Showing papers in "Journal of Clinical Periodontology in 1988"

Bacteroides gingivalis, Bacteroides intermedius and Actinobacillus actinomycetemcomitans in human periodontal diseases

Abstract: Bacteroides gingivalis, Bacteroides intermedius and Actinobacillus actinomycetemcomitans seem to be major pathogens in advancing periodontitis in man. First, these organisms are recovered in higher prevalence and proportions from progressive periodontitis lesions than from quiescent periodontal sites. Second, antibody levels against B. gingivalis and A. actinomycetemcomitans are markedly elevated in serum and gingival crevice fluid of periodontitis patients compared to normal controls. Third, B. gingivalis and B. intermedius elaborate potent proteases and A. actinomycetemcomitans various noxious substances which have the potential to perturb important host defenses and to disintegrate key constituents of the periodontal tissues. Monitoring these bacteria in advanced periodontal lesions may greatly assist the assessment of treatment efficacy and risk of further periodontal breakdown.

The predominant cultivable microbiota of active and inactive lesions of destructive periodontal diseases

Abstract: Subgingival plaque samples were taken from active and inactive lesions in 33 subjects exhibiting active destructive periodontal diseases Active diseased sites were those which showed a significant loss of attachment within a 2-month interval as computed by the "tolerance method" The predominant cultivable species from 100 active sites were compared with those found in 150 inactive sites of comparable pocket depth and attachment level loss Among the 33 subjects, W recta, B intermedius, F nucleatum, B gingivalis and B forsythus were elevated more often in active sites; whereas, S mitis, C ochracea, S sanguis II, V parvula and an unnamed Actinomyces sp were elevated in inactive sites The likelihood of a site being active was increased if B forsythus, B gingivalis, P micros, A actinomycetemcomitans, W recta, or B intermedius were detected in that site, and decreased if S sanguis II, the Actinomyces sp, or C ochracea were detected

Chemotherapeutic agents for controlling plaque and gingivitis

Abstract: There has been a vigorous search for many years for chemical agents that could supplement or even supplant patient-dependent mechanical plaque control and thus reduce or prevent oral disease. 5 categories of agents or approaches have been considered: (1) broad spectrum antiseptics, (2) antibiotics aimed at specific bacteria, (3) single or combinations of enzymes that could modify plaque structure or activity, (4) non-enzymatic dispersing or modifying agents and (5) agents that could affect bacterial attachment. The success of these approaches can be evaluated clinically by the use of standard scoring methods for measuring plaque and gingivitis and their safety established by soft tissue and microbiologic examination. Antiseptic agents have received the bulk of the attention over the years. At present, only 2 antiseptics, the bis-biguanide, chlorhexidine gluconate (Peridex) and a combination of phenol related essential oils (Listerine), have developed sufficient supporting data in 6-month (or longer) studies to gain the approval of the Council On Dental Therapeutics of the American Dental Association. On the basis of short-term studies, cetylpyridinium chloride, zinc and copper salts, sanguinarine and octenidine warrant continued study as does stannous fluoride at an appropriate concentration. On the basis of current research, a new generation of more specific antibacterial agents that interfere with attachment to pellicle can be developed. It is hard to predict, however, that they will affect gingivitis, at least until there is more information on what specific organisms should be targeted.

Guided tissue regeneration in degree II furcation-involved mandibular molars. A clinical study.

Abstract: The present clinical trial was designed to evaluate the regenerative potential of the periodontal tissues in degree II furcation defects at mandibular molars using a surgical treatment technique based on the principles of guided tissue regeneration. The patient sample included 21 subjects, 22-65 years of age. The patients selected had periodontal lesions in the right and left molar regions including advanced periodontal tissue destruction within the interradicular area. After an initial examination, each patient received a series of full-mouth scalings and root planings. 2-3 months later, they were recalled for a baseline examination including assessment of plaque, gingivitis, probing depths and probing attachment levels. The furcation involved molars were randomly assigned in each patient to either a test or a control treatment procedure. The test procedure included the elevation of mucoperiosteal flaps at the buccal and lingual aspect of the alveolar process. The inner surface of each flap was carefully curetted to remove epithelium and granulation tissue. The root surfaces were scaled and planed. A teflon membrane was adjusted to cover the entrance of the furcation area and the adjacent root surfaces as well as a portion of the alveolar bone apical to the crest. The flaps were repositioned and placed on the outer surface of the membrane and secured with interdental sutures which were removed after 10 days of healing. Following surgery, the patients were instructed to rinse the mouth twice daily with chlorhexidine gluconate. A second surgical procedure was performed after a healing period of 1-2 months to remove the teflon membrane.(ABSTRACT TRUNCATED AT 250 WORDS)

The role of black‐pigmented Bacteroides in human oral infections

Abstract: Today, 10 black-pigmented Bacteroides (BPB) species are recognized The majority of these species can be isolated from the oral cavity BPB species are involved in anaerobic infections of oral and non-oral sites In the oral cavity, BPB species are associated with gingivitis, periodontitis, endodontal infections and odontogenic abscesses Cultural studies suggest a specific role of the various BPB species in the different types of infection Bacteroides gingivalis is closely correlated with destructive periodontitis in adults as well as in juveniles Bacteroides intermedius seems to be less specific since it is found in gingivitis, periodontitis, endodontal infections and odontogenic abscesses The recently described Bacteroides endodontalis is closely associated with endodontal infections and odontogenic abscesses of endodontal origin There are indications that these periodontopathic BPB species are only present in the oral cavity of subjects suffering from periodontal breakdown, being absent on the mucosal surfaces of subjects without periodontal breakdown BPB species associated with healthy oral conditions are Bacteroides melaninogenicus, Bacteroides denticola and Bacteroides loescheii There are indications that these BPB species are part of the normal indigenous oral microflora Many studies in the past have documented the pathogenic potential and virulence of BPB species This virulence can be explained by the large numbers of virulence factors demonstrated in this group of micro-organisms Among others, the proteolytic activity seems to be one of the most important features Several artificial substrates as well as numerous biological proteins are degraded These include anti-inflammatory proteins such as alpha-2-macroglobulin, alpha-1-antitrypsin, C3 and C5 complement factors and immunoglobulins B gingivalis is by far the most proteolytic species, followed by B endodontalis Like other bacteria, the lipopolysaccharide of B gingivalis has shown to be active in bone resorption in vitro and is capable in stimulating interleukin-1 production in human peripheral monocytes Based on the well documented association with periodontal disease and the possession of relevant virulence factors, BPB species must be considered as important micro-organisms in the etiology of oral infections B gingivalis seems to be the most pathogenic and virulent species

Clinical, microbiological and immunological features of subjects with destructive periodontal diseases.

Abstract: 76 subjects with prior evidence of destructive periodontal diseases were monitored clinically and immunologically every 2 months for up to 5 years. Clinical parameters measured included bleeding on probing, gingival redness, plaque accumulation, suppuration, pocket depth and attachment level. Blood samples were taken by venipuncture and serum antibody levels to a series of 18 subgingival species determined. 33 of these subjects showed evidence of active disease during the monitoring period, based on changes in attachment level measurements assessed using the tolerance method of analysis. Mean attachment loss in these 33 subjects varied from 1.4 mm to 9.0 (median value 3.4 mm) and subjects whose mean attachment level was above the median showed a higher % of pockets greater than 3 mm and more suppuration. Severity of gingival inflammation related poorly to mean attachment loss. Subgingival plaque samples were taken from the active site(s) and from control sites of equal pocket depth and attachment loss in the same active disease subjects, prior to therapy, for predominant cultivable microbiota studies. 50 randomly selected isolates were identified from each sample. Predominant cultivable species in 170 pretreatment active and inactive sites combined (8500 isolates) were enumerated. The most frequently detected species were F. nucleatum (112 sites) and S. intermedius (106 sites), although the predominant species in the samples from each subject differed. The distribution of putative pathogens differed among subjects. For example, A. actinomycetemcomitans was found in 21 samples in 11 subjects and B. forsythus was found in 18 samples from 10 individuals. Antibody response patterns to the 18 subgingival species also varied among subjects.(ABSTRACT TRUNCATED AT 250 WORDS)

Description and clinical evaluation of a new computerized periodontal probe‐the Florida Probe

Abstract: A new periodontal probing system has been developed which incorporates the advantages of constant probing force, precise electronic measurement to 0.1 mm and computer storage of the data. The system includes a probe handpiece, displacement transducer with digital readout, foot switch, computer interface and personal computer. A unique movable arm design enables the probe handpiece to maintain smooth operation and makes it easy to clean and sterilize. Electronic recording of the data (actuated by pressing a foot switch) eliminates errors which occur when probe tip markings are read visually and the data are called to an assistant. Computer storage and analysis of the data facilitates detecting changes in pocket depth and attachment level by rapidly comparing data recorded at different visits. The system was evaluated in 3 experiments using a 0.4 mm diameter tip and a 25 g probing force. The standard deviation of repeated pocket depth measurement was less (0.58 mm versus 0.82 mm) than that of a common probe. With paired readings referenced to an occlusal stent, the standard deviation of repeated attachment level measurements was 0.28 mm. A loss of attachment level was detected to a certainty of 99% with less than a 1 mm change. This is a significant improvement over common probes, which require a 2-3 mm change for equivalent positive identification of change in attachment level.

Periodontal diseases in adult Kenyans

Abstract: This study comprised 1131 persons who constitute a stratified random sample of the entire population aged 15-65 years in Machakos District, Kenya. Each person was examined for tooth mobility, plaque, calculus, gingival bleeding, loss of attachment and pocket depth on the mesial, buccal, distal and lingual surface of each tooth. The oral hygiene was poor with plaque on 75-95% and calculus on 10-85% of the surfaces depending on age. Irrespective of age, pockets greater than or equal to 4 mm was seen on less than 20% of the surfaces, whereas 10-85% of the surfaces had loss of attachment greater than or equal to 1 mm. The proportion of surfaces per individual with loss of attachment greater than or equal to 4 mm or greater than or equal to 7 mm, and pocket depths greater than or equal to 4 mm or greater than or equal to 7 mm, respectively, showed a pronounced skewed distribution, indicating that in each age group, a subfraction of individuals is responsible for a substantial proportion of the total periodontal breakdown. The individual teeth within the dentition also showed a marked variation in the severity of periodontal breakdown. Our findings provide additional evidence that destructive periodontal disease should not be perceived as an inevitable consequence of gingivitis which ultimately leads to considerable tooth loss. A more specific characterization of the features of periodontal breakdown in those individuals who seem particularly susceptible is therefore warranted.

Periodontal status in relation to age and tooth type. A cross-sectional radiographic study.

Abstract: The purpose of the present study was to assess by radiographic means the pattern of destructive periodontal disease within the dentition of individuals of different ages. Full-mouth series of intra-oral radiographs from 531 dentate individuals aged 25-75 years were examined with respect to number and type of remaining teeth, location of the alveolar bone in relation to the cemento-enamel junction and presence of angular bony defects. The assessments of alveolar bone levels and angular bony defects were performed at the approximal surfaces of all teeth present. The results showed that although most individuals had experienced a reduction in alveolar bone height with age, only a small number of subjects had developed advanced breakdown of the periodontium. Hence, pronounced bone loss was observed in only 11% of the subjects and was non-existent in ages below 35 years. 23% of the individuals accounted for 3/4 of the total number of sites with bone level values (bone loss) of greater than or equal to 6 mm. Out of the total number of tooth sites examined, 28% showed no bone loss, while 13% demonstrated pronounced periodontal tissue breakdown. Angular bony defects were found at 8% of all teeth examined and were most frequent at the maxillary first premolars. Teeth in the incisor regions consistently showed the highest frequency of advanced alveolar bone loss and the lowest frequency of normal tissue support, while corresponding figures for teeth in the molar regions were found to be the opposite. However, molars were the most frequently missing teeth.

The mechanism of action of chlorhexidine. A study of plaque growth on enamel inserts in vivo.

Abstract: Controversy exists concerning the mode of action of chlorhexidine in plaque inhibition This study attempted to determine whether an oral reservoir of chlorhexidine was necessary for plaque inhibition Plaque growth on enamel under the influence of topically applied or rinsed chlorhexidine was closely monitored by clinical scoring, bacterial culturing and scanning electron microscopy Thus, 3 subjects wore removable acrylic appliances containing enamel inserts In the first regimen, inserts on one side of the appliances were exposed to 02% chlorhexidine and on the other, water for 1 min twice a day for 14 days In the second regimen, subjects rinsed with 02% chlorhexidine for 1 min twice a day for 14 days with the appliances in situ Results demonstrated that plaque growth assessed by the 3 study methods was very small on chlorhexidine-treated inserts by comparison with water-treated specimens Importantly, inserts treated with chlorhexidine topically or by rinsing could not be distinguished by any method of evaluation It is concluded that chlorhexidine achieves plaque inhibition as a result of an immediate bactericidal action during the time of application and a prolonged bacteriostatic action as a result of adsorption to the pellicle coated enamel surface Consistent with other clinical studies, it is apparent that a progressively desorbing oral reservoir of antiseptic is not the mechanism by which chlorhexidine achieves plaque inhibition on teeth

Computer-assisted densitometric image analysis in periodontal radiography. A methodological study

Abstract: A videobased computer assisted densitometric image analysis (CADIA) system to quantify alveolar bone density changes on standardized dental radiographs was tested. An algorithm was used for grey level correction of a subsequent image to the baseline image. Quantitative information regarding positive and/or negative grey level changes were obtained automatically. Comparison of the ability of CADIA to detect surgically induced bone loss with interpretation of digital subtraction images and conventional radiographic interpretation revealed that CADIA was the most sensitive of the 3 methods, followed by interpretation of digital subtraction images which was considerably more sensitive than conventional radiographic interpretation. CADIA was capable of assessing differences in alveolar bone changes due to periodontal surgery between sites exposed to ostectomy/osteoplasty and control sites and sites exposed to periodontal surgery without ostectomy/osteoplasty. Finally, CADIA was capable of assessing differences in remodeling activity over 4-6 weeks after periodontal surgery between 45 surgical sites and 45 control sites. The system offers an objective method to quantitatively follow alveolar bone density changes over time and appears to be the most sensitive of previously described radiographic interpretation techniques.

Detection of high-risk groups and individuals for periodontal diseases. Evidence for the existence of high-risk groups and individuals and approaches to their detection.

Abstract: It is argued that the periodontal diseases can no longer be regarded as universally prevalent conditions to which all members of the world's population are at equal risk if they fail to practise good oral hygiene. Rather, they should be regarded as a range of different diseases for each of which certain individuals, which together comprise certain minority groups, are at relatively high risk. The epidemiological evidence for the existence of high-risk groups is reviewed, from which it is concluded that world-wide the prevalence of severe destructive periodontitis is of the order of only 7-15% of the adult dentate population. A working classification of the different types of gingivitis and periodontitis is offered, as is a summary of the theoretically possible approaches to the detection of high-risk groups and individuals which are explored in detail in subsequent papers. Successful identification of such individuals will permit scientifically valid, rational and targetted prevention and treatment.

Role of "diseased" root cementum in healing following treatment of periodontal disease. A clinical study.

Abstract: This clinical trial was undertaken to examine whether root debridement in the treatment of periodontal disease must include the removal of the exposed cementum in order to achieve periodontal health. The study included 11 adult patients with moderate to advanced periodontal disease. In a split-mouth design, the dentition of each patient was by random selection divided into test- and control quadrants comprising the incisors, canines and premolars. Following a baseline examination, all patients were given a case presentation and a detailed instruction in self-performed oral hygiene measures. The patients were then subjected to periodontal surgery. Following reverse bevel incisions, buccal and lingual mucoperiosteal flaps were elevated and all granulation tissue was removed. In 2 jaw quadrants (control quadrants) in each patient, the denuded root surfaces were carefully scaled and planed in order to remove soft and hard deposits as well as all cementum, using hand instruments and flame-formed diamond stones. In the contralateral quadrants (test quadrants) the roots were not scaled and planed but soft microbial deposits were removed by polishing the root surfaces with the but soft microbial deposits were removed by polishing the root surfaces with the use of rubber cups, interdental rubber tips and a polishing paste. Calculus in the test quadrants was removed by the use of a curette, but precaution was taken to avoid the removal of cementum. The flaps were repositioned to their original level and sutured. The patients were following active treatment enrolled in a supervised maintenance care program including "professional tooth cleaning" once every 2 weeks for a 3-month period.(ABSTRACT TRUNCATED AT 250 WORDS)

Relationship between lactate dehydrogenase and myeloperoxidase levels in human gingival crevicular fluid and clinical and microbial measurements.

Abstract: The present study was designed to determine, in a cross-sectional study, whether there was any relationship between levels of lactate dehydrogenase (LDH) and myeloperoxidase (MPO) in gingival crevicular fluid (GCF) and clinical periodontal status or microbial parameters. Another objective was to determine, in a longitudinal study, the effect of a single session of root planning on GCF levels of LDH and MPO and the relation to changes in clinical and microbial measurements. 15 and 12 test subjects with moderate to severe periodontal disease were seen in the cross-sectional and longitudinal study, respectively. 1 healthy and 2 diseased sites were evaluated in each subject. Higher LDH and MPO levels in GCF were closely associated with higher clinical and microbial signs of periodontal disease. Root planing was effective in reducing these enzymes in GCF, with an accompanying decrease in clinical and microbial signs associated with disease. The return of LDH to baseline levels at 3 months after instrumentation, without a corresponding return of clinical signs of disease, may serve as a marker for subclinical periodontal pathology.

Probing depth, attachment loss and gingival recession. Findings from a clinical examination in Ushiku, Japan.

Abstract: The present investigation describes probing pocket depth, probing attachment level and recession data from 319 randomly selected subjects, aged 20-79 years, from Ushiku, Japan. The findings are reported as mean values, frequency distributions and percentile plots of the 3 parameters at buccal, interproximal and lingual surfaces of single rooted (incisors, canines, premolars) and molar teeth. Inter-as well as intra-examiner errors for probing pocket depth and probing attachment levels were assessed and found to be small. The data reported revealed that practically all subjects studied had one or more sites in the dentition affected by destructive periodontal disease and that the severity of disease increased with age. It was further observed that in each age group, molars had suffered more attachment loss than single rooted teeth and that the interproximal surfaces as a rule had lost more periodontal tissue support than corresponding buccal and lingual surfaces. The attachment loss difference observed between different surfaces of a given tooth or a group of teeth, however, was comparatively small. In the age groups between 20-59 years, advanced destructive periodontal disease was found in a small subgroup of the subject sample, while after the age of 60 years, widespread destructive periodontitis was common. An attempt was made to examine the progression of destructive disease with age by comparing the frequency distributions of sites with attachment loss of greater than or equal to 3 mm in subjects of different age groups. The data suggested that in younger subject groups, progression was confined to a subset of individuals, while in older age groups, more subjects and sites became involved. A major feature of destructive periodontal disease in older individuals was the accompaniment of attachment loss with recession at the gingival margin. Deep pockets were relatively infrequently detected, while advanced loss of attachment (with recession) occurred at many sites.

Remodelling of interdental alveolar bone after periodontal flap procedures assessed by means of computer‐assisted densitometric image analysis (CADIA)

Abstract: The purposes of this study were to evaluate digitized images from standardized radiographs for quantitative changes in alveolar bone density following periodontal surgical procedures, and to correlate these changes to the changes in the clinical parameters P1I, GI, PD, AL. 14 crown-lengthening procedures for restorative purposes were performed in 13 patients and 15 modified Widman flaps were performed in 15 patients, providing 61 surgical interdental test sites and 61 matching controls. Standardized radiographs were obtained immediately post-operatively, and at 1 and 6 months postsurgically. Digitized images were obtained from the radiographs by means of a video camera linked to an image processor and a computer. Quantitative information regarding density changes within windows covering the interdental alveolar crest was obtained after superimposition and grey-level correction of images to be compared. The results indicated statistically significantly more density loss 4 to 6 weeks postsurgically at test sites treated by periodontal surgical procedures compared to corresponding controls. Significant differences in the remodelling activity between the patients exposed to crown lengthening procedures for restorative purposes and the periodontitis patients in the period 1 to 6 months postsurgically were evident. CADIA assessed differences in the tissue changes in the healing phase following periodontal surgical procedures, which were not detected by the clinical variables applied.

The total protein concentration of gingival crevicular fluid. Variation with sampling time and gingival inflammation.

Abstract: The total protein concentration of gingival crevicular fluid (GCF), sampled repeatedly over a 10-min period with the minimum of physical irritation to the sulcus, was evaluated in a group of 32 healthy adolescents The mean concentration of the 1st sample was comparable to that of normal tissue fluids and lymph, irrespective of the state of inflammation of the sample site However, during repeated sampling, the values rose to resemble serum protein levels, except at those sites with no clinically detectable inflammation Gel electrophoretic analysis confirmed the increasing proportion of serum-derived molecules in the more proteinaceous GCF samples The results demonstrate the extreme sensitivity of the gingival vasculature to GCF sampling and consequently the need for accurate standardisation of GCF collection protocols This will apply particularly when compositional data is to be normalised with respect to the total protein content or when the levels of a serum constituent are being examined

Microbial succession in recolonizing deep periodontal pockets after a single course of supra- and subgingival debridement.

Abstract: In the present study, the effect of supra and subgingival plaque debridement on the dynamics of the subgingival microflora in deep pockets was investigated. 8 adult periodontitis patients participated in the study. In each patient, 4 clinically diseased sites were investigated microbiologically by phase contrast microscopy for the determination of both the %s as well as the total numbers of spirochetes and motile rods and by anaerobic cultivation for the determination of the different black-pigmented Bacteroides species. After base-line examination, patients were treated by mechanical removal of supra- and subgingival plaque deposits. 2 and 8 weeks after treatment, clinical and microbiological parameters were re-evaluated. During the experimental period, no oral hygiene procedures were performed in order to achieve fast recolonization of the pockets. Treatment resulted in a significant reduction in probing pocket depth and gain of probing attachment. 2 weeks after treatment, no further improvements could be observed. A positive correlation was found between the reduction in probing pocket depth and decrease in Bacteroides gingivalis (P less than 0.009) and between gain in probing attachment and reduction in the % of B. gingivalis (P less than 0.009). No correlation between these clinical parameters and B. intermedius, spirochetes or motile rods was apparent. An inverse relationship between B. gingivalis and B. intermedius was observed. We found that changes in %s of spirochetes and motile rods are not correlated with changes in total numbers of these bacterial groups. It was concluded that monitoring of %s of micro-organisms may not supply rational information on the microbiological conditions of the subgingival area.

Drugs and the periodontium

Abstract: The periodontium and periodontal disease activity can be affected by systemic drug therapy. Many drugs can have an adverse effect on the periodontium, i.e., gingival hyperplasia. Alternatively, some drugs can modify the inflammatory and immunological responses of the periodontal tissues to bacterial plaque. The aim of this review is to evaluate the effects of drug therapy on the periodontium and periodontal disease activity, and where possible, to relate such changes to the pharmacodynamics of the drugs considered. Drugs which have been reported to affect the periodontium can be categorised as follows: anti-epileptics, immunosuppressants, corticosteroids, non-steroidal anti-inflammatory drugs and hormones. Those drugs whose pharmacodynamics are clearly established and which affect the rate of periodontal disease activity, may provide information on the mechanisms of periodontal destruction. Finally, the mechanisms of drug-induced gingival hyperplasia (overgrowth) are discussed in relationship to the drugs' pharmacodynamics and pharmacokinetics.

Relationship of subgingival microbial complexes to clinical features at the sampled sites

Abstract: Subgingival plaque samples from 100 active destructive periodontal lesions and 150 inactive subgingival sites in 33 subjects were analyzed by predominant cultivable microbiota techniques, 50 isolates were characterized from each sample and where possible, the isolate was placed in 1 of 134 microbial species or groups The sites were clustered on the basis of the proportions of all of the species detected in each sample using a minimum similarity matching coefficient and an average unweighted linkage sort 10 clusters containing 166 sites were formed which exhibited > 35% minimum similarities All clusters were made up of sites from multiple subjects and were formed on the basis of different combinations of micro–organisms Certain complexes of microorganisms appeared to relate to the severity of periodontal destruction and the activity of the sampled site The combination of F nucleatum, B forsyth and W recta (cluster VII) or B gingivalis, B intermedius and S intermedius (cluster VIII) distinguished clusters made up of sites which on average had the most attachment loss and the deepest pockets These clusters contained the highest proportions of active sites and sites which lost > 3 mm of attachment after therapy Clusters dominated by V parvula (cluster III), the Actinomyces sp (cluster X) or the combination of S sanguis II, S mitis, V parvula and S intermedius (cluster II) were made up of sites which exhibited less active disease and responded more favorably to therapy Sites in other clusters exhibited moderate levels of prior destructive disease and disease activity status closer to the mean values for all 250 sites These clusters were dominated by S intermedius, E nucleatum and E corrodens; F nucleatum, S intermedius, E corrodens and W recta; S xylosusi; B inlermedius and E corrodens; C oehracea, W recta and B intermedius 83% of sites from refractory subjects fell into cluster groups, but only 53% of sites from subjects who responded well to therapy, suggesting a greater homogeneity of the microbiotas in subgingival sites of refractory subjects The cluster analysis suggested complexes of micro-organisms which might merit further investigation in human clinical studies as well as in mixed infection models

The role of dental plaque in gingivitis and periodontitis.

Abstract: A dynamic equilibrium between the periodontal microbiota and the host generally results in a clinical state of periodontal health, characterized by minimal inflammatory changes in the marginal gingival tissues. Maintenance of health is most easily achieved by controlling the resident mass of bacteria. In rare instances, control of specific microorganisms may be indicated. Lack of microbial control may lead to an imbalance between the microbiota and the host due to a markedly increased microbial mass and/or increased virulence of the micro-organisms present. Such alterations in the host-parasite equilibrium may result in transient episodes of tissue destruction and. in the long term, to cumulative damage to the periodontal tissues.

Methods of evaluating periodontal disease data in epidemiological research.

Abstract: 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)

Repair of periodontal furcation defects in beagle dogs following reconstructive surgery including root surface demineralization with tetracycline hydrochloride and topical fibronectin application

Abstract: This study examines the effects of root surface demineralization and topical fibronectin as adjuncts to reconstructive periodontal surgery. In 14 beagle dogs, horizontal periodontal defects were surgically induced around the mandibular premolars followed by a 6-week period without plaque control. Reconstructive surgery of the defects was subsequently carried out. The root surfaces were debrided and superficially demineralized with citric acid or tetracycline hydrochloride, with or without subsequent application of fibronectin. Mucoperiosteal flaps were raised to cover most of the crowns and sutured. The animals were sacrificed 12 weeks after surgery and block sections of the teeth and surrounding tissues were processed for histology. Analysis included incidence of furcation defects presenting with an epithelial lining, quantification of connective tissue repair relative to the furcation circumference, and regeneration of alveolar bone relative to the furcation defect height. The incidence of root resorption and ankylosis was also analyzed. Within the limitations of this study it was concluded that: (1) citric acid conditioning of the root surface frequently resulted in complete connective tissue repair of the furcation defect; (2) root resorption and ankylosis were prevalent features of the healing response; (3) citric acid and tetracycline treatment had similar potential to induce connective tissue repair and resulted in corresponding incidences of root resorption and ankylosis; (4) application of fibronectin to demineralized root surfaces did not enhance the amount of connective tissue repair and did not alter the pattern of root resorption and ankylosis.

Detection of high-risk groups and individuals for periodontal diseases. Clinical assessment of the periodontium.

Abstract: The fundamental concepts of measuring periodontal diseases and the interpretation of such information as an historical record of disease, rather than disease activity, emphasises the need for improved diagnostic and prognostic tests. Criteria for an indicator of disease activity were suggested and an index fulfilling these should allow sites to be categorised as "active", quiescent or healing, and enable one to predict the risk of future disease activity. The ability of current measurements and indices, routinely used during clinical assessments of periodontal diseases, to fulfill the suggested criteria was considered and rejected in all cases. It is concluded that clinical parameters are only capable of identifying disease retrospectively, indicating the need for longitudinal, rather than cross-sectional studies in the search for clinical and laboratory markers of disease activity and susceptibility.

Clinical and microbiological effects of root debridement in periodontal furcation pockets

Abstract: The aim of the present study was to investigate longitudinally over 52 weeks the clinical and microbiology effects of plaque control and root debridement at molar furcation sites. The results were compared with changes at non-molar sites. 24 non-molar sites and 31 grade II molar furcation sites with probing depth ≥5.0 mm were monitored in 11 patients. Clinical measurements consisted of plaque scores, probing depths, and changes in probing attachment level. Microbiological monitoring was carried out with phase-contrast microscopy and anaerobic culturing. The debridement resulted in improvement in probing measurements and microbiological counts for both groups of sites. A slightly less favorable clinical response was noted for molar furcation sites. Higher post-operative microbiological counts were found throughout the 52-week, observation period for molar furcation sites. Sites with probing attachment loss showed higher microbial counts and higher proportions of spirochetes, black pigmented colony forming units (CFU), and Bacteroides gingivalis CFU than sites with probing attachment gain. Individual site analysis, however, demonstrated marked variations of the microbiological counts at the different postoperative time points. In the few available sites undergoing probing attachment loss, no apparent association between target micro-organisms and periodontal deterioration was observed.

Effect of modified Widman flap surgery and systemic tetracycline on the subgingival microbiota of periodontal lesions

Abstract: 33 subjects with evidence of active destructive periodontal disease were treated by modified Widman flap surgery and systemic tetracycline (1 g/day for 21 days). Subgingival plaque samples were taken from 41 sites in 12 of these subjects before and 6 months after therapy for predominant cultivable microbiota studies. Mean pocket depth and attachment levels in the 41 sampled sites were 7.1 +/- 2.9 mm and 7.7 +/- 3.2 mm prior to therapy and 4.8 +/- 2.3 mm and 6.2 +/- 3.4 mm after therapy. B. melaninogenicus and V. parvula were more frequently detected in samples taken after therapy, while S. intermedius, S. morbillorum, S. uberis and W. recta were less frequently detected after therapy. A. actinomycetemcomitans were detected in 7 sites pretherapy and 1 site post therapy. The frequency of detection of B. gingivalis and B. intermedius was virtually unchanged. The mean levels of the Actinomyces sp., A. actinomycetemcomitans, B. gingivalis, B. intermedius, S. morbillorum, S. uberis and W. recta were decreased after therapy, while the mean levels of B. melaninogenicus, S. mitis, S. sanguis II and V. parvula were increased after therapy. V. parvula showed the greatest increase to 8.2% of the microbiota. In the second phase of the study, subgingival plaque samples from 94 sites in the 33 treated subjects were analyzed by predominant cultivable techniques. As a result of therapy, 24 sites exhibited attachment loss greater than 2 mm, 23 sites exhibited "gain" greater than 2 mm and the remaining 47 sites were considered to be unchanging.(ABSTRACT TRUNCATED AT 250 WORDS)

Treatment of periodontal furcation defects. (II). Bone regeneration in mandibular class II defects.

Abstract: A total of 30 mandibular, buccal class II furcation defects were treated in 22 subjects using a regenerative surgical therapy that included citric acid root conditioning and coronally positioned flaps secured by crown-attached sutures. In addition, grafts of freeze-dried, decalcified allogenic bone were placed in 16 of the 30 defects. The effect of the therapies was evaluated from a series of soft and hard tissue measurements. These measurements demonstrated notable improvement 12 months following therapy. On the average. 61% of the defect volume became filled with bone. 43% of treated defects were completely closed by bone fill. No difference was observed between defects treated with and without bone grafts.

A comparison of 4 methods of data presentation for lysosomal enzyme activity in gingival crevicular fluid.

Abstract: In previous studies, we have emphasized the importance of considering the methods used for analysis of gingival crevicular fluid (GCF). This study evaluated 4 different approaches for data presentation of lysosomal enzyme activity in GCF. GCF was collected from patients displaying at least 2 mm of clinical attachment loss at a minimum of 3 sites in the mouth (DA), and patients who did not display clinical attachment loss of 2 mm or more at any site in the mouth (DI), during a 3-month interval following entry into a longitudinal trial. GCF was collected by the timed intrasulcular placement of precut filter paper strips. 16 to 28 individual GCF samples were collected from each patient. The lysosomal enzymes studied were B-glucuronidase (BG) and arylsulfatase. The mean values for the DA and DI groups at baseline and 3 months are reported. The results indicate that when the data is expressed as total enzyme activity (unit activity) per 30-s collection (UA) or UA x GCF volume (μl) per mm of probing depth, the DA group demonstrated significantly greater mean values than the DI group at baseline and 3 months. In contrast, when the data was expressed as concentration (UA/μl), or UA per mm of probing depth, differences between the DA and DI groups were observed only at the 3-month evaluation. The difficulty in using concentration when reporting GCF lysosomal enzyme activity is emphsized by comparison of the data from the DA group and the high and low enzyme activity subsets of the DI group. At baseline, the DA group had a significantly lower BG concentration than the DI high enzyme subset, but a significantly higher BG concentration compared to the DI low enzyme subset. In addition, determination of true volume presents a potential source of error in the calculation of concentration of any factor in GCF. When GCF is collected for diagnostic purposes with a timed insertion of a precut filter strip, our data indicates that the preferred method of presentation for lysosomal enzyme activity is UA.

Detection of high-risk groups and individuals for periodontal diseases. Systemic predisposition and markers of general health.

Abstract: The evidence for systemic predisposition to periodontal diseases is reviewed in relation to cellular and humoral immunity, drug therapy, diet and nutrition and stress. It is concluded that, apart from defects of polymorphonuclear leukocytes (PMN) and Ehlers-Danlos Syndrome, little firm evidence exists for other diseases, though insulin-dependent diabetes and acquired immune deficiency syndrome (AIDS) may accelerate and/or potentiate the damage of existing disease. The precise role of drugs, diet and nutrition and stress remain to be elucidated, but recent advances in these areas offer the prospect of assessing risk using carefully controlled studies.

Dental plaque removal by cavitational activity during ultrasonic scaling

Abstract: . Photomicrographs of the surfaces of recently extracted teeth stained with erythrosin dye were obtained. The stained surfaces were treated with an ultrasonic sealer using two different types of scaling tips driven by the same instrument operated at a medium power setting. Small areas of stained plaque removal occurred when the stationary scaling tip was operated without water cooling. Additional areas of removal were observed where a water coolant was present, which were larger than those produced by the non-water cooled tip. These additional areas were influenced by the type of scaling tip used, it's orientation to the tooth surface and it's displacement amplitude. Cavitational activity in the cooling water supply of the ultrasonic sealer is able lo remove dental plaque from tooth surfaces and may be a useful adjunct to the mechanical action of the instrument.