Dentistry Commons^™

Exploring Systemic Challenges In The Western North Carolina Dental Safety Net: A Qualitative Analysis, Blaire Mirmow, Bill Milner, Nadia Laniado

Journal of Appalachian Health

Introduction: Despite statewide growth, rural communities in Western North Carolina (WNC) face persistent barriers to oral health care driven by chronic dental workforce shortages and systemic geographic disparities. Within this Appalachian region, the dental safety net serves as a vital yet strained support system, struggling with limited financial resources and a lack of provider participation that leaves many underserved populations without essential oral health services.

Purpose: This study aims to explore the experiences of individuals working within the WNC dental safety net to identify barriers and strategies required to strengthen the delivery of oral health care in high-need rural settings. …

Localized Periodontitis In Young Individuals: Aggregatibacter Jp2 Clone, Immunological Dysfunctions And Other Stories, Luigi Nibali, Meaad M. Alamri, Manuela Maria Viana Miguel, Luciana M. Shaddox

Oral Health Science Faculty Publications

Grade C molar-incisor pattern periodontitis (C-MIP) is the latest in a series of names given to a unique phenotype, characterized by an aggressive and rapid loss of tooth-supporting structures, starting early in life and usually affecting first molars and incisors. Although much less prevalent than the more generalized “chronic” forms of this disease in adults, it affects mostly young individuals of lower socioeconomic status and African descent, or from mixed-race populations, and shows a strong familial aggregation, pointing to a possible genetic contribution, yet not fully elucidated. Even though most of the studies report this disease in adolescents/young adults, it …

Feasibility Of Brief Behavioral Telehealth Interventions For Sleep And Pain In Adults With Chronic Musculoskeletal Orofacial Pain: An Idiographic Clinical Trial, Linda Sangalli, Gabriel Gilmore, Isabel Moreno-Hay, Lauren N. Whitehurst, Anna Alessandri-Bonetti, Ian Andres Boggero

Oral Health Science Faculty Publications

Objective: Brief behavioral interventions targeting pain (Physical Self-Regulation, PSR) or sleep (Brief Behavioral Intervention for Insomnia, BBTI) show promise for interdisciplinary management of chronic pain, though their feasibility with chronic musculoskeletal orofacial pain (MSK-OFP) populations remains underexplored. This pilot study assessed the feasibility of a randomized clinical trial (RCT) of these interventions in a university-affiliated tertiary OFP clinic and explored clinical changes in pain, sleep, and other secondary outcomes.

Methods: Treatment-seeking participants (N=19) with chronic MSK-OFP and insomnia were randomized to three-session PSR or BBTI. At pre- and post-intervention, participants completed questionnaires (assessing pain intensity, insomnia symptomatology, sleep …

Molar–Incisor And Generalized Grade C Periodontitis: Distinct Microbiome–Immune Interactions Suggest Divergent Pathogenesis, Camila S. Stolf, Hélvis E. S. Paz, Murilo C. Paraluppi, Manuela Maria Viana Miguel, Mauro P. Santamaria, Mabelle F. Monteiro, Deyvid E. Amgarten, Raquel R. A. Franco, Luciana S. Branco-De-Almeida, Luciana M. Shaddox, Renato C. V. Casarin

Oral Health Practice Faculty Publications

Aim:

Molar-Incisor (PerioC-MIP) and Generalized (PerioC-G) Grade C Periodontitis could have distinctive etiopathogenesis behind their unique clinical patterns. Thus, this study aimed to distinguish these two phenotypes by analyzing the subgingival metagenomic profile and the inflammatory markers levels.

Methods:

In this cross-sectional comparative study, Gingival Crevicular Fluid (GCF) and Subgingival Biofilm (SB) were collected from 18 PerioC-MIP North Americans and 14 periodontally healthy controls (HC) from the same location (HC-MIP) and 20 PerioC-G Brazilians and 20 controls (HC-G). From GCF, immunoenzymatic analysis was performed. SB functional and taxonomic bacterial content was determined using shotgun metagenomics sequencing.

Results:

Taxonomic results showed …

Evaluating The Implementation Of Social Determinants Of Health Screening In An Interdisciplinary Clinic, Taylor M. Adams

DNP Projects

Background: Social Determinants of Health (SDOH), including food, housing, interpersonal violence, and transportation are non-medical problems that can influence health outcomes (World Health Organization, 2020). Low-income minorities and public-payer groups are at considerable higher risk for social needs. Collaboration within the community can improve health outcomes (Sulley et al., 2021). A literature review revealed limited evidence of screening in dental clinic settings. Failure to identify and address SDOH needs in this population can lead to poorer health outcomes.

Purpose: The purpose of this quality improvement project was to implement and evaluate social determinants of health screening and evaluate the …

The Role Of A Dental Healthcare Provider, Jeffrey P. Okeson

Neurology Faculty Publications

No abstract provided.

Dental Outreach In Academic Dental Settings, Tisha Clayborn

Theses and Dissertations--Public Health (M.P.H. & Dr.P.H.)

Creating an effective outreach program in a dental academic setting involves a strategic approach combining educational objectives and community service. This Dental Outreach Program Guide aligns with organizational objectives, contributes to community well-being, and serves as a model for future outreach initiatives in academic dental settings. This program utilizes the PRECEDE-PROCEED planning model to design and evaluate an oral health strategy. This program aims to outline a strategic plan incorporating evidence-based decision-making, data-driven metrics, and a comprehensive roadmap for successful implementation.

Improving Dental Students' Knowledge And Confidence In Treating Tobacco Use, Victoria Pierce

DNP Projects

Background: Tobacco use can lead to numerous chronic health conditions. Healthcare professionals in the dental field are in a unique position to broach this issue with patients. Research shows that dental students do not feel equipped to provide tobacco cessation care, citing lack of education on the subject among their top reasons for this.

Purpose: The purpose of this project was to evaluate changes in dental students’ knowledge and confidence related to treating tobacco use after participation in an educational intervention about the 5A’s, behavioral counseling, and first-line prescription medications.

Methods: This quality improvement initiative utilized a quasi-experimental survey design …

Advanced Microstructural Characterization Of Functionally Graded Dental Ceramic Material For Materials-Informed Finishing, Angani Vigneswaran

Theses and Dissertations--Manufacturing Systems Engineering

Yttria-stabilized tetragonal zirconia polycrystal (Y-TZP) has gained popularity as the choice of material for dental prosthetics. Ivoclar Vivadent’s IPS e.max ZirCAD Prime dental ceramic incorporates a unique gradient technology that varies the yttria content over the thickness of the material. The top layer is composed of 5Y-TZP which is desired for its optical properties while the bottom layer is composed of a much stronger 3Y-TZP. In between the two layers, 5Y-TZP and 3Y-TZP are mixed to form a transition layer. Varying the amount of yttria allows for more esthetically pleasing translucency in the visible areas of the restoration without compromising …

Acute Invasive Fungal Rhinosinusitis Related Orbital Infection Secondary To Odontogenic Infection, Dennis Levy, Melvyn Yeoh

Oral Health Science Faculty Publications

A 64-year old male presented to our institution with painful ophthalmoplegia. The initial differential diagnosis included orbital apex disorders, such as orbital apex syndrome (OAS), cavernous sinus thrombosis (CST), and superior orbital fissure syndrome (SOFS). Ultimately, the diagnosis was acute invasive fungal rhinosinusitis (AIFRS) secondary to an odontogenic infection from carious teeth in the maxilla. Significant overlap exists between AIFRS and orbital apex disorders, making it prudent to include AIFRS in the differential diagnosis for painful ophthalmoplegia. The purpose of this review is to detail this specific patient's presentation and hospital course along with a brief review of AIFRS and …

A Rare Case Of Idiopathic Painful Nervus Intermedius Neuropathy In A 13-Year-Old Female: A Case Report And Discussion In The Context Of The Literature, Diego Fernandez-Vial, Linda Sangalli, Christina Perez

Oral Health Science Faculty Publications

(1) Background: Painful nervus intermedius neuropathy involves continuous or near-continuous pain affecting the distribution of the intermedius nerve(s). The diagnosis of this entity is challenging, particularly when the clinical and demographic features do not resemble the typical presentation of this condition. To the best of our knowledge, only three case reports have described the occurrence of nervus intermedius neuropathy in young patients. (2) Case Description: A 13-year-old female referred to the orofacial pain clinic with a complaint of pain located deep in the right ear and mastoid area. The pain was described as constant, throbbing and dull, with an intensity …

Gingival Transcriptome Of Innate Antimicrobial Factors And The Oral Microbiome With Aging And Periodontitis, Jeffrey L. Ebersole, Sreenatha S. Kirakodu, Linh Nguyen, Octavio A. Gonzalez

Center for Oral Health Research Faculty Publications

The epithelial barrier at mucosal sites comprises an important mechanical protective feature of innate immunity, and is intimately involved in communicating signals of infection/tissue damage to inflammatory and immune cells in these local environments. A wide array of antimicrobial factors (AMF) exist at mucosal sites and in secretions that contribute to this innate immunity. A non-human primate model of ligature-induced periodontitis was used to explore characteristics of the antimicrobial factor transcriptome (n = 114 genes) of gingival biopsies in health, initiation and progression of periodontal lesions, and in samples with clinical resolution. Age effects and relationship of AMF to …

Optimizing Mandibular Advancement Maneuvers During Sleep Endoscopy With A Titratable Positioner: Dise-Sam Protocol, Patricia Fernández-Sanjuán, Juan José Arrieta, Jaime Sanabria, Marta Alcaraz, Gabriela Bosco, Nuria Pérez-Martín, Adriana Pérez, Marina Carrasco-Llatas, Isabel Moreno-Hay, Marcos Ríos-Lago, Rodolfo Lugo, Carlos O’Connor-Reina, Peter Baptista, Guillermo Plaza

Oral Health Science Faculty Publications

Mandibular advancement devices (MAD) are an effective alternative treatment to CPAP. Different maneuvers were performed during drug sleep-induced endoscopy (DISE) to mimic the effect of MAD. Using the Selector Avance Mandibular (SAM) device, we aimed to identify MAD candidates during DISE using a titratable, reproducible, and measurable maneuver. This DISE-SAM protocol may help to find the relationship between the severity of the respiratory disorder and the degree of response and determine the advancement required to improve the collapsibility of the upper airway. Explorations were performed in 161 patients (132 males; 29 females) with a mean age of 46.81 (SD = …

Long-Term Water Balance Evaluation In Glass Ionomer Restorative Materials, Howard Roberts, David Berzins, John Nicholson

Oral Health Practice Faculty Publications

The complex role of water in glass ionomer cement (polyalkenoate) dental restorative materials has been studied, but much of the present understanding concerning water balance within these materials is based on very early studies and short-term experiments. This study evaluated the nature of the water species of six conventional and four resin modified glass ionomer restorative materials over 3 years using thermogravimetric analysis techniques. Materials were prepared, placed in crucibles, and stored in physiologic phosphate buffered saline and evaluated at 24 h, 1 week, and then at 1, 3, 6, 9, 12, 18, 24, 30 and 36 months. All materials …

Impact Of Impaired Glucose Metabolism On Periodontitis Progression Over Three Years, Oelisoa M. Andriankaja, Kaumudi Joshipura, Francisco Muñoz, Bruce A. Dye, Frank B. Hu, Cynthia M. Pérez

Center for Oral Health Research Faculty Publications

We evaluated the relationship between glucose abnormalities and periodontitis in overweight/obese individuals. Eight hundred and seventy (870) diabetes-free participants aged 40–65 years completed the three-year follow-up in the San Juan Overweight Adults Longitudinal Study. The ADA thresholds for fasting and 2-h post-load glucose and HbA1c were used to define prediabetes. The NHANES methods were used to assess periodontitis. Multivariable linear regression was used to evaluate the relationship between baseline glucose metabolism measures and periodontitis at follow-up, adjusting for potential confounders. There was no association between impaired glucose measures and mean pocket depth (PD), mean clinical attachment loss (CAL), or mean …

Bacterial Biofilm Growth On Various Dental Stabilization Systems For Avulsed And Luxated Teeth, Mahmoud Mona, Clay Walker, Luciana M. Shaddox, Roberta Pileggi

Oral Health Practice Faculty Publications

With the increased incidence of traumatic injuries and the advanced understanding of the periodontal and alveolar healing process, teeth splinting has become a common practice for stabilizing traumatized teeth. Consequently, several splinting materials and techniques have been introduced in the past few years. Despite the detrimental role of bacterial biofilm on healing, the level of biofilm development on these material surfaces has not been well investigated. Bacterial biofilms are severely detrimental for periodontal healing of avulsed and luxated teeth. Thus, biofilm growth becomes a critical factor in selecting the material of choice for dental splints. In this study, we aim …

Oral Microbiome And Gingival Gene Expression Of Inflammatory Biomolecules With Aging And Periodontitis, Jeffrey L. Ebersole, Radhakrishnan Nagarajan, Sreenatha S. Kirakodu, Octavio A. Gonzalez

Center for Oral Health Research Faculty Publications

Although data describe the presence and increase of inflammatory mediators in the local environment in periodontitis vs. health in humans, details regarding how these responses evolve in the transition from health to disease, changes during disease progression, and features of a resolved lesion remain unknown. This study used a nonhuman primate model of ligature-induced periodontitis in young, adolescent, adult, and aged animals to document features of inflammatory response affected by age. Rhesus monkeys had ligatures tied and provided gingival tissue biopsy specimens at baseline, 0.5, 1, and 3 months of disease and at 5 months of the study, which was …

Effects Of Remote Digital Monitoring On Oral Hygiene Of Orthodontic Patients: A Prospective Study, Linda Sangalli, Fabio Savoldi, Domenico Dalessandri, Stefano Bonetti, Min Gu, Alberto Signoroni, Corrado Paganelli

Oral Health Science Graduate Research

BACKGROUND: Remote digital monitoring during orthodontic treatment can help patients in improving their oral hygiene performance and reducing the number of appointments due to emergency reasons, especially in time of COVID-19 pandemic where non-urgent appointments might be discouraged.

METHODS: Thirty patients scheduled to start an orthodontic treatment were divided into two groups of fifteen. Compared to controls, study group patients were provided with scan box and cheek retractor (Dental Monitoring®) and were instructed to take monthly intra-oral scans. Plaque Index (PI), Gingival Index (GI), and White Spot Lesions (WSL) were recorded for both groups at baseline (t₀), every …

Analysis Of Pretreatment Factors Associated With Stability In Early Class Iii Treatment, Yasuko Inoue, Toru Deguchi, James K. Hartsfield Jr., Wakako Tome, Noriyuki Kitai

Oral Health Science Faculty Publications

BACKGROUND: The purpose of this study was to identify pretreatment factors associated with the stability of early class III treatment, since most orthodontists start the treatment with their uncertain hypotheses and/or predictions. Subjects consisted of 75 patients with a class III skeletal relationship (ANB < 2° and overjet < 0 mm) who had been consecutively treated with rapid maxillary expansion and facemask and followed until their second phase treatment. The patients were divided into two groups according to whether they showed relapse in follow-up. The stable group maintained their positive overjet (n = 55), and the unstable group experienced relapse with a zero or negative overjet (n = 20). Two general, three dental, and 13 cephalometric pretreatment factors were investigated to determine which factors were associated with stability.

RESULTS: Sex, pretreatment age, and anteroposterior functional shift, which were hypothesized as associated factors, were not related to …

Reprogramming Oral Epithelial Keratinocytes Into A Pluripotent Phenotype For Tissue Regeneration, Fayrouz Bazina, Sabine M. Brouxhon, Stephanos Kyrkanides

Center for Oral Health Research Faculty Publications

OBJECTIVES: We set out to reprogram adult somatic oral epithelial keratinocytes into pluripotent cells for regenerative dentistry.

SETTING AND SAMPLE POPULATION: Immortalized murine oral keratinocyte cell (IMOK) line raised from adult mouse mucosa were cultured in vitro in our studies.

MATERIALS AND METHODS: Adult murine oral epithelial keratinocytes were chronically treated with TGF-β1 in vitro, and the expression of Oct4, Nanog, Sox2 and Nestin, as well as specific homeobox Gata and Pax gene family members were investigated.

RESULTS: We documented the induction of stem factors linked with pluripotency and/or the maintenance and regulation of stem-cell self-renewal in oral epithelial keratinocytes …

The Moth-Eaten Mandible: Osteomyelitis, Galal Omami

Oral Health Practice Faculty Publications

Inflammatory lesions such as osteomyelitis of the jaw may share some of the radiographic features of malignancy; however, a demonstrable dental cause for it usually exists. In addition, inflammatory lesions generally stimulate a sclerotic bone reaction, which is uncommon in malignancy. The imaging modality of choice for aiding in the differential diagnosis is computed tomography imaging because of its ability to clearly delineate sequestra and periosteal new bone formation.

Transcriptomic Phases Of Periodontitis Lesions Using The Nonhuman Primate Model, Jeffrey L. Ebersole, Radhakrishnan Nagarajan, Sreenatha S. Kirakodu, Octavio A. Gonzalez

Center for Oral Health Research Faculty Publications

We used a nonhuman primate model of ligature-induced periodontitis to identify patterns of gingival transcriptomic after changes demarcating phases of periodontitis lesions (initiation, progression, resolution). A total of 18 adult Macaca mulatta (12–22 years) had ligatures placed (premolar, 1st molar teeth) in all 4 quadrants. Gingival tissue samples were obtained (baseline, 2 weeks, 1 and 3 months during periodontitis and at 5 months resolution). Gene expression was analyzed by microarray [Rhesus Gene 1.0 ST Array (Affymetrix)]. Compared to baseline, a large array of genes were significantly altered at initiation (n = 6049), early progression (n = 4893), and late progression …

Variations In Schedule Iii Prescription Patterns In A Medicaid Population Pre- And Post-Policy, Radhakrishnan Nagarajan, Jeffery C. Talbert, Craig S. Miller, Jeffrey Ebersole

Pharmacy Practice and Science Faculty Publications

The present study investigated variations in patient movement patterns between prescribers before and after House Bill 1 (HB1) implementation in Kentucky using network abstractions (PPN: prescriber-prescriber networks) from a one-month cross-sectional Schedule III prescription data in a Medicaid population. Network characteristics such as degree centrality distribution of PPN was positively skewed and revealed Dental Practitioners to be the highly connected specialty with opioid analgesic hydrocodone-acetaminophen to be the most commonly prescribed drug. Taxonomy enrichment of the prescriber specialties in PPN using chi-square test revealed a reduction in the enriched taxonomies Post-HB1 compared to Pre-HB1 with Dental practitioners being constitutively enriched …

Magnetic Resonance And Ct Imaging Biomarkers For Prediction Of Acute And Chronic Radiation-Induced Xerostomia, Anastasia Katsavochristou, Dimitrios Koumoulis

Oral Health Practice Faculty Publications

Xerostomia is a common adverse effect of radiation therapy at the head and neck area. Radiation-induced xerostomia can be severe and detrimental for the quality of life. Clinicians and radiologists have focused on the prevention of xerostomia as feasible, which has been significantly improved in the recent decades with the use of the contemporary radiation technology. However, radiation-induced xerostomia still remains one of the most devastating side effects of radiation therapy. Clinical risk factors have been identified, but the variation of its incidence and presentation has turned the focus on the investigation of parameters that would be able to predict …

Biofilm And Cell Adhesion Strength On Dental Implant Surfaces Via The Laser Spallation Technique, James D. Boyd, Arnold J. Stromberg, Craig S. Miller, Martha E. Grady

Statistics Faculty Publications

OBJECTIVE: The aims of this study are to quantify the adhesion strength differential between an oral bacterial biofilm and an osteoblast-like cell monolayer to a dental implant-simulant surface and develop a metric that quantifies the biocompatible effect of implant surfaces on bacterial and cell adhesion.

METHODS: High-amplitude short-duration stress waves generated by laser pulse absorption are used to spall bacteria and cells from titanium substrates. By carefully controlling laser fluence and calibration of laser fluence with applied stress, the adhesion difference between Streptococcus mutans biofilms and MG 63 osteoblast-like cell monolayers on smooth and rough titanium substrates is obtained. The …

S. Gordonii-Produced Hydrogen Peroxide Modulates Mir-663a And Ccl20 Expression In Oral Epithelial Cells, Marshall Houston Maynard

Theses and Dissertations--Medical Sciences

The mechanisms through which a persistent recognition of commensal bacteria by oral epithelial cells (OECs) mitigates an uncontrolled inflammatory response of the oral mucosa remain unknown. CCL20 secretion by OECs in response to pathogenic bacteria is regulated by S. gordonii (Sg)-induced miR-663a; nevertheless, the mechanisms involved in these Sg-modulated responses remain to be elucidated. Since Sg is a hydrogen peroxide (H₂O₂) producer, and H₂O₂ has been shown to stimulate miRNA expression, we hypothesized that H₂O₂ could be involved in Sg-induced miR663a and CCL20 responses. Expression of miR663a …

Comparison Of Implant-Retained Overdenture And Conventional Complete Denture In The Edentulous Mandible: A Survey Study To Measure Patients' Satisfaction And Quality Of Life In Dental School Clinical Environment, Ahmad Kutkut

Theses and Dissertations--Clinical and Translational Science

Patient satisfaction and quality of life are integral parts of assessing the quality of oral health care. Current aging population trends suggest a growing need to understand the effects of edentulism on oral health and quality of life. As the proportion of aged Americans expands, there will be an increased need to understand treatment options and patient communication strategies. In addition, as new treatment options and innovative technologies emerge, it will be essential to understand patients' concerns and identify best practices associated with denture treatments' individual fit and function. Advanced denture treatments can now be fabricated using CAD/CAM digital denture …

Oral Microbiome And Gingival Tissue Apoptosis And Autophagy Transcriptomics, Jeffrey L. Ebersole, Sreenatha S. Kirakodu, Elliot Neumann, Luis Orraca, Janis Gonzalez Martinez, Octavio A. Gonzalez

Center for Oral Health Research Faculty Publications

Objective: This study focused on documenting characteristics of the gingival transcriptome during various stages of periodontitis targeting genes associated with apoptotic and autophagic pathways and changes that specifically associate with features of the oral microbiome.

Methods: Macaca mulatta (n = 18; 12–23 years) were examined at baseline and 0.5, 1, and 3 months of disease progression, as well as 5 months with clinical disease resolution. 16S sequencing and microarray analyses examined changes in the microbiome and gingival transcriptome, respectively, at each time point from every animal.

Results: Specific patterns of apoptotic and autophagic genes were identified related to the …

Multilocular Radiolucency Of The Mandibular Ramus And Body, Galal Omami

Oral Health Practice Faculty Publications

No abstract provided.

Multicentric Synchronous Giant Cell Granulomas Of The Mandible, Galal Omami

Oral Health Practice Faculty Publications

No abstract provided.