Self-reporting measures for periodontal disease.
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Comment↗
Biomedical subjects
Björn Klinge
Publications and source records attributed to Björn Klinge.
Soft-tissue integration of implants. Consensus report of Working Group 2.
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Biofilms↗
Peri-implantitis.
The risk of developing peri-implantitis seems to be more pronounced in patients with a history of periodontitis. Pretreatment to eliminate periodontal pathogens from the patient's oral cavity before dental implant treatment therefore is important to reduce the risk of peri-implantitis. Smoking has been shown to be a negative risk factor for treatment success. Several protocols have been used in the treatment of peri-implantitis. Mechanical infection control following surgical flap procedures, particularly in conjunction with antimicrobial therapy, is the most successful concept. There is no reliable evidence that suggests which intervention is the most effective for treating peri-implantitis. This article includes background information on the biology of tissue-destructive periodontitis and peri-implantitis to help clinicians interpret the clinical manifestation of the risk for peri-implantitis.
Anti-Bacterial Agents↗
Oral health of homeless adults in Stockholm, Sweden.
The aim of the present study was to record and describe the oral condition of homeless adults in Stockholm, Sweden. There have been no clinical studies of the oral health of the homeless in Sweden since the 1970s. The study population comprised 147 homeless individuals (110 M, 37 F) in the age range 22-77 years. All underwent oral examination, including registration of periodontal status and caries data. The results show that homeless adults in Stockholm have fewer remaining teeth than the general population. Because conservative periodontal treatment is expensive and time-consuming, teeth with doubtful prognoses are usually extracted and only those with optimal periodontal health are retained. Another consequence of inadequate periodontal treatment, including insufficient oral hygiene instruction, is the high percentage of tooth surfaces with plaque accumulation. Heavy plaque accumulation will also have an effect on caries progression, expressed in this study as high DMFT values. Loss of teeth is likely to create dental and chewing problems, possibly resulting in increased dental and medical treatment needs.
Adult↗
Bone height changes in individuals with periodontal disease: a 17-year prospective longitudinal study.
OBJECTIVE: The aim of this study was to analyse changes in bone height after 17 years in smokers and non-smokers with periodontal disease, and to compare these with clinical assessment outcome. MATERIAL AND METHODS: Participants comprised 50 adults with periodontitis and 18 healthy controls from a randomly selected epidemiological sample. Their mean age at the end of the study was 54.2 (SD+/-3.09) years. The study included radiographic analysis compared with clinical data. RESULTS: The periodontitis group had significantly (p<0.001) higher values than their healthy counterparts for plaque index (PLI), gingival index (GI), calculus index (CI), and bleeding on probing (BOP) at baseline and after 17 years. At the end of the follow-up, never-smokers with periodontitis had higher values for PLI (p<0.05) and ex-smokers and smokers had higher GI and BOP (p<0.001) than the controls. In all individuals with periodontitis, maxillary molars were most affected. Smokers had more severe marginal bone loss over time. Vertical bone defects were more often seen on the mesial side of teeth (p<0.05). CONCLUSION: Marginal bone level in this prospective study did reveal tooth groups at higher risk for progression of periodontal disease.
Adult↗
A socio-economic perspective on periodontal diseases: a systematic review.
OBJECTIVE: The aim of this systematic review was to ascertain whether socio-economic conditions increase the risk of periodontal diseases. METHODS: A MEDLINE search was conducted for the period 1965-April 2004. Only original articles were included; 47 studies remained for the final assessment. The studies were analysed regarding the outcome of the association between socio-economic variables and periodontal disease, depending on the study design (cross-sectional survey or longitudinal case-control) and whether smoking was included or not. RESULTS: Twenty-nine out of 36 studies with a cross-sectional design were in favour of the association between socio-economic factors and periodontal diseases. In the studies with a longitudinal or case-control design, there were five in favour of the association, and also six against. When smoking was included in the analysis of cross-sectional studies, a significant association between socio-economic variables and periodontal disease was found in 11 studies and no significance in another five studies. The corresponding figures for case-control studies showed four studies being significant, but also four studies showing no significance. CONCLUSION: Based on relevant study designs and including smoking in the analysis, the socio-economic variables associated with periodontal diseases appear to be of less importance than smoking.
Body Weight↗
Oral health in women with coronary heart disease.
BACKGROUND: Over the last few decades, oral diseases including periodontitis, have been discussed as a possible risk factor for cardiovascular disease. The purpose of this study was to compare the oral health of age-matched women with or without coronary heart disease (CHD). METHODS: A total of 143 consecutive women, aged 43 to 79 years, with diagnosed CHD underwent a thorough dental examination including a panoramic radiograph and were compared to 50 women, aged 45 to 77 years without CHD. RESULTS: The number of remaining teeth and pathological periodontal pockets (> or =4 mm) between the groups differed. The women with CHD had 18.9 +/- 8.5 remaining teeth versus 23.4 +/- 6.3 teeth in the control group (P < 0.001). The CHD group had more pathological periodontal pockets compared to the controls, 14.2 +/- 12.4 versus 9.6 +/- 13.3 (P = 0.002), respectively. The mean marginal bone level assessed on radiographs was the same in both groups, while the number of vertical bone defects differed (P = 0.022). Dentures were more frequent in the CHD group than in the controls (27% versus 6%, P = 0.022), as was edentulousness, 10.5% versus 0% (P = 0.017), respectively. Multiple regression analysis adjusted for age, smoking, body mass index (BMI), diabetes, education, and place of birth showed a relation between the number of periodontal pockets and CHD with an odds ratio (OR) of 3.8 (1.68 to 8.74), and a tendency between dentures and CHD, with an OR of 4.6 (0.99 to 21.28). CONCLUSION: This study indicates that women with CHD have worse oral health than those in a comparable group with no history of CHD.
Adult↗
Periodontal disease in a group of Swedish adult snuff and cigarette users.
The aim of this study was to compare the prevalence of periodontal disease in different groups of tobacco users. Participants (n = 1674) were selected from an initial random sample of residents in the Stockholm region. Socio-demographic characteristics and life-time history of tobacco use were registered in a self-completed questionnaire, followed by a clinical examination. Cumulative life-time tobacco use was analyzed in pack-years and can-years as the exposure of interest. Among participants, 50.8% were females and 49.2% were males. Life-time tobacco use was categorized into four mutually exclusive categories. Approximately, two-thirds of snuff users had combined snuff use with cigarette smoking during their life. Tobacco users had a higher prevalence of periodontal disease compared to never users. Exclusive smokers and mixed users presented the less favorable situation. Unhealthy periodontal conditions increased with increasing exposure to smoking, most evidently at the level of 15 or more pack-years. There was a significant positive association between current or former smoking and periodontal disease (OR = 2.7, CI = 1.7-4.3 and OR = 2.0, CI = 1.2-3.3, respectively) even after adjustment for plaque level. An indication of association was also apparent with former snuff use. Plaque was independently associated with periodontal disease, with a dose gradient. Smoking is associated with periodontal disease independently of plaque. Combining cigarette smoking and snuff use during life does not convey a decreased probability of being diagnosed with periodontal disease compared to smoking exclusively.
Adult↗
Self-reporting of periodontal diseases and clinical assessment outcome in a Swedish urban population of smokers and non-smokers.
The aim of this study was to determine whether there is an association between self-reporting of periodontal diseases and outcome in a clinical examination, and whether any difference is present in awareness of periodontal status between smokers and non-smokers. Participants comprised 1676 adults (838 M and 838 F aged between 31 and 40 years), 564 of whom reported being smokers. Subjects were asked via questionnaire whether they thought they had periodontal disease and why. A total of 1655 subjects answered the questionnaire and were subsequently divided into those who suspected having periodontal disease (Yes-group) and those who did not (No-group). A full-mouth clinical examination was carried out in all subjects. Female smokers in the Yes-group had a significantly higher number of teeth with pockets > or = 5 mm (P < 0.001) and a higher calculus index (CI-S, P < 0.01) than female smokers in the No-group. Male smokers in the Yes-group had significantly less remaining teeth (P < 0.01), more teeth with pockets > or = 5 mm (P < 0.001), and a higher CI-S (P < 0.05) than their counterparts in the No-group. For smokers, multivariate logistic regression analysis yielded an odds ratio (OR 3.21 [95% CI 1.73 5.74]) of self-reported periodontal disease to periodontitis outcome which was significant (P < 0.001). This association remained significant (P < 0.01) after adjustment for confounding factors. Subjects who reported having periodontal disease, especially those who also reported having movable teeth, were confirmed to have the disease. Smokers were more aware of their periodontal status than non-smokers.
Adult↗
Risk factors for cardiovascular disease in patients with periodontitis.
AIMS: This study compared plasma levels of established risk markers for atherosclerosis and indices of inflammation in 50 patients with severe periodontitis to those in 46 healthy cases. METHODS AND RESULTS: Full blood counts were performed and levels of high density lipoproteins (HDL), total cholesterol, haptoglobin, elastase, C-reactive protein (CRP), IL-6, TNFalpha receptor-1, alpha-1-antitrypsin and antibodies against human heat shock protein (Hsp) 60, mycobacterial Hsp65 and oxLDL were determined. Total cholesterol levels were similar in both groups, whereas HDL levels were lower (P=0.007) and the lipid profile (total cholesterol/HDL) was consequentially higher (P=0.03) in patients. Monocyte counts were elevated (0.56 vs 0.44x10(9)/l; P=0.002) and CRP levels were higher in patients, but TNFalpha receptor-1 and elastase levels were not. Anti-oxLDL antibody levels were similar, as were levels of haptoglobin, IgG anti HSP60, IgA and IgG anti-Hsp65 antibodies. Levels of IgA anti-Hsp60 antibodies were lower in patients (P=0.0001). Logistic regression analysis revealed a relationship between periodontitis and HDL (OR 2.15/0.5mmol/l, P=0.02) and body mass index (OR 4.54 P=0.005). CONCLUSIONS: Serological differences in subjects with periodontitis, some of which involve established risk factors for atherosclerosis, might provide insight into the reported epidemiological association between periodontitis and cardiovascular disease.
Adult↗
Plasma levels of lidocaine, o-toluidine, and prilocaine after application of 8.5 g Oraqix in patients with generalized periodontitis: effect on blood methemoglobin and tolerability.
Oraqix, a novel non-injectable anesthetic gel containing lidocaine and prilocaine and a thermosetting agent has been developed to provide localized anesthesia in periodontal pockets during scaling/root planing (SRP). The aim of this open study was to determine the plasma levels of lidocaine and prilocaine following application of 8.5 g Oraqix (5 cartridges) to 11 patients with generalized periodontitis (> or = 49% of tooth pockets > or = 5 mm and > or = 23% of pockets > or = 6 mm). Oraqix was applied to the pockets during periodontal probing and SRP over a 2.6 3.4 h period. Blood samples were collected up to 10 h after the start of application of Oraqix. Peak plasma levels of lidocaine (0.16-0.55 mg/L) and prilocaine (0.05-0.18 mg/L) occurred 2.0-3.7 h and 2.0-3.3 h, respectively, after the start of application of Oraqix. These levels are well below threshold levels for initial signs of central nervous system (CNS) toxicity. In conclusion, application of 8.5 g Oraqix (212.5 mg of lidocaine base and 212.5 mg of prilocaine base) in periodontal pockets was well tolerated and displayed a wide safety margin with respect to plasma levels normally associated with systemic toxicity.
Adult↗
Self-reported oral health, dental care habits and cardiovascular disease in an adult Swedish population.
PURPOSE: The primary aim was to investigate the oral health; oral care habits and the ability of the participants to afford dental care in an adult Swedish population. A secondary aim was to study whether there is a relationship between dental care habits, self-reported oral health status and cardiovascular disease (CVD). MATERIALS AND METHODS: The participants answered a questionnaire about the frequencies of diseases, the need for treatment and the effects of socio-economic factors on oral care habits. A questionnaire was mailed to 893 persons in 3 age groups (20-29, 50-59, and 75-84 years of age) of whom 723 replied (81.0%). RESULTS: The answers indicated that 16% had experienced dental problems without seeking help and more then 10% reported problems with chewing. In the group as a whole, 31.5% had sought no dental treatment, partly for financial reasons. When using a logistic regression model, as regards bleeding gums as a risk indicator of CVD, correcting for diabetes, education, gender, age and tobacco use, the estimated odds ratio (OR) was 1.70 (p = 0.05). The OR for those 50 years old or more was 1.79 (p = 0.05). For the oldest group alone, the OR was 2.69 (p = 0.05). The model showed an increased risk of CVD among those who had problems with their teeth without seeking help, OR 2.45 (p = 0.05). CONCLUSION: The study indicates that a large proportion of those answering the questionnaire had experienced dental problems without seeking help, partly for financial reasons. This group is more likely to have CVD and bleeding gums. It shows a relationship between the presence of bleeding gums and CVD, especially amongst the oldest participants.
Adult↗
Microbiological findings and host response in patients with peri-implantitis.
The aim of the present study was to characterise microbiota and inflammatory host response around implants and teeth in patients with peri-implantitis. We included 17 partly edentulous patients with a total of 98 implants, of which 45 showed marginal bone loss of more than three fixture threads after the first year of loading. Nineteen subjects with stable marginal tissue conditions served as controls. Oral hygiene, gingival inflammation, and probing pocket depth were evaluated clinically at teeth and implants. Microbiological and crevicular fluid samples were collected from five categories of sites: 1) implants with peri-implantitis (PI), 2) stable implants (SI) in patients with both stable and peri-implantitis implants, 3) control implants (CI) in patients with stable implants alone, 4) teeth in patients (TP) and 5) controls (TC). Crevicular fluid from teeth and implants was analysed for elastase activity, lactoferrin and IL-1 beta concentrations. Elastase activity was higher at PI than at CI in controls. Lactoferrin concentration was higher at PI than at SI in patients with peri-implantitis. Higher levels of both lactoferrin and elastase activity were found at PI than at teeth in patients. The concentrations of IL-1 beta were about the same in the various sites. Microbiological DNA-probe analysis revealed a putative periodontal microflora at teeth and implants in patients and controls. Patients with peri-implantitis harboured high levels of periodontal pathogens, Actinobacillus actinomycetemcomitans, Porphyromonas gingivalis, Prevotella intermedia, Bacteroides forsythus and Treponema denticola. These findings indicate a site-specific inflammation rather than a patient-associated specific host response.
Aged↗
A systematic review of the incidence of biological and technical complications in implant dentistry reported in prospective longitudinal studies of at least 5 years.
OBJECTIVE: To systematically review the incidence of biological and technical complications in implant therapy reported in prospective longitudinal studies of at least 5 years. METHODS: A MEDLINE search was conducted for prospective longitudinal studies with follow-up periods of at least 5 years. Screening and data abstraction were performed independently by multiple reviewers. The types of complications assessed were as follows: implant loss, sensory disturbance, soft tissue complications, peri-implantitis, bone loss >or=2.5 mm, implant fracture and technical complications related to implant components and suprastructures. RESULTS: The search provided 1310 titles and abstracts, out of which 159 were selected for full-text analysis. Finally, 51 studies were included. Meta analysis of these studies indicated that implant loss prior to functional loading is to be expected to occur in about 2.5% of all implants placed in implant therapy including more than one implant and when routine procedures are used. Implant loss during function occurs in about 2-3% of implants supporting fixed reconstructions, while in overdenture therapy >5% of the implants can be expected to be lost during a 5-year period. Few studies (41% of those included) reported data on the incidence of persisting sensory disturbance >1 year following implant surgery. Most of the studies that provided such data reported on the absence or a low incidence (1-2%) of this complication beyond this interval. A higher incidence of soft tissue complications was reported for patients treated with implants supporting overdentures. There is limited information regarding the occurrence of peri-implantitis and implants exhibiting bone loss >or=2.5 mm. Implant fracture is a rare complication and occurs in <1% of all implants during a 5-year period. The incidence of technical complications related to implant components and suprastructures was higher in overdentures than in fixed reconstructions. CONCLUSION: Implant loss was most frequently described (reported in about 100% of studies), while biological complications were considered in only 40-60% and technical complications in only 60-80% of the studies. This observation indicates that data on the incidence of biological and technical complications may be underestimated and should be interpreted with caution.
Alveolar Bone Loss↗
A systematic review of the effect of anti-infective therapy in the treatment of peri-implantitis.
The aim of this systematic review was to assess the treatment of peri-implantitis with special emphasis on the role of anti-infective therapy. No randomized controlled clinical trial was available for analysis. Of 145 peri-implant studies initially screened, 21 studies (six human and 15 animal studies) were analysed regarding the outcome of treatment of peri-implantitis. A multitude of treatment regimens, including anti-infective therapy, was reported. The antibiotic regimens varied between studies. No standardized medication protocol was used. Type of antibiotic, dosage, duration and time for initiation of antibiotic treatment were different for all studies, but details were not always reported. A non-medicated control group was reported in one animal experiment only. The outcomes following anti-infective treatment of peri-implantitis are highly variable. The evidence for a consistent and clinically relevant advantage using antibiotics can be questioned in this context. There are to date no data available to support specific treatment protocols. It is suggested that randomized human controlled clinical trials for the treatment of peri-implantitis be initiated.
Animals↗
Validity and limitations of self-reported periodontal health.
OBJECTIVES: To study the agreement between self-reported dental conditions and clinical findings in an adult population (20-84 years of age), and thus evaluate questionnaires as a tool in epidemiological studies of oral health, in general, and periodontal health, in particular. MATERIAL AND METHODS: A questionnaire was sent to 900 randomly selected subjects in the age groups 20-29, 50-59 and 75-84 years. Of these, 723 subjects (81.0%) answered the questionnaire and 20% of them underwent a clinical examination. RESULTS: As regards the remaining teeth, there was a mean difference of 1.4 teeth between the number indicated in the questionnaire and that found on the clinical examination. This difference was most marked in the older subjects. Eight of the nine subjects with removable dentures reported in their answers that they had removable dentures. Periodontal variables--we found significantly more subjects with pathological gingival pockets among those who stated that they had pockets than among those who answered that they did not (P = 0.01; chi-square independent test). Gingival bleeding was common in those who answered 'Yes' than in those who answered 'No' to the question concerning bleeding gums. This difference was significant (P = 0.05; chi-square independent test) in the three age groups. However, there was no correlation between the questionnaires and the clinical examination concerning tooth mobility. CONCLUSION: Questionnaires concerning oral status are valid concerning the number of remaining teeth and use of removable dentures. They are less reliable about specific periodontal variables, but can still become a valuable tool for epidemiological studies of periodontal health.
Adult↗
[A gap in the welfare. Every other low-income earner skips visits to the dentist--a public health problem is to be expected].
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Dental Health Services↗