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[The prevalence of periodontal disease. Periodontal disease in black Africa. The impact of socioeconomic factors and cultural customs].

The lack of reliable and recent information about the oral and dental health conditions of many African countries is a serious object of concern. There is an urgent need of up-to-date information about the oral and dental diseases existing among the various African populations and about their deciding factors. This study takes stock of the periodontal diseases in black Africa and mention the influence of the socio-economic advancing and the cultural habits.

Adult↗

Bacteriocin production by Actinobacillus actinomycetemcomitans isolated from the oral cavity of humans with periodontal disease, periodontally healthy subjects and marmosets.

The ability of Actinobacillus actinomycetemcomitans to produce bacteriocin has rarely been reported. Antagonistic substance production may confer an important ecological advantage for the producer microorganisms, especially in a competitive ecosystem such as the oral cavity. In the present study, 75 A. actinomycetemcomitans strains isolated from the oral cavity of human patients with periodontal disease, periodontally healthy subjects and marmosets, as well as two reference strains (A. actinomycetemcomitans ATCC 29523 and FDC Y4) were evaluated for auto-, iso-, and heteroantagonistic activity. Fifty-one (68.00%) strains exhibited antagonistic activity; heteroantagonism was observed more often than isoantagonism. Isolated strains antagonized 17 different species of gram-positive and gram-negative bacteria from the oral and nonoral microbiota. Sensitivity to heat and to proteolytic enzymes constituted strong evidence that the antagonistic substance has a proteic nature. Taken together, our data enabled us to confirm that the antagonistic substance detected was a bacteriocin. The wide spectrum of activity indicates the possibility that more than one antagonistic substance is produced and that these substances play an important role in the ecological balance of the oral ecosystem.

Actinobacillus Infections↗

Clinical usefulness of microbiological diagnostic tools in the management of periodontal disease.

Periodontal diseases comprises a group of chronic inflammatory conditions affecting tooth supporting structures. It has been known for a long time that pathogenic oral bacteria colonizing the tooth surface are associated with the initiation of the disease process. However, to date, a dozen or so bacterial species have been implicated in the pathogenesis of periodontal disease and no one species by itself is synonymous with disease onset. This multibacterial etiology renders the diagnosis of active periodontal disease based on microbiological data difficult. Numerous studies have attempted to relate the usefulness of microbiological diagnostic aids such as microscopy, bacterial culture, immunological and enzymatic assays. Furthermore, recent technical advances have resulted in the use of nucleic acid probes and amplification techniques for the identification of genetic material belonging to potential periodontal pathogens. Despite the availability of a large number of microbiological testing protocols, identification of the microbial etiological agents remains hampered by the complexity of the microbial challenge during periodontal disease. This review discusses the clinical usefulness of these tests in detection and management of periodontal disease.

Bacteria↗

Polymorphism of the N-acetyltransferase (NAT2), smoking and the potential risk of periodontal disease.

Periodontal disease is a common multifactorial process that leads to bone destruction and tooth loss. Interactions of environmental and genetic factors determine the extent and severity of periodontal disease. Smoking is one of the risk factors for periodontal disease, and the risk may be influenced by the polymorphism of N-acetyltransferase (NAT2) via metabolism of smoke-derived xenobiotics. We therefore hypothesized that a NAT2 genotype would be a risk factor for periodontal disease. A total of 154 Caucasian subjects were assigned to one of two groups (1) no or mild and (2) severe periodontal disease based on radiographic (bone destruction) and clinical criteria (probing depth, attachment loss) and the number of teeth. In all subjects genotyping for mutations on NAT2 was performed by means of PCR and RFLP analysis. In the less-affected group genotyping showed a fraction of predicted slow and rapid acetylators (53.6% and 46.4%, respectively) corresponding to the normal distribution in Caucasians. Severely affected patients were predominantly slow acetylators, the odds ratios being between 2.38 and 5.02 for the NAT2-related risk depending on the outcome parameters chosen. Adjustment for age had no influence on these findings. Our data indicate that the slow acetylator phenotype is associated with a higher risk of periodontitis, especially with respect to the severity of the disease. Possible implications with respect to the risk associated with smoking are discussed.

Acetylation↗

The effect of oral hygiene instructions on diabetic type 2 male patients with periodontal diseases.

Periodontal disease and diabetes are two common chronic diseases affecting humans. The aim of this study was to assess the effect of oral hygiene instructions on periodontal disease among type 2 male diabetic Saudi subjects. Sixty subjects completed the study and were divided into three groups of 20: healthy (non-diabetic) with periodontal disease, type 2 diabetic with early or moderate periodontal disease, and type 2 diabetic with advanced periodontitis. The age ranged from 24-64 (42 +/- 13.60) years. The subjects were examined at King Saud University, College of Dentistry, Riyadh, Saudi Arabia. Oral hygiene practices and smoking habits were recorded. Oral hygiene instructions given to patients were to use an Oral B medium toothbrush and brush three times daily for 7 days using the by Bass technique for 2 minutes. Fasting blood glucose level (FBGL), gingival crevicular fluid (GCF), community periodontal index of treatment needs (CPITN), and plaque index (Pll) were used to assess patients' profiles at baseline and at recall visit after 7 days. The results showed there was a significant overall decrease in FBGL, baseline 172.67 mg/dl (+/-64.69) to recall visit 162.20 (+/-58.78) P = 0.000, and GCF volume decreased from.4041 micro l (+/-.1260) to .3698 micro l (+/-.1164) P = 0.000. There was a significant reduction in subjects' CPITN mean scores (from 13.98 (+/-8.24) to 13.32 (+/-8.97) P = 0.000), but there was no significant difference in Group 3 with advanced periodontitis, i.e., 22.25 (+/-1.37) to 22.30 (+/-1.38). There was more than a 47% reduction in the overall percentage of plaque scores. The decrease ranged from 82.27 (+/-19.34) to 34.45 (+/-17.04) at baseline and recall visit respectively. It is concluded oral hygiene instructions (a standardized regimen) has an effect on FBGL, GCF, CPITN, and PlI. It is also concluded CPITN is not very sensitive to assess change in periodontal status over a 7 days period. Further studies are needed among diabetic and healthy subjects with a larger sample size and over a longer period of time.

Adult↗

Current concepts in periodontal diseases.

Periodontal diseases are common oral diseases that afflict all humans to some degree. The major aetiological agent is dental plaque--the complex microflora which forms on teeth in the absence of effective oral hygiene. The interaction of the microbial flora and the periodontal tissues produces an inflammatory response and tissue breakdown. Recent information has categorized periodontal diseases on the basis of increased knowledge about the particular microorganisms associated with the different clinical conditions. In addition, the important role of host defences, in particular the phagocytic cellular elements, has allowed for a better understanding of the pathological processes. This knowledge is contributing towards the development of rational and effective therapy for all forms of periodontal diseases. Because of the widespread occurrence of periodontal diseases and their potential relationships to systemic conditions, it is important that medical practitioners should be able to recognize, and be conversant with methods of treatment of, these diseases.

Acute Disease↗

Periodontal disease and biomarkers related to cardiovascular disease.

Periodontal disease is a chronic infection of the gums characterized by a loss of attachment between the tooth and bone, and by bone loss. We evaluated cross-sectionally the association between periodontal disease and C-reactive protein (CRP), fibrinogen, factor VII, tissue plasminogen activator (t-PA), LDL-C, von Willebrand factor, and soluble tumor necrosis factor receptors 1 and 2. The final sample consisted of 468 men (ages 47-80 yrs), participating in the Health Professional Follow-up Study, who provided blood and were free of CVD, diabetes, and cancer. In multivariate regression models controlling for age, cigarette smoking, alcohol intake, physical activity, and aspirin intake, self-reported periodontal disease was associated with significantly higher levels of CRP (30% higher among periodontal cases compared with non-cases), t-PA (11% higher), and LDL-C (11% higher). Based on our data, periodontal disease showed significant associations with biomarkers of endothelial dysfunction and dyslipidemia, which may potentially mediate the association between periodontal and cardiovascular disease.

Age Factors↗

Inhibition of alveolar bone loss by matrix metalloproteinase inhibitors in experimental periodontal disease.

Periodontal disease is characterized by excessive host collagenase resulting in loss of gingival and periodontal ligament collagen and adjacent alveolar bone. Intragingival endotoxin injection induces a model of periodontal disease characterized by rapid bone loss with biochemical features similar to that of naturally occurring adult periodontitis. CH1766, a peptide with a zinc binding moeity which fits into the active site of the enzyme, and CH6631, a hydroxamic acid derivative with aryl-substituted sulphonamide residues, are inhibitors of matrix metalloproteinases (MMPIs) with differing inhibitory profiles as characterized by in vitro assays. In this study, endotoxin was injected into the gingivae of rats which were then treated orally with either 3 mg/kg or 30 mg/kg of one of the two inhibitory compounds. The gingival tissues were assessed for collagenase and gelatinase activity, plus three different pro-inflammatory cytokines. In addition, alveolar bone height in defleshed jaws was studied by computerized morphometric analysis and scanning electron microscopy. Both drugs reduced active and/or total MMP activity, in many cases to normal, and also partially normalized cytokine levels as well. A dose-response effect was seen with regard to amelioration of lipopolysaccharide-induced alveolar bone loss with both drugs. Other than studies with tetracyclines, this is the first report of beneficial effects of MMPIs in a model of periodontal disease, strongly suggesting that this class of agents could bring therapeutic benefit to patients with this disorder, and that periodontal disease can be used as a model to demonstrate in vivo efficacy of this class of drugs.

ADAM Proteins↗

Peripheral blood leukocyte populations in the elderly with and without periodontal disease.

Periodontal disease in the elderly has not been characterized. Initial reports suggest that the disease is common and severe. Deficiencies in the immune response have also been reported to occur in the elderly. Consequently it was hypothesized that aging-related changes in the immune response may contribute to the severity and occurrence of periodontal disease in the elderly. To test that hypothesis, the % and number of leukocytes and leukocyte subsets in the peripheral blood of elderly (65-75 years) subjects were tested and used as indicators of the immune potential of those individuals. Age and gender effects on several of the parameters tested were identified. With the exception of increased number of leukocytes in the elderly group with severe periodontal disease, no other alteration in the leukocyte parameters tested were identified. These results suggest that periodontal disease in the elderly was not associated with obvious changes in the leukocyte and leukocyte subsets in the peripheral blood due to aging.

Adult↗

[Computed tomography in the study of periodontal disease].

Periodontal disease, an affection of bacterial etiology, causes the destruction of the periodontal tissue. From both the diagnostic and the prognostic points of view, it is extremely important to evaluate the changes occurring in the alveolar bone in patients affected with periodontal disease. The information obtained by conventional radiographic techniques is usually poor due to the overlapping of anatomical structures and to the lack of an axial view of the structures. CT, thanks to millimetrical sections of the dental structures along the planes which parallel the hard palate, allows the evaluation of: 1) the size and the relationship between teeth roots, with no overlapping of anatomical structures; 2) bone thickness; 3) very early bone lesions around the teeth roots. The authors suggest CT as a valuable tool in the study of periodontal disease in its early stage and in the evaluation of advanced lesions, both before treatment and during follow-up, when it is important to check the results of conservative treatment.

Humans↗

Using antimicrobial agents to manage periodontal diseases.

Periodontal diseases are bacterial infections and anti-microbials have been shown to be useful in their treatment and prevention. State-of-the-art treatment of refractory forms of destructive periodontal disease presently includes adjunctive use of systemic antibiotics directed to eliminating or suppressing pathogenic subgingival bacteria. Also, local application of antimicrobials by subgingival deposition or their use as irrigants during periodontal therapy are soon likely to be major components of anti-infective management of periodontal diseases. A new approach to anti-infective periodontal therapy combines ultrasonic surgical debridement with antimicrobial irrigation.

Anti-Bacterial Agents↗

Host responses in the etiology and pathogenesis of periodontal disease.

Periodontal disease is an inflammatory condition of the supporting structures of teeth. This condition is actually considered to be caused by a number of different diseases, possibly associated with different etiologies, rather than a single disease. Due to limitations in our present understanding of cellular and molecular events involved in the pathogenesis of various periodontal diseases, many therapeutic failures still occur. For this reason, studies concerning the responses of the host to pathogenic bacteria are thought to be critically important. This review presents current opinions on the role of host responses in periodontal disease.

Antibody Formation↗

Periodontal disease and its association with systemic disease.

Periodontal diseases are oral disorders characterized by inflammation of the supporting tissues of the teeth. Usually, periodontitis is a progressively destructive loss of bone and periodontal ligament (loss of the attachment apparatus of the teeth). Periodontitis has documented risk factors, including but not limited to specific plaque bacteria, smoking, and diabetes mellitus. Initially, the link between systemic disease and periodontal diseases was thought to be unidirectional. Currently, there is increasing evidence that the relationship between these entities may be bidirectional. Recent case-control and cross-sectional studies indicate that periodontitis may confer a 7-fold increase in risk for preterm low birth weight infants and a 2-fold increase in risk for cardiovascular disease. These early reports indicate the potential association between systemic and oral health. Additionally, these studies support the central hypothesis that periodontal disease involves both a local and a systemic host inflammatory response. This knowledge of disease interrelationships may prove vital in intervention strategies to reduce patient risks and prevent systemic disease outcomes. Based on the current evidence of the periodontal-systemic disease connection, the purpose of this report is to help establish the groundwork for closer communication between physicians and periodontists in the military health care setting.

Cardiovascular Diseases↗