Patients will undergo up to five sessions of full-mouth removal of subgingival dental plaque by the use of scaling and root planning under local anesthesia. Any hopeless teeth will be extracted during this treatment period, which will be as short as possible, but will extend to no more than 4 weeks. In addition to standard scaling and root planning, the investigators seek to better suppress the oral biofilm by administering Arestin locally into the periodontal pockets ≥6 mm. All patients will be reexamined at 3, 6 and 9 months for safety checks. Patients will be given instructions in basic oral hygiene and treated for stroke risk factors in accordance to the current guidelines for secondary stroke prevention.

Patients will undergo supragingival mechanical scaling and polishing. They will be informed of the presence and severity of their periodontal disease and will be advised to be seen by their dentist if their condition requires immediate attention. If they have no dental provider they will be referred for care. All patients will be reexamined at 3, 6 and 9 months for safety checks. Among the group the periodontal condition will be monitored to assure there is no progression of disease. If any site demonstrates an increase in periodontal pockets >3mm, they will receive site-directed scaling and root planing. Patients will be given instructions in basic oral hygiene and treated for stroke risk factors in accordance to the current guidelines for secondary stroke prevention. At the completion of the study, the control treatment patients will be offered to receive the same dental care as provided to the intensive treatment group as needed.

Periodontal Disease

Stroke

Up to five sessions of full-mouth removal of subgingival dental plaque by the use of scaling and root planning under local anesthesia. Any hopeless teeth will be extracted during this treatment period, which will be as short as possible, but will extend to no more than 4 weeks. In addition to standard scaling and root planning, the investigators seek to better suppress the oral biofilm by administering Arestin locally into the periodontal pockets ≥6 mm.

Intensive dental treatment

Supragingival mechanical scaling and polishing.

Standard dental treatment

To better suppress the oral biofilm by administering Arestin locally into the periodontal pockets ≥6 mm.

Arestin

University of North Carolina at Chapel Hill

University of South Carolina School of Medicine Department of Neurology

PeRiodontal Treatment to Eliminate Minority InEquality and Rural Disparities in Stroke

Carotid IMT will be measured and analyzed on the mean IMT of the far wall for 1cm lengths of right and left carotid bifurcation and internal and common carotid arteries.

White matter disease will be assessed using MRI and the Montreal Cognitive Assessment (MOCA) will be administered to assess eight domains of cognitive function: attention and concentration, executive functions, memory, language, visuoconstructional skills, conceptual thinking, calculations, and orientation.

Souvik Sen

Professor and Chair, Department of Neurology

University of South Carolina

University of North Carolina, Chapel Hill

This group is randomized to continue their current medical management strategies for pain as recommended/prescribed by health care providers. Primary and secondary outcomes are collected at the same time intervals as the biopsychosocial intervention group.

This group continues all standard of care procedures for managing pain and adds to this additional cognitive-behavioral treatment (CBT) strategies for managing pain. The intervention explicitly frames the CBT strategies as added, complimentary pain management methods to add to the standard of care treatment.

Sickle Cell Disease

Participants complete a manualized, single session of training which includes: (A) education about the causes of sickle cell pain, (B) education about how the nervous system processes pain signals, and (C) explanations of how one can use cognitive and behavioral treatment (CBT) strategies to decrease the extent of pain experienced (all based on how the nervous system processes pain). Four specific CBT skills are taught and practiced by the participant (Progressive muscle relaxation, Controlled Deep Breathing, Imagery, and Distraction). The protocol explicitly emphasizes the use of CBT as a complimentary pain management tool to use in addition to the standard of care methods.

sabal palmetto/insult

PeRiodontal Treatment to Eliminate Minority InEquality and Rural Disparities in Stroke

Pain Management Protocol for Pediatric Sickle Cell Disease

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