Department of Periodontology Works

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Assessing Effectiveness of an Audiovisual Educational Tool for Improving Dental Students' Probing Depth Consistency
(Wiley, 2019-04) Prabhu, Srividya; John, Vanchit; Blanchard, Steven; Eckert, George J.; Hamada, Yusuke; Periodontology, School of Dentistry
Dental students often underestimate their probing depth (PD) measurements, which emphasizes the need for effective and novel methods for teaching proper probing technique. The aim of this study was to evaluate the efficacy of audiovisual learning aids, recorded from the point of view of examiners, for improvement in PD agreement in dental students. In 2017‐18, 22 third‐year dental students were randomized into test and control groups. Each student and a single blinded faculty examiner performed PD measurements on a minimum of three patients. The test group viewed a video demonstrating proper probing technique, while the control group received only probing technique instruction from prior lectures. All measurements, the periodontal diagnoses, and the total time taken to complete PD measurements were recorded. A survey of student attitudes about the audiovisual tool was conducted after the intervention; all 22 students completed the survey. A total of 11,426 PD sites were measured. The test group had 10% greater accuracy in PD sites=4 mm. The control group had a minor but statistically significant increase in accuracy for 2 mm PD sites. For all incorrect measurements at sites PD≥4, the students tended to underestimate the PD. Tooth type, site location around tooth, and diagnosis had no significant effect on PD measurement agreement. No significant difference between groups was found for the proportions of gingivitis and periodontitis patients or for examination time. This study found that use of the audiovisual learning aid “Calibrated Periodontal Training Video” improved the students' probing depth accuracy for sites with PD of 4 mm.
Assessing readiness to manage medical emergencies among dental students at four dental schools
(Wiley, 2021-09) Solanki, Charmi; Geisinger, Maria L.; Luepke, Paul G.; Al-Bitar, Kinan; Palomo, Leena; Lee, Wangsoo; Blanchard, Steven; Shin, Daniel; Maupome, Gerardo; Eckert, George J.; John, Vanchit; Periodontology, School of Dentistry
Background and Purpose Dentists treat a wide range of patients, including patients with compromised health conditions. While rendering treatment, various medical emergencies can and do occur. To help increase the knowledge required to manage such emergencies, dental students must be trained while in dental school. This study aims to assess the level of medical emergency preparedness and knowledge among dental students at four dental schools. Material and Methods The participating dental schools were IUSD, Case Western Reserve University School of Dentistry, Marquette University School of Dentistry, and the University of Alabama School of Dentistry. Groups were designed to include 20 dental students from Years 1 to 4. Students were asked to fill out a survey and were then tested on 10 clinical medical emergency scenarios. Results A total of 331 dental students participated in the study. The scores based on 10 case scenarios presented with a range of 4.35–8.02. There was no statistically significant difference in the level of preparedness when dental schools were compared. However, Year 1 and Year 2 dental students had significantly lower total scores than those of Years 3 and 4. The students in Years 1 and 2 demonstrated less confidence in their current knowledge to manage medical emergencies. Satisfaction with the training received ranged from 38% to 84%. Conclusion The results from this study indicate that students’ preparedness to manage medical emergencies at these four dental schools is statistically similar. Additional yearly training could enhance students’ preparedness in the management of medical emergencies in the dental setting.
Assessment of the Calibration of Periodontal Diagnosis and Treatment Planning Among Dental Students at Three Dental Schools
(American Dental Education Association, 2015-01) Lane, Brittany A.; Luepke, Paul; Chaves, Eros; Maupome, Gerardo; Eckert, George J.; Blanchard, Steven; John, Vanchit; Department of Periodontics and Allied Dental Programs, IU School of Dentistry
Calibration in diagnosis and treatment planning is difficult to achieve due to variations that exist in clinical interpretation. To determine if dental faculty members are consistent in teaching how to diagnose and treat periodontal disease, variations among dental students can be evaluated. A previous study reported high variability in diagnoses and treatment plans of periodontal cases at Indiana University School of Dentistry. This study aimed to build on that one by extending the research to two additional schools: Marquette University School of Dentistry and West Virginia University School of Dentistry. Diagnosis and treatment planning by 40 third- and fourth-year dental students were assessed at each of the schools. Students were asked to select the diagnosis and treatment plans on a questionnaire pertaining to 11 cases. Their responses were compared using chi-square tests, and multirater kappa statistics were used to assess agreement between classes and between schools. Logistic regression models were used to evaluate the effects of school, class year, prior experience, and GPA/class rank on correct responses. One case had a statistically significant difference in responses between third- and fourth-year dental students. Kappas for school agreement and class agreement were low. The students from Indiana University had higher diagnosis and treatment agreements than the Marquette University students, and the Marquette students fared better than the West Virginia University students. This study can help restructure future periodontal courses for a better understanding of periodontal diagnosis and treatment planning.
Association between intracranial carotid artery calcifications and periodontitis: A cone-beam computed tomography study
(AAP, 2021-10) AlSakr, Abdulaziz; Blanchard, Steven; Wong, Phillip; Thyvalikakath, Thankam; Hamada, Yusuke; Periodontology, School of Dentistry
Background Intracranial carotid artery calcifications (ICACs) are one type of calcification that may be detected as incidental findings in cone-beam computed tomography (CBCT). This retrospective study aimed to examine the prevalence of ICACs on CBCT images and their associations among age, gender, chronic periodontitis, and patient-reported cardiovascular diseases (CVDs). Methods A total of 303 CBCT scans were reviewed and a total of 208 patients met the inclusion criteria. The presence or absence of ICACs was evaluated in the ophthalmic and cavernous segments of each scan. Patient demographic data, including age, gender, and medical history, specifically focused on CVDs were recorded. The presence or absence of periodontitis was recorded from each subject with full mouth radiographs and clinical measurements. Odds ratios (ORs) were calculated as part of the logistic regression analysis. Results Overall, ICACs were found in 93 subjects (45%). The bilateral ICACs were found in 43 subjects (21% of the total subjects, 46% of the subjects with ICACs). There were statistically significant associations between presence of ICACs and periodontitis (OR = 4.55), hypertension (OR = 3.02), hyperlipidemia (OR = 2.87), increasing age (OR = 2.24), and the male gender (OR = 1.85). Smoking status was not significantly correlated with ICACs. Conclusion This study revealed that nearly half (45%) of the subjects displayed ICACs on the CBCT images. ICACs are significantly related to the status of chronic periodontitis, age, gender, and CVDs. A more careful review of CBCT scans is highly recommended to detect these calcifications and refer patients for further medical evaluation.
Differential profiles of soluble and cellular toll like receptor (TLR)-2 and 4 in chronic periodontitis
(PLOS, 2018-12-20) AlQallaf, Hawra; Hamada, Yusuke; Blanchard, Steven; Shin, Daniel; Gregory, Richard; Srinivasan, Mythily; Periodontology, School of Dentistry
Chronic periodontitis is a common inflammatory disease initiated by a complex microbial biofilm and mediated by the host response causing destruction of the supporting tissues of the teeth. Host recognition of pathogens is mediated by toll-like receptors (TLRs) that bind conserved molecular patterns shared by large groups of microorganisms. The oral epithelial cells respond to most periodontopathic bacteria via TLR-2 and TLR-4. In addition to the membrane-associated receptors, soluble forms of TLR-2 (sTLR-2) and TLR-4 (sTLR-4) have been identified and are thought to play a regulatory role by binding microbial ligands. sTLR-2 has been shown to arise from ectodomain shedding of the extracellular domain of the membrane receptor and sTLR-4 is thought to be an alternate spliced form. Many studies have previously reported the presence of elevated numbers of viable exfoliated epithelial cells in the saliva of patients with chronic periodontitis. The objective of this study was to investigate the potential value of salivary sTLR-2 and sTLR-4 together with the paired epithelial cell-associated TLR-2/4 mRNA as diagnostic markers for chronic periodontitis. Unstimulated whole saliva was collected after obtaining informed consent from 40 individuals with either periodontitis or gingivitis. The sTLR-2 and sTLR4 in saliva was measured by enzyme-linked immunosorbent assay. The TLR-2 and TLR-4 transcript in the epithelial cells in saliva was measured by real time polymerase chain reaction. While levels of sTLR-2 exhibited an inverse correlation, sTLR-4 positively correlated with clinical parameters in the gingivitis cohort. Interestingly, both correlations were lost in the periodontitis cohort indicating a dysregulated host response. On the other hand, while the sTLR-2 and the paired epithelial cell associated TLR-2 mRNA exhibited a direct correlation (r2 = 0.62), that of sTLR4 and TLR-4 mRNA exhibited an inverse correlation (r2 = 0.53) in the periodontitis cohort. Collectively, assessments of salivary sTLR2 and sTLR4 together with the respective transcripts in the epithelial cells could provide clinically relevant markers of disease progression from gingivitis to periodontitis.
Differential profiles of soluble and cellular toll like receptor (TLR)-2 and 4 in chronic periodontitis
(PLOS, 2018-12-20) AlQallaf, Hawra; Hamada, Yusuke; Blanchard, Steven; Shin, Daniel; Gregory, Richard; Srinivasan, Mythily; Periodontology, School of Dentistry
Chronic periodontitis is a common inflammatory disease initiated by a complex microbial biofilm and mediated by the host response causing destruction of the supporting tissues of the teeth. Host recognition of pathogens is mediated by toll-like receptors (TLRs) that bind conserved molecular patterns shared by large groups of microorganisms. The oral epithelial cells respond to most periodontopathic bacteria via TLR-2 and TLR-4. In addition to the membrane-associated receptors, soluble forms of TLR-2 (sTLR-2) and TLR-4 (sTLR-4) have been identified and are thought to play a regulatory role by binding microbial ligands. sTLR-2 has been shown to arise from ectodomain shedding of the extracellular domain of the membrane receptor and sTLR-4 is thought to be an alternate spliced form. Many studies have previously reported the presence of elevated numbers of viable exfoliated epithelial cells in the saliva of patients with chronic periodontitis. The objective of this study was to investigate the potential value of salivary sTLR-2 and sTLR-4 together with the paired epithelial cell-associated TLR-2/4 mRNA as diagnostic markers for chronic periodontitis. Unstimulated whole saliva was collected after obtaining informed consent from 40 individuals with either periodontitis or gingivitis. The sTLR-2 and sTLR4 in saliva was measured by enzyme-linked immunosorbent assay. The TLR-2 and TLR-4 transcript in the epithelial cells in saliva was measured by real time polymerase chain reaction. While levels of sTLR-2 exhibited an inverse correlation, sTLR-4 positively correlated with clinical parameters in the gingivitis cohort. Interestingly, both correlations were lost in the periodontitis cohort indicating a dysregulated host response. On the other hand, while the sTLR-2 and the paired epithelial cell associated TLR-2 mRNA exhibited a direct correlation (r2 = 0.62), that of sTLR4 and TLR-4 mRNA exhibited an inverse correlation (r2 = 0.53) in the periodontitis cohort. Collectively, assessments of salivary sTLR2 and sTLR4 together with the respective transcripts in the epithelial cells could provide clinically relevant markers of disease progression from gingivitis to periodontitis.
Periodontal diagnosis and treatment planning – An assessment of the understanding of the new classification system
(Wiley, 2022-12) Kakar, Arushi; Blanchard, Steven; Shin, Daniel; Maupomé, Gerardo; Eckert, George J.; John, Vanchit; Periodontology, School of Dentistry
Objectives Substantial variations are seen among clinicians in the diagnosis and treatment planning of periodontal diseases. Accurate diagnosis and treatment planning are fundamental requirements for effective outcome-based patient care. The aim of this study was to evaluate the understanding of the American Academy of Periodontology and the European Federation of Periodontology 2017 periodontal disease classifications in diagnoses and treatment plans across four study groups. Methods The study recruited at least 20 participants in each of the four study groups. These included 1) Periodontal faculty and residents at Indiana University School of Dentistry (IUSD-PF) 2) IUSD general practice faculty (IUSD-GPF), 3) private practice periodontists (PPP), and 4) general practitioners (GP). The participants were provided with 10 HIPPA de-identified case records and a link to a survey. The survey comprised five demographic questions and two questions on diagnosis and treatment plan for each case along with a fixed list of responses. The responses were then compared against gold standards that were determined by a group of three board-certified periodontists. Results Overall, for diagnostic questions, GP (69%) were correct significantly less often than IUSD-PF (86%, p < 0.001), IUSD-GPF (79%, p = 0.002), and PPP (80%, p = 0.001). No significant differences (p > 0.05) in the overall correct treatment plan responses were found among the four groups (IUSD-PF: 69%, IUSD-GPF: 62%, PPP: 68%, and GP: 60%). The multi-rater kappas for with-in-group agreement on overall diagnosis ranged from 0.36 (GP) to 0.55 (IUSD-PF) and on overall treatment plan ranged from 0.32 (IUSD-GPF) to 0.42 (IUSD-PF). Overall agreement for diagnosis and treatment plans among the four groups was relatively low and none of the groups were statistically different from each other (p > 0.05). Conclusion Regular participation in calibration sessions may lead to more accurate adoption of the 2017 periodontal classification and thereby help provide consistent diagnosis and treatment.
Verruciform xanthoma of the buccal gingiva: two cases with different clinical presentations
(Wiley, 2018) Marlow, Allison K.; Ramos, Elizabeth; Blanchard, Steven; Periodontics and Allied Dental Programs, School of Dentistry
Introduction: Verruciform xanthoma is an uncommon, benign, asymptomatic lesion commonly affecting the attached tissues in the oral cavity, especially the gingiva. Clinical presentation can be variable and requires biopsy to confirm the diagnosis. Case Series: Two cases of verruciform xanthoma in a 21‐year old male and a 46‐year old female are reported, emphasizing the need for thorough comprehensive analysis of all oral lesions. The clinical features, differential diagnoses, typical and atypical histological features and potential etiology are presented. Conclusions: Verruciform xanthoma should be considered in the differential diagnosis of solitary lesions in the oral cavity with a papillary, granular or verrucous surface texture, and confirmed with histopathological examination. Continued monitoring for recurrence at routine examination is necessary especially in sites where the lesion may not have been completely excised.

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