Regeneration of mineralized and soft connective tissue components of the attachment apparatus is the main goal in the treatment of periodontal diseases. Often, apical migration of epithelium (long junctional epithelium) effectively prevents the formation of bone and connective tissue attachment after periodontal surgery. The purpose of the present study was to compare conventional periodontal surgery combined with carbon dioxide laser and conventional periodontal surgery alone with respect to epithelial elimination and degree of necrosis of mucoperiosteal flaps. After signing a consent form, five patients with at least two comparable bilateral periodontal defects needing pocket elimination surgery participated in this study. The investigators randomly divided each side into test and control sites. Each patient received oral hygiene instruction and initial therapy prior to surgery. At surgery, the test site received a sulcular incision and carbon dioxide laser de-epithelialization of the outer and inner aspects of the flap. The control group received reverse bevel incision only. The surgeon performed open flap debridement on all teeth. At the time of surgery, the surgeon did a biopsy of each site and submitted specimens for histologic evaluation. A matched pairs t-test was used to analyze the data. The results show significant differences between the carbon dioxide laser and reverse bevel incision with respect to sulcular (P < or = 0.025) and gingival (external) (P < or = 0.01) flap surface epithelial elimination and tissue necrosis (P < or = 0.005). These results should be replicated with a larger number of subjects. The carbon dioxide laser eliminated sulcular and gingival (external) epithelium without disturbing underlying connective tissue. This finding supports the concept that the carbon dioxide wavelength has little or no effect on tissues beyond the target. However, neither laser nor blade eliminated all the epithelium. Researchers observed chronic inflammation in the control and test sites, with a predominance of plasma cells. Lining the sulcular and gingival (external) lased areas, investigators found coagulation necrosis covered by fibrin and coagulated blood. The laser appears to effectively remove epithelium at the time of surgery; however, future long-term, well-controlled quantitative histologic studies are needed to evaluate the effect of repeated carbon dioxide laser de-epithelialization of the gingival (external) surface of mucoperiosteal flaps at intervals during the healing period.
The purpose of this study was to determine if instruction in how to perform the MDS (Minimum Data Set) oral health assessment and RAP (Resident Assessment Protocol) Summary required by federal regulations will improve nurses' accuracy of the assessments. Fifty residents, admitted within 90 days before a training lecture, were assessed by 18 nurses. A 30-minute training session demonstrated how to perform an oral examination, including hands-on practice under a dentist's supervision. Seven to ten days after the lecture, the nurses re-examined the same residents. These assessments were compared with the admission assessments and a dentist's findings (reference). The results of this study indicate that a 30-minute training session made a significant difference in improving nurses' accuracy in completing the assessments with regard to oral health status and treatment need.
The purpose of this study was to determine the effect of nurses' background on their accuracy in determining oral health status and treatment need of newly admitted nursing home residents before and after tutoring. Eighteen nurses examined 50 nursing home residents before and after an In-service training lecture. Examinations performed by a dentist served as reference. Background items evaluated were: regularity of each nurse's own dental visits; years since graduation from nursing school; length of experience in an LTC facility; and training received in oral health care. At the second evaluation, nurses greatly improved the % agreement on all items. The results of this study indicate that, regardless of background characteristics, the combination of training, the presence of the dentist, and knowledge that they were in a study appeared to improve nurses' performance on the assessment. Before training, more experienced nurses were better able to determine hard tissue abnormalities than their less experienced counterparts; before training, neither group performed well in assessing soft tissue lesions. Therefore, improvements in basic nursing training in this area appear to be necessary.
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