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The relationship between general osteoporosis of the organism and periodontal diseases.

Osteoporosis and periodontitis are very prevalent diseases and are most common in middle-aged and elderly women. These diseases are related as both damage bone tissue and share common risk factors. Discussions about the association between these two bone-damaging diseases began in 1960. A hypothesis was raised that systemic imbalance in bone resorption and deposition might manifest itself in the alveolar bone earlier than in other bones. When analyzing systemic and local changes in bone density, a number of issues were investigated and attempted to answer the question of whether dental osteopenia is a local manifestation of osteoporosis having similar etiology and risk factors, or it is an independent process depending primarily on factors that cause periodontal disease. Histomorphometric and microradiographic studies showed that increasing porosity of the cortical layer in mandible resulted in the decrease in bone mass. Bone strength is best expressed through bone mineral density, and it can be called a diagnostic criterion of osteoporosis. The examination of bone mineral density is called densitometry and may be performed using dual-energy x-ray absorptiometry. Orthopantomography is a method that is widely applied in odontological practice and is also informative in determining the bone density of the mandible. It can be applied when performing orthopantomographic and vertical linear measurements, as well as in determining indices in the studies of osteoporotic changes. Since many patients attend odontological clinics, nearly all of them undergo orthopantomography. This is a good possibility to investigate osteoporotic changes in the mandible, to select individuals for further studies, and to ensure clinical benefit and good treatment results.

Absorptiometry, Photon↗

A new concept of periodontal diseases.

Both the inflammatory and noninflammatory types of periodontal diseases begin with an aseptic, traumatic destruction of alveolar bone, caused by traumatizing parafunctions and followed by changes in the gingiva. The latter may or may not have a superimposed infectious inflammatory process. A new concept to fit these facts is proposed: periodontal diseases are autodestructive processes in the masticatory system, with or without superimposed septic inflammation. To confirm the theory of autodestruction, direct evidence as well as indirect but conclusive evidence is given for the existence of traumatizing forces in the masticatory system, for traumatic destruction of alveolar bone, for changes in the gingiva following destruction of alveolar bone, and for the parafunctions by all persons afflicted by periodontal disease. It is concluded that traumatizing parafunctions are the main factor in the etiology of periodontal diseases and that in therapy recurrences are inevitable unless parafunctions have been eliminated.

Alveolar Process↗

Aerobes in periodontal disease in the dog: a review.

Periodontal disease has been shown to be caused by bacteria. Periodontal inflammation results as the plaque bacteria change from a predominantly non-motile, Gram-positive, aerobic coccoid microbiotal flora to a more motile, Gram-negative, anaerobic, rod-shaped flora. A review of the literature related to aerobic flora is included. The important effects of aerobic flora as well as their importance in contributing to periodontal disease development is reported.

Animals↗

Periodontal therapy may reduce the risk of preterm low birth weight in women with periodontal disease: a randomized controlled trial.

BACKGROUND: Recent studies have suggested that periodontal disease is a risk factor for preterm low birth weight (PLBW). A randomized controlled trial was undertaken to help further evaluate the proposed association between periodontal disease and PLBW. METHODS: Four hundred pregnant women with periodontal disease, aged 18 to 35, were enrolled while receiving prenatal care in Santiago, Chile. Women were randomly assigned to either an experimental group (n = 200), which received periodontal treatment before 28 weeks of gestation or to a control group (n = 200) which received periodontal treatment after delivery. Previous and current pregnancies and known risk factors were obtained from patient medical records and interviews. The primary outcome assessed was the delivery at less than 37 weeks of gestation or an infant weighing less than 2,500 g. RESULTS: Of the 400 women enrolled, 49 were excluded from the analyses for different reasons. The incidence of PLBW in the treatment group was 1.84% (3/163) and in the control group was 10.11% (19/188), (odds ratio [OR] 5.49, 95% confidence interval [CI] 1.65 to 18.22, P= 0.001). Multivariate logistic regression analysis showed that periodontal disease was the strongest factor related to PLBW (OR 4.70, 95% CI 1.29 to 17.13). Other factors significantly associated with such deliveries were: previous PLBW (OR 3.98, 95% CI 1.11 to 14.21), less than 6 prenatal visits (OR 3.70, 95% Cl 1.46 to 9.38), and maternal low weight gain (OR 3.42, 95% CI 1.16 to 10.03). CONCLUSIONS: Periodontal disease appears to be an independent risk factor for PLBW. Periodontal therapy significantly reduces the rates of PLBW in this population of women with periodontal disease.

Adolescent↗

Humoral antibody responses in periodontal disease.

Several forms of periodontal disease are considered to be infectious diseases with associated specific bacteria. This study examined the humoral antibody levels as assayed by ELISA to Actinobacillus actinomycetemcomitans, Porphyromonas gingivalis, and Prevotella intermedia in adult periodontitis (AP), localized juvenile periodontitis (LJP), rapidly progressive periodontitis (RPP), and in periodontally healthy subjects (HS). Sixty-two of the 64 (96.9%) patients had significantly elevated antibody levels to at least one of the three organisms. Elevated levels of antibodies to P. gingivalis occurred in 82.8% of the RPP, LJP, and AP patients with all 3 disease groups showing greater responses than HS controls. Antibodies to A. actinomycetemcomitans were found in 59.4% of the RPP, LJP, and AP patients and were significantly higher in both LJP and RPP patients. Only 21.9% of the RPP, LJP, and AP patients showed elevated levels to P. intermedia with only significantly higher levels in the RPP and LJP groups. Antibodies to A. actinomycetemcomitans and P. intermedia were rarely found alone (only 5.1% and 2.6% of the patients respectively) but were usually accompanied by P. gingivalis. These results suggest that one or more combinations of these 3 bacteria may play a role in the pathogenesis of these forms of periodontal disease.

Adolescent↗

Relationship of destructive periodontal disease to the acute-phase response.

BACKGROUND: Destructive periodontal diseases have been associated with an increased risk of atherosclerotic complications; however, the potential mechanisms are yet to be defined. Inflammation plays a central role in atherosclerosis since C-reactive protein (CRP), an acute-phase protein monitored as a marker of inflammatory status, has been identified as a major risk factor for atherosclerotic complications. Recent reports that destructive periodontal diseases can increase CRP values present the possibility that the acute-phase response may link these 2 disease processes. The objective of the present investigation was to determine the effect of destructive periodontal disease status, severity, and progression on components of the acute-phase response in an urban minority population. METHODS: Clinical measurements recorded included probing depth, attachment level, gingival erythema, bleeding upon probing, suppuration, and plaque. Disease progression was defined as a >2 mm loss of attachment 2 months post-baseline. Serum antibody was measured by enzyme-linked immunosorbent assay. CRP was measured using a high-sensitivity CRP (hsCRP) assay. A commercial laboratory measured serum glucose (non-fasting), albumin, cholesterol, high-density lipoprotein (HDL), triglycerides, low-density lipoprotein (LDL), and iron. RESULTS: Increased serum IgG antibody to Porphyromonas gingivalis, but not to 5 other species, was associated with periodontal disease status, increased severity, and progression as were age, male gender, and smoking. Cholesterol and LDL were increased in disease, and HDL and iron were increased in health. hsCRP, glucose, and cholesterol increased with disease progression. By regression analysis, IgG antibody to P. gingivalis correlated with age, probing depth, and hsCRP, and negatively correlated with albumin and iron. By logistic regression, subjects who experienced multiple sites of disease progression and elevated antibody to P. gingivalis increased the odds ratio of hsCRP>2.08 mg/l by 14.1 and 5.6, respectively. CONCLUSION: These results suggest that destructive periodontal disease and disease progression are associated with changes in serum components consistent with an acute-phase response.

Acute-Phase Reaction↗

Antibody responses to suspected periodontal pathogens in elderly subjects with periodontal disease.

Little is known about the relationship of aging to periodontal disease. The immune response undergoes aging-related changes resulting in loss of functional capacity. The aim of this study was to investigate the relationship between levels of serum IgG antibodies against suspected periodontal pathogenic microorganisms to the presence or absence of periodontal disease in an elderly (65-75 yrs) population. From this study, we obtained information concerning: (1) the ability to differentiate elderly individuals without disease from those with disease by their levels of antibodies against periodontal pathogens and (2) which periodontal pathogen(s) triggered those responses. IgG anti- Porphyromonas gingivalis (strains W83 and 381) levels in the serum of elderly patients with severe periodontal disease were the only antibody responses measured which were elevated compared to the elderly control group of subjects with no periodontal disease. Anti- Prevotella intermedia IgG levels in both elderly patient groups were depressed compared to anti- P. intermedia levels in the young normal control subjects. Serum IgG antibody levels to six other plaque microorganisms did not differentiate between diseased and normal, elderly or young subjects. This data suggested that P. gingivalis was associated with periodontal disease in this elderly group of individuals and that those elderly individuals were able to respond with a normal IgG immune response.

Adult↗

Java project on periodontal diseases. The natural development of periodontitis: risk factors, risk predictors and risk determinants.

OBJECTIVE: To identify risk factors, risk predictors and risk determinants for onset and progression of periodontitis. MATERIAL AND METHODS: For this longitudinal, prospective study all subjects in the age range 15-25 years living in a village of approximately 2000 inhabitants at a tea estate on Western Java, Indonesia, were selected. Baseline examination was carried out in 1987 and follow-up examinations in 1994 and 2002. In 2002, 128 subjects could be retrieved from the original group of 255. Baseline examination included evaluation of plaque, bleeding on probing, calculus, pocket depth, attachment loss and presence of Actinobacillus actinomycetemcomitans, Porphyromonas gingivalis, Prevotella intermedia, spirochetes and motile microorganisms. RESULTS: The mean attachment loss increased from 0.33 mm in 1987 to 0.72 mm in 1994 and 1.97 mm in 2002. Analysis identified the amount of subgingival calculus and subgingival presence of A. actinomycetemcomitans as risk factors, and age as a risk determinant, for the onset of disease. Regarding disease progression, the number of sites with a probing depth > or = 5 mm and the number of sites with recession were identified as risk predictors and male gender as a risk determinant. CONCLUSION: Screening of these parameters early in life could be helpful in the prevention of onset and progression of periodontal diseases.

Adolescent↗

Epidemiology of periodontal disease in poodles.

The periodontal condition of 123 poodles was assessed using the parameters of depth of gum pocket, attachment level, bleeding on probing, and plaque and calculus accumulation. No dogs were free of periodontal disease. The number of deep pockets and dramatic loss of attachment ranged from 0.1 teeth in young dogs to 4.2 teeth in old animals. A sixfold increase in deep pocketing took place in dogs between the ages of six and seven, followed by a twofold increase in the number of teeth missing in dogs within the 10 to 11 year age group. First premolars, incisors and second molars were at highest risk. No correlation between dietary conditions and disease incidence could be detected. It is concluded that, by concentrating their diagnostic efforts on those age groups and types of teeth at highest risk, clinicians could improve the effectiveness of their treatment interventions.

Age Distribution↗

Serum IgG antibody response to periodontal pathogens in minority populations: relationship to periodontal disease status and progression.

Differences in periodontal disease prevalence, severity, subgingival microflora and host immune response have been reported for various ethnic/racial groups, which implies that risk factors for destructive periodontal disease progression may also vary in these populations. As it is possible that these differences may be due to confounding variables other than ethnicity/race, we have measured serum IgG antibody response to six periodontal pathogens, and compared these data with microbiological, clinical and demographic parameters in three urban minority populations. The study population consisted of 23 Asiatic, 48 African-American and 37 Hispanic subjects, who were resident in the greater New York region. Clinical indices that were recorded included pocket depth, attachment level, gingival erythema, bleeding upon probing, suppuration and supragingival plaque. Attachment level measurements were taken twice at each visit, and the difference between the means of pairs of measurements taken at baseline and two months later was used to determine disease progression. Subgingival microbiological species were identified and enumerated using DNA-DNA checkerboard hybridization. Serum IgG antibody levels to Actinobacillus actinomycetemcomitans serotyopes a and b, Bacteroides forsythus, Campylobacter rectus, Porphyromonas gingivalis and Prevotella intermedia were measured by enzyme-linked immunosorbant assay (ELISA). Mean serum IgG antibody to P. gingivalis was found to be higher in the African-American group, while IgG antibody to B. forsythus was lower in the Hispanic group. However, the African-American group also had greater mean probing depth, attachment loss, number of missing teeth and numbers of individuals within the unskilled occupational group. When the data were analyzed by occupational status, mean serum IgG antibody to P. gingivalis increased from professional to skilled to unskilled groups. For the entire study population, prior disease and subsequent attachment loss were associated with elevated serum IgG antibody to P. gingivalis. Increasing pocket depth, attachment level, gingival erythema and age were also positively correlated with serum IgG antibody to P. gingivalis, but not with serum IgG antibody to the other five subgingival species. No correlation was found between whole-mouth bacterial levels and homologous serum IgG antibody levels. These results suggest that elevated serum IgG antibody to P. gingivalis reflects destructive periodontal disease status, and may be considered a risk factor for disease progression in these ethnic/racial populations. In addition, although differences in serum IgG antibody profiles to subgingival species were found among the three ethnic/racial groups, environmental and socioeconomic variables may have a greater influence on serum IgG antibody levels in these populations.

Adult↗

Diabetes and periodontal disease: two sides of a coin.

Diabetes and periodontal disease are two seemingly unrelated disorders whose complex interrelationship is only now being clarified. How does diabetes, a metabolic disease, affect the periodontium? Perhaps even more interesting for the diabetic patient: How does periodontal disease, a bacterial infection that results in inflammation and tissue destruction in the oral cavity, impact the metabolic control of diabetes? Evidence clearly supports diabetes as a risk factor for periodontal disease. The mechanisms by which diabetes adversely influences the periodontium are in many ways similar to the mechanisms responsible for the classic complications of diabetes. In recent years, research has demonstrated that the relationship between periodontal disease and diabetes is more complex than previously realized. Not only does diabetes affect the periodontium, but periodontal infection can adversely impact glycemic control in diabetes. Periodontal treatment that decreases the bacterial challenge and the resulting inflammatory periodontal destruction can improve glycemia in some diabetic patients. These research findings are of importance to diabetic patients and their health care providers, because the findings support the need for examination, diagnosis, treatment, and prevention of periodontal infection.

Blood Glucose↗

Interleukin 1 beta, interleukin 6, beta 2-microglobulin, and transforming growth factor-alpha in gingival crevicular fluid from human periodontal disease.

Inflammatory mediators are central to the pathogenesis of periodontal diseases and may be used as markers in diagnosis. The aim of this study was to identify and quantify the various growth factors, apoptosis-related modifiers [soluble form of Fas (sFas) and bcl-2] and cytokines in the gingival crevicular fluid (GCF) of patients with different severities of periodontitis as compared with those of controls. GCF samples were taken from patients with periodontal disease and from controls. The concentrations of epidermal growth factor, transforming growth factor (TGF)-alpha, interleukin (IL)-1 beta, IL-6, interferon-gamma, beta 2-microglobulin (beta 2-MG), and apoptosis-related modifiers sFas and bcl-2 in the samples were determined by enzyme-linked immunosorbent assay. TGF-alpha was significantly lower in patients with periodontal disease than in the controls. In contrast, the concentrations of IL-1 beta, IL-6; and beta 2-MG were significantly higher in the group with severe periodontal disease than in the controls. The amount of total protein in the GCF was considerably higher in the disease group than the controls (p < 0.05). TGF-alpha, IL-1 beta, and beta 2-MG concentrations were associated (Spearman rank correlation, r < 0.05 for all) with clinical measures of disease severity (pocket depth) and inflammation (bleeding when probed). Apoptosis-related modifiers (sFas and bcl-2) could not be detected in any samples. These results suggest that the growth factor TGF-alpha and certain cytokines are associated with the presence of periodontal disease.

Adult↗

Trends in tooth loss due to caries and periodontal disease by tooth type.

Although the patterns of dental disease is gradually changing, caries and periodontal disease still account for the most important reason for extractions in most countries. However their relative contributions towards overall tooth mortality figures varies. The aim of this study is to investigate the types of teeth usually associated with extractions due to caries or periodontal disease and its relation to the age at which the tooth was lost. The highest proportion of extractions due to caries occurred between 21 to 30 years of age while that for periodontal disease occurred between 41 to 50 years. For caries, the greatest proportion of extractions involved the posterior teeth. The most frequently extracted teeth due to caries are the molars, in particular the first permanent molar. However, for periodontal disease a slightly greater proportion of anterior teeth were lost than the posteriors. This trend is more marked in the lower jaw than the upper. Overall, extractions related to caries tend to increase posteriorly, while that for periodontal disease tend to increase anteriorly.

Adolescent↗

[Effect of metabolic control in type I diabetes patients and its association with periodontal disease].

OBJECTIVE: To compare the frequency of periodontal disease in type 1 diabetes mellitus patients with and without metabolic control, having a control group of healthy patients. MATERIAL AND METHODS: A prolective cross sectional study with simple random sampling was carried out; patients were divided in three groups: A). Forty healthy subjects, B). Twenty diabetic patients with metabolic control, and C). Twenty diabetic patients without metabolic control. The diabetic subjects were evaluated with glycosylated hemoglobin (GHb) to determine the glucose control; clinical periodontal evaluations were performed for all teeth in each subject and following indexes were included: Plaque, gingival, mobility, probing depth, attachment level, bleeding on probing, and marginal bone loss. RESULTS: The imbalance of glucose of subjects with diabetes mellitus type 1 was associated with more frequency of periodontal disease (p < 0.05). CONCLUSION: The population of type 1 diabetes mellitus with imbalance of glucose showed association with periodontal disease.

Adolescent↗

Identification of lysine decarboxylase as a mammalian cell growth inhibitor in Eikenella corrodens: possible role in periodontal disease.

The pathogenesis of inflammatory periodontal disease was studied by examining the mechanism of HeLa and HL60 cell growth inhibition by cell-free saline-soluble extracts of Eikenella corrodens and bacterial plaque. Previous studies identified a protein (p80) as causing growth inhibition by E. corrodens extracts. After purification by two-dimensional SDS-PAGE, p80 was digested with protease lysC. Amino acid sequences were obtained and backtranslated for use as PCR primers. A 5840 nucleotide sequence containing a lysine decarboxylase gene was obtained from a Sau3 A1 genomic library of E. corrodens DNA. Lysine decarboxylase activity was present at physiologic pH in the E. corrodens extracts containing p80, and also in bacterial plaque. Both extracts caused growth inhibition by depleting lysine from cell culture media through conversion to cadaverine. Adding lysine, or immune goat IgG to a peptide derived from the active site sequence of E. corrodens lysine decarboxylase, retarded lysine depletion and growth inhibition. epsilon-Amino caproic acid specifically enhanced lysine decarboxylase activity at the low lysine concentration in HL60 cell culture media, and also increased the growth inhibition. Thus, lysine decarboxylases such as p80 inhibit growth by removing lysine from mammalian cell culture media. A new role for lysine decarboxylase activity in the microbial aetiology of periodontal disease is discussed.

Carboxy-Lyases↗

Periodontal disease, tooth loss, and oral hygiene among older Americans.

Recent research has suggested that susceptibility to destructive periodontal disease may not be as universal as was previously thought. This report analyzes data from a representative national sample of 11 338 American adults aged 25-74, examined in a national survey in 1971-74. Results showed that 46.1% of those aged 65-74 were edentulous, but half of the dentate persons in that age group were diagnosed as free of destructive periodontal disease. Periodontal (PI) and oral hygiene (OHI-S) index scores in this group were significantly better in those persons who had lost fewest teeth. When persons aged 65-74 who retained 25 or more teeth were compared with younger adults who also had 25 or more teeth, OHI-S and CI scores were similar. It is hypothesized that maintenance of oral hygiene levels corresponding to OHI-S scores of 0.3-0.6, and calculus levels corresponding to CI scores of 0.1-0.2, is sufficient to maintain a dentition free of periodontal disease throughout life. Slightly higher OHI-S levels (0.7-1.3) and CI levels (0.3-0.6) might be compatible with acceptably low levels of periodontal disease.

Adult↗