Showing papers in "Journal of Clinical Periodontology in 1993"

Long‐term control of diabetes mellitus and periodontitis

Abstract: The purpose of this study was to evaluate the association between long-term control of diabetes mellitus (DM) and periodontitis, A total of 75 diabetics (Type I or II) aged 20–70 years with long-term records of their diabetic control were selected for the study. The following periodontal variables were recorded in a randomized half-mouth examination: plaque, calculus (+/−), probing depth (pd) and attachment loss (al). The mean of glycosylated hemoglobin measurements (IIbAlc) over the past 2–5 years was used to indicate the long-term control of DM. The study participants were divided into well-, moderately- and poorly-controlled diabetics. An increase in the prevalence, severity and extent of periodontitis with poorer control of diabetes was observed. The extent of calculus also increased with poorer control. In a multiple regression analysis, calculus and long-term control of diabetes were significant variables when pd≥4 mm was used as the dependent variable. Age was a significant predictor for al > 3 mm but not for pd ≥4 mm. Sex, duration and type of DM were not significant variables in the regression models. Less than 2% of sites with no calculus demonstrated pd≥4mm. When calculus was present, the frequency of pd ≥4 mm increased from 6% in the well-controlled diabetics to 16% in the poorly-controlled ones. We conclude that periodontitis in diabetics is associated with long-term metabolic control and presence of calculus. Therefore, regular maintenance care, including patient motivation and instruction as well as professional calculus removal, is important for diabetic patients.

On the relationship between crown form and clinical features of the gingiva in adolescents

Abstract: The purpose of the present study was to examine the relationship between the form of the crowns in the maxillary front tooth segment and (1) a group of morphological characteristics and (2) the thickness of the gingiva. 108 subjects devoid of symptoms of destructive periodontal disease were examined regarding, e.g., probing depth, thickness of the free gingiva, width of the keratinized gingiva and the contour of the marginal gingiva. From clinical photographs of the maxillary front tooth region, the width (at the apical third – CW) and the length (CL) of the crowns of the 6 front teeth were determined. A CW/ CL-ratio was calculated for each tooth and averaged for each tooth region. The individual mean CW/CL-ratio values for the central incisors were ranked. After correction for incisal attrition, the 10 subjects ranked highest and the 10 ranked lowest were selected as having either a long-narrow (group N) or a short-wide (group W) form of the crown of the tooth. The data for each of the examined parameters were averaged for each tooth region in each subject and mean values for subjects in groups W and N were compared using the Student t-test. Stepwise multiple regression analysis, including data from the whole sample, was performed for each tooth region with the thickness of the free gingiva as the dependent variable. The results from the analyses demonstrated that individuals with a long-narrow form of the central incisors displayed, compared to individuals with a short-wide crown, form (i) a narrow zone of keratinized gingiva, (ii) shallow probing depth, and (hi) a pronounced “scalloped” contour of the gingival margin. There was no significant difference between groups N and W with respect to the thickness of the free gingiva. The CW/CL-ratio data revealed that a certain form of the crowns in the central incisors was accompanied by a similar form in the lateral incisor and canine tooth region. The regression analyses demonstrated that the thickness of the free gingiva in central incisors was significantly related to (i) the width of the keratinized gingiva, (ii) the buccolingual width of the crown and (iii) the presence of an interproximal gingival groove. In lateral incisors, the thickness of the free gingiva was associated with the probing depth at the buccal surface. No single variable was significantly related to the thickness of the gingiva in canines.

A longitudinal study on insulin-dependent diabetes mellitus and periodontal disease.

Abstract: In the present two-year longitudinal investigation, the progression of periodontal disease was assessed after 1 year from the baseline examination in 38 dentate subjects and after 2 years in 22 dentate subjects with a mean duration of 18 years of insulin-dependent diabetes mellitus. The diabetics, aged 35 to 56 years at baseline, were under medical treatment at the outpatient clinic of the III Department of Medicine, University Central Hospital of Helsinki and at 2 diabetic clinics of the Helsinki Health Centre. Based upon their long-term medical records, 26 subjects were at baseline identified as having poorly controlled insulin-dependent diabetes (PIDD) with a mean blood glucose level of 12.5 mmol/l and a mean glycosylated hemoglobin (HBA1) level of 10.1%. 12 subjects were classified as having controlled insulin-dependent diabetes (CIDD) with a mean blood glucose level of 6.7 mmol/l and a mean HBA1 level of 9.2% at baseline. For each individual, recordings were made at baseline and after 1 and 2 years from the baseline for the plaque index, gingival index, pocket depth, loss of attachment, bleeding after probing, gingival recession, and radiographic loss of alveolar bone. At baseline and 2 years after the baseline examination, the PIDD subjects had similar plaque conditions as the CIDD subjects. At baseline and after 1 and 2 years from baseline the PIDD subjects had more gingivitis and bleeding after probing (P < 0.05, chi 2-test) than the CIDD subjects.(ABSTRACT TRUNCATED AT 250 WORDS)

Periodontal disease experience in adult long‐duration insulin‐dependent diabetics

Abstract: The aim of this study was to analyse periodontal disease experience in 40- to 70-year-old, sex-matched insulin-dependent diabetics and non-diabetics. The study involved 83 diabetics and 99 non-diabetics. The clinical and radiographic examination comprised recordings of number of teeth, presence of plaque, gingival conditions, probing pocket depth and alveolar bone level (main variable). Diabetics aged 40 to 49 years had more periodontal pockets > or = 6 mm and more extensive alveolar bone loss than non-diabetics in the same age-group. There was also a significantly higher number of subjects belonging to classification groups with severe periodontal disease experience among diabetics in that age-group. In the age-groups 50-59 and 60-69 years, no major differences were found. The disease duration in these 3 age groups was 25.6 years, 20.5 years and 18.6 years, respectively, and the age of onset thus appears to be an important risk factor for future periodontal destruction.

Probing depth at implants and teeth. An experimental study in the dog

Abstract: The aim of the present investigation was to assess the resistance offered by the gingiva at teeth and the peri-implant mucosa at osseointegrated titanium implants to mechanical probing. 5 beagle dogs were used in the experiment. The 2nd and 3rd premolars and the 1st molars of the right and left mandibular dentition were extracted. 2 titanium implants were installed in the edentulous right and left premolar- and molar-regions. Abutment connection was performed 3 months later. The remaining premolar in the left jaw (P4) was exposed to "experimental periodontitis" during a 4-month period and, thus, the 4th premolar in the right jaw (4P) was representing healthy periodontium. The inflamed soft tissues at P4 were treated using a flap procedure. Following 2 weeks of healing, the main experiment was started, i.e., day 0. During the subsequent 360 days, the teeth and abutment parts of the implants were regularly exposed to plaque control (3 x/week). Radiographs of 4P-, P4- and the implant-regions were obtained on days 0 and 360. Mobility measurements were performed on days 0 and 360. Biopsies of the experimental teeth and the implants were sampled at the end of the study. The results of the present experiment demonstrated that differences in terms of tissue composition, organization and attachment between the gingiva and the root surface on one hand and between the peri-implant mucosa and the implant surface on the other, make the conditions for probing depth measurements at teeth and implants different.(ABSTRACT TRUNCATED AT 250 WORDS)

Gingival fluid IL-1 and IL-6 levels in refractory periodontitis.

Abstract: Selected gingival bacteria and cytokine profiles associated with patients who did not respond to conventional periodontal therapy (refractory) were evaluated. 10 subjects with a high incidence of post-active treatment clinical attachment loss (> 2% sites/year lost > or = 3 mm) were compared to 10 age-, race-, and supragingival plaque-matched patients with low post-treatment clinical attachment loss (< 0.5% sites/year) relative to the following parameters at 2 sites/patient with the deepest probing depths: (1) presence of 3 selected periodontal pathogens (Actinobacillus actinomycetemcomitans, Porphyromonas gingivalis, Eikenella corrodens) in subgingival plaque as determined by selective culturing, and (2) gingival crevicular fluid (GCF) levels of 3 cytokines associated with bone resorption (IL-1 alpha, IL-1 beta, IL-6) as determined by two-site ELISA. Results indicated no significant differences in any clinical measurement (except incidence of clinical attachment loss), in the presence of any bacterial pathogen, or in GCF cytokine levels between refractory subject sites versus stable subject sites. However, when sites producing the greatest total GCF cytokine/patient were compared, sites from refractory patient produced significantly more IL-6 (30.1 +/- 4.0 versus 15.4 +/- 2.8 nM, p < 0.01). The subgingival presence of each of the 3 bacterial pathogens was associated with elevated GCF IL-1 concentrations. These data suggest that gingival IL-1 and IL-6 production is different in response to local and systemic factors associated with periodontitis, and that IL-6 may play a role in the identification and mechanisms of refractory periodontitis.

The prevalence and severity of cyclosporin and nifedipine‐induced gingival overgrowth

Abstract: The gingival health of 32 renal transplant patients who were medicated with cyclosporin was compared with a similar cohort of 23 renal transplant patients medicated with both cyclosporin and nifedipine. Both groups of patients had been taking the above medication for at least 3 months. Plaque scores, gingival inflammation and probing depths were similar for both groups. Patients medicated with the combination of nifedipine and cyclosporin had a significantly higher gingival overgrowth score (p = 0.046) when compared with the group receiving cyclosporin alone. The incidence of clinically significant overgrowth (i.e., overgrowth > 30% which would require surgical intervention) was similar in both groups. Gingival overgrowth was not related to cyclosporin dosage. It is concluded that patients taking cyclosporin or cyclosporin and nifedipine experience gingival overgrowth and that the severity of the overgrowth is greater in patients taking the combined therapy. The levels of plaque and gingival inflammation appear to be associated with this phenomenon.

A comparative study of electric toothbrushes for the effectiveness of plaque removal in relation to toothbrushing duration. Timerstudy.

Abstract: The purpose of the present study was to test the plaque-removing efficacy of 4 different toothbrushes in relation to duration of toothbrushing. The brushes studied were a manual toothbrush (M), a conventional electric toothbrush – the Blend-a-Dent® (BPC), the Interplak® (IP) and the Braun Plak Control® (BPC). For this study, 20 subjects were selected. The study was divided into 5 experiments which differed only in respect to the brushing time. The available time in experiment 1 through 5 was 7.5, 15, 30, 45, 90 s per quadrant respectively. Prior to each experiment, all subjects were asked to abstain from oral hygiene procedures for at least 24 h. The efficacy of toothbrushing in each experiment was studied while one investigator (MAL) brushed the teeth of the subjects. In each subject, all 4 brushes were tested. Each brush was assigned to a quadrant in a random order. No toothpaste was used throughout this study. The amount of dental plaque was evaluated before and after brushing by means of the Silness & Loe plaque index at 6 sites around each tooth investigated. The results show an increase in efficacy for all brushes varying from 7.5 s per quadrant to 90 s per quadrant (mean plaque reduction in terms of percentage 7.5 s-90 s: M =40%-75%, BL = 45%-82%, BPC = 51%-94%. IP=64%-92%). The IP removed significantly more plaque than the other 3 after 7.5 s of brushing. From 15 s through 90 s, the IP and BPC were equally effective. Both were, at all times, significantly more effective than the M and BL. This difference was mainly caused by a greater plaque removal from the interproximal areas, since brushing for 30 s or more with all 4 brushes removed about 90% of the plaque from the vestibular and lingual surfaces. Evaluation of the efficacy in relation to brushing time showed for all brushes that the greater part of the effect is reached after 30 s of brushing per quadrant. The brushing time appears to be an important variable in the evaluation of plaque removing effectiveness since the efficacy increases with time and differs per toothbrush.

Platelet‐derived growth factor and dexamethasone combined with a collagen matrix induce regeneration of the periodontium in monkeys

Abstract: Platelet-derived growth factor (PDGF) and the glucocorticoid dexamethasone combined with a collagen carrier matrix (CM) induced regeneration of the periodontium in monkeys. Regeneration was stringently defined as: (1) new cementum, (2) new supra-crestal bone extending coronally from the residual alveolar interdental septum and (3) functionally-oriented periodontal ligament fibers attaching new cementum to new bone. A single application of PDGF/dexamethasone/CM or CM was placed in debrided lesions of experimental periodontitis displaying 3-5 mm of attachment loss associated with horizontal and angular bony defects. Regeneration, judged histologically by these criteria and quantified by computer assisted histomorphometry after 4 weeks, was present only in PDGF/dexamethasone/CM treated lesions and not in those treated with CM or debridement alone. PDGF/dexamethasone/CM induced 5-fold more new cementum and ligament, and 7-fold more supra-crestal bone than control treatments. The presence of substantial amounts of regenerated periodontium including increased height of the alveolar bone; fill of vertically resorbed interdental alveolar septa in PDGF/dexamethasone/CM treated lesions suggests that this combination may provide a new therapeutic agent for the regeneration of lesions of periodontitis associated with horizontal as well as angular bony defects.

Gingival hyperplasia in renal allograft recipients receiving cyclosporin‐A and calcium antagonists

Abstract: Although it is established that the immunosuppressant cyclosporin-A (CsA) and calcium antagonists [Nifedipine (Nif) and Diltiazem (Dz)] can independently induce gingival enlargement, little has been documented on the significance of the salivary CsA levels and the combined effect of CsA and a calcium antagonist upon gingival tissues. In the present cross-sectional investigation, clinical periodontal parameters and the pharmacologic profiles of CsA, Nif, and Dz were determined for 66 renal transplant recipients. Subjects were divided into the following groups: Group (Gp) I: CsA [n=18]; Gp 2: CsA + Nif [n=15]; Gp 3: CsA + Dz [n=12] and a negative Control Gp 4: azathioprine [n=21]. A gingival enlargment score was assessed for each patient from study models using a byperplastic index (HI). Pharmacologic profiles included CsA whole blood and whole saliva levels as measured by fluorescence polarization immunoassay. The HI scores between Gp 1, 2 and 3 were not significantly different. However, when compared with controls (Gp 4), there was a significant difference in HI and all individual groups (Gp 1, 2, 3) (p<0.05). Gingival hyperplasia was only weakly related to plaque and calculus but was unrelated to CsA dose (mg/kg/day), duration of CsA therapy (months), CsA blood or saliva levels (ng/ml), or the concurrent administration of a Nif or Dz. Gingival enlargement was found to occur in 49% of subjects who were either on CsA or CsA and a calcium antagonist. It is concluded that CsA alone or in combination with a calcium antagonist caused a significant increase in gingival enlargement compared with controls. However, the CsA effect in inducing gingiva] hyperplasia did not appear to be potentiated by the addition of a calcium antagonist.

A 6-month home usage trial of a 1% chlorhexidine toothpaste (1). Effects on plaque, gingivitis, calculus and toothstaining.

Abstract: Research and development has been aimed towards the development of toothpastes for oral hygiene and gingival health benefits. The most effective antiplaque agent to date, chlorhexidine, is difficult to formulate into active toothpaste products. Despite some encouraging findings for experimental chlorhexidine toothpastes, there are to date no commercially available products. Based on positive findings from an experimental gingivitis study, this investigation evaluated 2 chlorhexidine toothpastes, one with fluoride, as adjuncts to oral hygiene. The study was a double-blind controlled, parallel, balanced group design, extending over 6 months. A total of 297 volunteers commenced the study after screening for a minimum acceptance level of gingivitis. At baseline, 6, 12 and 24 weeks, stain, gingival, bleeding and plaque indices were recorded, together with a calculus index at 6, 12 and 24 weeks. After a baseline prophylaxis, volunteers used the allocated product 2 x per day, with no other oral hygiene instructions given. Plaque, gingival and bleeding scores improved in all 3 groups, but to an overall significantly greater extent in the active groups. However, staining and calculus indices were significantly increased in the active compared to the control group. If the local side-effects of chlorhexidine are considered to be acceptable, these chlorhexidine toothpastes could be recommended for the same clinical applications as other chlorhexidine products. The apparent compatibility of fluoride with chlorhexidine in the one product may be pertinent to caries prevention.

Natural distribution of 5 bacteria associated with periodontal disease

Abstract: The purpose of this study was to determine the prevalence and distribution of 5 bacterial pathogens in subgingival plaque, their relationship with each other and probing depth. Plaque was collected from 6905 sites in 938 subjects. A bacterial concentration fluorescence immunoassay and bacterial specific monoclonal antibodies were used to determine the presence and level of P. gingivalis (Pg), A. actinomycetemcomitans (Aa), P. intermedia (Pi), E. corrodens (Ec) and F. nucleatum (Fn) in each plaque sample. The prevalence in subjects was lowest for Pg (32%) and highest for Ec (49%). The site-based frequency distribution of these bacterial species ranged from 10.3% for Pg to 18.7% for Ec. Pi and Ec were the bacterial combination most often found together in a subject (27.2%). While 64.0% of the sites were without any of the 5 bacterial species evaluated, 20.2% had only 1 of the 5 bacterial species evaluated. The remaining 15.8% of sites had at least 2 bacteria species present. There was a general linear association of the detection level of bacterial species and probing depth. The odds ratios were 3.9 (Pg), 3.0 (Aa), 4.0 (Pi), 2.7 (Ec) and 2.8 (Fn) of finding high levels of these bacterial pathogens at > 5 mm probing depth (p < or = 0.01). Mean probing depth at molar sites without a specific bacteria was greater (p < or = 0.01) in subjects with a specific bacterium compared to molar sites in subjects without the bacteria.(ABSTRACT TRUNCATED AT 250 WORDS)

Transmission of Porphyromonas gingivalis between spouses

Abstract: Porphyromonas gingivalis has been associated with severe forms of periodontitis. The question can be raised about the origin of this suspected periodontal pathogen. The purpose of the present investigation was to study the possibility of transmission of P. gingivalis between spouses. 18 patients were selected with severe periodontitis and colonized with P. gingivalis. 10 of their spouses appeared to be colonized with P. gingivalis too. 8 of the patients and their spouses were investigated further clinically and microbiologically. Microbiological evaluation revealed mostly high %s of P. gingivalis in the pockets, not only of the patients (5-48% of the cultivable flora), but also in 7 of the 8 spouses (0.2-61%). Furthermore, this species was isolated often from the saliva, the tongue, the buccal mucosa and the tonsillar area from both patients and spouses. For typing purposes, bacterial DNA was isolated, treated with the restriction endonucleases Bam HI or Pst I, after which the DNA fragments were separated by agarose gelelectrophoresis. With one exception, each individual was colonized with only one clonal type of P. gingivalis. The DNA patterns of all P. gingivalis isolates from unrelated individuals were found to be distinct. In contrast, in 6 of the 8 couples, the DNA patterns of isolates from husband and wife were indistinguishable. From these data, it can be concluded that it is most likely, that P. gingivalis can be transmitted between spouses. It remains to be investigated whether transmission of P. gingivalis is a risk factor for developing periodontal destruction.

The effect of a triclosan-containing dentifrice on established plaque and gingivitis.

Abstract: The aim of the present clinical trial was to study the effect on existing plaque and gingivitis of an oral hygiene regimen which utilized a dentifrice which contained triclosan. 120 subjects were recruited for the trial. They were examined for plaque and gingivitis using the criteria of (i) the Turesky modification of the Quigley & Hein plaque index and (ii) the Loe & Silness gingival index. Plaque and gingivitis were assessed in all parts of the dentition and at 6 location points around each tooth. Following a baseline examination, the subjects were stratified in 2 balanced groups based on age, plaque and gingivitis scores. The subjects were randomly assigned to the following treatment: 1 test group used a dentifrice containing triclosan/copolymer/fluoride and 1 control group used a traditional fluoride containing dentifrice. The participants were given the assigned dentifrice and a soft-bristled toothbrush for home use. They were instructed to brush their teeth in the morning and in the evening for one minute each time. They were re-examined 6 weeks, 3 and 6 months after the baseline examination. The findings from the re-examinations revealed that an oral hygiene regimen which utilized a dentifrice which contained triclosan/copolymer significantly reduced pre-existing plaque and gingivitis above what was accomplished by a traditional fluoride containing dentifrice. The improvement of the gingival conditions occurred in all parts of the dentition and at all tooth surfaces and units. In addition, the present data support the hypothesis that triclosan may induce alterations in the quality of existing plaque.

Oral hygiene, periodontal conditions and carious lesions in patients treated with dental bridges. A 15-year clinical and radiographic follow-up study.

Abstract: A longitudinal study, extending over a period of 15 years, was carried out in a group of 102 patients who received 108 bridges made by the senior students at the Dental Faculty, University of Oslo, in 1967/68. The study included 343 abutment teeth, and the remaining teeth in the same jaw which received the restoration, 525 in all, served as control. The oral hygiene, gingival condition, pocket depth, caries on crowned teeth, location of crown margins and changes of alveolar bone level were recorded during the study. During the first 10 years, the patients received oral hygiene prophylaxis every 6 months. The mean age of the patients at the beginning of the study was 48 years. Of the original group of 102 patients, 88 attended the clinical examination after 5 years, 71 after 10 years, and 55 after 15 years. The amount of plaque did not differ between the crowned teeth and the control teeth during the observation period, while GI score 2 and 3 was more frequent in crowned teeth than in the control teeth during this period. This was mainly observed when the crown margins were located sub-gingivally. A slight increase in mean pocket depth was recorded in the crowned teeth while the mean pocket depth for the control teeth remained at the same level during the 15 years. Caries lesions were recorded in 3.3% of the abutment tooth surfaces at the 5th year, in 10.0% at the 10th year and in 12.0% at the 15th year examination. No statistical differences in bone loss could be detected between the control teeth and the crowned teeth.

Metronidazole in the treatment of localized juvenile periodontitis

Abstract: Systemic metronidazole and tetracycline were compared as adjunctive agents in the treatment of localized juvenile periodontitis (LJP). 27 patients with Actinobacillus actinomycetemcomitans-positive (Aa) LJP were treated with scaling and rootplaning, control of oral hygiene and periodontal surgery if indicated. The patients were randomly divided into 3 equal groups: the 1st group had metronidazole 200 mg × 3 × 10 days, the 2nd tetracycline 250 mg × 4 × 12 days, the 3rd group received no medication and served as a control. 6 patients had periodontal surgery. 4 sites with the most advanced bone loss as determined on radiographs were selected in each subject for test sites. Gingival index, gingival bleeding after probing (GB), probing depth (PD), suppuration, and radiographic bone loss were registered, and subgingival Aa was selectively cultured. GB and PD>4 mm were registered in the whole dentition as well. All parameters were monitored at baseline and at 6 and 18 months after treatment. By the end of the study, Aa was suppressed to below detection level at all test sites only in the metronidazole group, at 17/26 sites (4 patients) in the tetracycline group and at 19/26 sites (6 patients) in the control group. Clinically, all groups showed improvement. In conclusion, metronidazole was more effective than tetracycline in the suppression of Aa and the suppression of Aa appeared to produce better clinical results.

Metronidazole in periodontitis (IV). The effect of patient compliance on treatment parameters.

Abstract: Patient compliance with the unsupervised usage of prescription medication can be poor. In the treatment of periodontal infections with systemic antimicrobial agents, in situations where the efficacy of the antimicrobial agent is being evaluated, non-compliance could underestimate the true efficacy of the agent. Metronidazole is an agent with reported success in the treatment of anaerobic periodontal infections. Metronidazole is particularly effective in vitro against spirochetes, and this efficacy was investigated as a means of measuring patient compliance with metronidazole usage. Patients who had high proportions of spirochetes, i.e., > 20%, in plaques removed from diseased periodontal sites, were given metronidazole (500 mg bid) under supervision. In all individuals who received the metronidazole, there was a significant and rapid decline and/or disappearance of spirochetes from the plaque during the time interval that metronidazole was detectable in the saliva. This observed decline in spirochetes was then used to determine which patients had been compliant in a double-blind clinical trial involving the unsupervised usage of metronidazole. Only 10 of 18 patients (56%) were considered compliant in their usage of metronidazole. These 10 patients experienced a significantly greater benefit from the metronidazole than did the 8 patients who were considered noncompliant, i.e., a reduction of surgical needs of 8.3 teeth per compliant patient versus 3.6 teeth per non-compliant patient. A test for the hydrolysis of the synthetic peptide (BANA) was also able to identify most non-compliant patients. Clinical trials involving the unsupervised usage of systemic medication need to take into account patient non-compliance.

Relationship between periapical and periodontal status. A clinical retrospective study.

Abstract: The purpose of the present investigation was to explore possible relationships between clinical periodontal status in periodontally involved teeth with and without endodontic infection. The investigation was conducted as a retrospective study on a consecutive referral population. The periapical conditions in endodontically-involved single-rooted teeth from a selected patient sample were evaluated and correlated to their periodontal status. There was a significant correlation between periapical pathology and vertical bony destructions. An intra-individual comparison between pocket depth in teeth with and without periapical pathology showed that periapical pathology was significantly correlated to an increased pocket depth in the absence of a vertical bony destruction. It was concluded that an endotontic infection, evident as a periapical radiolucency. promotes periodontal pocket-formation on an instrumented marginal root surface and, consequently, should be regarded as a risk factor in periodontitis progression and be given appropriate consideration in periodonlal treatment planning.

Healing in periodontal defects treated by decalcified freeze-dried bone allografts in combination with ePTFE membranes (I). Clinical and scanning electron microscope analysis.

Abstract: This study quantitatively assessed radiographic changes in alveolar bone density by computer-assisted densitometric image analysis (CADIA) in periodontal defects that were treated with decalcified freeze dried bone allograft (DFDBA) alone or in combination with interproximal expanded polytetrafluoroethylene membranes (ePTFE). The radiographic changes where then analyzed for correlation with the clinically assessed changes. The radio-graphic changes were evaluated on standardized radiographs of treated sites treated prior to, 1 week after surgery, and 6 months post-operatively. 15 patients with one pair of bilateral interproximal periodontal defects of similar morphology and 3:6 mm in pocket depth participated. Analysis of the changes 6 months after treatment showed that the increases in density in the defect areas that received the graft were significantly greater than the adjacent areas (p <0.001). These adjacent areas, in contrast, demonstrated significantly larger loss in radio-graphic density than the defect area (p <0.001). The placement of DFDBA into the defects produced in itself significant increases in radiographic density, as illustrated by the results of one week which remained at six months. Utilization of ePTFE addition to DFDBA did not lead to additional radiographic gains in the defect area. While at one week the analysis suggested increased resorption by the combined treatment over grafting alone, such differences did not persist at 6 months post-surgery. Analysis comparing CADIA derived values for change with those of the clinical assessment revealed some associations. When categorizing outcomes of density measurements as equal to 0 or numerically greater than 0, changes in density showed a non-random correlation with clinical changes expressed by the distance from CEJ to the bottom of the defect (p <0.001) among sites treated by DFDBA. The corresponding correlation was not significant upon adjunctive treatment by ePTFE. Further analysis, however, demonstrated that the magnitudes of change by the different assessment methods were not significantly correlated. This may be an effect of the region-of-interest selection in this study. Further studies are needed to clarify the correlations between radiographic and clinical methods for assessing treatment effects.

Epidemiology and transmission of Porphyromonas gingivalis and Actinobacillus actinomycetemcomitans among children and their family members. A report of 4 surveys

Abstract: The distribution and transmission of Porphyromonas gingivalis and Actinobacillus actinomycetemcomitans in 4 families were studied. The families were included, based on the isolation of P. gingivalis from a young child or adolescent. The probands of these 4 families were: a 5-year old periodontally healthy boy; a 17-year old girl with severe generalized juvenile periodontitis; an 11-year old girl with prepubertal periodontitis; 2 sisters, 5 and 17-years old, with untreated severe periodontitis as a component of the Papillon-Lefevre syndrome. All members of the 4 families were examined clinically and microbiologically for the presence of P. gingivalis and A. actinomycetemcomitans. Most of the parents appeared to be adult periodontitis patients; the parents of one proband were edentulous. Results showed that in all cases at least one of the parents was positive for P. gingivalis. On the basis of indistinguishable restriction endonuclease patterns (REPs) of P. gingivalis and A. actinomycetemcomitans isolates from parents and their children, and distinct REPs from unrelated individuals, the present study indicates that P. gingivalis and A. actinomycetemcomitans were transmitted between parents and their children.

Relationship between palatoradicular grooves and localized periodontitis

Abstract: A total of 404 maxillary lateral and central incisors were examined in a group of 101 individuals comprising 64 males and 37 females for the presence of palato-radicular groove (PRG). The methods used to document the presence of PRG situated at or apical to the cemento-enamel junction (CEJ) included clinical probing, flap operation and inspection with the aid of an enlarging oral mirror. PRGs were classified by location in the mesial, distal and midpalatal areas of affected teeth. The plaque index (P1I), gingival index (GI) and probing pocket depth (PPD) were recorded on the lingual aspect of the teeth examined. Those PRG with initial PPDs of > or = 4 mm and located at or apical to the CEJ were counted as PRG with PPD. The difference in the PRG location for teeth with and without PPDs was analyzed via the chi 2 test. The relationship between the presence of a PRG and the patients periodontal health and plaque accumulation were analyzed using the t-test.(ABSTRACT TRUNCATED AT 250 WORDS)

The effect of a mouthrinse based on nisin, a bacteriocin, on developing plaque and gingivitis in beagle dogs

Abstract: The aim of this study was to evaluate the effect of nisin, an antimicrobial peptide, on the development of plaque and gingivitis in beagle dogs when compared with 0.12% chlorhexidine and a placebo. 16 female beagle dogs 1 year of age were brought to optimum gingival health by scaling, root planing and polishing. At the conclusion of the pretreatment phase, the dogs were divided into 4 groups for the application of the test agents and were placed on a plaque promoting diet of Purina Dog Chow softened with water. Test agents included 100 micrograms/ml nisin and 300 micrograms/ml nisin formulated in a vehicle containing 1 mM NaEDTA; negative control comprised of exactly the same formulation but omitting nisin; and 0.12% chlorhexidine as Peridex. Throughout the treatment period, formulations were applied 2x daily to premolar teeth in each quadrant for 1 min using a Monojet syringe. The development of plaque and gingivitis was monitored at 15, 27, 39, 53, 74 and 88 days during the treatment phase using standard measurements of gingival index, plaque index, stain index and bleeding to probing. Throughout the treatment phase, plaque accumulation increased in all groups, but the rate of plaque build-up was less in groups treated with either nisin or chlorhexidine formulations compared with the placebo treated group. The gingival index of dogs in all groups increased throughout the study period. However, from day 27 onward, the groups receiving nisin had lower gingival index scores than did the placebo group.(ABSTRACT TRUNCATED AT 250 WORDS)

The plaque-removing efficacy of an oscillating/rotating toothbrush. A short-term study.

Abstract: The purpose of the present study was to test the effectiveness of a new type of BRAUN electric toothbrush (D5) in comparison with the traditional BRAUN electric toothbrush (D3) and to a manual toothbrush (M). For this study, 60 dental students were selected who had no previous experience with the use of an electric toothbrush. The study consisted of 3 experiments. Prior to each experiment, all students were asked to abstain from all oral hygiene procedures for at least 24 h. In Exp I, the efficacy of toothbrushing was studied when one of the investigators brushed the teeth of the students. No toothpaste was used in this first part of the study. In Exp II, the efficacy of brushing was evaluated when the brushing was carried out by the students themselves. In Exp III, the efficacy of the brushing was studied after the students had received a professional instruction and oral prophylaxis. The available time for the brushing amounted to a total of 2 min per mouth. The amount of dental plaque was evaluated by means of the Silness and Loe plaque index at 6 sites around the tooth. Results showed in Exp I that both electric toothbrushes proved to remove significantly more plaque than the manual toothbrush (M 78%; D3 85%; D5 86%). In Exp II, no significant differences in plaque-removing efficacy were found between the 3 brushes (M 73%; D3 72%; D5 73%). In Exp III, the D5 proved to remove significantly more plaque than the other two brushes (M 77%; D3 77%; D5 83%).(ABSTRACT TRUNCATED AT 250 WORDS)

Relationship of “bleeding on probing” and “gingival index bleeding” as clinical parameters of gingival inflammation

Abstract: Bleeding on probing (BOP) and the gingival index have been used to clinically characterize the degree of gingival inflammation. It is, however, unclear to what extent these parameters correlate to each other and to probing pocket depth (PD). The purpose of this clinical study was to evaluate the association between BOP and GI bleeding (scores of 2 and 3), as well as the relationship of these variables to PD, in a group of patients presenting with naturally-occurring gingivitis. Based on screening examinations of 125 subjects with at least 20 teeth, no more than 4 sites with PD over 6 mm, a BOP frequency of 30% or greater, and no systemic condition that would influence the inflammatory response, were selected. 2 weeks after screening they were examined at 6 sites per tooth for plaque index, GI, PD and BOP. A standardized pressure sensitive probe (Florida Probe) with 20 g probing force was used for BOP and PD measurements. In this population, means of 40.9% (S.E. = 1.36) BOP sites and 35.3% (S.E. = 1.81) GI bleeding sites per patient were found. A total of 20,008 sites ranging in PD up to 5.9 mm were evaluated; however, the majority of sites (19,723, 98.6%) presented with < 4 mm PD. When sites were evaluated, BOP demonstrated a positive correlation with PD, whereas GI bleeding correlated with PD. For sites characterized by the absence of BOP as well as the absence of GI bleeding (scores 0 and 1), the highest % of agreement between the 2 indices (77.7%) was found in shallow sites (0.1-2 mm).(ABSTRACT TRUNCATED AT 250 WORDS)

The effect of sibling relationship on the periodontal condition.

Abstract: The purpose of this investigation was to study clinically as well as microbiologically the effect of sibling relationship on the periodontal condition in a young population with a relatively high prevalence of periodontal disease and deprived from regular dental care. In this study, 23 family units consisting of 3 more siblings were evaluated. In all, 78 subjects aged 15 to 25 years were included in the study. The mean interproximal amount of loss of attachment in this population was 0.29 mm. The individual mean ranged from 0 to 1.27 mm. In 33% of the subjects, > or = 1 sites with a probing depth of 5 mm or more in conjunction with 2 mm of attachment loss were present. The results show a significant sibship effect for: plaque, calculus, loss of attachment, spirochetes on the tongue and in the pocket, Porphyromonas gingivalis on the gingiva and in the saliva and Prevotella intermedia in the saliva. These results support the hypothesis that periodontitis aggregates in families.

Assessment of pain in cervical dentinal sensitivity studies. A review.

Abstract: Traditionally cervical dentinal sensitivity (CDS) has been evaluated mainly subjectively on the basis of the individual patient's subjective response, e.g., in the form of verbal rating and visual analogue scales and questionnaires. The stimuli used for evaluating this response can be grouped into 4 main categories: mechanical, chemical, electrical and thermal. This review of the literature, however, indicates that there are problems in evaluating patient subjective response to these various test stimuli used in the assessment and treatment of CDS. Opinions also vary as to the reliability of some of these methods of assessment, although recently, efforts have been made to develop controlled reproducible stimuli more suited to the evaluation of CDS. Currently no single method of eliciting and assessing CDS may be considered ideal. Further research is required to evaluate suitable methodology for the quantification of realistic test stimuli under controlled clinical conditions, whereby the subjective response may be objectively measured by the investigator.

Comparative estimation of periodontal conditions by means of different index systems

Abstract: The aim of the present study was to compare epidemiological data of periodontal disease obtained from a sample of adults by means of different, commonly employed, partial and full-mouth index systems, in order to explore the amount of discrepancy attributed to the methodology per se. 169 dentate subjects, aged 25-64 years, were subjected to a clinical examination, including circumferential probing assessments of pocket depth (PPD) and attachment level (PAL) at all teeth present. The individual mean % of tooth sites with PPD of > or = 6 mm and the % of subjects exhibiting at least one such deep pocket were calculated based on (i) full-mouth data, (ii) data derived from the buccal and mesial surfaces from 1 randomly selected upper and 1 lower quadrant, (iii) probing assessments at the 6 "Ramfjord teeth", (iv) the full-mouth community periodontal index for treatment needs (CPITN), and (v) the partial CPITN based on 10 index teeth. The PAL data were analyzed by means of 3 versions of the extent and severity index, 1 generated by full-mouth assessments and 2 by partial assessments based on 28 and 10 tooth sites, respectively. In the entire sample, the individual mean % of sites with PPD of > or = 6 mm generated by the different systems ranged between 5.0 and 4.2 sites/subject. By full-mouth CPITN scorings, an average of 1.0 score-4 sextants/subject was recorded, while the partial CPITN generated a corresponding value of 0.8 score-4 sextants/subject.(ABSTRACT TRUNCATED AT 250 WORDS)

The effects of orthodontic tooth movement on the glycosaminoglycan components of gingival crevicular fluid

Abstract: In this study, gingival crevicular fluid (GCF) was collected from around a canine tooth, in children, before and during orthodontic tooth movement. The aim was to identify and quantify the glycosaminoglycan (GAG) components of GCF and relate them to tooth movement, gingival inflammation, plaque accumulation, pocket probing depth and GCF volume recorded at the site of sampling. GAG in GCF samples, collected for a 15-min period into microcapillary tubes, were separated electrophoretically, stained with Alcian blue and quantified using a laser densitometer. 2 GAG components of hyaluronic acid (HA) and chondroitin sulphate (CS) were identified. The increase in GCF volume during orthodontic tooth movement was only partly due to increased gingival inflammation. GAG levels varied with different types of orthodontic tooth movement. In GCF, levels of CS, in particular, may reflect the changes in the deeper periodontal tissues which could be monitored during orthodontic tooth movements.

Lactoferrin in the gingival crevice as a marker of polymorphonuclear leucocytes in periodontal diseases.

Abstract: This study examined lactoferrin (LF) levels in gingival crevicular fluid (GCF) and set out to test the hypothesis that LF could act as a marker of crevicular polymorphonuclear leucocytes (PMN). Therefore, 2 experiments were conducted: (a) to quantify total LF (ng/30 s sample) in GCF; (b) to correlate LF levels (ng/microliters) and PMN numbers (PMNs/microliters) in gingival crevicular washings (GCW). GCF was collected from 71 sites in a total of 22 patients. These sites were classified on the basis of clinical indices of gingivitis (GI) and pocket depth (PD) into three clinical groups: 'healthy', 'gingivitis' and 'periodontitis'. GCWs were obtained from an additional 63 sites in 21 patients. LF in GCF and GCWs was assayed by a sandwich ELISA. Total leucocyte and differential counts were performed on the GCWs. GCF LF (ng/30 s) correlated positively with GI (r = 0.418, p < 0.001), PD (r = 0.415, p < 0.001) and GCF volume (r = 0.624, p < 0.001). Gingivitis (n = 21) and periodontitis sites (n = 24) demonstrated significantly higher (p < 0.05) total GCF LF than healthy (n = 26) sites. In GCWs LF (ng/microliters) showed stronger correlations with clinical indices (GI: r = 0.452, PD: r = 0.513, p < 0.001) than did PMN numbers (PMNs/microliters) (GI: r = 0.279, PD: r = 0.388, p < 0.05). LF correlated strongly with PMNs in GCWs (r = 0.531, p < 0.001) and provides a simple and effective marker of crevicular PMN numbers.

Periodontal healing in teeth with periapical lesions. A clinical retrospective study.

Abstract: The purpose of the present investigation was to compare clinical periodontal healing in periodontally involved teeth with and without pulpal pathosis. The investigation was conducted as a retrospective study on a consecutive referral population. The periapical conditions in endodontically involved single-rooted teeth from a selected patient sample were evaluated and correlated with their periodontal healing pattern. Multiple regression analysis of the registered variables showed that initial mean pocket depth and time elapsed after treatment significantly influenced change in pocket-depth. Non-surgical treatment of periodontal pockets exceeding 2.5 mm in teeth with horizontal marginal defects, over the observation period, showed significantly reduced mean pocket depth reduction in teeth with periapical pathology compared to teeth without periapical pathology. It was, furthermore, evident that proximal restorations, abutments for fixed bridges and root fillings with and without dowels did not significantly influence pocket depth reduction in the present material. It was concluded, based on the present results, that a root-canal infection, evident as a periapical radiolucency, if left untreated may in the long term perspective result in retarded or impaired periodontal healing following periodontal therapy and, consequently, should be given appropriate consideration when coordinating endodontic therapy and periodontal treatment.