrhea, and postoperative pain. Its long half-life enables it to be administered once daily. The drug has also been shown to be effective if administered rectally. Gastrointestinal complaints are the most frequently reported side effects. [NIH] Potassium: An element that is in the alkali group of metals. It has an atomic
170 Gingivitis
symbol K, atomic number 19, and atomic weight 39.10. It is the chief cation in the intracellular fluid of muscle and other cells. Potassium ion is a strong electrolyte and it plays a significant role in the regulation of fluid volume and maintenance of the water-electrolyte balance. [NIH] Riboflavin: Nutritional factor found in milk, eggs, malted barley, liver, kidney, heart, and leafy vegetables. The richest natural source is yeast. It occurs in the free form only in the retina of the eye, in whey, and in urine; its principal forms in tissues and cells are as FMN and FAD. [NIH] Thermoregulation: Heat regulation. [EU] Thyroxine: An amino acid of the thyroid gland which exerts a stimulating effect on thyroid metabolism. [NIH]
Finding Medical Libraries 171
APPENDIX D. FINDING MEDICAL LIBRARIES Overview At a medical library you can find medical texts and reference books, consumer health publications, specialty newspapers and magazines, as well as medical journals. In this Appendix, we show you how to quickly find a medical library in your area.
Preparation Before going to the library, highlight the references mentioned in this sourcebook that you find interesting. Focus on those items that are not available via the Internet, and ask the reference librarian for help with your search. He or she may know of additional resources that could be helpful to you. Most importantly, your local public library and medical libraries have Interlibrary Loan programs with the National Library of Medicine (NLM), one of the largest medical collections in the world. According to the NLM, most of the literature in the general and historical collections of the National Library of Medicine is available on interlibrary loan to any library. NLM's interlibrary loan services are only available to libraries. If you would like to access NLM medical literature, then visit a library in your area that can request the publications for you.49
49
Adapted from the NLM: http://www.nlm.nih.gov/psd/cas/interlibrary.html.
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Finding a Local Medical Library The quickest method to locate medical libraries is to use the Internet-based directory published by the National Network of Libraries of Medicine (NN/LM). This network includes 4626 members and affiliates that provide many services to librarians, health professionals, and the public. To find a library in your area, simply visit http://nnlm.gov/members/adv.html or call 1-800-338-7657.
Medical Libraries Open to the Public In addition to the NN/LM, the National Library of Medicine (NLM) lists a number of libraries that are generally open to the public and have reference facilities. The following is the NLM’s list plus hyperlinks to each library Web site. These Web pages can provide information on hours of operation and other restrictions. The list below is a small sample of libraries recommended by the National Library of Medicine (sorted alphabetically by name of the U.S. state or Canadian province where the library is located):50 ·
Alabama: Health InfoNet of Jefferson County (Jefferson County Library Cooperative, Lister Hill Library of the Health Sciences), http://www.uab.edu/infonet/
·
Alabama: Richard M. Scrushy Library (American Sports Medicine Institute), http://www.asmi.org/LIBRARY.HTM
·
Arizona: Samaritan Regional Medical Center: The Learning Center (Samaritan Health System, Phoenix, Arizona), http://www.samaritan.edu/library/bannerlibs.htm
·
California: Kris Kelly Health Information Center (St. Joseph Health System), http://www.humboldt1.com/~kkhic/index.html
·
California: Community Health Library of Los Gatos (Community Health Library of Los Gatos), http://www.healthlib.org/orgresources.html
·
California: Consumer Health Program and Services (CHIPS) (County of Los Angeles Public Library, Los Angeles County Harbor-UCLA Medical Center Library) - Carson, CA, http://www.colapublib.org/services/chips.html
·
California: Gateway Health Library (Sutter Gould Medical Foundation)
·
California: Health Library (Stanford University Medical Center), http://www-med.stanford.edu/healthlibrary/
50
Abstracted from http://www.nlm.nih.gov/medlineplus/libraries.html.
Finding Medical Libraries 173
·
California: Patient Education Resource Center - Health Information and Resources (University of California, San Francisco), http://sfghdean.ucsf.edu/barnett/PERC/default.asp
·
California: Redwood Health Library (Petaluma Health Care District), http://www.phcd.org/rdwdlib.html
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California: San José PlaneTree Health Library, http://planetreesanjose.org/
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California: Sutter Resource Library (Sutter Hospitals Foundation), http://go.sutterhealth.org/comm/resc-library/sac-resources.html
·
California: University of California, Davis. Health Sciences Libraries
·
California: ValleyCare Health Library & Ryan Comer Cancer Resource Center (ValleyCare Health System), http://www.valleycare.com/library.html
·
California: Washington Community Health Resource Library (Washington Community Health Resource Library), http://www.healthlibrary.org/
·
Colorado: William V. Gervasini Memorial Library (Exempla Healthcare), http://www.exempla.org/conslib.htm
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Connecticut: Hartford Hospital Health Science Libraries (Hartford Hospital), http://www.harthosp.org/library/
·
Connecticut: Healthnet: Connecticut Consumer Health Information Center (University of Connecticut Health Center, Lyman Maynard Stowe Library), http://library.uchc.edu/departm/hnet/
·
Connecticut: Waterbury Hospital Health Center Library (Waterbury Hospital), http://www.waterburyhospital.com/library/consumer.shtml
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Delaware: Consumer Health Library (Christiana Care Health System, Eugene du Pont Preventive Medicine & Rehabilitation Institute), http://www.christianacare.org/health_guide/health_guide_pmri_health _info.cfm
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Delaware: Lewis B. Flinn Library (Delaware Academy of Medicine), http://www.delamed.org/chls.html
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Georgia: Family Resource Library (Medical College of Georgia), http://cmc.mcg.edu/kids_families/fam_resources/fam_res_lib/frl.htm
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Georgia: Health Resource Center (Medical Center of Central Georgia), http://www.mccg.org/hrc/hrchome.asp
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Hawaii: Hawaii Medical Library: Consumer Health Information Service (Hawaii Medical Library), http://hml.org/CHIS/
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·
Idaho: DeArmond Consumer Health Library (Kootenai Medical Center), http://www.nicon.org/DeArmond/index.htm
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Illinois: Health Learning Center of Northwestern Memorial Hospital (Northwestern Memorial Hospital, Health Learning Center), http://www.nmh.org/health_info/hlc.html
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Illinois: Medical Library (OSF Saint Francis Medical Center), http://www.osfsaintfrancis.org/general/library/
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Kentucky: Medical Library - Services for Patients, Families, Students & the Public (Central Baptist Hospital), http://www.centralbap.com/education/community/library.htm
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Kentucky: University of Kentucky - Health Information Library (University of Kentucky, Chandler Medical Center, Health Information Library), http://www.mc.uky.edu/PatientEd/
·
Louisiana: Alton Ochsner Medical Foundation Library (Alton Ochsner Medical Foundation), http://www.ochsner.org/library/
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Louisiana: Louisiana State University Health Sciences Center Medical Library-Shreveport, http://lib-sh.lsuhsc.edu/
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Maine: Franklin Memorial Hospital Medical Library (Franklin Memorial Hospital), http://www.fchn.org/fmh/lib.htm
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Maine: Gerrish-True Health Sciences Library (Central Maine Medical Center), http://www.cmmc.org/library/library.html
·
Maine: Hadley Parrot Health Science Library (Eastern Maine Healthcare), http://www.emh.org/hll/hpl/guide.htm
·
Maine: Maine Medical Center Library (Maine Medical Center), http://www.mmc.org/library/
·
Maine: Parkview Hospital, http://www.parkviewhospital.org/communit.htm#Library
·
Maine: Southern Maine Medical Center Health Sciences Library (Southern Maine Medical Center), http://www.smmc.org/services/service.php3?choice=10
·
Maine: Stephens Memorial Hospital Health Information Library (Western Maine Health), http://www.wmhcc.com/hil_frame.html
·
Manitoba, Canada: Consumer & Patient Health Information Service (University of Manitoba Libraries), http://www.umanitoba.ca/libraries/units/health/reference/chis.html
·
Manitoba, Canada: J.W. Crane Memorial Library (Deer Lodge Centre), http://www.deerlodge.mb.ca/library/libraryservices.shtml
Finding Medical Libraries 175
·
Maryland: Health Information Center at the Wheaton Regional Library (Montgomery County, Md., Dept. of Public Libraries, Wheaton Regional Library), http://www.mont.lib.md.us/healthinfo/hic.asp
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Massachusetts: Baystate Medical Center Library (Baystate Health System), http://www.baystatehealth.com/1024/
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Massachusetts: Boston University Medical Center Alumni Medical Library (Boston University Medical Center), http://medlibwww.bu.edu/library/lib.html
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Massachusetts: Lowell General Hospital Health Sciences Library (Lowell General Hospital), http://www.lowellgeneral.org/library/HomePageLinks/WWW.htm
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Massachusetts: Paul E. Woodard Health Sciences Library (New England Baptist Hospital), http://www.nebh.org/health_lib.asp
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Massachusetts: St. Luke's Hospital Health Sciences Library (St. Luke's Hospital), http://www.southcoast.org/library/
·
Massachusetts: Treadwell Library Consumer Health Reference Center (Massachusetts General Hospital), http://www.mgh.harvard.edu/library/chrcindex.html
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Massachusetts: UMass HealthNet (University of Massachusetts Medical School), http://healthnet.umassmed.edu/
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Michigan: Botsford General Hospital Library - Consumer Health (Botsford General Hospital, Library & Internet Services), http://www.botsfordlibrary.org/consumer.htm
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Michigan: Helen DeRoy Medical Library (Providence Hospital and Medical Centers), http://www.providence-hospital.org/library/
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Michigan: Marquette General Hospital - Consumer Health Library (Marquette General Hospital, Health Information Center), http://www.mgh.org/center.html
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Michigan: Patient Education Resouce Center - University of Michigan Cancer Center (University of Michigan Comprehensive Cancer Center), http://www.cancer.med.umich.edu/learn/leares.htm
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Michigan: Sladen Library & Center for Health Information Resources Consumer Health Information, http://www.sladen.hfhs.org/library/consumer/index.html
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Montana: Center for Health Information (St. Patrick Hospital and Health Sciences Center), http://www.saintpatrick.org/chi/librarydetail.php3?ID=41
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·
National: Consumer Health Library Directory (Medical Library Association, Consumer and Patient Health Information Section), http://caphis.mlanet.org/directory/index.html
·
National: National Network of Libraries of Medicine (National Library of Medicine) - provides library services for health professionals in the United States who do not have access to a medical library, http://nnlm.gov/
·
National: NN/LM List of Libraries Serving the Public (National Network of Libraries of Medicine), http://nnlm.gov/members/
·
Nevada: Health Science Library, West Charleston Library (Las Vegas Clark County Library District), http://www.lvccld.org/special_collections/medical/index.htm
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New Hampshire: Dartmouth Biomedical Libraries (Dartmouth College Library), http://www.dartmouth.edu/~biomed/resources.htmld/conshealth.htmld /
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New Jersey: Consumer Health Library (Rahway Hospital), http://www.rahwayhospital.com/library.htm
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New Jersey: Dr. Walter Phillips Health Sciences Library (Englewood Hospital and Medical Center), http://www.englewoodhospital.com/links/index.htm
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New Jersey: Meland Foundation (Englewood Hospital and Medical Center), http://www.geocities.com/ResearchTriangle/9360/
·
New York: Choices in Health Information (New York Public Library) NLM Consumer Pilot Project participant, http://www.nypl.org/branch/health/links.html
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New York: Health Information Center (Upstate Medical University, State University of New York), http://www.upstate.edu/library/hic/
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New York: Health Sciences Library (Long Island Jewish Medical Center), http://www.lij.edu/library/library.html
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New York: ViaHealth Medical Library (Rochester General Hospital), http://www.nyam.org/library/
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Ohio: Consumer Health Library (Akron General Medical Center, Medical & Consumer Health Library), http://www.akrongeneral.org/hwlibrary.htm
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Oklahoma: Saint Francis Health System Patient/Family Resource Center (Saint Francis Health System), http://www.sfhtulsa.com/patientfamilycenter/default.asp
Finding Medical Libraries 177
·
Oregon: Planetree Health Resource Center (Mid-Columbia Medical Center), http://www.mcmc.net/phrc/
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Pennsylvania: Community Health Information Library (Milton S. Hershey Medical Center), http://www.hmc.psu.edu/commhealth/
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Pennsylvania: Community Health Resource Library (Geisinger Medical Center), http://www.geisinger.edu/education/commlib.shtml
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Pennsylvania: HealthInfo Library (Moses Taylor Hospital), http://www.mth.org/healthwellness.html
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Pennsylvania: Hopwood Library (University of Pittsburgh, Health Sciences Library System), http://www.hsls.pitt.edu/chi/hhrcinfo.html
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Pennsylvania: Koop Community Health Information Center (College of Physicians of Philadelphia), http://www.collphyphil.org/kooppg1.shtml
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Pennsylvania: Learning Resources Center - Medical Library (Susquehanna Health System), http://www.shscares.org/services/lrc/index.asp
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Pennsylvania: Medical Library (UPMC Health System), http://www.upmc.edu/passavant/library.htm
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Quebec, Canada: Medical Library (Montreal General Hospital), http://ww2.mcgill.ca/mghlib/
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South Dakota: Rapid City Regional Hospital - Health Information Center (Rapid City Regional Hospital, Health Information Center), http://www.rcrh.org/education/LibraryResourcesConsumers.htm
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Texas: Houston HealthWays (Houston Academy of Medicine-Texas Medical Center Library), http://hhw.library.tmc.edu/
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Texas: Matustik Family Resource Center (Cook Children's Health Care System), http://www.cookchildrens.com/Matustik_Library.html
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Washington: Community Health Library (Kittitas Valley Community Hospital), http://www.kvch.com/
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Washington: Southwest Washington Medical Center Library (Southwest Washington Medical Center), http://www.swmedctr.com/Home/
Your Rights and Insurance 179
APPENDIX E. YOUR RIGHTS AND INSURANCE Overview Any patient with gingivitis faces a series of issues related more to the healthcare industry than to the medical condition itself. This appendix covers two important topics in this regard: your rights and responsibilities as a patient, and how to get the most out of your medical insurance plan.
Your Rights as a Patient The President’s Advisory Commission on Consumer Protection and Quality in the Healthcare Industry has created the following summary of your rights as a patient.51 Information Disclosure Consumers have the right to receive accurate, easily understood information. Some consumers require assistance in making informed decisions about health plans, health professionals, and healthcare facilities. Such information includes: ·
Health plans. Covered benefits, cost-sharing, and procedures for resolving complaints, licensure, certification, and accreditation status, comparable measures of quality and consumer satisfaction, provider network composition, the procedures that govern access to specialists and emergency services, and care management information.
51Adapted
from Consumer Bill of Rights and Responsibilities: http://www.hcqualitycommission.gov/press/cbor.html#head1.
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·
Health professionals. Education, board certification, and recertification, years of practice, experience performing certain procedures, and comparable measures of quality and consumer satisfaction.
·
Healthcare facilities. Experience in performing certain procedures and services, accreditation status, comparable measures of quality, worker, and consumer satisfaction, and procedures for resolving complaints.
·
Consumer assistance programs. Programs must be carefully structured to promote consumer confidence and to work cooperatively with health plans, providers, payers, and regulators. Desirable characteristics of such programs are sponsorship that ensures accountability to the interests of consumers and stable, adequate funding.
Choice of Providers and Plans Consumers have the right to a choice of healthcare providers that is sufficient to ensure access to appropriate high-quality healthcare. To ensure such choice, the Commission recommends the following: ·
Provider network adequacy. All health plan networks should provide access to sufficient numbers and types of providers to assure that all covered services will be accessible without unreasonable delay -including access to emergency services 24 hours a day and 7 days a week. If a health plan has an insufficient number or type of providers to provide a covered benefit with the appropriate degree of specialization, the plan should ensure that the consumer obtains the benefit outside the network at no greater cost than if the benefit were obtained from participating providers.
·
Women's health services. Women should be able to choose a qualified provider offered by a plan -- such as gynecologists, certified nurse midwives, and other qualified healthcare providers -- for the provision of covered care necessary to provide routine and preventative women's healthcare services.
·
Access to specialists. Consumers with complex or serious medical conditions who require frequent specialty care should have direct access to a qualified specialist of their choice within a plan's network of providers. Authorizations, when required, should be for an adequate number of direct access visits under an approved treatment plan.
·
Transitional care. Consumers who are undergoing a course of treatment for a chronic or disabling condition (or who are in the second or third trimester of a pregnancy) at the time they involuntarily change health
Your Rights and Insurance 181
plans or at a time when a provider is terminated by a plan for other than cause should be able to continue seeing their current specialty providers for up to 90 days (or through completion of postpartum care) to allow for transition of care. ·
Choice of health plans. Public and private group purchasers should, wherever feasible, offer consumers a choice of high-quality health insurance plans.
Access to Emergency Services Consumers have the right to access emergency healthcare services when and where the need arises. Health plans should provide payment when a consumer presents to an emergency department with acute symptoms of sufficient severity--including severe pain--such that a “prudent layperson” could reasonably expect the absence of medical attention to result in placing that consumer's health in serious jeopardy, serious impairment to bodily functions, or serious dysfunction of any bodily organ or part.
Participation in Treatment Decisions Consumers have the right and responsibility to fully participate in all decisions related to their healthcare. Consumers who are unable to fully participate in treatment decisions have the right to be represented by parents, guardians, family members, or other conservators. Dentists and other health professionals should: ·
Provide patients with sufficient information and opportunity to decide among treatment options consistent with the informed consent process.
·
Discuss all treatment options with a patient in a culturally competent manner, including the option of no treatment at all.
·
Ensure that persons with disabilities have effective communications with members of the health system in making such decisions.
·
Discuss all current treatments a consumer may be undergoing.
·
Discuss all risks, nontreatment.
·
Give patients the opportunity to refuse treatment and to express preferences about future treatment decisions.
benefits,
and
consequences
to
treatment
or
182 Gingivitis
·
Discuss the use of advance directives -- both living wills and durable powers of attorney for healthcare -- with patients and their designated family members.
·
Abide by the decisions made by their patients and/or their designated representatives consistent with the informed consent process.
Health plans, health providers, and healthcare facilities should: ·
Disclose to consumers factors -- such as methods of compensation, ownership of or interest in healthcare facilities, or matters of conscience -that could influence advice or treatment decisions.
·
Assure that provider contracts do not contain any so-called “gag clauses” or other contractual mechanisms that restrict healthcare providers' ability to communicate with and advise patients about medically necessary treatment options.
·
Be prohibited from penalizing or seeking retribution against healthcare professionals or other health workers for advocating on behalf of their patients.
Respect and Nondiscrimination Consumers have the right to considerate, respectful care from all members of the healthcare industry at all times and under all circumstances. An environment of mutual respect is essential to maintain a quality healthcare system. To assure that right, the Commission recommends the following: ·
Consumers must not be discriminated against in the delivery of healthcare services consistent with the benefits covered in their policy, or as required by law, based on race, ethnicity, national origin, religion, sex, age, mental or physical disability, sexual orientation, genetic information, or source of payment.
·
Consumers eligible for coverage under the terms and conditions of a health plan or program, or as required by law, must not be discriminated against in marketing and enrollment practices based on race, ethnicity, national origin, religion, sex, age, mental or physical disability, sexual orientation, genetic information, or source of payment. Confidentiality of Health Information
Consumers have the right to communicate with healthcare providers in confidence and to have the confidentiality of their individually identifiable
Your Rights and Insurance 183
healthcare information protected. Consumers also have the right to review and copy their own medical records and request amendments to their records. Complaints and Appeals Consumers have the right to a fair and efficient process for resolving differences with their health plans, healthcare providers, and the institutions that serve them, including a rigorous system of internal review and an independent system of external review. A free copy of the Patient's Bill of Rights is available from the American Hospital Association.52
Patient Responsibilities Treatment is a two-way street between you and your healthcare providers. To underscore the importance of finance in modern healthcare as well as your responsibility for the financial aspects of your care, the President’s Advisory Commission on Consumer Protection and Quality in the Healthcare Industry has proposed that patients understand the following “Consumer Responsibilities.”53 In a healthcare system that protects consumers' rights, it is reasonable to expect and encourage consumers to assume certain responsibilities. Greater individual involvement by the consumer in his or her care increases the likelihood of achieving the best outcome and helps support a quality-oriented, cost-conscious environment. Such responsibilities include: ·
Take responsibility for maximizing healthy habits such as exercising, not smoking, and eating a healthy diet.
·
Work collaboratively with healthcare providers in developing and carrying out agreed-upon treatment plans.
·
Disclose relevant information and clearly communicate wants and needs.
·
Use your health insurance plan's internal complaint and appeal processes to address your concerns.
·
Avoid knowingly spreading disease.
52 To order your free copy of the Patient's Bill of Rights, telephone 312-422-3000 or visit the American Hospital Association’s Web site: http://www.aha.org. Click on “Resource Center,” go to “Search” at bottom of page, and then type in “Patient's Bill of Rights.” The Patient’s Bill of Rights is also available from Fax on Demand, at 312-422-2020, document number 471124. 53 Adapted from http://www.hcqualitycommission.gov/press/cbor.html#head1.
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·
Recognize the reality of risks, the limits of the medical science, and the human fallibility of the healthcare professional.
·
Be aware of a healthcare provider's obligation to be reasonably efficient and equitable in providing care to other patients and the community.
·
Become knowledgeable about your health plan’s coverage and options (when available) including all covered benefits, limitations, and exclusions, rules regarding use of network providers, coverage and referral rules, appropriate processes to secure additional information, and the process to appeal coverage decisions.
·
Show respect for other patients and health workers.
·
Make a good-faith effort to meet financial obligations.
·
Abide by administrative and operational procedures of health plans, healthcare providers, and Government health benefit programs.
Choosing an Insurance Plan There are a number of official government agencies that help consumers understand their healthcare insurance choices.54 The U.S. Department of Labor, in particular, recommends ten ways to make your health benefits choices work best for you.55 1. Your options are important. There are many different types of health benefit plans. Find out which one your employer offers, then check out the plan, or plans, offered. Your employer's human resource office, the health plan administrator, or your union can provide information to help you match your needs and preferences with the available plans. The more information you have, the better your healthcare decisions will be. 2. Reviewing the benefits available. Do the plans offered cover preventive care, well-baby care, vision or dental care? Are there deductibles? Answers to these questions can help determine the out-of-pocket expenses you may face. Matching your needs and those of your family members will result in the best possible benefits. Cheapest may not always be best. Your goal is high quality health benefits.
More information about quality across programs is provided at the following AHRQ Web site: http://www.ahrq.gov/consumer/qntascii/qnthplan.htm. 55 Adapted from the Department of Labor: http://www.dol.gov/dol/pwba/public/pubs/health/top10-text.html. 54
Your Rights and Insurance 185
3. Look for quality. The quality of healthcare services varies, but quality can be measured. You should consider the quality of healthcare in deciding among the healthcare plans or options available to you. Not all health plans, dentists, hospitals and other providers give the highest quality care. Fortunately, there is quality information you can use right now to help you compare your healthcare choices. Find out how you can measure quality. Consult the U.S. Department of Health and Human Services publication “Your Guide to Choosing Quality Health Care” on the Internet at www.ahcpr.gov/consumer. 4. Your plan's summary plan description (SPD) provides a wealth of information. Your health plan administrator can provide you with a copy of your plan’s SPD. It outlines your benefits and your legal rights under the Employee Retirement Income Security Act (ERISA), the federal law that protects your health benefits. It should contain information about the coverage of dependents, what services will require a co-pay, and the circumstances under which your employer can change or terminate a health benefits plan. Save the SPD and all other health plan brochures and documents, along with memos or correspondence from your employer relating to health benefits. 5. Assess your benefit coverage as your family status changes. Marriage, divorce, childbirth or adoption, and the death of a spouse are all life events that may signal a need to change your health benefits. You, your spouse and dependent children may be eligible for a special enrollment period under provisions of the Health Insurance Portability and Accountability Act (HIPAA). Even without life-changing events, the information provided by your employer should tell you how you can change benefits or switch plans, if more than one plan is offered. If your spouse's employer also offers a health benefits package, consider coordinating both plans for maximum coverage. 6. Changing jobs and other life events can affect your health benefits. Under the Consolidated Omnibus Budget Reconciliation Act (COBRA), you, your covered spouse, and your dependent children may be eligible to purchase extended health coverage under your employer's plan if you lose your job, change employers, get divorced, or upon occurrence of certain other events. Coverage can range from 18 to 36 months depending on your situation. COBRA applies to most employers with 20 or more workers and requires your plan to notify you of your rights. Most plans require eligible individuals to make their COBRA election within 60 days of the plan's notice. Be sure to follow up with your plan sponsor if you don't receive notice, and make sure you respond within the allotted time.
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7. HIPAA can also help if you are changing jobs, particularly if you have a medical condition. HIPAA generally limits pre-existing condition exclusions to a maximum of 12 months (18 months for late enrollees). HIPAA also requires this maximum period to be reduced by the length of time you had prior “creditable coverage.” You should receive a certificate documenting your prior creditable coverage from your old plan when coverage ends. 8. Plan for retirement. Before you retire, find out what health benefits, if any, extend to you and your spouse during your retirement years. Consult with your employer's human resources office, your union, the plan administrator, and check your SPD. Make sure there is no conflicting information among these sources about the benefits you will receive or the circumstances under which they can change or be eliminated. With this information in hand, you can make other important choices, like finding out if you are eligible for Medicare and Medigap insurance coverage. 9. Know how to file an appeal if your health benefits claim is denied. Understand how your plan handles grievances and where to make appeals of the plan's decisions. Keep records and copies of correspondence. Check your health benefits package and your SPD to determine who is responsible for handling problems with benefit claims. Contact PWBA for customer service assistance if you are unable to obtain a response to your complaint. 10. You can take steps to improve the quality of the healthcare and the health benefits you receive. Look for and use things like Quality Reports and Accreditation Reports whenever you can. Quality reports may contain consumer ratings -- how satisfied consumers are with the dentists in their plan, for instance-- and clinical performance measures -- how well a healthcare organization prevents and treats illness. Accreditation reports provide information on how accredited organizations meet national standards, and often include clinical performance measures. Look for these quality measures whenever possible. Consult “Your Guide to Choosing Quality Health Care” on the Internet at www.ahcpr.gov/consumer.
Medicare and Medicaid Illness strikes both rich and poor families. For low-income families, Medicaid is available to defer the costs of treatment. The Health Care Financing Administration (HCFA) administers Medicare, the nation's largest health insurance program, which covers 39 million Americans. In the following pages, you will learn the basics about Medicare insurance as well as useful
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contact information on how to find more in-depth information about Medicaid.56
Who is Eligible for Medicare? Generally, you are eligible for Medicare if you or your spouse worked for at least 10 years in Medicare-covered employment and you are 65 years old and a citizen or permanent resident of the United States. You might also qualify for coverage if you are under age 65 but have a disability or EndStage Renal disease (permanent kidney failure requiring dialysis or transplant). Here are some simple guidelines: You can get Part A at age 65 without having to pay premiums if: ·
You are already receiving retirement benefits from Social Security or the Railroad Retirement Board.
·
You are eligible to receive Social Security or Railroad benefits but have not yet filed for them.
·
You or your spouse had Medicare-covered government employment.
If you are under 65, you can get Part A without having to pay premiums if: ·
You have received Social Security or Railroad Retirement Board disability benefit for 24 months.
·
You are a kidney dialysis or kidney transplant patient.
Medicare has two parts: ·
Part A (Hospital Insurance). Most people do not have to pay for Part A.
·
Part B (Medical Insurance). Most people pay monthly for Part B. Part A (Hospital Insurance)
Helps Pay For: Inpatient hospital care, care in critical access hospitals (small facilities that give limited outpatient and inpatient services to people in rural areas) and skilled nursing facilities, hospice care, and some home healthcare.
This section has been adapted from the Official U.S. Site for Medicare Information: http://www.medicare.gov/Basics/Overview.asp.
56
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Cost: Most people get Part A automatically when they turn age 65. You do not have to pay a monthly payment called a premium for Part A because you or a spouse paid Medicare taxes while you were working. If you (or your spouse) did not pay Medicare taxes while you were working and you are age 65 or older, you still may be able to buy Part A. If you are not sure you have Part A, look on your red, white, and blue Medicare card. It will show “Hospital Part A” on the lower left corner of the card. You can also call the Social Security Administration toll free at 1-800-772-1213 or call your local Social Security office for more information about buying Part A. If you get benefits from the Railroad Retirement Board, call your local RRB office or 1-800-808-0772. For more information, call your Fiscal Intermediary about Part A bills and services. The phone number for the Fiscal Intermediary office in your area can be obtained from the following Web site: http://www.medicare.gov/Contacts/home.asp. Part B (Medical Insurance) Helps Pay For: Healthcare providers, services, outpatient hospital care, and some other medical services that Part A does not cover, such as the services of physical and occupational therapists, and some home healthcare. Part B helps pay for covered services and supplies when they are medically necessary. Cost: As of 2001, you pay the Medicare Part B premium of $50.00 per month. In some cases this amount may be higher if you did not choose Part B when you first became eligible at age 65. The cost of Part B may go up 10% for each 12-month period that you were eligible for Part B but declined coverage, except in special cases. You will have to pay the extra 10% cost for the rest of your life. Enrolling in Part B is your choice. You can sign up for Part B anytime during a 7-month period that begins 3 months before you turn 65. Visit your local Social Security office, or call the Social Security Administration at 1-800-7721213 to sign up. If you choose to enroll in Part B, the premium is usually taken out of your monthly Social Security, Railroad Retirement, or Civil Service Retirement payment. If you do not receive any of the above payments, Medicare sends you a bill for your part B premium every 3 months. You should receive your Medicare premium bill in the mail by the 10th of the month. If you do not, call the Social Security Administration at 1800-772-1213, or your local Social Security office. If you get benefits from the Railroad Retirement Board, call your local RRB office or 1-800-808-0772. For
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more information, call your Medicare carrier about bills and services. The phone number for the Medicare carrier in your area can be found at the following Web site: http://www.medicare.gov/Contacts/home.asp. You may have choices in how you get your healthcare including the Original Medicare Plan, Medicare Managed Care Plans (like HMOs), and Medicare Private Fee-for-Service Plans.
Medicaid Medicaid is a joint federal and state program that helps pay medical costs for some people with low incomes and limited resources. Medicaid programs vary from state to state. People on Medicaid may also get coverage for nursing home care and outpatient prescription drugs which are not covered by Medicare. You can find more information about Medicaid on the HCFA.gov Web site at http://www.hcfa.gov/medicaid/medicaid.htm. States also have programs that pay some or all of Medicare's premiums and may also pay Medicare deductibles and coinsurance for certain people who have Medicare and a low income. To qualify, you must have: ·
Part A (Hospital Insurance),
·
Assets, such as bank accounts, stocks, and bonds that are not more than $4,000 for a single person, or $6,000 for a couple, and
·
A monthly income that is below certain limits.
For more information on these programs, look at the Medicare Savings Programs brochure, http://www.medicare.gov/Library/PDFNavigation/PDFInterim.asp?Langua ge=English&Type=Pub&PubID=10126. There are also Prescription Drug Assistance Programs available. Find information on these programs which offer discounts or free medications to individuals in need at http://www.medicare.gov/Prescription/Home.asp.
NORD’s Medication Assistance Programs Finally, the National Organization for Rare Disorders, Inc. (NORD) administers medication programs sponsored by humanitarian-minded pharmaceutical and biotechnology companies to help uninsured or under-
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insured individuals secure life-saving or life-sustaining drugs.57 NORD programs ensure that certain vital drugs are available “to those individuals whose income is too high to qualify for Medicaid but too low to pay for their prescribed medications.” The program has standards for fairness, equity, and unbiased eligibility. It currently covers some 14 programs for nine pharmaceutical companies. NORD also offers early access programs for investigational new drugs (IND) under the approved “Treatment INDs” programs of the Food and Drug Administration (FDA). In these programs, a limited number of individuals can receive investigational drugs that have yet to be approved by the FDA. These programs are generally designed for rare diseases or disorders. For more information, visit www.rarediseases.org.
Additional Resources In addition to the references already listed in this chapter, you may need more information on health insurance, hospitals, or the healthcare system in general. The NIH has set up an excellent guidance Web site that addresses these and other issues. Topics include:58 ·
Health Insurance: http://www.nlm.nih.gov/medlineplus/healthinsurance.html
·
Health Statistics: http://www.nlm.nih.gov/medlineplus/healthstatistics.html
·
HMO and Managed Care: http://www.nlm.nih.gov/medlineplus/managedcare.html
·
Hospice Care: http://www.nlm.nih.gov/medlineplus/hospicecare.html
·
Medicaid: http://www.nlm.nih.gov/medlineplus/medicaid.html
·
Medicare: http://www.nlm.nih.gov/medlineplus/medicare.html
·
Nursing Homes and Long-term Care: http://www.nlm.nih.gov/medlineplus/nursinghomes.html
·
Patient's Rights, Confidentiality, Informed Consent, Ombudsman Programs, Privacy and Patient Issues: http://www.nlm.nih.gov/medlineplus/patientissues.html
·
Veteran's Health, Persian Gulf War, Gulf War Syndrome, Agent Orange: http://www.nlm.nih.gov/medlineplus/veteranshealth.html
Adapted from NORD: http://www.rarediseases.org/cgibin/nord/progserv#patient?id=rPIzL9oD&mv_pc=30. 58 You can access this information at: http://www.nlm.nih.gov/medlineplus/healthsystem.html. 57
Your Rights and Insurance 191
Vocabulary Builder Malaise: A vague feeling of bodily discomfort. [EU]
Online Glossaries 193
ONLINE GLOSSARIES The Internet provides access to a number of free-to-use medical dictionaries and glossaries. The National Library of Medicine has compiled the following list of online dictionaries: ·
ADAM Medical Encyclopedia (A.D.A.M., Inc.), comprehensive medical reference: http://www.nlm.nih.gov/medlineplus/encyclopedia.html
·
MedicineNet.com Medical Dictionary (MedicineNet, Inc.): http://www.medterms.com/Script/Main/hp.asp
·
Merriam-Webster Medical Dictionary (Inteli-Health, Inc.): http://www.intelihealth.com/IH/
·
Multilingual Glossary of Technical and Popular Medical Terms in Eight European Languages (European Commission) - Danish, Dutch, English, French, German, Italian, Portuguese, and Spanish: http://allserv.rug.ac.be/~rvdstich/eugloss/welcome.html
·
On-line Medical Dictionary (CancerWEB): http://www.graylab.ac.uk/omd/
·
Technology Glossary (National Library of Medicine) - Health Care Technology: http://www.nlm.nih.gov/nichsr/ta101/ta10108.htm
·
Terms and Definitions (Office of Rare Diseases): http://rarediseases.info.nih.gov/ord/glossary_a-e.html
Beyond these, MEDLINEplus contains a very user-friendly encyclopedia covering every aspect of medicine (licensed from A.D.A.M., Inc.). The ADAM Medical Encyclopedia Web site address is http://www.nlm.nih.gov/medlineplus/encyclopedia.html. ADAM is also available on commercial Web sites such as drkoop.com (http://www.drkoop.com/) and Web MD (http://my.webmd.com/adam/asset/adam_disease_articles/a_to_z/a). Topics of interest can be researched by using keywords before continuing elsewhere, as these basic definitions and concepts will be useful in more advanced areas of research. You may choose to print various pages specifically relating to gingivitis and keep them on file. The NIH, in particular, suggests that patients with gingivitis visit the following Web sites in the ADAM Medical Encyclopedia: ·
Basic Guidelines for Gingivitis
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Gingivitis Web site: http://www.nlm.nih.gov/medlineplus/ency/article/001056.htm ·
Signs & Symptoms for Gingivitis Erythema Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003220.htm Fever Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003090.htm Gums bleed easily Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003062.htm Halitosis Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003058.htm Malaise Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003089.htm Mouth sores Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003059.htm Swelling Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003103.htm Swollen gums Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003066.htm Ulcers Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003228.htm
Online Glossaries 195
·
Diagnostics and Tests for Gingivitis ALT Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003473.htm Dental X-rays Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003801.htm X-ray Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003337.htm
·
Background Topics for Gingivitis Acute Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002215.htm Bleeding Web site: http://www.nlm.nih.gov/medlineplus/ency/article/000045.htm Chronic Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002312.htm Dental hygiene Web site: http://www.nlm.nih.gov/medlineplus/ency/article/001957.htm Oral hygiene Web site: http://www.nlm.nih.gov/medlineplus/ency/article/001957.htm Scaling Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003226.htm
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Systemic Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002294.htm Toxins Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002331.htm
Online Dictionary Directories The following are additional online directories compiled by the National Library of Medicine, including a number of specialized medical dictionaries and glossaries: ·
Medical Dictionaries: Medical & Biological (World Health Organization): http://www.who.int/hlt/virtuallibrary/English/diction.htm#Medical
·
MEL-Michigan Electronic Library List of Online Health and Medical Dictionaries (Michigan Electronic Library): http://mel.lib.mi.us/health/health-dictionaries.html
·
Patient Education: Glossaries (DMOZ Open Directory Project): http://dmoz.org/Health/Education/Patient_Education/Glossaries/
·
Web of Online Dictionaries (Bucknell University): http://www.yourdictionary.com/diction5.html#medicine
Glossary 197
GINGIVITIS GLOSSARY The following is a complete glossary of terms used in this sourcebook. The definitions are derived from official public sources including the National Institutes of Health [NIH] and the European Union [EU]. After this glossary, we list a number of additional hardbound and electronic glossaries and dictionaries that you may wish to consult. Actinomyces: A genus of gram-positive, rod-shaped bacteria whose organisms are nonmotile. Filaments that may be present in certain species are either straight or wavy and may have swollen or clubbed heads. [NIH] Adsorption: The attachment of one substance to the surface of another; the concentration of a gas or a substance in solution in a liquid on a surface in contact with the gas or liquid, resulting in a relatively high concentration of the gas or solution at the surface. [EU] Adverse: Harmful. [EU] Anesthesia: A state characterized by loss of feeling or sensation. This depression of nerve function is usually the result of pharmacologic action and is induced to allow performance of surgery or other painful procedures. [NIH]
Angioedema: A vascular reaction involving the deep dermis or subcutaneous or submucal tissues, representing localized edema caused by dilatation and increased permeability of the capillaries, and characterized by development of giant wheals. [EU] Antibiotic: A chemical substance produced by a microorganism which has the capacity, in dilute solutions, to inhibit the growth of or to kill other microorganisms. Antibiotics that are sufficiently nontoxic to the host are used as chemotherapeutic agents in the treatment of infectious diseases of man, animals and plants. [EU] Antibody: An immunoglobulin molecule that has a specific amino acid sequence by virtue of which it interacts only with the antigen that induced its synthesis in cells of the lymphoid series (especially plasma cells), or with antigen closely related to it. Antibodies are classified according to their ode of action as agglutinins, bacteriolysins, haemolysins, opsonins, precipitins, etc. [EU] Antidepressant: An agent that stimulates the mood of a depressed patient, including tricyclic antidepressants and monoamine oxidase inhibitors. [EU] Antigen: Any substance which is capable, under appropriate conditions, of inducing a specific immune response and of reacting with the products of
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that response, that is, with specific antibody or specifically sensitized Tlymphocytes, or both. Antigens may be soluble substances, such as toxins and foreign proteins, or particulate, such as bacteria and tissue cells; however, only the portion of the protein or polysaccharide molecule known as the antigenic determinant (q.v.) combines with antibody or a specific receptor on a lymphocyte. Abbreviated Ag. [EU] Antimicrobial: Killing microorganisms, or suppressing their multiplication or growth. [EU] Antioxidant: One of many widely used synthetic or natural substances added to a product to prevent or delay its deterioration by action of oxygen in the air. Rubber, paints, vegetable oils, and prepared foods commonly contain antioxidants. [EU] Antiseptic: A substance that inhibits the growth and development of microorganisms without necessarily killing them. [EU] Anxiety: The unpleasant emotional state consisting of psychophysiological responses to anticipation of unreal or imagined danger, ostensibly resulting from unrecognized intrapsychic conflict. Physiological concomitants include increased heart rate, altered respiration rate, sweating, trembling, weakness, and fatigue; psychological concomitants include feelings of impending danger, powerlessness, apprehension, and tension. [EU] Assay: Determination of the amount of a particular constituent of a mixture, or of the biological or pharmacological potency of a drug. [EU] Atypical: Irregular; not conformable to the type; in microbiology, applied specifically to strains of unusual type. [EU] Autoimmunity: Process whereby the immune system reacts against the body's own tissues. Autoimmunity may produce or be caused by AUTOIMMUNE DISEASES. [NIH] Bacteremia: The presence of viable bacteria circulating in the blood. Fever, chills, tachycardia, and tachypnea are common acute manifestations of bacteremia. The majority of cases are seen in already hospitalized patients, most of whom have underlying diseases or procedures which render their bloodstreams susceptible to invasion. [NIH] Bacteria: Unicellular prokaryotic microorganisms which generally possess rigid cell walls, multiply by cell division, and exhibit three principal forms: round or coccal, rodlike or bacillary, and spiral or spirochetal. [NIH] Bacteroides: A genus of gram-negative, anaerobic, rod-shaped bacteria. Its organisms are normal inhabitants of the oral, respiratory, intestinal, and urogenital cavities of humans, animals, and insects. Some species may be pathogenic. [NIH] Benign: Not malignant; not recurrent; favourable for recovery. [EU]
Glossary 199
Biochemical: Relating to biochemistry; characterized by, produced by, or involving chemical reactions in living organisms. [EU] Bradykinin: A nonapeptide messenger that is enzymatically produced from kallidin in the blood where it is a potent but short-lived agent of arteriolar dilation and increased capillary permeability. Bradykinin is also released from mast cells during asthma attacks, from gut walls as a gastrointestinal vasodilator, from damaged tissues as a pain signal, and may be a neurotransmitter. [NIH] Brucellosis: Infection caused by bacteria of the genus Brucella mainly involving the reticuloendothelial system. This condition is characterized by fever, weakness, malaise, and weight loss. [NIH] Bruxism: A disorder characterized by grinding and clenching of the teeth. [NIH]
Buccal: Pertaining to or directed toward the cheek. In dental anatomy, used to refer to the buccal surface of a tooth. [EU] Candidiasis: Infection with a fungus of the genus Candida. It is usually a superficial infection of the moist cutaneous areas of the body, and is generally caused by C. albicans; it most commonly involves the skin (dermatocandidiasis), oral mucous membranes (thrush, def. 1), respiratory tract (bronchocandidiasis), and vagina (vaginitis). Rarely there is a systemic infection or endocarditis. Called also moniliasis, candidosis, oidiomycosis, and formerly blastodendriosis. [EU] Capsules: Hard or soft soluble containers used for the oral administration of medicine. [NIH] Carbohydrate: An aldehyde or ketone derivative of a polyhydric alcohol, particularly of the pentahydric and hexahydric alcohols. They are so named because the hydrogen and oxygen are usually in the proportion to form water, (CH2O)n. The most important carbohydrates are the starches, sugars, celluloses, and gums. They are classified into mono-, di-, tri-, poly- and heterosaccharides. [EU] Cardiovascular: Pertaining to the heart and blood vessels. [EU] Cataract: An opacity, partial or complete, of one or both eyes, on or in the lens or capsule, especially an opacity impairing vision or causing blindness. The many kinds of cataract are classified by their morphology (size, shape, location) or etiology (cause and time of occurrence). [EU] Cetylpyridinium: Cationic bactericidal surfactant used as a topical antiseptic for skin, wounds, mucous membranes, instruments, etc.; and also as a component in mouthwash and lozenges. [NIH] Cheilitis: Inflammation of the lips. It is of various etiologies and degrees of pathology. [NIH]
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Chemotaxis: The movement of cells or organisms toward or away from a substance in response to its concentration gradient. [NIH] Chemotherapy: The treatment of disease by means of chemicals that have a specific toxic effect upon the disease - producing microorganisms or that selectively destroy cancerous tissue. [EU] Chlorhexidine: Disinfectant and topical anti-infective agent used also as mouthwash to prevent oral plaque. [NIH] Chlorine: A greenish-yellow, diatomic gas that is a member of the halogen family of elements. It has the atomic symbol Cl, atomic number 17, and atomic weight 70.906. It is a powerful irritant that can cause fatal pulmonary edema. Chlorine is used in manufacturing, as a reagent in synthetic chemistry, for water purification, and in the production of chlorinated lime, which is used in fabric bleaching. [NIH] Cholesterol: The principal sterol of all higher animals, distributed in body tissues, especially the brain and spinal cord, and in animal fats and oils. [NIH] Chronic: Persisting over a long period of time. [EU] Clindamycin: An antibacterial agent that is a semisynthetic analog of Lincomycin. [NIH] Collagen: The protein substance of the white fibres (collagenous fibres) of skin, tendon, bone, cartilage, and all other connective tissue; composed of molecules of tropocollagen (q.v.), it is converted into gelatin by boiling. collagenous pertaining to collagen; forming or producing collagen. [EU] Commensal: 1. living on or within another organism, and deriving benefit without injuring or benefiting the other individual. 2. an organism living on or within another, but not causing injury to the host. [EU] Condyloma: C. acuminatum; a papilloma with a central core of connective tissue in a treelike structure covered with epithelium, usually occurring on the mucous membrane or skin of the external genitals or in the perianal region. [EU] Contraceptive: conception. [EU]
An agent that diminishes the likelihood of or prevents
Curative: Tending to overcome disease and promote recovery. [EU] Cutaneous: Pertaining to the skin; dermal; dermic. [EU] Cyst: Any closed cavity or sac; normal or abnormal, lined by epithelium, and especially one that contains a liquid or semisolid material. [EU] Cytokines: Non-antibody proteins secreted by inflammatory leukocytes and some non-leukocytic cells, that act as intercellular mediators. They differ from classical hormones in that they are produced by a number of tissue or cell types rather than by specialized glands. They generally act locally in a
Glossary 201
paracrine or autocrine rather than endocrine manner. [NIH] Cytomegalovirus: A genus of the family Herpesviridae, subfamily Betaherpesvirinae, infecting the salivary glands, liver, spleen, lungs, eyes, and other organs, in which they produce characteristically enlarged cells with intranuclear inclusions. Infection with Cytomegalovirus is also seen as an opportunistic infection in AIDS. [NIH] Cytotoxic: Pertaining to or exhibiting cytotoxicity. [EU] Defensins: Family of antimicrobial peptides that have been identified in humans, animals, and plants. They are thought to play a role in host defenses against infections, inflammation, wound repair, and acquired immunity. Based on the disulfide pairing of their characteristic six cysteine residues, they are divided into alpha-defensins and beta-defensins. [NIH] Degenerative: Undergoing degeneration : tending to degenerate; having the character of or involving degeneration; causing or tending to cause degeneration. [EU] Dentifrices: Any preparations used for cleansing teeth; they usually contain an abrasive, detergent, binder and flavoring agent and may exist in the form of liquid, paste or powder; may also contain medicaments and caries preventives. [NIH] Dentition: The teeth in the dental arch; ordinarily used to designate the natural teeth in position in their alveoli. [EU] Dermatitis: Inflammation of the skin. [EU] Dermatosis: Any skin disease, especially one not characterized by inflammation. [EU] Diarrhea: Passage of excessively liquid or excessively frequent stools. [NIH] Disinfectant: An agent that disinfects; applied particularly to agents used on inanimate objects. [EU] Diuretic: An agent that promotes the excretion of urine. [EU] Doxycycline: A synthetic Tetracycline derivative with a range of antimicrobial activity and mode of action similar to that of tetracycline, but more effective against many species. Animal studies suggest that it may cause less tooth staining than other tetracyclines. [NIH] Electrophoresis: An electrochemical process in which macromolecules or colloidal particles with a net electric charge migrate in a solution under the influence of an electric current. [NIH] Endocarditis: Exudative and proliferative inflammatory alterations of the endocardium, characterized by the presence of vegetations on the surface of the endocardium or in the endocardium itself, and most commonly involving a heart valve, but sometimes affecting the inner lining of the
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cardiac chambers or the endocardium elsewhere. It may occur as a primary disorder or as a complication of or in association with another disease. [EU] Endotoxic: Of, relating to, or acting as an endotoxin (= a heat-stable toxin, associated with the outer membranes of certain gram-negative bacteria. Endotoxins are not secreted and are released only when the cells are disrupted). [EU] Enzyme: A protein molecule that catalyses chemical reactions of other substances without itself being destroyed or altered upon completion of the reactions. Enzymes are classified according to the recommendations of the Nomenclature Committee of the International Union of Biochemistry. Each enzyme is assigned a recommended name and an Enzyme Commission (EC) number. They are divided into six main groups; oxidoreductases, transferases, hydrolases, lyases, isomerases, and ligases. [EU] Epidemiological: Relating to, or involving epidemiology. [EU] Epidermal: Pertaining to or resembling epidermis. Called also epidermic or epidermoid. [EU] Erythema: A name applied to redness of the skin produced by congestion of the capillaries, which may result from a variety of causes, the etiology or a specific type of lesion often being indicated by a modifying term. [EU] Ethnopharmacology: The study of the actions and properties of drugs, usually derived from medicinal plants, indigenous to a population or ethnic group. [NIH] Exocrine: 1. secreting outwardly, via a duct;. [EU] Febrile: Pertaining to or characterized by fever. [EU] Fibroblasts: Connective tissue cells which secrete an extracellular matrix rich in collagen and other macromolecules. [NIH] Fibrosis: The formation of fibrous tissue; fibroid or fibrous degeneration [EU] Fissure: Any cleft or groove, normal or otherwise; especially a deep fold in the cerebral cortex which involves the entire thickness of the brain wall. [EU] Gelatin: A product formed from skin, white connective tissue, or bone collagen. It is used as a protein food adjuvant, plasma substitute, hemostatic, suspending agent in pharmaceutical preparations, and in the manufacturing of capsules and suppositories. [NIH] Gels: Colloids with a solid continuous phase and liquid as the dispersed phase; gels may be unstable when, due to temperature or other cause, the solid phase liquifies; the resulting colloid is called a sol. [NIH] Genotype: The genetic constitution of the individual; the characterization of the genes. [NIH] Geriatric: Pertaining to the treatment of the aged. [EU]
Glossary 203
Gingivitis: Inflammation of the gingivae. Gingivitis associated with bony changes is referred to as periodontitis. Called also oulitis and ulitis. [EU] Glossitis: Inflammation of the tongue. [EU] Glucose: D-glucose, a monosaccharide (hexose), C6H12O6, also known as dextrose (q.v.), found in certain foodstuffs, especially fruits, and in the normal blood of all animals. It is the end product of carbohydrate metabolism and is the chief source of energy for living organisms, its utilization being controlled by insulin. Excess glucose is converted to glycogen and stored in the liver and muscles for use as needed and, beyond that, is converted to fat and stored as adipose tissue. Glucose appears in the urine in diabetes mellitus. [EU] Haemophilus: A genus of pasteurellaceae that consists of several species occurring in animals and humans. Its organisms are described as gramnegative, facultatively anaerobic, coccobacillus or rod-shaped, and nonmotile. [NIH] Halitosis: An offensive, foul breath odor resulting from a variety of causes such as poor oral hygiene, dental or oral infections, or the ingestion of certain foods. [NIH] Hematology: A subspecialty of internal medicine concerned with morphology, physiology, and pathology of the blood and blood-forming tissues. [NIH] Hemorrhage: Bleeding or escape of blood from a vessel. [NIH] Hepatitis: Inflammation of the liver. [EU] Herpes: Any inflammatory skin disease caused by a herpesvirus and characterized by the formation of clusters of small vesicles. When used alone, the term may refer to herpes simplex or to herpes zoster. [EU] Hormonal: Pertaining to or of the nature of a hormone. [EU] Hormones: Chemical substances having a specific regulatory effect on the activity of a certain organ or organs. The term was originally applied to substances secreted by various endocrine glands and transported in the bloodstream to the target organs. It is sometimes extended to include those substances that are not produced by the endocrine glands but that have similar effects. [NIH] Hybridization: The genetic process of crossbreeding to produce a hybrid. Hybrid nucleic acids can be formed by nucleic acid hybridization of dna and rna molecules. protein hybridization allows for hybrid proteins to be formed from polypeptide chains. [NIH] Hyperpigmentation: Excessive pigmentation of the skin, usually as a result of increased melanization of the epidermis rather than as a result of an increased number of melanocytes. Etiology is varied and the condition may
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arise from exposure to light, chemicals or other substances, or from a primary metabolic imbalance. [NIH] Hyperplasia: The abnormal multiplication or increase in the number of normal cells in normal arrangement in a tissue. [EU] Hypersensitivity: A state of altered reactivity in which the body reacts with an exaggerated immune response to a foreign substance. Hypersensitivity reactions are classified as immediate or delayed, types I and IV, respectively, in the Gell and Coombs classification (q.v.) of immune responses. [EU] Hypertension: Persistently high arterial blood pressure. Various criteria for its threshold have been suggested, ranging from 140 mm. Hg systolic and 90 mm. Hg diastolic to as high as 200 mm. Hg systolic and 110 mm. Hg diastolic. Hypertension may have no known cause (essential or idiopathic h.) or be associated with other primary diseases (secondary h.). [EU] Immunization: The induction of immunity. [EU] Impetigo: A common superficial bacterial infection caused by staphylococcus aureus or group A beta-hemolytic streptococci. Characteristics include pustular lesions that rupture and discharge a thin, amber-colored fluid that dries and forms a crust. This condition is commonly located on the face, especially about the mouth and nose. [NIH] Inflammation: A pathological process characterized by injury or destruction of tissues caused by a variety of cytologic and chemical reactions. It is usually manifested by typical signs of pain, heat, redness, swelling, and loss of function. [NIH] Inhalation: The drawing of air or other substances into the lungs. [EU] Insulin: A protein hormone secreted by beta cells of the pancreas. Insulin plays a major role in the regulation of glucose metabolism, generally promoting the cellular utilization of glucose. It is also an important regulator of protein and lipid metabolism. Insulin is used as a drug to control insulindependent diabetes mellitus. [NIH] Intestinal: Pertaining to the intestine. [EU] Invasive: 1. having the quality of invasiveness. 2. involving puncture or incision of the skin or insertion of an instrument or foreign material into the body; said of diagnostic techniques. [EU] Iodine: A nonmetallic element of the halogen group that is represented by the atomic symbol I, atomic number 53, and atomic weight of 126.90. It is a nutritionally essential element, especially important in thyroid hormone synthesis. In solution, it has anti-infective properties and is used topically. [NIH]
Itraconazole: An antifungal agent that has been used in the treatment of histoplasmosis, blastomycosis, cryptococcal meningitis, and aspergillosis.
Glossary 205
[NIH]
Keloid: A sharply elevated, irregularly- shaped, progressively enlarging scar due to the formation of excessive amounts of collagen in the corium during connective tissue repair. [EU] Keratosis: Any horny growth such as a wart or callus. [NIH] Klebsiella: A genus of gram-negative, facultatively anaerobic, rod-shaped bacteria whose organisms arrange singly, in pairs, or short chains. This genus is commonly found in the intestinal tract and is an opportunistic pathogen that can give rise to bacteremia, pneumonia, urinary tract and several other types of human infection. [NIH] Lesion: Any pathological or traumatic discontinuity of tissue or loss of function of a part. [EU] Liquifilm: A thin liquid layer of coating. [EU] Lupus: A form of cutaneous tuberculosis. It is seen predominantly in women and typically involves the nasal, buccal, and conjunctival mucosa. [NIH]
Lymphocytic: Pertaining to, characterized by, or of the nature of lymphocytes. [EU] Lymphoma: Any neoplastic disorder of the lymphoid tissue, the term lymphoma often is used alone to denote malignant lymphoma. [EU] Lytic: 1. pertaining to lysis or to a lysin. 2. producing lysis. [EU] Malaise: A vague feeling of bodily discomfort. [EU] Malformation: A morphologic defect resulting from an intrinsically abnormal developmental process. [EU] Mediator: An object or substance by which something is mediated, such as (1) a structure of the nervous system that transmits impulses eliciting a specific response; (2) a chemical substance (transmitter substance) that induces activity in an excitable tissue, such as nerve or muscle; or (3) a substance released from cells as the result of the interaction of antigen with antibody or by the action of antigen with a sensitized lymphocyte. [EU] Melanosis: A disorder caused by a disturbance in melanin pigmentation; melanism. [EU] Membrane: A thin layer of tissue which covers a surface, lines a cavity or divides a space or organ. [EU] Methotrexate: An antineoplastic antimetabolite with immunosuppressant properties. It is an inhibitor of dihydrofolate reductase and prevents the formation of tetrahydrofolate, necessary for synthesis of thymidylate, an essential component of DNA. [NIH] Microbiology: The study of microorganisms such as fungi, bacteria, algae,
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archaea, and viruses. [NIH] Microorganism: A microscopic organism; those of medical interest include bacteria, viruses, fungi and protozoa. [EU] Microscopy: The application of microscope magnification to the study of materials that cannot be properly seen by the unaided eye. [NIH] Microspheres: Small uniformly-sized spherical particles frequently labeled with radioisotopes or various reagents acting as tags or markers. [NIH] Minocycline: A semisynthetic antibiotic effective against tetracyclineresistant staphylococcus infections. [NIH] Molecular: Of, pertaining to, or composed of molecules : a very small mass of matter. [EU] Mononucleosis: The presence of an abnormally large number of mononuclear leucocytes (monocytes) in the blood. The term is often used alone to refer to infectious mononucleosis. [EU] Mucus: The free slime of the mucous membranes, composed of secretion of the glands, along with various inorganic salts, desquamated cells, and leucocytes. [EU] Nasal: Pertaining to the nose. [EU] Necrolysis: Separation or exfoliation of tissue due to necrosis. [EU] Neoplasms: New abnormal growth of tissue. Malignant neoplasms show a greater degree of anaplasia and have the properties of invasion and metastasis, compared to benign neoplasms. [NIH] Nephropathy: Disease of the kidneys. [EU] Neuralgia: Paroxysmal pain which extends along the course of one or more nerves. Many varieties of neuralgia are distinguished according to the part affected or to the cause, as brachial, facial, occipital, supraorbital, etc., or anaemic, diabetic, gouty, malarial, syphilitic, etc. [EU] Neuropathy: A general term denoting functional disturbances and/or pathological changes in the peripheral nervous system. The etiology may be known e.g. arsenical n., diabetic n., ischemic n., traumatic n.) or unknown. Encephalopathy and myelopathy are corresponding terms relating to involvement of the brain and spinal cord, respectively. The term is also used to designate noninflammatory lesions in the peripheral nervous system, in contrast to inflammatory lesions (neuritis). [EU] Neutropenia: Leukopenia in which the decrease in white blood cells is chiefly in neutrophils. [EU] Niacin: Water-soluble vitamin of the B complex occurring in various animal and plant tissues. Required by the body for the formation of coenzymes NAD and NADP. Has pellagra-curative, vasodilating, and antilipemic
Glossary 207
properties. [NIH] Nicotine: Nicotine is highly toxic alkaloid. It is the prototypical agonist at nicotinic cholinergic receptors where it dramatically stimulates neurons and ultimately blocks synaptic transmission. Nicotine is also important medically because of its presence in tobacco smoke. [NIH] Nystatin: Macrolide antifungal antibiotic complex produced by Streptomyces noursei, S. aureus, and other Streptomyces species. The biologically active components of the complex are nystatin A1, A2, and A3. [NIH]
Ophthalmic: Pertaining to the eye. [EU] Oral: Pertaining to the mouth, taken through or applied in the mouth, as an oral medication or an oral thermometer. [EU] Orofacial: Of or relating to the mouth and face. [EU] Overdose: 1. to administer an excessive dose. 2. an excessive dose. [EU] Paralysis: Loss or impairment of motor function in a part due to lesion of the neural or muscular mechanism; also by analogy, impairment of sensory function (sensory paralysis). In addition to the types named below, paralysis is further distinguished as traumatic, syphilitic, toxic, etc., according to its cause; or as obturator, ulnar, etc., according to the nerve part, or muscle specially affected. [EU] Parasitic: Pertaining to, of the nature of, or caused by a parasite. [EU] Particle: A tiny mass of material. [EU] Pemphigus: A group of chronic, relapsing, sometimes fatal skin diseases characterized clinically by the development of successive crops of vesicles and bullae, histologically by acantholysis, and immunologically by serum autoantibodies directed against antigens in the intracellular zones of the epidermis. The specific disease is usually indicated by a modifying term; but the term pemphigus is often used alone to designate pemphigus vulgaris. [EU] Periodontics: A dental specialty concerned with the histology, physiology, and pathology of the tissues that support, attach, and surround the teeth, and of the treatment and prevention of disease affecting these tissues. [NIH] Perioral: Situated or occurring around the mouth. [EU] Pharmacokinetics: The action of drugs in the body over a period of time, including the processes of absorption, distribution, localization in tissues, biotransformation, and excretion. [EU] Pharmacologic: Pertaining to pharmacology or to the properties and reactions of drugs. [EU] Phenotype: The outward appearance of the individual. It is the product of interactions between genes and between the genotype and the environment.
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This includes the killer phenotype, characteristic of yeasts. [NIH] Phenytoin: An anticonvulsant that is used in a wide variety of seizures. It is also an anti-arrhythmic and a muscle relaxant. The mechanism of therapeutic action is not clear, although several cellular actions have been described including effects on ion channels, active transport, and general membrane stabilization. The mechanism of its muscle relaxant effect appears to involve a reduction in the sensitivity of muscle spindles to stretch. Phenytoin has been proposed for several other therapeutic uses, but its use has been limited by its many adverse effects and interactions with other drugs. [NIH] Piroxicam: 4-Hydroxy-2-methyl-N-2-pyridyl-2H-1,2-benzothiazine-3carboxamide 1,1-dioxide. A non-steroidal anti-inflammatory agent that is well established in the treatment of rheumatoid arthritis and osteoarthritis. Its usefulness has also been demonstrated in the treatment of musculoskeletal disorders, dysmenorrhea, and postoperative pain. Its long half-life enables it to be administered once daily. The drug has also been shown to be effective if administered rectally. Gastrointestinal complaints are the most frequently reported side effects. [NIH] Pneumonia: Inflammation of the lungs with consolidation. [EU] Porphyromonas: A genus of gram-negative, anaerobic, nonsporeforming, nonmotile rods or coccobacilli. Organisms in this genus had originally been classified as members of the bacteroides genus but overwhelming biochemical and chemical findings indicated the need to separate them from other Bacteroides species, and hence, this new genus was created. [NIH] Postoperative: Occurring after a surgical operation. [EU] Potassium: An element that is in the alkali group of metals. It has an atomic symbol K, atomic number 19, and atomic weight 39.10. It is the chief cation in the intracellular fluid of muscle and other cells. Potassium ion is a strong electrolyte and it plays a significant role in the regulation of fluid volume and maintenance of the water-electrolyte balance. [NIH] Prevalence: The total number of cases of a given disease in a specified population at a designated time. It is differentiated from INCIDENCE, which refers to the number of new cases in the population at a given time. [NIH] Prevotella: A genus of gram-negative, anaerobic, nonsporeforming, nonmotile rods. Organisms of this genus had originally been classified as members of the bacteroides genus but overwhelming biochemical and chemical findings in 1990 indicated the need to separate them from other Bacteroides species, and hence, this new genus was established. [NIH] Prophylaxis: The prevention of disease; preventive treatment. [EU] Prostaglandins:
A group of compounds derived from unsaturated 20-
Glossary 209
carbon fatty acids, primarily arachidonic acid, via the cyclooxygenase pathway. They are extremely potent mediators of a diverse group of physiological processes. [NIH] Protease: Proteinase (= any enzyme that catalyses the splitting of interior peptide bonds in a protein). [EU] Proteins: Polymers of amino acids linked by peptide bonds. The specific sequence of amino acids determines the shape and function of the protein. [NIH]
Proxy: A person authorized to decide or act for another person, for example, a person having durable power of attorney. [NIH] Psoriasis: A common genetically determined, chronic, inflammatory skin disease characterized by rounded erythematous, dry, scaling patches. The lesions have a predilection for nails, scalp, genitalia, extensor surfaces, and the lumbosacral region. Accelerated epidermopoiesis is considered to be the fundamental pathologic feature in psoriasis. [NIH] Puberty: The period during which the secondary sex characteristics begin to develop and the capability of sexual reproduction is attained. [EU] Quaternary: 1. fourth in order. 2. containing four elements or groups. [EU] Receptor: 1. a molecular structure within a cell or on the surface characterized by (1) selective binding of a specific substance and (2) a specific physiologic effect that accompanies the binding, e.g., cell-surface receptors for peptide hormones, neurotransmitters, antigens, complement fragments, and immunoglobulins and cytoplasmic receptors for steroid hormones. 2. a sensory nerve terminal that responds to stimuli of various kinds. [EU] Recombinant: 1. a cell or an individual with a new combination of genes not found together in either parent; usually applied to linked genes. [EU] Rectal: Pertaining to the rectum (= distal portion of the large intestine). [EU] Regeneration: The natural renewal of a structure, as of a lost tissue or part. [EU]
Respiratory: Pertaining to respiration. [EU] Retinopathy: 1. retinitis (= inflammation of the retina). 2. retinosis (= degenerative, noninflammatory condition of the retina). [EU] Riboflavin: Nutritional factor found in milk, eggs, malted barley, liver, kidney, heart, and leafy vegetables. The richest natural source is yeast. It occurs in the free form only in the retina of the eye, in whey, and in urine; its principal forms in tissues and cells are as FMN and FAD. [NIH] Saliva: The clear, viscous fluid secreted by the salivary glands and mucous glands of the mouth. it contains mucins, water, organic salts, and ptylin. [NIH] Sarcoidosis: An idiopathic systemic inflammatory granulomatous disorder
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comprised of epithelioid and multinucleated giant cells with little necrosis. It usually invades the lungs with fibrosis and may also involve lymph nodes, skin, liver, spleen, eyes, phalangeal bones, and parotid glands. [NIH] Sarcoma: A tumour made up of a substance like the embryonic connective tissue; tissue composed of closely packed cells embedded in a fibrillar or homogeneous substance. Sarcomas are often highly malignant. [EU] Secretion: 1. the process of elaborating a specific product as a result of the activity of a gland; this activity may range from separating a specific substance of the blood to the elaboration of a new chemical substance. 2. any substance produced by secretion. [EU] Sequela: Any lesion or affection following or caused by an attack of disease. [EU]
Serum: The clear portion of any body fluid; the clear fluid moistening serous membranes. 2. blood serum; the clear liquid that separates from blood on clotting. 3. immune serum; blood serum from an immunized animal used for passive immunization; an antiserum; antitoxin, or antivenin. [EU] Sialorrhea: Increased salivary flow. [NIH] Sinusitis: Inflammation of a sinus. The condition may be purulent or nonpurulent, acute or chronic. Depending on the site of involvement it is known as ethmoid, frontal, maxillary, or sphenoid sinusitis. [EU] Sirolimus: A macrolide compound obtained from Streptomyces hygroscopicus that acts by selectively blocking the transcriptional activation of cytokines thereby inhibiting cytokine production. It is bioactive only when bound to immunophilins. Sirolimus is a potent immunosuppressant and possesses both antifungal and antineoplastic properties. [NIH] Species: A taxonomic category subordinate to a genus (or subgenus) and superior to a subspecies or variety, composed of individuals possessing common characters distinguishing them from other categories of individuals of the same taxonomic level. In taxonomic nomenclature, species are designated by the genus name followed by a Latin or Latinized adjective or noun. [EU] Spectrum: A charted band of wavelengths of electromagnetic vibrations obtained by refraction and diffraction. By extension, a measurable range of activity, such as the range of bacteria affected by an antibiotic (antibacterial s.) or the complete range of manifestations of a disease. [EU] Stomatitis: Inflammation of the oral mucosa, due to local or systemic factors which may involve the buccal and labial mucosa, palate, tongue, floor of the mouth, and the gingivae. [EU] Streptococcus: A genus of gram-positive, coccoid bacteria whose organisms occur in pairs or chains. No endospores are produced. Many species exist as
Glossary 211
commensals or parasites on man or animals with some being highly pathogenic. A few species are saprophytes and occur in the natural environment. [NIH] Sublingual: Located beneath the tongue. [EU] Sulfur: An element that is a member of the chalcogen family. It has an atomic symbol S, atomic number 16, and atomic weight 32.066. It is found in the amino acids cysteine and methionine. [NIH] Surgical: Of, pertaining to, or correctable by surgery. [EU] Syphilis: A contagious venereal disease caused by the spirochete treponema pallidum. [NIH] Systemic: Pertaining to or affecting the body as a whole. [EU] Tetracycline: An antibiotic originally produced by Streptomyces viridifaciens, but used mostly in synthetic form. It is an inhibitor of aminoacyl-tRNA binding during protein synthesis. [NIH] Thermoregulation: Heat regulation. [EU] Thrombocytopenia: Decrease in the number of blood platelets. [EU] Thyroxine: An amino acid of the thyroid gland which exerts a stimulating effect on thyroid metabolism. [NIH] Tomography: The recording of internal body images at a predetermined plane by means of the tomograph; called also body section roentgenography. [EU]
Topical: Pertaining to a particular surface area, as a topical anti-infective applied to a certain area of the skin and affecting only the area to which it is applied. [EU] Toxic: Pertaining to, due to, or of the nature of a poison or toxin; manifesting the symptoms of severe infection. [EU] Toxicity: The quality of being poisonous, especially the degree of virulence of a toxic microbe or of a poison. [EU] Toxin: A poison; frequently used to refer specifically to a protein produced by some higher plants, certain animals, and pathogenic bacteria, which is highly toxic for other living organisms. Such substances are differentiated from the simple chemical poisons and the vegetable alkaloids by their high molecular weight and antigenicity. [EU] Treponema: A genus of microorganisms of the order spirochaetales, many of which are pathogenic and parasitic for man. [NIH] Triclosan: A diphenyl ether derivative used in cosmetics and toilet soaps as an antiseptic. It has some bacteriostatic and fungistatic action. [NIH] Tuberculosis: Any of the infectious diseases of man and other animals caused by species of mycobacterium. [NIH]
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Tularemia: A plague-like disease of rodents, transmissible to man. It is caused by Francisella Tularensis and is characterized by fever, chills, headache, backache, and weakness. [NIH] Ulceration: 1. the formation or development of an ulcer. 2. an ulcer. [EU] Urticaria: Pathology: a transient condition of the skin, usually caused by an allergic reaction, characterized by pale or reddened irregular, elevated patches and severe itching; hives. [EU] Vaginal: 1. of the nature of a sheath; ensheathing. 2. pertaining to the vagina. 3. pertaining to the tunica vaginalis testis. [EU] Varicella: Chicken pox. [EU] Vesicular: 1. composed of or relating to small, saclike bodies. 2. pertaining to or made up of vesicles on the skin. [EU] Viral: Pertaining to, caused by, or of the nature of virus. [EU] Virulence: The degree of pathogenicity within a group or species of microorganisms or viruses as indicated by case fatality rates and/or the ability of the organism to invade the tissues of the host. [NIH] Viruses: Minute infectious agents whose genomes are composed of DNA or RNA, but not both. They are characterized by a lack of independent metabolism and the inability to replicate outside living host cells. [NIH] Warts: Benign epidermal proliferations or tumors; some are viral in origin. [NIH]
Xerostomia: Dryness of the mouth from salivary gland dysfunction, as in Sjögren's syndrome. [EU]
General Dictionaries and Glossaries While the above glossary is essentially complete, the dictionaries listed here cover virtually all aspects of medicine, from basic words and phrases to more advanced terms (sorted alphabetically by title; hyperlinks provide rankings, information and reviews at Amazon.com): ·
Dictionary of Medical Acronymns & Abbreviations by Stanley Jablonski (Editor), Paperback, 4th edition (2001), Lippincott Williams & Wilkins Publishers, ISBN: 1560534605, http://www.amazon.com/exec/obidos/ASIN/1560534605/icongroupinter na
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Dictionary of Medical Terms : For the Nonmedical Person (Dictionary of Medical Terms for the Nonmedical Person, Ed 4) by Mikel A. Rothenberg, M.D, et al, Paperback - 544 pages, 4th edition (2000), Barrons Educational Series, ISBN: 0764112015,
Glossary 213
http://www.amazon.com/exec/obidos/ASIN/0764112015/icongroupinter na ·
A Dictionary of the History of Medicine by A. Sebastian, CD-Rom edition (2001), CRC Press-Parthenon Publishers, ISBN: 185070368X, http://www.amazon.com/exec/obidos/ASIN/185070368X/icongroupinter na
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Dorland's Illustrated Medical Dictionary (Standard Version) by Dorland, et al, Hardcover - 2088 pages, 29th edition (2000), W B Saunders Co, ISBN: 0721662544, http://www.amazon.com/exec/obidos/ASIN/0721662544/icongroupinter na
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Dorland's Electronic Medical Dictionary by Dorland, et al, Software, 29th Book & CD-Rom edition (2000), Harcourt Health Sciences, ISBN: 0721694934, http://www.amazon.com/exec/obidos/ASIN/0721694934/icongroupinter na
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Dorland's Pocket Medical Dictionary (Dorland's Pocket Medical Dictionary, 26th Ed) Hardcover - 912 pages, 26th edition (2001), W B Saunders Co, ISBN: 0721682812, http://www.amazon.com/exec/obidos/ASIN/0721682812/icongroupinter na/103-4193558-7304618
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Melloni's Illustrated Medical Dictionary (Melloni's Illustrated Medical Dictionary, 4th Ed) by Melloni, Hardcover, 4th edition (2001), CRC Press-Parthenon Publishers, ISBN: 85070094X, http://www.amazon.com/exec/obidos/ASIN/85070094X/icongroupintern a
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Stedman's Electronic Medical Dictionary Version 5.0 (CD-ROM for Windows and Macintosh, Individual) by Stedmans, CD-ROM edition (2000), Lippincott Williams & Wilkins Publishers, ISBN: 0781726328, http://www.amazon.com/exec/obidos/ASIN/0781726328/icongroupinter na
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Stedman's Medical Dictionary by Thomas Lathrop Stedman, Hardcover - 2098 pages, 27th edition (2000), Lippincott, Williams & Wilkins, ISBN: 068340007X, http://www.amazon.com/exec/obidos/ASIN/068340007X/icongroupinter na
·
Tabers Cyclopedic Medical Dictionary (Thumb Index) by Donald Venes (Editor), et al, Hardcover - 2439 pages, 19th edition (2001), F A Davis Co, ISBN: 0803606540,
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http://www.amazon.com/exec/obidos/ASIN/0803606540/icongroupinter na
Index 215
INDEX A Adsorption .............................................69 Adverse .................................93, 102, 208 Antibiotic 15, 28, 29, 57, 79, 103, 136, 206, 207, 210, 211 Antibody...........75, 76, 104, 198, 200, 205 Antigen ....................64, 74, 104, 197, 205 Antimicrobial ....14, 27, 55, 59, 65, 76, 201 Antiseptic ...............80, 166, 169, 199, 211 Anxiety...................................................82 Assay.....................................................70 Atypical ..................................................83 Autoimmunity.........................................64 B Bacteremia ................57, 75, 92, 198, 205 Benign ...................................85, 121, 206 Biochemical .............................68, 78, 208 Bromine .................................................59 Brucellosis .............................................64 Bruxism..........................................85, 145 Buccal ..........83, 90, 92, 94, 199, 205, 210 C Candidiasis ..........................83, 84, 85, 88 Capsules................................28, 161, 202 Carbohydrate.........................28, 161, 203 Cardiovascular.....................................102 Cataract .........................................27, 199 Cetylpyridinium ....................................165 Cheilitis ............................................82, 83 Chemotaxis..........................................147 Chemotherapy .....................................111 Chlorhexidine 14, 42, 55, 65, 87, 88, 146, 163, 164 Chlorine .................................................59 Cholesterol ..................................158, 161 Collagen ......20, 27, 38, 77, 200, 202, 205 Commensal ...........................................67 Condyloma ............................................83 Curative ...............................108, 169, 206 Cutaneous .......................76, 92, 199, 205 Cytokines ...............................67, 137, 210 Cytomegalovirus....................................83 Cytotoxic ................................................66 D Defensins...............................................67 Degenerative .........................29, 159, 209 Dentifrices..............................................53 Dentists 2, 4, 20, 35, 36, 37, 112, 127, 132, 157, 185, 186 Dentition ................................................88 Diarrhea...............................................158
Disinfectant ........................................... 65 Doxycycline........................................... 15 E Electrophoresis ..................................... 69 Endocarditis ............................ 76, 82, 199 Endotoxic .............................................. 68 Enzyme ..................... 16, 27, 78, 202, 209 Epidermal.............................. 83, 121, 212 Erythema................................. 82, 83, 111 Exocrine ................................................ 70 F Febrile ................................................... 57 Fibroblasts ............................................ 68 Fibrosis ......................................... 79, 210 G Gelatin..................................... 14, 27, 200 Gels............................................... 77, 202 Geriatric ................................................ 88 Glossitis .......................................... 82, 85 Glucose................... 19, 28, 169, 203, 204 H Halitosis .................................... 56, 82, 84 Hematology........................................... 83 Hepatitis ................................................ 82 Herpes .............................. 83, 88, 91, 203 Hormones ............... 76, 86, 121, 200, 209 Hybridization ................................... 64, 70 Hyperpigmentation................................ 83 Hyperplasia ........................................... 83 Hypersensitivity..................................... 82 Hypertension......................................... 83 I Immunization ........................ 79, 110, 210 Impetigo ................................................ 83 Inflammation 10, 11, 13, 14, 16, 19, 29, 58, 60, 66, 76, 85, 86, 87, 88, 91, 97, 102, 201, 209 Insulin.................... 28, 164, 169, 203, 204 Intestinal.................. 75, 92, 158, 198, 205 Invasive......................................... 60, 110 L Lesion ......... 79, 83, 91, 93, 202, 207, 210 Lymphocytic ........................................ 146 Lymphoma ...................... 83, 92, 116, 205 Lytic....................................................... 63 M Malaise.......................................... 76, 199 Melanosis.............................................. 84 Membrane................. 68, 90, 93, 200, 208 Microbiology.................... 56, 90, 110, 198 Microorganism .............................. 26, 197
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Microscopy ............................................86 Microspheres .........................................15 Minocycline............................................15 Molecular 29, 33, 63, 68, 69, 106, 113, 115, 121, 209, 211 Mononucleosis.........................64, 78, 206 Mucus ....................................................11 N Nasal .............................................92, 205 Necrolysis ..............................................83 Neoplasms...................................121, 206 Neuralgia .................................85, 93, 206 Niacin...................................................159 Nicotine..................................................82 Nystatin........................................136, 207 O Orofacial ..............................................110 Overdose .............................................159 P Paralysis ..................................83, 93, 207 Parasitic .........................................80, 211 Pemphigus...........................111, 121, 207 Periodontics.....................................32, 97 Perioral ..................................................84 Pharmacokinetics ............................58, 66 Pharmacologic...............................90, 197 Phenotype .....................................78, 208 Phenytoin...............................................88 Piroxicam .............................................164 Pneumonia ..............................83, 92, 205 Postoperative...................57, 82, 169, 208 Potassium............................................161 Precipitation...........................................69 Prophylaxis ............................................57 Prostaglandins.......................................24 Protease ..............................................146 Proteins 29, 62, 68, 69, 75, 76, 77, 158, 160, 198, 200, 203 Proxy ...................................................109 Psoriasis ........................................93, 209 Puberty ............................................19, 88 Q Quaternary.............................................55 R Receptor ........................................75, 198 Recombinant .........................................63
Regeneration .......................... 16, 21, 110 Respiratory................ 19, 75, 76, 198, 199 Riboflavin ............................................ 158 S Saliva ...................................... 12, 86, 110 Sarcoidosis ........................................... 64 Sarcoma................................................ 83 Secretion......................... 28, 79, 206, 210 Selenium ....................................... 66, 160 Sequela................................................. 57 Serum ..................... 70, 79, 121, 207, 210 Sinusitis................................... 82, 94, 210 Species 27, 62, 63, 68, 74, 75, 77, 78, 79, 80, 136, 197, 198, 201, 203, 207, 208, 210, 211, 212 Spectrum............................................... 65 Stomatitis .................................. 83, 84, 85 Sublingual ............................................. 69 Sulfur..................................................... 66 Surgical ........................... 21, 78, 110, 208 Systemic19, 63, 76, 79, 94, 103, 109, 145, 199, 209, 210 T Tetracycline............... 15, 27, 28, 201, 206 Thermoregulation................................ 158 Thrombocytopenia ................................ 83 Thyroxine ............................................ 160 Topical 27, 79, 108, 109, 145, 169, 199, 200, 211 Toxic 19, 29, 79, 83, 93, 121, 159, 200, 207, 211 Toxicity...................................... 58, 59, 66 Toxin ............................... 29, 77, 202, 211 Triclosan ................. 55, 59, 163, 164, 165 Tuberculosis...................... 64, 83, 92, 205 Tularemia .............................................. 64 U Ulceration.............................................. 83 V Varicella ................................................ 83 Viral................................. 62, 64, 121, 212 Virulence ................................. 68, 79, 211 Viruses ...................... 65, 78, 80, 206, 212 X Xerostomia............................ 82, 102, 111
Index 217
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