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PubMed1993

Oral and dental infections with anaerobic bacteria: clinical features, predominant pathogens, and treatment.

Microbial populations colonizing the teeth are a major source of pathogens responsible for oral and dental infections, including periodontal diseases, gingivitis, pericoronitis, endodontitis, peri-implantitis, and postextraction infections. Each entity has distinct clinical and microbial features. Bacterial species associated with oral infections include Actinobacillus actinomycetemcomitans, Porphyromonas gingivalis, Prevotella intermedia, Bacteroides forsythus, Campylobacter rectus, Eubacterium species, Fusobacterium nucleatum, Eikenella corrodens, and Peptostreptococcus micros. Treponema pallidum-related spirochetes have been associated with acute necrotizing ulcerative gingivitis. Porphyromonas endodontalis appears to be specifically related to endodontic infections. Oral infections in medically compromised patients, including those with AIDS, are associated with similar species and are usually complicated by superinfection with enteric and Candida species. Isolation of species causing oral infections requires the collection of appropriate samples and the use of strictly anaerobic techniques. Rapid selective culture, immunofluorescence, and DNA probe methods have been developed for the identification of these oral species. The varied measures required in the management of oral and dental infections may include antimicrobial therapy. Accurate microbiological diagnosis, including antibiotic susceptibility testing, is indicated for cases that do not respond to therapy.

Bacteria, Anaerobic↗
PubMed1999

Development of a classification system for periodontal diseases and conditions.

Classification systems are necessary in order to provide a framework in which to scientifically study the etiology, pathogenesis, and treatment of diseases in an orderly fashion. In addition, such systems give clinicians a way to organize the health care needs of their patients. The last time scientists and clinicians in the field of periodontology and related areas agreed upon a classification system for periodontal diseases was in 1989 at the World Workshop in Clinical Periodontics. Subsequently, a simpler classification was agreed upon at the 1st European Workshop in Periodontology. These classification systems have been widely used by clinicians and research scientists throughout the world. Unfortunately, the 1989 classification had many shortcomings including: 1) considerable overlap in disease categories, 2) absence of a gingival disease component, 3) inappropriate emphasis on age of onset of disease and rates of progression, and 4) inadequate or unclear classification criteria. The 1993 European classification lacked the detail necessary for adequate characterization of the broad spectrum of periodontal diseases encountered in clinical practice. The need for a revised classification system for periodontal diseases was emphasized during the 1996 World Workshop in Periodontics. In 1997 the American Academy of Periodontology responded to this need and formed a committee to plan and organize an international workshop to revise the classification system for periodontal diseases. The proceedings in this volume are the result of this reclassification effort. The process involved development by the Organizing Committee of an outline for a new classification and identification of individuals to write state-of-the-science reviews for each of the items on the outline. The reviewers were encouraged to depart from the preliminary outline if there were data to support any modifications. On October 30-November 2, 1999, the International Workshop for a Classification of Periodontal Diseases and Conditions was held and a new classification was agreed upon (Fig. 1). This paper summarizes how the new classification for periodontal diseases and conditions presented in this volume differs from the classification system developed at the 1989 World Workshop in Clinical Periodontics. In addition, an analysis of the rationale is provided for each of the modifications and changes.

Humans↗
PubMed1978

The use of extracted teeth to evaluate clinical measurements of periodontal disease.

Clinical indicators of periodontal disease, Gingivitis Index, Gingival crevicular fluid and pocket depth measurements were obtained from the gingiva surfaces of 30 teeth. The gingival margins were marked on the surfaces of the teeth prior to extraction. The extracted teeth were stained with hematoxylin and air dried, and the distances from the groove to the base of the calculus, plaque, and connective tissue attachment were obtained. The plaque-free zone was also measured. Comparisons were made between clinical and tooth surface measurements. A high correlation was found between clinical pocket depth measurements and tooth surface parameters. The correlations between all tooth surface parameters and GCF were statistically significant. The G.I. was significantly correlated only with the penetration of calculus into the pocket. The clinical pocket depth was statistically the same as the distance from the gingival groove to the coronal connective tissue attachment. The plaque-free zone appeared to represent the junctional epithelium.

Dental Calculus↗
PubMed1984

Systemic histiocytosis: an unusual cause of perianal disease in a child.

A male child first presented with chronic perianal skin disease at 33 months of age and later developed gingival disease and loose teeth associated with alveolar bone erosion. Biopsy of gingival and perianal lesions showed histiocytic proliferation. Following therapy with vinblastine, prednisone, methotrexate, and cyclophosphamide, the lesions healed but disease recurred in the mastoid and was successfully treated with vinblastine alone. Although the perianal area is an unusual site of skin involvement in systemic histiocytosis, this disorder should be considered in any child with chronic unexplained perianal disease, and biopsy of these lesions should be obtained.

Alveolar Process↗
PubMed1989

Immunohistochemical study of types I, III and IV collagen in diseased human gingiva of patients with rapidly progressive periodontitis: a light and electron microscopic study.

The distribution of type I, III and IV collagens and their ultrastructural organization have been studied in diseased gingival connective tissue of patients with rapidly progressive periodontitis. This disease is characterized by acute destruction of the gingival collagenous components. The use of an immunofluorescent procedure has shown that the diseased connective tissue was made up of both type I and III collagens but that type III collagen was less resistant to acute inflammation. Ultrastructural immunolabelling, using the peroxidase procedure has shown that the large, dense bundles of type I collagen of PI, the main pattern of organization of the gingival connective tissue offered a better resistance to acute destruction than PII, a loose pattern of organization mainly composed of type III collagen. Type IV collagen was exclusively located in degraded lamina densa of basement membrane.

Adult↗
PubMed2005

A clinical study of plasminogen activator activity in gingival tissue in dogs with gingivitis and periodontitis.

The aim of the present study was to evaluate plasminogen activator activity (PAA), tissue-type plasminogen activator (t-PA) antigen level and plasminogen activator inhibitor-1 (PAI-1) antigen in normal canine gingival tissue samples, gingivitis as well as in different stages of periodontal disease. Gingival tissue from 141 adult dogs were analysed spectrophotometrically in order to determine PAA. The tissues were also examined histopathologically. The Sulcus Bleeding Index was used to evaluate the active and inactive phase of periodontal disease. T-PA antigen as well as PAI-1 antigen level was measured by ELISA. There was a significant increase of PAA and t-PA antigen in samples from inflamed gingival tissue compared with normal gingival tissue, while PAI-1 antigen was not detected in either normal or inflamed gingiva. As the severity of periodontal disease was increasing, PAA and t-PA antigen values were significantly higher in periodontitis tissue sample groups, according to the pattern: gingivitis moderate bleeding>slight bleeding, P<0.001). In conclusion, this study indicates that PAA and t-PA antigen level may be used to evaluate the evolution of periodontal disease in dog.

Animals↗
PubMed2002

An update on HIV and periodontal disease.

With the advent of newer pharmacological approaches to the treatment of human immunodeficiency virus (HIV) infection, the incidence and progression of both atypical and conventional periodontal diseases are changing. The incidence of necrotizing periodontitis and gingival diseases of fungal origin appears to be on the decline as a result of these therapies that have led to increased life spans for HIV patients. However, in cases where these therapies lose their effectiveness and HIV patients relapse into an immunosuppressed state, these conditions may recur. Recent evidence has shown that HIV patients with more conventional periodontal diseases such as chronic periodontitis may have increased attachment loss and gingival recession when compared to their HIV-negative counterparts. This pattern of loss of periodontal support may be due in part to a diffuse invasion of opportunistic bacterial infections, viruses, and fungi into the gingival tissue, leading to a more elevated and more diffuse destructive inflammatory response in the periodontal soft and hard tissues. While the accepted approaches to treating the spectrum of periodontal diseases in HIV patients remain essentially unchanged over the past 15 years, the impact of newer systemic therapies on patient immunocompetence may influence treatment decisions.

Candidiasis, Oral↗
PubMed2007

The impact of oral disease and nonsurgical treatment on bacteremia in children.

BACKGROUND: The authors examine the role of dental disease and nonsurgical dental procedures in the incidence and duration of bacteremia in children. METHODS: The authors randomized a group of children to receive amoxicillin or a placebo before dental rehabilitation in an operating room setting. They collected eight blood draws at the following times: two minutes after intubation (draw 1); after dental restorations, pulp therapy and cleaning (draw 2); 10 minutes later (draw 3); and five draws during and after dental extractions (draws 4-8). The authors compared dental disease parameters and the type of dental procedures performed with the incidence and duration of bacteremia. RESULTS: The authors enrolled 100 children (aged 1-8 years) in the study. The incidence of bacteremia from draw 2 was 20 percent in the placebo group and 6 percent in the amoxicillin group (P = .07), and the incidence from draw 3 was 16 percent in the placebo group and zero percent in the amoxicillin group (P = .03). Subjects with higher gingival scores were more likely to have a bacteremia for draw 2 (P = .01). The authors found that subjects in the group with bacteremia for draw 3 had undergone more pulpotomies than did subjects in the group without bacteremia for draw 3 (3 +/- 2.5 standard deviation [SD] versus 1.5 +/- 1.6 SD, P = .04), while they found almost no differences for draw 2. CONCLUSIONS: This study suggests that gingival disease has an impact on bacteremia after dental restorations and prophylaxis. Although antibiotics have an impact, they do not eliminate bacteremia altogether.

Amoxicillin↗
PubMed1998

Interactions between non-immune host cells and the immune system during periodontal disease: role of the gingival keratinocyte.

Periodontal disease and inflammatory dermatoses, such as psoriasis, are characterized by the accumulation of dense inflammatory infiltrates immediately beneath the epithelial cell layer of the gingiva and skin, respectively. Dermatologists are increasingly aware that the epidermal keratinocyte probably contributes to inflammatory disease progression by secreting a number of pro-inflammatory cytokines and expressing various adhesion molecules. In psoriatic lesions, it is now believed that epidermal keratinocytes may also act as antigen-presenting cells and participate directly in the superantigenic activation of T-cell clones, some of which may initiate, contribute to, or maintain the disease process. Although the role of the host response in periodontal disease has been extensively studied over the years, very little is known about the contribution of the gingival keratinocyte to the inflammatory response. The available published information is discussed in this review, and we suggest that, like its epidermal counterpart, the gingival keratinocyte may participate actively in the pathogenesis of periodontal disease.

Antigen-Presenting Cells↗
PubMed1991

Oral prophylactic procedures and gingival health among Nigerian school children.

Various researchers have advocated the use of chewing sticks in community oral health programmes because they are readily available, cheaper than the toothbrush and paste, and are found to possess antiplaque properties. Oral health education is essential for enlightenment on good oral health maintenance. The study was thus aimed at educating children on how to maintain a good oral health (including the efficient use of various oral hygiene implements) and noting the impact on their gingival health. 120 school children with no gingival disease, aged 12 to 14 years, participated in the study. They were all examined intra-orally and their plaque scores were recorded. After two weeks of oral health education programmes, they were randomly assigned into three equal groups, each group using either the toothbrush/paste, the Massularia acuminata chewing stick or the Sorindeia warneckei chewing stick for three months. Their plaque scores and gingivitis incidence were recorded. 36.0% had gingivitis, 2.0% had periodontitis with pocketing greater than or equal to 5 mm, and about 3.0% had gingival recession. More toothbrush users than the chewing stick users in the study had gingivitis (P less than .05). The inherent danger in introducing unfamiliar oral hygiene procedures to children without close monitoring is highlighted. Whatever mode of oral hygiene is adopted for use in children, adequate supervision by knowledgeable parents and teachers, and close monitoring by oral health personnel is mandatory in order to ensure effective use.

Adolescent↗
PubMed2002

Oral health status of peri-urban schoolchildren in Accra, Ghana.

AIM: To update and add to the sparse information available on the dental disease experience of Ghanaian children. METHOD: A cross-sectional survey where all 4-16-year-old schoolchildren in a peri-urban community of Accra, Ghana, were examined. Three primary schools had been selected by the school authorities for the study. RESULTS: Plaque scores ranged from 78.9% in the 4-5-year-olds to a high of 97% in the 6-year-olds with the older age groups occupying intermediate levels. The proportion with calculus ranged from a low of 40% in the 4-5-year-olds to a high of 67% in the 13-16-year-olds. Gingival disease increased with age from slight to low in the lower age groups and increasing significantly from 12 years to 16 years. Caries experience was low to very low from a high of a DMFT score of 1.11 (SE 0.07 ) in the 7-9-year-olds to a low of 0.30 (SE 0.06 ) in the 13-16-year-olds. CONCLUSION: Sustained community preventive dental activity needs to be instituted in both rural and urban regions to prevent and control both caries and periodontal diseases and to prevent future increases in the caries rates as has been experienced in some developing countries.

Adolescent↗
PubMed1997

Risk for periodontal disease in patients with longstanding rheumatoid arthritis.

OBJECTIVE: To quantify periodontal disease in rheumatoid arthritis (RA) patients and controls, and to correlate the degree of destruction from periodontal disease and from RA. METHODS: Fifty RA patients were matched for age, sex, smoking status, and oral hygiene with 101 controls. Correlations between indices of chronic destruction in periodontal disease (gingival attachment loss) and in RA (Larsen radiographic score) were determined. RESULTS: Patients with longstanding active RA (mean +/- SD 13 +/- 8 years) who were receiving treatment with disease-modifying antirheumatic drugs (n = 46), corticosteroids (n = 38), or nonsteroidal antiinflammatory drugs (n = 43) had a higher rate of gingival bleeding (increased by 50%), greater probing depth (increased by 26%), greater attachment loss (increased by 173%), and higher number of missing teeth (increased by 29%) compared with controls. No correlation was found between the Larsen radiographic score and gingival attachment. CONCLUSION: Patients with longstanding active RA have a substantially increased frequency of periodontal disease, including loss of teeth, compared with controls. Antiinflammatory treatment interferes with periodontal disease and might have masked a possible correlation between the indices of chronic destruction in RA and periodontal disease.

Adult↗
PubMedDate not supplied

Periodontal status of diabetics compared with nondiabetics: a meta-analysis.

BACKGROUND: This meta-analysis was conducted to assess the association between diabetes mellitus and periodontal diseases by comparing the extent and severity of periodontal diseases between diabetics and nondiabetics. METHODS: A literature search was performed using MEDLINE database for published studies from January 1970 through October 2003 with manual search for references in relevant studies. This meta-analysis was based on 18 comparative cross-sectional studies, three prospective cohort studies and baseline data of two clinical trials that compared oral hygiene, gingival and periodontal status between diabetics and nondiabetics. Heterogeneity was obvious among included studies; therefore, the analysis using random-effects model was conducted. RESULTS: This study demonstrated that diabetics had significantly worse oral hygiene as measured by the average of plaque index (P1I), higher severity of gingival disease as measured by the average of gingival index (GI) and higher severity of periodontal disease as measured by the average of probing pocket depth (PPD) and clinical attachment loss (CAL). However, diabetics had similar extent of oral hygiene, gingival and periodontal disease as measured by percentages of surfaces or sites with specific scores of P1I, GI, bleeding on probing (BOP), PPD and CAL. CONCLUSIONS: Diabetics had a significantly higher severity but the same extent of periodontal disease than nondiabetics.

Adolescent↗