The classification of malocclusion

This systematic review considers the evidence available for a relationship between periodontal disease and rheumatoid arthritis. MEDLINE/PubMed, CINAHL, DOSS, Embase, Scopus, Web of Knowledge, MedNar, and ProQuest Theses and Dissertations were searched from the inception of the database until June 2012 for any quantitative studies that examined the association between periodontal disease and rheumatoid arthritis. Nineteen studies met our inclusion criteria. Good evidence was found to support an association between these conditions with regard to tooth loss, clinical attachment levels, and erythrocyte sedimentation rates. Moderate evidence was noted for C-reactive protein and interleukin-1β. Some evidence for a positive outcome of periodontal treatment on the clinical features of rheumatoid arthritis was noted. These results provide moderate evidence based on biochemical markers and stronger evidence with regard to clinical parameters that common risk factors or common pathologic processes may be responsible for an association between rheumatoid arthritis and periodontal disease. Further studies are required to fully explore both the biochemical processes and clinical relationships between these 2 chronic inflammatory conditions. There is a need to move from case-control studies to more rigorous studies using well-defined populations and well-defined biochemical and clinical outcomes as the primary outcome measures with consideration of potential confounding factors.

Periodontal Disease and Rheumatoid Arthritis A Systematic Review

Objective: To investigate the effects of an orally administered probiotic on the oral microbiota. Methods: A placebo-controlled, parallel study was conducted in 40 gingivitis subjects during 8 weeks. Treatment consisted on the administration of a daily tablet, either containing Lactobacillus reuteri or placebo. Unstimulated saliva and subgingival samples were collected and analysed by culture and PCR. Clinical and microbiological outcome variables were compared between and within groups. Results: There were no significant changes between and within the groups in the clinical variables. In saliva, total anaerobic counts after 4 weeks (p = 0.021) and counts of Prevotella intermedia after 8 weeks (p = 0.030), showed reductions in the test group. In subgingival samples, significant reductions in the changes baseline to 4 weeks were observed for P. gingivalis counts (p = 0.008). With PCR, L. reuteri ATCC-PTA-5289 was more frequently detected than L. reuteri DSM-17938. Conclusions: The effect of L. reuteri administered in tablets resulted in a reduction in the number of selected periodontal pathogens in the subgingival microbiota, without an associated clinical impact.

Probiotic effects of orally administered Lactobacillus reuteri‐containing tablets on the subgingival and salivary microbiota in patients with gingivitis. A randomized clinical trial

Periodontitis is a complex infectious disease that affects low-income individuals disproportionately. Periodontitis is associated with specific bacterial species and herpesviruses, and successful prevention and treatment of the disease is contingent upon effective control of these pathogens. This article presents an efficacious, highly safe, minimally invasive, practical and low-cost periodontal therapy that involves professional and patient-administered mechanical therapy and antimicrobial agents. The major components are scaling for calculus removal, periodontal pocket irrigation with potent antiseptics, and treatment with systemic antibiotics for advanced disease. Povidone-iodine and sodium hypochlorite have all the characteristics for becoming the first-choice antiseptics in the management of periodontal diseases. Both agents show excellent antibacterial and antiviral properties, are readily available throughout the world, have been safely used in periodontal therapy for decades, offer significant benefits for individuals with very limited financial resources, and are well accepted by most dental professionals and patients. Four per cent chlorhexidine applied with a toothbrush to the most posterior part to the tongue dorsum can markedly reduce or eliminate halitosis in most individuals. Systemic antibiotics are used to treat periodontopathic bacteria that are not readily reached by topical therapy, such as pathogens within gingival tissue, within furcation defects, at the base of periodontal pockets, and on the tongue, tonsils and buccal mucosae. Valuable antibiotic therapies are amoxicillin-metronidazole (250 mg of amoxicillin and 250 mg of metronidazole, three times daily for 8 days) for young and middle-aged patients, and ciprofloxacin-metronidazole (500 mg of each, twice daily for 8 days) for elderly patients and for patients in developing countries who frequently harbor enteric rods subgingivally. Scaling to remove dental calculus and the prudent use of inexpensive antimicrobial agents can significantly retard or arrest progressive periodontitis in the great majority of patients.

Low‐cost periodontal therapy

Background: With increase in the incidence of resistance to antibiotics, probiotics are emerging as a promising adjunctive periodontal therapy. The authors of this study evaluate the influence of probiotic (PROB) supplementation on ligature-induced periodontitis (LIP) and intestinal morphology in rats.Methods: Thirty-two rats were randomly divided into four groups: control (C), LIP, PROB, and LIP/PROB. In groups PROB and LIP/PROB, the PROB was administered orally by addition to the drinking water of the animals for 44 days. In groups LIP and LIP/PROB, the mandibular right first molar of the animals received a cotton ligature that was left in the same position for 14 days. All animals were euthanized 44 days after the start of the PROB supplementation. The jaws were resected and histomorphometric analyses were performed. The measurements included evaluation of attachment loss (AL) and alveolar bone level (ABL) on the distal root of the mandibular first molar. Samples of the duodenum, jejunum, and ileum wer...

Probiotic Therapy Reduces Periodontal Tissue Destruction and Improves the Intestinal Morphology in Rats With Ligature-Induced Periodontitis

Class III malocclusion represents a growth-related dentofacial deformity with mandibular prognathism in relation to the maxilla and/or cranial base. Its prevalence varies greatly among and within different races, ethnic groups, and geographic regions studied. Class III malocclusion has a multifactorial etiology, which is the expression of a moderate distortion of normal development as a result of interaction between innate factors or genetic hereditary with environmental factors. Various skeletal topographies of underlying Class III malocclusion are due to discrepancy in the maxillary and mandibular growth along with vertical and/or transverse problems apart from sagittal malformations. The spectrum of complications for Class III malocclusion ranges in gravity from dentoalveolar problems with functional anterior shift of the mandible to true skeletal problems with serious maxillomandibular discrepancies, which makes its diagnosis highly challenging in growing children. Concern regarding early treatment and the need for interceptive care in the case of Class III malocclusion has always been a dilemma, knowing that not all problems will be solved in these cases until maxillomandibular growth is further completed, and the long-term outcome of various treatment approaches may depend on the growth tendency of an individual. Interceptive treatment of Class III malocclusions should be undertaken if it prevents damage to the oral tissues and/or significantly reduces the amount or severity of future orthodontic and surgical interventions. This paper presents an overview of developing Class III malocclusion, with the emphasis on challenges and their solutions based on the best current available evidence.

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Developing Class III malocclusions: challenges and solutions.

Indices for measuring periodontitis: a literature review

Traditional tooth-supported and implant-supported fixed/removable restorations are currently used to replace teeth lost due to periodontal disease. This article reviews the existing literature for oral rehabilitation of partially edentulous periodontal patients with various designs of removable dental prosthesis (RDP), fixed dental prosthesis (FDP) and implant-supported single crown (SC), by addressing their (a) general features, (b) survival and complication rates, along with considerations for treatment planning in periodontal patients, and (c) preference by patients. To answer these issues, relevant articles were searched and critically analyzed, and their data were extracted. Data reviewed indicated that despite many advantages, implant-supported restorations have higher complication rates than tooth-supported restorations. Systematic reviews on conventional RDPs are lacking, but existing literature reviews provide limited evidence suggesting the use of RDPs with design modifications along with strict periodontal care in periodontal patients. Numerous systematic reviews on conventional FDPs and implant-supported restorations provide a moderate level of evidence favoring their survival in periodontal patients; however, for long-term success of these restorations, the patient's periodontal condition needs to be stabilized. In terms of patient preference, no restoration is superior, as they all are governed by their cost, advantages, and disadvantages. Thus, in the wake of existing weak evidence for prosthodontic rehabilitation of periodontal patients by these restorations (especially, conventional RDPs and for FDPs and SCs in implant-supported restorations), longitudinal studies with standardized treatment protocol and methodology are needed to evaluate and compare tooth-supported and implant-supported restorations in periodontal patients with regard to survival rates, cost, maintenance, and patient-centered outcomes.

Oral Rehabilitation Considerations for Partially Edentulous Periodontal Patients

Objectives: There are conflicting reports in the past literature documenting the tendency of anemia in patients with periodontitis. Hence, this study was undertaken to assess whether periodontitis may cause an anemic state, by evaluating and comparing the red blood cell count, levels of hemoglobin, hematocrit, erythrocyte sedimentation rate (ESR), serum iron and serum ferritin between subjects with and without periodontitis. Methods: In this cross-sectional study, 140 systemically healthy subjects of both sexes (mean age 46 years) were recruited as control group (50 subjects without periodontitis) and study groups comprising 30 patients each with mild, moderate and severe chronic generalized periodontitis. Periodontal parameters and orthopantamographs were taken for all the groups and then 5 mL venous blood samples were sent for complete blood count and biochemical analysis. Inter-group and intra-group comparisons were performed for all the assessed parameters Results: The periodontal parameters were significantly higher (P≤.05) in periodontitis patients. Except for the ESR, which was significantly higher (P=.03) in the mild periodontitis group than the control group, hematological and biochemical parameters were not significantly different (P>.05) among the study groups or between the control and study groups. This difference was not evident even among the male and female subjects of both control and study groups (P>.05). Conclusions: Within the limits of this cross-sectional study, it can be concluded that the presence and severity of periodontitis may not affect the hematological and biochemical parameters of an individual. Further long term studies are however encouraged to validate these findings. (Eur J Dent 2012;6:287-294)softening of enamel (erosion). In respect to the chemical variables tested, despite not statistically significant, the pH seems to have more influence on the erosive potential of these drinks. (Eur J Dent 2007;1:10-13)

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Similar hematological and biochemical parameters among periodontitis and control group subjects.

To cite this article: Int J Dent Hygiene9, 2011; 296–302 DOI: 10.1111/j.1601-5037.2011.00506.x Dhingra K, Vandana KL. Management of gingival inflammation in orthodontic patients with ozonated water irrigation – a pilot study.



Abstract:  Objective:  Ozonated water irrigation has recently been tried for its antimicrobial and anti-inflammatory effects in treatment of periodontitis. During orthodontic treatment, gingival inflammation occurs along with increased lactate dehydrogenase (LDH) enzyme levels in gingival crevicular fluid (GCF). Thus, the aim of this pilot study was to evaluate the clinical effects of a single subgingival irrigation with ozonated water on gingival inflammation in orthodontic patients and also to correlate the clinical effects with LDH enzyme activity in GCF.



Methods:  Fifteen systemically healthy orthodontic patients (seven men and eight women, mean age 17.3 years) with full-mouth brackets were included in this prospective, cross-sectional, clinical and laboratory investigation. Clinical parameters, LDH enzyme activity and GCF volume were measured at baseline (0 day) followed by subgingival irrigation with 0.01 mg l−1 ozonated water. These parameters were again assessed on 14th and 28th day.



Results:  There was significant (P < 0.05) reduction in values of clinical parameters, GCF LDH activity and GCF volume after subgingival irrigation with ozonated water. Also, a significant correlation (r = 0.50, P = 0.01) was observed only between the post-treatment changes of plaque index and LDH values, among the clinical parameters assessed.



Conclusions:  A single subgingival irrigation of 0.01 mg l−1 ozonated water can effectively reduce the gingival inflammation in orthodontic patients, which is also reflected in the reduction of LDH enzyme levels. However, further randomized controlled trials are required to validate the use of ozone irrigation in orthodontic patients for plaque control measures.

Kunaal Dhingra

Papers

Developing Class III malocclusions: challenges and solutions.

Indices for measuring periodontitis: a literature review

Oral Rehabilitation Considerations for Partially Edentulous Periodontal Patients

Similar hematological and biochemical parameters among periodontitis and control group subjects.

Management of gingival inflammation in orthodontic patients with ozonated water irrigation--a pilot study.