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PubMed2005

Use of radiographs in the diagnosis of periodontal disease.

UNLABELLED: Radiographs are commonly used in the diagnosis of periodontal diseases. They can be used to assess bone loss and the pattern of loss as well as in the identification of other periodontally relevant features, such as overhanging restoration margins, calculus deposits and furcation lesions. Horizontal and vertical bitewings, panoramic radiographs and periapicals can be used for periodontal assessment. Referral (selection) criteria based on clinical signs can assist the decision of the radiographs to use. All exposures must be made in accordance with the Ionizing Radiation (Medical Examination) Regulations 2000 and each exposure justified. CLINICAL RELEVANCE: Following a clinical examination, optimum selection of radiographs can assist in the assessment of patients with periodontal diseases.

Alveolar Bone Loss↗

PubMed1984

The prevention of dental caries and periodontal disease. Fédération Dentaire Internationale Technical Report No. 20.

The use of effective preventive methods has produced good results in developed countries, where caries is declining and periodontal disease is probably getting no worse. There are special problems with prevention in developing countries, principally high periodontal disease prevalence, rising caries rates and lack of resources to deal with these problems. With appropriate assistance, much can still be accomplished in these developing countries. Depending on economic resources and disease patterns, the following procedures for oral disease prevention can be recommended. Priority order will vary from country to country, and national and local laws may also determine what procedures can or cannot be employed. Fluoridation of water supplies is the most effective action to prevent caries in communities where piped water supplies are in place. It is relatively cheap and does not depend on individual action. Where water fluoridation is not feasible, community-based alternatives are salt fluoridation, school-water fluoridation or supervised ingestion of fluoride supplements. Supervised mouthrinsing with fluoride solutions, usually in schools, is effective in fluoridated and non-fluoridated communities. Dentists or auxiliaries can also apply fluoride gels or solutions to the teeth of individual patients. The use of fluoride toothpastes is recommended wherever possible as a routine part of self care. All preventive activities have an educational component. Community leaders and others should be educated regarding the institution and maintenance of community preventive measures which affect them. Individual patients should be educated regarding their oral hygiene, use of fluoride, restriction of sugary snacks between meals and the necessity for regular dental visits when services are available. Dental health education of the public can be concentrated in special target groups such as expectant mothers. Because dental caries is a public health problem in many countries, public policy to control the availability of highly cariogenic foods should be considered. Fissure sealants, when applied properly, are highly effective in preventing caries in occlusal surfaces. Their use is recommended on newly erupted teeth in susceptible persons, and they may be specially useful in the handicapped. Trained operators are required and the procedure is reasonably expensive; these factors may restrict the use of sealants where resources are limited. The ability of the individual patient to control plaque by toothbrushing, flossing or chewsticks should be developed to the utmost as the first step in controlling periodontal disease. 2+.

Animals↗

PubMed1990

A new degradable controlled release device for treatment of periodontal disease: in vitro release study.

The substantivity of a drug in the periodontal pocket is an important factor determining its effect on the subgingival flora. Therefore, one of the predominant factors in the development of a sustained release delivery device is the ability to control the rate of release of the drug. Previous studies have demonstrated the advantages of the local sustained release of chlorhexidine from nondegradable devices in the treatment of periodontal diseases. The aim of this study was to develop a degradable sustained release device composed of a cross-linked protein containing chlorhexidine as the therapeutic agent. The in vitro release profile of chlorhexidine from the degradable films was altered by the amount of chlorhexidine incorporated into the film, by the cross-link density of the polymer, and by the chlorhexidine salt used. The chlorhexidine in the final pharmaceutical preparation did not lose its antibacterial activity as was shown in an in vitro antibacterial test. This work demonstrates that the release of chlorhexidine from a degradable delivery system and the degradation of the matrix can be controlled by variation in the formulation. This presents a new dental drug delivery system that can be used as an adjunct in the treatment of periodontal diseases in the future. These studies enable us to choose the pharmaceutical formulations for clinical trials to be conducted testing the efficacy of this treatment modality.

Biodegradation, Environmental↗

PubMed2003

Orthodontic movement into infrabony defects in patients with advanced periodontal disease: a clinical and radiological study.

BACKGROUND: In cases of advanced periodontal disease with a pathologic flaring of frontal teeth, a combined periodontic-orthodontic therapy may be a reliable approach in order to solve both functional and esthetic problems. The aim of the present study was to evaluate the periodontal tissue alterations following periodontal surgery and orthodontic intrusion in migrated upper central incisors with intrabony defects. METHODS: Ten patients with advanced periodontal disease and an extruded maxillary central incisor infrabony defect at its mesial aspect and probing depth (PD) > or = 6 mm were included in the present study. At baseline, PD and clinical attachment level (CAL) were measured. The vertical and horizontal dimensions of the defects were assessed on standardized radiographs. Seven to 10 days after surgery the active orthodontic treatment started using the segmented arch technique, in order to intrude and move the teeth into the defects. Maintenance therapy was performed every 2 to 3 months until the orthodontic treatment was completed. RESULTS: At the end of treatment, mean PD reduction was 4.35 mm, with a residual mean PD of 2.80 mm. Mean CAL gain was 5.50 mm. The mean radiological vertical and horizontal bone fills were, respectively, 1.35 mm and 1.40 mm. All differences were of statistical significance (P<0.001). CONCLUSION: The present study showed that the combined orthodontic and periodontic therapy performed resulted in the realignment of extruded teeth with infrabony defects, obtaining a significant probing depth reduction, clinical attachment gain, and radiological bone fill.

Adult↗

PubMed1995

Psychosocial factors in inflammatory periodontal diseases. A review.

Reviewing the literature concerning the possible rôle of psychosocial factors in the aetiology of inflammatory periodontal diseases, it may be concluded that there is evidence which strongly suggests that emotional stress is one of the predisposing factors to ANUG. On the other hand, it is not clear that the scientific evidence is sufficient to substantiate the hypothesis that psychosocial factors are of aetiological importance in periodontitis. The proposed mechanisms which may mediate the putative relationship between psychosocial conditions and inflammatory periodontal diseases remain to be tested. However, psychoneuroimmunologic studies make lowered host resistance especially interesting as a possible mechanism. Although available studies do not definitively support causal relationships, they suggest that psychosocial factors may be involved in the aetiology of inflammatory periodontal diseases, which, in turn, would relate to clinical management of these conditions.

Animals↗

PubMed1989

Effect of initial treatment of chronic inflammatory periodontal disease in adults on spontaneous peripheral blood lymphocyte proliferation.

The spontaneous proliferative response (SPR) of peripheral blood lymphocytes, as a measure of the autologous mixed lymphocyte reaction (AMLR), has been found to be depressed in adults with chronic inflammatory periodontal disease (CIPD). The aim of the present study was to test the hypothesis that initial treatment of CIPD in adults restores the SPR to normal levels. 10 periodontal disease subjects (mean probing attachment loss of 4.2 mm and a mean bleeding index of 0.65) and 10 age- and sex-matched healthy control subjects were studied. The SPR for each patient was evaluated on days 3, 5, 7, 9 and 11 in culture, before and after initial treatment for CIPD. The peak SPR, which occurred at day 5, was depressed in the untreated periodontal disease subjects compared to the healthy control subjects (p less than 0.01). In addition, the kinetics of the SPR were found to be significantly different in 4 of the 10 parameters compared with the untreated periodontal disease patients and the healthy control subjects. After treatment, there was a significant reduction in probing attachment loss and bleeding indexes (p less than 0.001). In addition, the magnitude of the peak SPR was not significantly different from that of the healthy control subjects. Nevertheless, a difference in 1 of the 10 kinetic parameters persisted, which suggested that complete restoration of the SPR to normal had not occurred so soon after treatment.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed1988

Methods of evaluating periodontal disease data in epidemiological research.

The purpose of the present investigation was to examine the use of different methods of data analysis to examine the pattern of periodontal tissue destruction in a group of adults. A clinical examination was carried out on 319 subjects, 20-79 years of age, randomly selected from the population of the city of Ushiku, Japan. The following parameters were studied: missing teeth, plaque, gingivitis, probing pocket depth and probing attachment level. All surfaces of all teeth were examined. The data obtained were evaluated in 3 ways: (i) mean values for each of the clinical parameters were computed for each subject and age group, (ii) the frequency of subjects with one or more sites of attachment loss above certain thresholds was assessed, (iii) percentile plots were generated in such a way that for each age group the percent of sites in subjects with varying attachment levels could be determined. The results revealed that the subjects included in the study had poor oral hygiene, high frequency of gingivitis and loss of probing attachment which increased with age. The mean annual attachment loss for all tooth surfaces was calculated to be less than 0.1 mm. Severe periodontal tissue breakdown was not as common as might have been expected. Hence, the majority of the subjects in the 20-59 year age group had very little evidence of destructive periodontal disease. In these age groups, a comparatively small subfraction accounted for most of the disease detected. After the age of 60, periodontal disease appeared to be more widespread among the subjects examined.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed1984

In vivo crevicular leucocyte response in humans to a chemotactic challenge. Effects of periodontal diseases.

An in vivo assay was recently developed to monitor the crevicular leucocyte response to chemotactic agents, e.g., casein and N-formyl peptides. This method was used to monitor humans with little or no gingival disease (C group), gingivitis (G group), chronic periodontitis (CP group) and localized juvenile periodontitis (LJP group). Casein (0.2 microliters, 2 mg/ml) was placed into an isolated gingival crevice of each subject with a calibrated wire loop and the time recorded (t = 0). Leucocytes were counted in crevicular washes (10 microliters) 15 minutes later and every 5 minutes thereafter up to t = 50 minutes. This protocol was repeated for the crevice of an adjacent tooth except that the crevicular fluid flow response to the chemotactic challenge was monitored. The C, G and CP subjects showed a similar pattern of response to the chemoattractant with a single "peak" of leucocytes at approximately t = 25 minutes. However, the peak cell count was much greater in the G and CP groups than in the C group. LJPs showed an abnormal pattern with two leucocyte peaks, one at approximately 25 minutes and the other at 45 minutes. Both peaks tended to be higher than the single peak seen in Cs but were significantly lower than that in Gs or CPs, even at similar levels of inflammation. In addition, the peak leucocyte response (to casein) in LJPs did not increase with increasing leucocyte counts in the unchallenged (resting) crevice, whereas a positive relationship was seen in the other groups of subjects. These data suggest that this new assay may provide important diagnostic information on in vivo neutrophil migration in the gingival crevice and on susceptibility to periodontal disease.

Adolescent↗

PubMed1994

Collagenase activity and tissue inhibitor of metalloproteinases-1 (TIMP-1) content in human whole saliva from clinically healthy and periodontally diseased subjects.

Total TIMP-1 concentration in whole saliva of periodontally diseased subjects, 137 +/- 67 ng/ml (mean +/- SD), was clearly lower (p < 0.001) than that of clinically healthy subjects, 273 +/- 145, and that of edentulous subjects, 332 +/- 121. On the contrary, both active [1.58 +/- 0.35 units/ml (mean +/- SD)] and total (2.08 +/- 0.25) collagenase activities in TIMP-1-free whole saliva of diseased subjects were significantly higher than the activities (0.14 +/- 0.14 and 0.50 +/- 0.27, respectively) in TIMP-1-free whole saliva of healthy subjects. Most of the total collagenase in whole saliva of healthy subjects consisted of procollagenase, while mainly active collagenase was present in whole saliva from patients with periodontal diseases. Significant reciprocal changes of TIMP-1 and collagenase levels, that is, increase in TIMP-1 concentration and decrease in collagenase activity, were observed after the initial therapy of periodontitis patients.

Adolescent↗

PubMed2004

Evidence that diabetes mellitus aggravates periodontal diseases and modifies the response to an oral pathogen in animal models.

Bacterial plaque has been shown to initiate periodontal diseases. Most studies indicate that the host response, rather than the direct effect of bacteria, is responsible for much of the destruction associated with periodontitis. Bacteria or their products have an indirect role by stimulating inflammation, which is associated with the excessive production of inflammatory mediators, such as prostaglandins, or cytokines, such as tumor necrosis factor-alpha (TNF-alpha) and interleukin-1. These mediators, in turn, induce the production and activation of enzymes that destroy gingival connective tissue and stimulate the formation of osteoclasts to resorb bone. Based on results in animal models and studies in humans showing that similar responses occur, the initial steps in the breakdown of connective tissue attachment to the tooth surface and bone resorption involve the production of inflammatory cytokines. Moreover, the risk and severity of periodontal diseases is affected by systemic factors, such as diabetes. Diabetes in particular seems to impair the ability to produce new bone formation after bone loss by preventing the formation of new bone that normally occurs after bone is resorbed, a process called coupling. In addition, the cytokines that stimulate loss of tissue, particularly TNF-alpha, may kill the cells that repair damaged connective tissue or bone. In diabetes there may be more TNF-alpha produced, leading to an even more limited capacity to repair tissue. The diminished capacity to form new bone may make it more difficult for diabetics in particular to repair the loss of tissue that occurs in periodontal diseases.

Alveolar Bone Loss↗

PubMed1976

Bioenergetics in clinical medicine. VI. adjunctive treatment of periodontal disease with coenzyme Q10.

Eighteen patients with periodontal disease and measurable pockets were treated on a double-blind basis with coenzyme Q10 and a maching placebo. The treatment was significant (p less than 0.01). Before decoding, all 8 patients receiving coenzyme Q10 and 7/10 patients receiving placebo were correctly assigned. Of the remaining 3 placebo patients, the status of one was borderline and could have been assigned to either group, and two improved due to better hygiene. Crevicular fluid flow as a measure of inflammation was newly monitored. Pocket-depth, periodontal health, calculus and plaque scores provided the most valuable data for evaluation.

Clinical Trials as Topic↗

PubMed2006

Periodontal disease as one possible explanation for the Mexican paradox.

Mexican-American women have similar low socio-economic status as compared to Non-Hispanic Blacks. However, Mexican-American women have consistently been shown to have a lower rate of low birth weight births as compared to Non-Hispanic Blacks and similar to Non-Hispanic Whites. This phenomenon is referred to as the "Mexican paradox", and the explanation for this is still unclear. We used data from the third US National Health and Nutrition Examination Survey (NHANES III) to compare the rate of periodontal disease in Non-Hispanic Black, Non-Hispanic White and Mexican-American pregnant and non-pregnant women. We found that Mexican-American women have a lower rate of periodontal disease before and during pregnancy when compared to Non-Hispanic Blacks. Since periodontal disease has been associated with an increased risk of preterm birth and low birth weight, we hypothesize that the lower prevalence of periodontal disease before and during pregnancy among Mexican-American women may contribute to the "Mexican paradox".

Adolescent↗

PubMed1989

Cotinine in saliva and gingival crevicular fluid of smokers with periodontal disease.

A study was undertaken to determine the presence of cotinine, a metabolite of nicotine, in the saliva and gingival crevicular fluid of smokers with periodontal disease. Saliva and crevicular fluid samples were obtained from 16 habitual cigarette smokers and analyzed by High Performance Liquid Chromatography (HPLC) for the presence of cotinine. Thirteen non-smokers with periodontal disease served as controls. There was no evidence of cotinine (within our detection levels) in either the saliva or crevicular fluid of any of the nonsmokers. Cotinine, in a wide range of concentrations, was detected in the saliva and crevicular fluid in all of the 16 cigarette smokers. The presence of a nicotine metabolite in the saliva and gingival crevicular fluid reflects the extent of the systemic distribution of nicotine in smokers. The vasoactive properties of nicotine are well known and may possibly affect the pathogenesis of periodontal disease.

Acetanilides↗

PubMed1999

Destructive periodontal disease in adults 30 years of age and older in the United States, 1988-1994.

BACKGROUND: Accurate information on the prevalence and extent of periodontal diseases in the United States adult population is lacking. This study estimated the prevalence and extent of periodontal disease in the United States using data from the third National Health and Nutrition Examination Survey (NHANES III). METHODS: A nationally representative sample was obtained during 1988 to 1994 by a stratified, multi-stage probability sampling design. A subsample of 9,689 dentate persons 30 to 90 years old who received a periodontal examination was used in this study, representing approximately 105.8 million civilian, non-institutionalized Americans in 1988 to 1994. Periodontal attachment loss, probing depth, and furcation involvement were assessed in 2 randomly selected quadrants per person. Attachment loss and probing depth were assessed at 2 sites per tooth, the mesiobuccal and mid-buccal surfaces. The periodontal status of each subject was assessed by criteria based on the extent and severity of probing depth and furcation involvement. These assessments were used to classify each subject as having a mild, moderate, or advanced form of the disease. In the analyses, weighted data were used to reflect the complex sampling method. RESULTS: Prevalence of attachment loss > or = 3 mm was 53.1% for the population of dentate U.S. adults 30 to 90 years of age and, on average, 19.6% of teeth per person were affected. The prevalence of probing depth > or = 3 mm was 63.9% and, on average, 19.6% of teeth were affected. Fourteen percent of these persons had furcation involvement in one or more teeth. We estimate that at least 35% of the dentate U.S. adults aged 30 to 90 have periodontitis, with 21.8% having a mild form and 12.6% having a moderate or severe form. The prevalence and extent of attachment loss and the prevalence of periodontitis increase considerably with age. However, the prevalence of moderate and advanced periodontitis decreases in adults 80 years of age and older. This is most likely attributed to a combination of a high prevalence of tooth loss and gingival recession in the oldest age cohorts. Attachment loss and destructive periodontitis were consistently more prevalent in males than females, and more prevalent in blacks and Mexican Americans than whites. We estimate that in persons 30 years and older, there are approximately 56.2 and 67.6 million persons who, on average, have about a third of their remaining teeth affected by > or = 3 mm attachment loss and probing depth, respectively. We also estimate that about 21 million persons have at least one site with > or = 5 mm attachment loss, and 35.7 million persons have periodontitis. These are conservative estimates based on partial-mouth examinations, and the true prevalence and extent of periodontal disease may be significantly higher than what is reported here. CONCLUSIONS: Periodontitis is prevalent in the U.S. adult population. The results show that black and Mexican American males have poorer periodontal health than the rest of the U.S. adult population. Primary and secondary preventive measures should therefore be specifically targeted towards these groups.

Adult↗

PubMed2001

Relationship of sulcular sulfide level to severity of periodontal disease and BANA test.

BACKGROUND: Volatile sulfur compounds (VSC), such as hydrogen sulfide and methyl mercaptan, are toxic metabolites produced by periodontal pathogens. Their relationship to periodontal disease severity is not yet fully understood. Hence, the aims of this study were to: 1) examine the relationship between sulcular sulfide (pS) levels and severity of periodontal disease and 2) examine the link between pS level and the BANA (benzoyl-DL-arginine-naphthylamide) test. METHODS: Seventy systemically healthy subjects with a mean age of 53.0 +/- 13.8 years participated. Three sites were selected from each subject based upon radiographic bone loss (RBL): RBL < 2 mm, healthy; RBL > or = 2 to < 4, low to moderate; RBL > or = 4 mm, severe. Periodontal parameters, probing depth (PD), clinical attachment level (CAL), and bleeding on probing (BOP), were recorded. The pS level was measured using a portable sulfide monitor in a digital score ranging from 0.0 (< 10(-7) M of S) to 5.0 (> or = 10(-2) M of S) in increments of 0.5. The presence of specific bacteria in subgingival plaque was detected using BANA test. RESULTS: The mean pS level was 0.10 +/- 0.23, 0.36 +/- 0.48, and 1.10 +/- 0.87 for healthy, low to moderate, and severe disease sites, respectively, and was statistically different (P<0.001). The pS level was positively correlated with the BANA test, and was higher in untreated subjects than maintenance subjects (P<0.01). CONCLUSIONS: The pS level may be a potential indicator for detecting severity of periodontal disease and identifying bacteria that are capable of hydrolyzing BANA.

Adult↗

PubMed2004

Effect of periodontal therapy in smokers and non-smokers with advanced periodontal disease: results after maintenance therapy for a minimum of 5 years.

BACKGROUND: Longitudinal clinical studies show smoking is a risk factor for periodontal disease progression. It has also been documented that smoking impairs healing after periodontal therapy. However, the longitudinal effect of smoking on treatment results in patients who undergo long-term maintenance therapy has not been extensively investigated. This study clinically and radiographically compared smoking and non-smoking patients who had been treated for advanced periodontal disease and who received maintenance therapy for a minimum of 5 years. METHODS: Twenty-nine patients were selected over a 6-month period when they presented for a regularly scheduled visit in a private office. Patients were selected on the basis of initially having lost 50% of bone support on 50% of their teeth; had received follow-up therapy for at least 5 years; were compliant at 75% of the appointments; and had plaque scores < 20% in 75% of the visits. All patients had received non-surgical and surgical therapy as required for pocket elimination. Fourteen were active smokers during the entire maintenance period. Clinical measurements of probing depths and presence of plaque and gingivitis and a new set of standardized radiographs were taken. RESULTS: Smokers had higher mean radiographic bone loss values prior to treatment (7.52 +/- 1.39 versus 6.65 +/- 1.39) and at the final examination (7.32 +/- 1.42 versus 6.29 +/- 1.29) mean radiographic bone loss as well as initial, immediate post-therapy, and final percent of pockets > or = 6 mm (1.42% +/- 1.87% versus 0.60% +/- 1.11%). Differences were not statistically significant. Over 5 to 8 years, seven sites in four non-smokers and 11 sites in six smokers exhibited radiographic bone loss > or = 2 mm. One tooth in a non-smoker and three teeth in two smokers were lost. In a logistic regression analysis, smoking increased the odds ratio 10.7 times of having > or = 1 site with bone loss > or = 2 mm. CONCLUSION: The present study on a small group of patients treated for advanced periodontal disease and well maintained over 5 to 8 years showed no statistically significant differences between smokers and non-smokers in clinical probing depth and radiographic bone loss measurements.

Adult↗

PubMed1996

Screening for periodontal disease: radiographs vs. PSR.

This study compares the evaluation of periodontal health using bone levels measured on periapical and bitewing radiographs with clinical parameters, such as periodontal screening and recording, gingival indexes, probing depths and attachment levels. The authors found that bitewing radiographs taken within six months of the clinical examination correlated better with the clinical data than older radiographs. However, they concluded that, overall, radiographs are not highly reflective of periodontal status. PSR scores, by contrast, showed significant associations with probing depths and attachment levels. The results support use of PSR as a screening tool for periodontal diseases.

Adolescent↗

PubMed1991

[Tetracycline resistance in oral microorganisms in patients with periodontal disease].

Several longitudinal studies have shown that periodontal treatment consisting of surgical and/or nonsurgical debridement of the teeth often is sufficient to prevent continued attachment loss when the patients' oral hygiene measures are good. Nevertheless, some patients will, in spite of excellent oral hygiene measures, continue to show attachment loss. The treatment of these patients has mainly been empirical, and the clinicians have used different kinds of antibiotics for different time intervals to eliminate proposed periodontal pathogens. The preferred antibiotic has been tetracycline. Most bacteria associated with destructive periodontal disease will normally be susceptible to tetracycline at the levels achieved in the gingival crevicular fluid after systemic administration of the antibiotic. Some patients have a microbial flora that will not change enough or be inhibited by these substances. The reason for this may in many cases be the development of antimicrobial resistance. Today 14 genotypes of tetracycline resistance have been found. The resistance is one of three types: active secretion, protection of the ribosomes by proteins and an active breakdown of tetracycline. The third type has recently been discovered as a cryptic gene in the microorganism Bacteroides fragilis. This gene is only expressed after transfer to Eschericia coli. Active breakdown of tetracycline does normally not occur in nature and the global level of the drug is increasing since tetracycline is the second most used antibiotic in the world today. It is therefore of interest to identify tetracycline resistance determinants in the oral cavity and to compare these with tetracycline resistance genes from other sources of human, animal and environmental origin.

Humans↗