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Biomedical subjects

K G Palcanis

Publications and source records attributed to K G Palcanis.

At least 19 recordsLinked to original sources

Efficacy of meclofenamate sodium (Meclomen) in the treatment of rapidly progressive periodontitis.

This 6-month, double-blind, controlled clinical trial determined the efficacy of the non-steroidal anti-inflammatory drug, meclofenamate sodium (Meclomen), as an adjunct to scaling and root planing in the treatment of rapidly progressive periodontitis (RPP). 22 subjects (7 male, 15 female) aged 36.5 +/- 7.88 years with RPP and disease-active sites as determined by pretreatment bone scan had standardized radiographs at baseline and 6 months, and clinical measurements at baseline, 3 and 6 months. Following full-mouth scaling and root planing, subjects were randomly assigned to either a placebo, 50 or 100 mg meclofenamate sodium bid group. Bone change over the 6-month period as assessed by subtraction radiography was the primary efficacy determinant. Specialized software was used to isolate the lesion from the subtraction image and to measure bone change along the root surface. ANOVA using the subject as the unit of analysis revealed a significant dose response (p < 0.001) with the placebo group having a mean bone loss of 0.42 +/- 0.06 mm and the low and high dose groups having mean bone gains of 0.07 +/- 0.05 and 0.20 +/- 0.07 mm, respectively. These findings indicate that meclofenamate sodium may be a useful adjunct in the treatment of rapidly progressive periodontitis.

Adolescent

Elastase as an indicator of periodontal disease progression.

THIS STUDY SOUGHT TO EVALUATE the ability of gingival crevicular fluid (GCF) elastase to predict attachment and bone loss in human periodontitis. Thirty subjects who were medically healthy and had a history of progressive periodontitis were studied with an automated probe. Five sites in each patient were monitored bi-monthly for a 6-month period for attachment loss. Subtraction radiography was utilized at the beginning and end of the study to monitor bone loss. GCF elastase was measured at 0 month and then bi-monthly by collecting GCF on paper strips impregnated with PMN leukocyte elastase substrate inserted into the gingival crevice for 15 seconds. After 8 minutes of reaction time, the strips were scored relative to fluorescent standards in an ultraviolet view box. Strips were then eluted in methanol and total elastase measured by spectrofluorometry. Total elastase was significantly higher in sites demonstrating progressive attachment loss than in inactive sites (2.81 +/- .29 versus 2.03 +/- .07, P less than 0.0005) and sites demonstrating bone loss (2.32 +/- .17 versus 2.01 +/- .08 P less than 0.05). When considering the joint presence of bone loss and attachment loss of 1.0 mm or greater in the 6-month period following a visual elastase kit score of 2 or greater, the test kit shows a sensitivity and specificity of 82% and 66%, respectively. This study demonstrated that GCF elastase levels are significantly higher in sites demonstrating progressive periodontal attachment and bone loss assessed 6 months later and may serve as a predictor of future bone and attachment loss.

Adult

The use of repeated measures analysis of variance for plaque and gingival indices.

Clinical trials for anti-gingivitis and anti-plaque agents commonly use the mean of Silness and Löe plaque indices and Löe and Silness gingival indices as response variables. The aim of this report is to determine if data from anti-plaque and anti-gingivitis clinical trials using Silness and Löe plaque indices and Löe and Silness gingival indices satisfy conditions necessary for the use of the univariate or multivariate approach to repeated measures. These conditions are multivariate normality, homogeneity of variance-covariance matrices, and for the univariate approach, a type-H variance-covariance matrix. Data from 5 separate clinical trials representing a wide range in sample size, pretreatment mean gingival and plaque indices and treatment effects were used to test these conditions. Either the univariate or multivariate approach to repeated measures was found to be appropriate for both responses of the 5 clinical trials. Thus, means of Silness & Löe and Löe and Silness gingival indices meet the necessary conditions for use of either the univariate and/or multivariate approach to repeated measures. However, significant time-treatment interactions are a common occurrence in these types of clinical trials and must be evaluated carefully. The analyses in this study were carried out using SAS. Other mainframe statistical software packages and many micro-computer statistical software packages have routines to analyze repeated measures experiments with analysis of variance methods. However, some of the packages may omit the multivariate approach to repeated measures or may not include interactions between within-subject and between-subject effects. These packages should be used with caution.

Alkaloids

Rapidly progressive periodontitis. Report of a case.

A nineteen year old white female was referred for an evaluation of severe, rapidly progressive periodontitis. Although the patient was physically healthy and did not demonstrate any remarkable abnormalities in routine laboratory tests or upon physical examination, a detailed immune profile elucidated abnormal findings. Additionally, the patient demonstrated a poor healing response after tooth removal and a continued loss of bone following insertion of dentures.

Adult

A longitudinal evaluation of varying widths of attached gingiva.

32 patients with bilateral areas of inadequate attached gingiva on the facial surface of homologous contralateral teeth have been followed for 6 years. Treatment consisted of scaling, root planing, oral hygiene and maintenance at 3- to 6-month intervals or as needed to control inflammation. A free gingival graft was placed on one side (experimental), while the other side served as the unoperated control. Areas of inadequate attached gingiva on control sides, to include those with recession and no attached gingiva, did not demonstrate additional recession or further loss of attachment. Gingival inflammation and plaque were significantly reduced. On experimental sides, the dimension of keratinized and attached gingiva increased and was stable over 6 years. Areas which began with recession and no attached gingiva exhibited a reduction in recession and gain in clinical attachment following the placement of a gingival graft. Examination of patients who had discontinued participation in the study for a period of 5 years revealed a re-establishment of gingival inflammation on the control sides associated with additional recession. Similar changes were not observed in areas treated by a free graft. The findings demonstrate that it is possible to maintain periodontal health and attachment through control of gingival inflammation despite the absence of attached gingiva.

Dental Scaling

Serum antibody reactive with predominant organisms in the subgingival flora of young adults with generalized severe periodontitis.

In the present study we sought to determine whether serum antibody was present against microorganisms which predominate in the subgingival flora of young adults with generalized severe periodontitis (SP). Subjects with SP were often seropositive for Eubacterium brachy, Fusobacterium nucleatum E3C22, and Peptostreptococcus micros, whereas subjects with juvenile periodontitis (JP) and subjects with healthy periodontium (HP) were not. Both SP and JP subjects were more frequently seropositive for Bacteroides gingivalis, F. nucleatum D52B16, and F. nucleatum E1D1 than were HP subjects. The data were most striking for B. gingivalis, for which both the incidence and the magnitude of specific antibody was clearly elevated for SP and JP subject groups. However, SP subjects generally had either a high antibody titer or no detectable titer. In contrast, JP and HP subjects generally had at least very small amounts of antibody. Except at very low levels of antibody, neither SP nor JP groups differed significantly from the HP group for antibody to Eubacterium nodatum, Bacteroides intermedius (homology group 4197 or 8944), or Lactobacillus minutus antibody. There was a high frequency of antibody to E. nodatum, with very high titers in all groups despite the fact that this organism is rarely found in HP subjects. For Eubacterium timidum, the JP group was clearly more frequently seropositive than the HP group. Despite high levels of L. minutus in subgingival flora, none of the 50 SP subjects had a detectable antibody titer, and only four of the HP and JP subjects had detectable antibody. These results indicate that many organisms in the subgingival flora elicit antibody responses. B. gingivalis is probably the best example among the species tested. However, some organisms that are present in high concentration, e.g., L. minutus, apparently fail to induce significant antibody responses.

Adolescent

Comparative bacteriology of juvenile periodontitis.

Statistical comparisons of the floras associated with juvenile periodontitis, severe periodontitis, and moderate periodontitis indicated that differences in the bacterial compositions of affected sites in these populations were not statistically significant. The subgingival flora of affected juvenile periodontitis sites was statistically significantly different from the adjacent supragingival flora and from the subgingival floras of people with healthy gingiva and of children with developing (experimental) gingivitis. However, the subgingival flora of affected juvenile periodontitis sites was not significantly different from the flora of sites with gingival index scores of 1 or 2 in adults with developing (experimental) gingivitis. Of 357 bacterial taxa among over 18,000 isolates, 54 non-treponemal species, 2 treponemal species, and mycoplasma were most associated with diseased periodontal sulci. These species comprised an increasing proportion of the flora during developing gingivitis and constituted over half of the cultivable flora of diseased sites.

Actinobacillus

A clinical trial of phenoxymethyl penicillin for adjunctive treatment of juvenile periodontitis.

A double-blind clinical trial of oral penicillin as an adjunct to conventional treatment of localized juvenile periodontitis (JP) was conducted. Sixteen subjects with JP were paired on the basis of general similarity of disease, and within each pair the persons were assigned randomly, one to a placebo group and one to a penicillin group. Neither patients nor therapist/examiner were aware of whether placebo or penicillin was being taken. All subjects received an initial scaling and root planing of all teeth and flap surgery of all affected sites. Every 12 weeks after surgery through Week 62 of the study, root planing and oral hygiene instructions were repeated. Phenoxymethyl penicillin (250 mg qid) or placebo was started the day of surgery and each recall visit and lasted for 10 days. Clinical measurements were made at the beginning of the study and at each recall visit. In both groups there was a significant decrease in plaque scores, gingival inflammation, gingival bleeding and probeable depths for all sites and for affected sites. Similarly there was a significant increase in attachment level and radiographic bone height, and a total elimination of suppuration. The favorable changes were apparent at the first postsurgical recall (Week 26 of the study) and remained essentially the same through Week 62. The magnitude of change in these parameters was similar to that reported by others for treatment regimes including tetracycline therapy. However, there were no differences in any parameters between the placebo and penicillin groups. Half of the subjects (4 in each group) were continued in the study for another 9 months (Week 98).(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent

Localized juvenile periodontitis and generalized severe periodontitis: clinical findings.

Medically healthy subjects (N = 103), 10-32 years of age, with localized (juvenile periodontitis = JP) or generalized (severe periodontitis = SP) advanced periodontal disease were analyzed for interrelationships of sex, race, age and clinical findings. Females predominated (2:1) in both JP and SP. There were significantly more subjects of the black race in JP, but when age was included as a cofactor the race distinction became insignificant. While whole mouth Plaque and Gingival Indices were lower in JP, these values at sites with attachment loss were equally high in both groups. Extent of disease was significantly related to both plaque and age in SP, and to plaque but not to age in JP. This suggests the existence of a factor(s) in JP which interfere(s) with the age-plaque-disease relationships found in SP and present in adult periodontitis. Contrary to implications of some definitions of JP, periodontal attachment loss was strongly associated with plaque and gingival inflammation in both localized and generalized patterns of disease.

Adolescent

Bacteriology of experimental gingivitis in children.

Children are more resistant to gingivitis than are adults. To determine possible differences in their periodontal floras, an experimental gingivitis study, identical in design to one reported earlier with young adults, was conducted with four 4- to 6-year-old children. The incidence of sites that developed gingival index scores of 2 in children was less than one-third of the incidence observed in adults. The composition of the flora of each child was statistically significantly different from that of any other child or adult. The floras of the children as a group were statistically significantly different from those of the adults. Children had 3-fold greater proportions of Leptotrichia species, 2.5-fold greater proportions of Capnocytophaga species, 2.3-fold greater proportions of Selenomonas species, 2-fold greater proportions of bacterial species that require formate and fumarate, and 1.5-fold greater proportions of Bacteroides species. Adults had greater proportions of Fusobacterium, Eubacterium, and Lactobacillus species. Fusobacterium nucleatum, Actinomyces WVa 963, Selenomonas D04, and Treponema socranskii were predominant species that correlated with increasing gingival index scores in both children and adults.

Age Factors

Variation in periodontal floras.

Statistical analyses indicated (i) that the floras of individual samples taken from the depth of sulci with nickel-plated Morse 00 scalers were highly reproducible and representative of the flora present at any given time, (ii) that the different compositions of floras of different people with similar clinical signs were statistically highly significant, and (iii) that floras of different affected sites may differ significantly in some (two of three) people at any one time or may differ from week to week in other people (one of three). Thus the flora composition of individual sites appears to be in dynamic flux, probably in response either to environmental changes or to host responses. There was no evidence that double sampling per se (two single passes with 00 scalers) changed the composition of the flora. Repeat samples taken after 1 week were slightly more similar to the initial samples than were samples taken after 3 weeks.

Humans

Role of monocytes in polyclonal immunoglobulin production stimulated by sonicates of periodontally associated bacteria.

These studies were initiated to investigate monocyte regulation of polyclonal antibody responses of human peripheral blood lymphocytes stimulated by sonicates of periodontally associated bacteria. With pokeweed mitogen (PWM) as a positive reference, the role of monocytes in the peripheral blood lymphocyte response to Streptococcus sanguis and Wolinella HVS was examined by manipulating the number of monocytes and lymphocytes in culture. In comparison to PWM, optimal responses to the bacterial sonicates required very few monocytes (0.3% of the total cultured cells). Restoration of monocytes to physiological levels resulted in suppression of the response. PWM-stimulated responses were optimal at 5 to 15% monocyte content and were abolished after monocyte depletion. Individuals who were low responders or nonresponders to bacterial sonicates responded at normal levels after manipulation of monocyte concentration. Nonresponders produced normal levels of antibody when the monocyte concentration was reduced to 0.3% but were inhibited after monocyte reconstitution. The effects of monocyte concentration were tested over a wide dose range of bacterial sonicate and found to conform to the observed pattern throughout the dose range tested (10 to 1,000 micrograms/ml). The contrasting monocyte requirement of peripheral blood lymphocytes stimulated with PWM versus bacterial sonicates may reflect a quantitative difference in optimal macrophage concentration or may be due to a qualitative difference in lymphocyte-monocyte interactions in response to these activators.

Adult

Bacteriology of experimental gingivitis in young adult humans.

From replicate trials of experimental gingivitis in four periodontally healthy subjects, 166 bacterial species and subspecies were detected among 3,034 randomly selected isolates from 96 samples. Of these bacteria, Actinomyces naeslundii (serotype III and phenotypically similar strains that were unreactive with available antisera), Actinomyces odontolyticus (serotype I and phenotypically similar strains that were unreactive with available antisera), Fusobacterium nucleatum, Lactobacillus species D-2, Streptococcus anginosus, Veillonella parvula, and Treponema species A appeared to be the most likely etiological agents of gingivitis. Statistical interpretations indicated that the greatest source of microbiological variation of the total flora observed was person-to-person differences in the floras. The next greatest source of variation was the inflammatory status of the sample sites. Person-to-person differences were smallest at experimental day 4. The floras became more diverse with time and as gingivitis developed and progressed. Analyses indicated that sequential colonization by certain species was repeatable and therefore probably predictable. Variation was relatively small between replicate trials, between two sites on the same teeth sampled on the same day, and between the same sites sampled at the same relative time in a replicate trial.

Actinomyces