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PubMed1997

Predictors of destructive periodontal disease incidence and progression in adult and elderly Chinese.

This study describes some predictors of new and progressing destructive periodontal disease over a 10-year period in rural Chinese. A total of 398 persons aged 20-80 years, who had participated in a baseline survey of tooth mortality, dental caries and periodontal conditions and were still dentate 10 years later, were reexamined for the same parameters as assessed at baseline. Three different threshold values were used to define new and progressing destructive periodontal disease. Irrespective of the threshold used, most persons experienced new disease. Progressing disease was very prevalent when a 2+ mm disease definition was used, but occurred less frequently at the higher threshold levels. The logistic regression models for 2+ and 3+ mm disease were essentially similar, and showed that women, persons with 104 sites or more, and persons with 0-5% sites with 4+ mm attachment levels had a lower risk of disease progression as well as of new disease than did men, persons with few sites and persons with 6% sites or more with attachment levels 4+ mm. The variables sex, number of sites present, percentage of sites with 4+ mm attachment levels, and presence of mobile teeth were predictive for new disease using a 4+ mm definition. Age, percentage of sites with 4+ mm attachment levels and percentage of sites with 4+ mm pockets were predictive for progressing disease using the 4+ mm disease definition.

Adult↗
PubMed2002

Systemic inflammation in cardiovascular and periodontal disease: comparative study.

Epidemiological studies have implicated periodontal disease (PD) as a risk factor for the development of cardiovascular disease (CVD). These studies addressed the premise that local infection may perturb the levels of systemic inflammatory mediators, thereby promoting mechanisms of atherosclerosis. Levels of inflammatory mediators in the sera of subjects with only PD, only CVD, both diseases, or neither condition were compared. Subjects were assessed for levels of C-reactive protein (CRP), serum amyloid A (SAA), ceruloplasmin, alpha(1)-acid-glycoprotein (AAG), alpha(1)-antichymotrypsin (ACT), and the soluble cellular adhesion molecules sICAM-1 and sVCAM by enzyme-linked immunoabsorbent and/or radial immunodiffusion assays. CRP levels in subjects with either condition alone were elevated twofold above subjects with neither disease, whereas a threefold increase was noted in subjects with both diseases (P = 0.0389). Statistically significant increases in SAA and ACT were noted in subjects with both conditions compared to those with one or neither condition (P = 0.0162 and 0.0408, respectively). Ceruloplasmin levels were increased in subjects with only CVD (P = 0.0001). Increases in sVCAM levels were noted in all subjects with CVD (P = 0.0054). No differences in sICAM levels were noted among subject groups. A trend toward higher levels of AAG was noted in subjects with both conditions and for ACT in subjects with only PD. Immunohistochemical examination of endarterectomy specimens of carotid arteries from subjects with atherosclerosis documented SAA and CRP deposition in association with atheromatous lesions. The data support the hypothesis that localized persistent infection may influence systemic levels of inflammatory mediators. Changes in inflammatory mediator levels potentially impact inflammation-associated atherosclerotic processes.

Acute-Phase Reaction↗
PubMed1987

Relative importance of periodontal disease for full mouth extractions in the Netherlands.

In order to determine the relative importance of periodontal disease, caries and non-disease reasons for full mouth extractions, a combined sociodental study was carried out in an urban and a rural area in the Netherlands. In the largest proportion of patients (57%) caries was the predominant disease. In only a small group (13%) was periodontal breakdown the predominant characteristic. In 16% of the patients non-disease factors possibly played a role because in this group no generalized periodontal disease or caries was found. It was concluded that in urban and rural areas and in all age groups caries and not periodontal disease was the most important reason for full mouth extractions. Non-disease factors may play a role in the decision to carry out full mouth extractions. Patients living in areas with different dentist-population ratios have a comparable caries status and periodontal condition at the time of full mouth extractions.

Adult↗
PubMed2002

The applicability of half-mouth examination to periodontal disease assessment in untreated adult populations.

BACKGROUND: Data from whole-mouth examinations are the gold standard for accurate assessment of periodontal disease. Since periodontal destruction exhibits left-right symmetry, however, it is hypothesized that a half-mouth exam provides an appropriate alternative to whole-mouth assessment, with considerable advantage over a more limited partial-mouth assessment of index teeth. METHODS: Data from 2 untreated populations were utilized in the analyses. Half-mouth (random diagonal quadrants) and Ramfjord teeth assessment was compared with whole-mouth assessment as follows. Intraclass correlation coefficients (ICCs) were calculated for mean plaque index (PI), gingival index (GI), probing depth (PD), and clinical attachment level (CAL) and for percentage of sites with PD > or = 4, 5, or 6 mm; CAL > or = 3, 4, 5, or 6 mm; and recession > or = 3 mm to determine the agreement between the whole- and partial-mouth assessment. Disease prevalence was also determined for both whole- and partial-mouth assessments. RESULTS: For mean PI, GI, PD, and CAL, both half-mouth and Ramfjord teeth assessment provided an acceptable alternative to whole-mouth assessment (ICCs > 0.92). For percentage of sites above a specified threshold, ICCs were generally greater than 0.90 in all age cohorts for half-mouth assessment, but consistently lower for Ramfjord teeth assessment. Ramfjord teeth assessment also considerably underestimated disease prevalence compared with half-mouth assessment. CONCLUSIONS: These results support the use of a half-mouth examination procedure, to conserve time, limit cost, and reduce patient and examiner fatigue while providing maximal clinical information. Ramfjord teeth assessment was not as suitable for evaluation of either disease extent or prevalence.

Adolescent↗
PubMed2006

Periodontal disease in the oldest-old living in Kungsholmen, Sweden: findings from the KEOHS project.

AIMS: The Kungsholmen Elders Oral Health Study evaluated the oral health status of generally healthy, community-dwelling persons aged 80 years and over living in Stockholm, Sweden. This paper reports periodontal disease findings and evaluates the distribution by sociodemographic factors. METHODS: Eligible persons were identified through the Kungsholmen Project, an ongoing, longitudinal, population-based study of older adults. A total of 121 study subjects received a periodontal examination. RESULTS: The mean pocket probing depth was 2.6 mm and the mean clinical attachment loss was 3.7 mm. Gingival bleeding was common. Over half of all study participants met the criteria used for "serious periodontitis" (SP). In the best fit adjusted odds ratio (OR) model, males were 3.1 times more likely than females to have "SP" (OR=3.1, 95% CI 1.2, 8.0), a statistically significant observation. A sub-analysis of the differences in proportion of participants with SP revealed that the difference by sex also increased by age. CONCLUSIONS: These findings document the substantial and ongoing impact of periodontal disease in a sample of generally healthy, community dwelling older adults and underscore the importance of continued periodontal disease prevention and treatment in the oldest-old.

Age Factors↗
PubMed1999

Periodontal disease in patients with cleft palate and patients with unilateral and bilateral clefts of lip, palate, and alveolus.

BACKGROUND: Long-term health of the stomatognathic system, as well as esthetics, is the therapeutic goal in patients with facial clefts. The aim of this study was to analyze the periodontal situation of patients with cleft palate (CP) and cleft lip, palate, and alveolus (CLPA) to elicit the differing degrees and localization of periodontal disease. METHODS: In 30 patients with unilateral cleft lip, palate, and alveolus (UCLPA), 30 patients with cleft palate (CP), and 20 patients with bilateral cleft lip, palate, and alveolus (BCLPA), the gingival situation was identified and classified according to the sulcus bleeding index (SBI). Periodontal attachment loss and pathological loosening of teeth were noted for identification of periodontal lesions. The state of oral hygiene was recorded by the approximal plaque index (API). RESULTS: In general, poor oral hygiene was found in all patients. The SBI showed a high incidence of gingivitis in patients with cleft lip, palate, and alveolus. Patients with cleft palate had a minor extent of sulcus bleeding. Periodontal disease was found to a similar extent to that in the general population in patients with cleft palate, whereas patients with cleft lip, palate, and alveolus had a predisposition to deep periodontal destruction of teeth adjacent to the cleft. The registration of pathological loosening of teeth, a result of attachment loss, corresponded to the degree of periodontal disease shown by the attachment loss. CONCLUSIONS: A critical periodontal situation was found in patients with unilateral and bilateral cleft lip, palate, and alveolus, ultimately leading to tooth loss in the front tooth region. In contrast, patients with cleft palate exhibited periodontal situations similar to that found in the general population with additional damage, which may be attributed to orthodontic treatment.

Adolescent↗
PubMed1990

[Microbiological aspects in the treatment planning of periodontal disease].

A large number of bacterial species are found in the periodontal pocket. It has been shown that the composition of the subgingival microbiota can differ significantly between individual pockets in one patient, as well as between different subjects. These different types of microfloras can be characterized by indicator bacteria. These indicator bacteria are strongly associated with active periodontal breakdown. Therefore, these microorganisms can be useful in the periodontal treatment of individual patients. It also supports the use of antibiotics in specific forms of periodontal disease. The application of microbiological data in diagnosis and treatment planning in four severe periodontitis patients is illustrated.

Actinobacillus↗
PubMed1989

[Phagocytosis, intracellular killing and interleukin 1 production of polymorphonuclear leukocytes in human periodontal diseases].

The role of the polymorphonuclear leukocyte (PMNL) as a primary protective cell in periodontal diseases has been well recognized. Functional abnormalities of PMNL chemotaxis have been implicated in the pathogenesis of some types of periodontitis. However, no consistent correlation with other PMNL functions has been reported. In the present study, phagocytosis and intracellular killing (oxidative product formation) of the PMNL from the patients with various forms of periodontal disease were evaluated by flow cytometry. Moreover, interleukin 1 (IL-1) production by the PMNL was determined by means of the enzyme-linked immunosorbent assay (ELISA) with monoclonal antibodies against rIL-1 alpha and rIL-1 beta. In order to examine these functions of peripheral (p-PMNL) and/or gingival crevicular PMNL (g-PMNL), 15 patients with localized juvenile periodontitis (LJP), 13 patients with generalized juvenile periodontitis (GJP) and 52 patients with adult periodontitis (AP) served as subjects. About 50% of the patients in LJP and GJP group exhibited depressed p-PMNL phagocytosis. While only a minimal number of the AP patients and no healthy subjects showed any reduction of p-PMNL phagocytosis. The reduction of phagocytosis was not related to the clinical periodontal status, and no detectable improvement of p-PMNL phagocytosis could be observed after periodontal therapy. In addition, it was suggested that complement receptors on the p-PMNL might be closely related with the reduction. Compared to p-PMNL, g-PMNL from the same individual have a lower phagocytic capacity in all subjects. However, no significant difference in g-PMNL phagocytosis could be demonstrated among three patient groups. Incremental oxidative responses in p-PMNL were observed in LJP, GJP and AP patients without any significant difference being found among these three groups. The increased rate of oxidative product formation was related to the clinical periodontal status, and it followed that periodontal therapy had significant effect on the improvement of this p-PMNL function. In IL-1 production assay of PMNL, a significant amount of IL-1, especially IL-1 beta, was observed in g-PMNL, but not in p-PMNL. The g-PMNL of the patients was found to produce greater amounts of IL-1 alpha and IL-1 beta than did the healthy controls. In addition, IL-1 production of p-PMNL was induced by the stimulation with some pathogenic bacteria including Bacteroides gingivalis. These results suggest that impaired PMNL phagocytosis may contribute to the early onset of periodontal deterioration in some young patients.(ABSTRACT TRUNCATED AT 400 WORDS)

Humans↗
PubMed1982

Patterns of progression and regression of advanced destructive periodontal disease.

Attachment level at two sites on each tooth in 22 untreated subjects with existing periodontal pockets was measured every month for 1 year. Regression analysis was then applied to the data from each periodontal site to determine if statistically significant trends in attachment level change could be detected. 82.8% of the sites monitored did not significantly change during the year. 5.7% of the sites became significantly deeper and 11.5% of the sites became significantly shallower (P less than 0.01) during the period. Among those sites in which pocket depth increased, approximately half exhibited a cyclic deepening followed by spontaneous recovery to their original depth. In 15 of the subjects, sites were found which became significantly deeper while other sites within the same subject became significantly shallower. In six subjects, who might be considered to have an arrested form of periodontal disease, virtually no sites became deeper during the monitoring period whereas 11-36% of their sites became significantly shallower. The results of this investigation suggest that a dynamic condition of disease exacerbation and remission as well as periods of inactivity may be characteristic of periodontal disease.

Adolescent↗
PubMed1997

Factors influencing the diagnosis and management of periodontal disease by general dental practitioners.

OBJECTIVE: To identify factors influencing the diagnosis and management of periodontal disease by general dental practitioners. DESIGN: The study was conducted in two stages. 1. Analysis of returns to the Scottish Dental Practice Board. 2. Data collection via a postal questionnaire distributed to 500 general dental practitioners (27% of Scottish practitioners). RESULTS: 374 (75%) questionnaires were completed and returned. Analysis revealed the majority of treatment provided was in the form of simple scale and polishes, with multi-visit periodontal therapy comprising less than 0.2% of all non-surgical periodontal treatment. While the majority of respondents were confident in their ability to diagnose periodontal disease, only 40% were confident in treating it. Patient related factors were seen as the major hindrance to disease management, although time factors and the low level of fees were viewed by at least one half of respondents as major constraints. CONCLUSIONS: Greater efforts are required to motivate and inform patients of the necessity for and benefits of periodontal treatment, as is emphasis on appropriate treatment of early to moderate forms of disease. There is also a need for the development of appropriate, evidence-based clinical guidelines and fiscal arrangements to facilitate such provision.

Adolescent↗
PubMed2002

Validity and accuracy of a risk calculator in predicting periodontal disease.

BACKGROUND: Research on the pathobiology of periodontal diseases has increased our knowledge of these diseases and is fostering a transition from the repair model to the medical or wellness model of periodontal care. Successful application of the wellness model depends on an accurate and valid assessment of disease risk, as well as institution of risk reduction as an integral part of prevention and treatment. A computer-based risk assessment tool has been developed. METHODS: The authors reviewed clinical records and radiographs of 523 subjects enrolled in the Veterans Affairs Dental Longitudinal Study to evaluate the validity of risk prediction using the computer-based tool. Data from baseline examinations was entered into the risk calculator, and a risk score on a scale from 1 (lowest risk) to 5 (highest risk) was calculated for each subject to predict periodontal deterioration. Actual periodontal status in terms of alveolar bone loss (determined from digitized radiographs) and tooth loss (determined from clinical records) was assessed at years 3, 9 and 15. The authors determined the statistical strength of the association between risk prediction and actual outcome. RESULTS: The risk scores were strong predictors of periodontal status, as measured by alveolar bone loss and loss of periodontally affected teeth. Risk scores consistently ranked risk score groups from least to most bone loss and tooth loss. Compared with a risk score of 2, the relative risk of tooth loss was 3.2 for a risk score of 3, 4.5 for a risk score of 4 and 10.6 for a risk score of 5. CONCLUSIONS AND PRACTICE IMPLICATIONS: Use of the risk assessment tool over time may result in more uniform and accurate periodontal clinical decision-making, improved oral health, reduction in the need for complex therapy, reduction in health care costs and a hastening of the transition from a repair model to a wellness model of care.

Alveolar Bone Loss↗
PubMed2001

Longitudinal comparison of the periodontal status of patients with moderate to severe periodontal disease receiving no treatment, non-surgical treatment, and surgical treatment utilizing individual sites for analysis.

BACKGROUND: The progression of periodontal disease without treatment and the response of existing periodontal disease to various types of treatment have been studied extensively. Many past studies have used the mean of the patient's probing depths or attachment levels to evaluate disease progression as opposed to following changes in individual sites or teeth. The purpose of the current study was to evaluate the response of individual teeth to treatment or non-treatment. METHODS: The records from a private periodontal practice were reviewed to find patients with complete periodontal examinations that were recorded at least 1 year apart. Patients who fit these criteria were divided into those who had none of the recommended treatment (untreated, n = 30); those who had only non-surgical treatment (partially treated, n = 20); and a control group who had completed all recommended treatment (surgically treated, n = 41). The data for each tooth of each patient were placed in a database and analyzed using the method of generalized estimating equations (GEE) to test for associations between increase or decrease in probing depths and various initial clinical parameters while adjusting for significant confounders. RESULTS: Teeth that received no treatment or non-surgical treatment showed significant increases in probing depths, worsening of prognosis, worsening of furcation involvement, and increases in mobility when compared to surgically treated teeth. Teeth that received surgical treatment showed significant decreases in probing depths. No significant difference was noted between teeth that had no treatment and teeth that had non-surgical treatment. CONCLUSIONS: When individual teeth are used as the basis for analysis, teeth that receive no treatment or non-surgical treatment show a significant worsening of probing depths, furcations, mobility, and prognosis when compared to teeth that receive surgical treatment, while surgically treated teeth show significant improvement in probing depths.

Adult↗
PubMed2003

[Role of human viruses in the pathogenesis of periodontal disease].

Human viruses play a fundamental role in the pathogenesis of periodontal disease due to their intrinsec capacity to interfere with immune system of the host. Herpesvirus maybe involved in the onset or progress of a number of periodontal diseases while HIV seems to be related to the linear gingival erythema (LGE) and necrotizing ulcerative periodontitis (NUP).

Gingival Crevicular Fluid↗
PubMed1994

Assessment of risk for periodontal disease. I. Risk indicators for attachment loss.

Specific risk indicators associated with either susceptibility or resistance to severe forms of periodontal disease were evaluated in a cross-section of 1,426 subjects, 25 to 74 years of age, mostly metropolitan dwellers, residing in Erie County, New York, and surrounding areas. The study sample exhibited a wide range of periodontal disease experience defined by different levels of attachment loss. Therefore, it was possible to accurately assess associations between the extent of periodontal disease and patient characteristics including age, smoking, systemic diseases, exposure to occupational hazards, and subgingival microbial flora. Age was the factor most strongly associated with attachment loss, with odds ratios for subjects 35 to 44 years old ranging from 1.72 (95% CI: 1.18 to 2.49) to 9.01 (5.86 to 13.89) for subjects 65 to 74 years old. Diabetes mellitus was the only systemic disease positively associated with attachment loss with an odds ratio of 2.32 (95% CI: 1.17-4.60). Smoking had relative risks ranging from 2.05 (95% CI: 1.47-2.87) for light smokers increasing to 4.75 (95% CI: 3.28-6.91) for heavy smokers. The presence of two bacteria, Porphyromonas gingivalis and Bacteroides forsythus, in the subgingival flora represented risks of 1.59 (95% CI: 1.11-2.25) and 2.45 (95% CI: 1.87-3.24), respectively. Our results show that age, smoking, diabetes mellitus, and the presence of subgingival P. gingivalis and B. forsythus are risk indicators for attachment loss. These associations remain valid after controlling for gender, socioeconomic status, income, education, and oral hygiene status expressed in terms of supragingival plaque accumulation and subgingival calculus. Longitudinal, intervention, and etiology-focused studies will establish whether these indicators are true risk factors.

Adult↗
PubMed1977

Bioenergetics in clinical medicine-X. Survey of the adjunctive use of coenzyme Q with oral therapy in treating periodontal disease.

Approximately 60% of young adults and 80% of middle-aged Americans have periodontal disease. Effective treatment of this widespread affliction is needed. It is generally believed that bacterial plaque on teeth and gingiva is the only direct cause of periodontal disease, and that control of plaque makes possible a normal periodontium in all age brackets. The fallacy in this common belief is the knowledge that effective oral physiotherapy can be ineffective in a small percentage of patients in periodontal practice. There is increasing knowledge and awareness that good nutrition is related to good periodontal health, and that many known vitamins influence the biochemistry of teeth, periodontium, and related bone.

Adolescent↗
PubMed1991

[Bacterial contamination, familial occurrence and periodontal disease].

The pathogenesis of the various periodontal diseases cannot only be explained on the basis of the relationship of specific bacteria to the clinical features of the disease. The microbiologic examination of various members of the same family, either by culturing or by the use of the DNA probe often showed similarities among several individuals in the same family. This could be accounted for on the basis of bacterial transmission or by contamination. These observations suggest the incidence of familial and genetic factors in the etiology of some forms of periodontitis.

Adult↗
PubMed2004

Some characteristics of 50/55-year-old individuals with various experience of destructive periodontal disease: a cross-sectional study.

OBJECTIVE: To analyze the association between subject characteristics and degree of destructive periodontal disease in a randomly selected sample of 50/55-year-old individuals. METHODS: A randomized and geographically stratified (urban/rural districts) subject sample composed of dentate 50-year-old (n = 190) and 55-year-old individuals (n = 359) from the county of Varmland, Sweden were examined. Data were collected through full mouth clinical and radiographic examinations and by the use of questionnaires. Based on the cumulative distribution of the individuals with respect to mean probing attachment loss (PAL), subgroups of subjects with the lowest (L20%) and highest (H20%) experience of PAL were identified. Similar classifications were made for never-smokers and current smokers. Correlation analyses and forward stepwise logistic regression models were performed. RESULTS: The subgroup with the most extensive PAL loss (H20%) included a significantly higher proportion of (i) males (60 vs 33%), (ii) subjects with low educational level (65 vs 41%), (iii) smokers (49 vs 15%), and had (iv) less favorable lifestyle characteristics than the subgroup with minimal experience of PAL loss (L20%). The same pattern of differences was observed when the analysis was restricted to never-smokers, with the addition of a significantly lower proportion of subjects living in urban areas (40 vs 69%) in the H20% compared to the L20% subgroup. The stepwise logistic regression analysis revealed that number of teeth and smoking habits were significant factors in the identification of individuals in the L20% subgroup. For the H20% subgroup, number of teeth, gender, number of cigarettes/day and lifestyle index were significant explanatory variables. CONCLUSION: Number of remaining teeth and smoking habits were identified as the main discriminating factors for classification of subjects with regard to degree of destructive periodontal disease.

Analysis of Variance↗