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Serum and gingival tissue antibody levels to oral microbial antigens in human chronic adult periodontitis.

Antibody levels against antigens from eight oral micro-organisms were measured in sera and gingival tissue extracts from adult periodontitis patients and healthy subjects by an enzyme-linked immunosorbent assay. The antibody levels of diseased serum samples were significantly higher than those of healthy serum samples. Analysis of diseased sera indicated that antibody levels against Bacteriodes gingivalis antigens were significantly higher than antibody levels against all the other antigens tested except for those from B. intermedius and B. asaccharolyticus. Extracts from diseased gingival tissues had significantly higher levels of antibody against B. gingivalis antigens than against antigens from all of the other micro-organisms tested, including B. intermedius and B. asaccharolyticus. These results suggest selective, specific and localized antibody production during or following the establishment of chronic adult periodontitis.

Adult↗

Evaluation of an oral disease control program administered to a clinic population at a suburban dental school.

This study included 99 patients. Seventy-four of these participated in the Oral Disease Control program at Emory University School of Dentistry and 25 control patients did not. Those who completed the Oral Disease Control program were examined and scored from 2 to 24 months afterward. The Patient Hygiene Performance Scoring was used. It was found that there was no significant difference in levels of plaque between subjects who completed the Oral Disease Program and those who did not participate. Also, the patient's knowledge of the causes of dental caries and gingival disease bore no significant relationship to the amount of plaque present. Further, certain selected hygiene habits had no significant effect on plaque level. The patients studied were enthusiastic about the control program and developed an increased awareness of oral disease control. However, this study confirms others that demonstrate the need for repeated professional reinforcement in any effective oral disease control program.

Adolescent↗

Periodontal diagnosis: current status and future directions.

It is of concern to both public health agencies and health professionals to know whether the prevalence of periodontal diseases is increasing or decreasing in the world today. Unfortunately, the answer does not appear to be that simple. Clinical signs of inflammation are unable to reliably distinguish between non-destructive forms of periodontal disease (gingivitis) and destructive forms (periodontitis). Physical assessments of damage to periodontal tissues, such as radiographic detection of bone loss or clinical attachment loss determined with a periodontal probe, measure damage from past episodes of destructive disease. New directions are needed to help to better diagnose periodontal diseases and some of the future possibilities are described and discussed.

Alveolar Bone Loss↗

Risk factors in the development of cyclosporine-induced gingival overgrowth.

BACKGROUND: Severe gingival hyperplasia (GH) is one of the most frequent side-effects associated with the prescription of cyclosporine-A (CsA). Using the largest group of renal allograft recipients assembled for this purpose, in this study, we statistically modeled the genetic (HLA), medical, and dental risk factors for the development of GH subsequent to administration of CsA. METHODS: Two hundred thirty-six renal transplant patients underwent full dental examination to quantify the extent and distribution of hyperplasia and dental disease (gingivitis, plaque, and calculus). Computerized data from all patients included pre-transplant medical history and dosage of nifedipine and azathioprine, as well as dose and serum levels of CsA and CsA microemulsion. Donor and host HLA haplotype were studied to investigate potential association of haplotype and donor-host mismatching with the development of GH. We evaluated the data by multivariate regression analysis, using Statistical Package for Social Sciences (SPSS). RESULTS: There was no association with age, sex, duration of renal replacement therapy, or interval since transplantation or pre-transplant disease (P>0.05). There also was no association of disease with host HLA haplotype, but degree of HLA-A mismatching was protective for GH development (P<0.002). GH was associated with the dose and serum levels of CsA (P<0.001) and the last dose of CsA microemulsion (P=0.009) but not nifedipine (P=0.10). Gingival inflammation and plaque were also strongly associated with GH (P<0.0003). In multivariate analysis, however, the last recorded dose of CsA (P<0.0001), presence of local gingival inflammation (P<0.0001), and gingivitis (P<0.003) were the independent predictors of the extent and severity of GH. CONCLUSIONS: Inter-patient variation in the extent and severity of GH is related to CsA dose and serum levels. Differences in host HLA phenotype do not explain individual susceptibility to GH, but donor-host HLA-A mismatching may be important. Inter-site variation in the extent and severity of the disease is related to local gingival inflammation.

Adolescent↗

[Halicephalobus (Syn. Micronema) deletrix as a cause of granulomatous gingivitis and osteomyelitis in a horse].

Therapy resistant swellings of the maxillary region and unilateral nasal discharge in older horses are mainly thought to be consequences of neoplasias of the oral cavity, especially of the gingiva and the teeth, or to develop from tumours of the nasal cavity. We report an unilateral swelling of the left nasal and buccal region in a 13-year-old gelding, which was accompanied by an aggressive destruction of involved osseous tissue due to a severe proliferative granulomatous inflammation. The granuloma was caused by the nematode Halicephalobus (syn. Micronema) deletrix. This nematode infection is known for over 30 years, even though the here reported form is uncommon and rarely diagnosed. However, this report shows that even in cases of unilateral maxillary swellings in horses a granulomatous inflammation due to nematodiasis should be considered as an additional differential diagnosis.

Animals↗

Prostaglandin E2 secretion from gingival fibroblasts treated with interleukin-1beta: effects of lipid extracts from Porphyromonas gingivalis or calculus.

Complex lipids of Porphyromonas gingivalis have been identified in lipid extracts from calculus-contaminated root surfaces and in diseased gingival tissues. However, little is known about the biological effects of these complex lipids on host cells. The purpose of this study was to evaluate the effects of P. gingivalis or calculus lipids on prostaglandin secretion from gingival fibroblasts. Lipids were extracted from paired subgingival plaque and teeth samples, and calculus-contaminated root surfaces before and after scaling and root planing, in order to determine the relevant levels of lipid extracts for the treatment of gingival fibroblasts in culture. Primary cultures of gingival fibroblasts were exposed to lipid extracts from either P. gingivalis or calculus/teeth for a period of 7 days. Control and lipid-treated cultures were exposed to human recombinant interleukin-1beta for 48 h and prostaglandin secretion from interleukin-1beta-treated fibroblasts was compared with control and lipid-treated fibroblasts without interleukin-1beta treatment. These experiments demonstrated that P. gingivalis lipids or calculus-tooth lipids potentiate interleukin-1beta-mediated prostaglandin secretory responses from gingival fibroblasts. Additionally, P. gingivalis or calculus-tooth lipid extracts were readily taken up by gingival fibroblasts as measured by bacterial fatty acid recovery in lipid extracts of cultured fibroblasts. These results indicate that bacterial lipid penetration into gingival tissues in combination with a chronic inflammatory response may substantially potentiate prostaglandin secretion from gingival fibroblasts, thereby promoting tissue destructive processes associated with adult periodontitis.

Adult↗

Oral soft tissue manifestations and CD4 lymphocyte counts in HIV-infected children.

This study investigated the prevalence of oral soft tissue lesions in children infected with HIV and the relationship of CD4 lymphocyte levels with the prevalence of those lesions. Sixty HIV-positive children enrolled in the Children's Hospital AIDS Program (age 5.8 +/- 3 years) were selected for study. Only five subjects (8%) had healthy gingiva and a low mean plaque index (22%). The remainder had gingivitis or periodontitis with relatively high plaque indices (47, 55, and 94%, respectively). A declining CD4 lymphocyte count (1357 to 35) was associated with an increasing severity of gingival disease.

AIDS-Related Opportunistic Infections↗

Drug-induced gingival overgrowth--a review.

Drug-induced gingival overgrowth is a side effect associated with 3 types of drugs: anticonvulsants (phenytoin), immunosuppressive agents (cyclosporine A), and various calcium channel blockers for cardiovascular diseases. Gingival overgrowth is characterized by the accumulation of extracellular matrix in gingival connective tissues, particularly collagenous components with various degrees of inflammation. Although the mechanisms of these disorders have not been elucidated, recent studies suggest that these disorders seem to be induced by the disruption of homeostasis of collagen synthesis and degradation in gingival connective tissue, predominantly through the inhibition of collagen phagocytosis of gingival fibroblasts. The integrins are a large family of heterodimeric transmembrane receptors for extracellular matrix molecules. alpha2beta1 integrin serves as a specific receptor for type I collagen on fibroblasts, and alpha2 integrin has been shown to play a crucial role in collagen phagocytosis. Actin filaments, which are assembled from monomers and oligomers, are involved in collagen internalization after binding to integrins. Furthermore, the implication of intracellular calcium in the regulation of integrin-mediated binding activity and gelsolin activity, known as a calcium-dependent actin-severing protein, is also described. In this review, we focus on collagen metabolism in drug-induced gingival overgrowth, focusing on the regulation of collagen phagocytosis in fibroblasts.

Anticonvulsants↗

Gingival crevicular fluid of patients with gingivitis or periodontal disease: evaluation of elastase-alpha 1 proteinase inhibitor complex.

Elastase-alpha 1 proteinase inhibitor (E alpha 1PI) concentrations were assessed in gingival crevicular fluids and evaluated in relation to the clinical signs of periodontal disease. 7 gingivitis patients (group G), 38 patients with adult periodontitis and clinically stable lesions (group AP), 21 patients with rapidly progressive periodontitis and clinically stable lesions (group RPP) and 11 patients with either adult periodontitis or rapidly progressive periodontitis and clinically progressive lesions (group Pr) were studied. 6 healthy subjects served as the control group (group H). Significantly differences were observed in the E alpha 1PI concentration between the healthy, gingivitis, clinically stable periodontitis and clinically progressive periodontitis group. In the control group, no E alpha 1PI was detected. Groups G, AP and RPP showed mean E alpha 1PI concentrations of 10.95 +/- 4.96 micrograms/ml, 35.55 +/- 18.64 micrograms/ml and 38.56 +/- 20.89 micrograms/ml, respectively. In these groups, high enzyme levels were correlated with clinical signs of inflammation. The highest E alpha 1PI levels were observed in the clinically progressive lesions. However, they were not necessarily associated with bleeding on probing or clinical evidence of inflammation. These data suggest that a significant increase in crevicular E alpha 1PI levels may be an early manifestation of a progressive or potentially progressive periodontal lesion.

Adult↗

[The use of discriminant analysis for the differential diagnosis of periodontal diseases].

Basing on rheo- and photoplethysmography combined with mathematical methods and computers the authors have developed a method for the differential diagnosis of periodontal diseases (gingivitis, periodontitis). Diagnostic studies carried out in 200 patients have shown a high probability (at least 92 percent) of the method for the differential diagnosis of periodontal diseases.

Adolescent↗

Experimental gingivitis in women using oral contraceptives.

Oral contraceptives (OC) have historically been considered a risk factor for gingival diseases. We set out to investigate this premise further, given that, over recent years, hormone concentrations in OC have been substantially reduced. Using a prospective, split-mouth, experimental gingivitis model, pre-menopausal women either taking (n 14) or not taking (n = 16) OC refrained from all oral hygiene practices in one maxillary (test) quadrant while continuing to perform normal oral hygiene activities in the contralateral (control) quadrant. Mean increases in plaque index (PI), gingival index (GI), and gingival crevicular fluid (GCF) volume from days 0 to 21 were significant in test quadrants (P < 0.05) but did not differ regardless of whether subjects received OC (P > 0.05). PI, GI, and GCF volume did not vary in control quadrants over the course of the study (P > 0.05). Analysis of these data suggests that current OC formulations do not affect the inflammatory response of the gingiva to dental plaque.

Adult↗

Antibiotic gels for periodontal disease.

Periodontal disease is a major cause of tooth loss. The underlying pathology is inflammation caused by bacterial plaque affecting the supporting structures of the teeth. Conventional treatment involves mechanical debridement of calcified plaque (calculus) by the dentist combined with meticulous oral hygiene by the patient. A more recent approach is to apply antimicrobial drugs locally to the diseased gingival tissue after debridement. Two antibiotic preparations, minocycline 2% gel (Dentomycin-Lederle) and metronidazole 25% gel (Elyzol-Dumex), are now licensed for the treatment of patients with periodontal disease. Are these treatments an advance on conventional therapy?

Gels↗