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PubMed2006

Increased leukotriene concentrations in gingival crevicular fluid from subjects with periodontal disease and atherosclerosis.

Recent studies indicate that periodontal disease is associated with the development of early atherosclerotic lesions in the carotid artery. Since inflammation is a key feature in both atherosclerosis and periodontal disease, a common mediator of the two diseases could be anticipated. Leukotrienes are lipid-derived inflammatory mediators recently implicated in the pathogenesis of atherosclerosis and previously shown to be produced in periodontitis. The aim of the present study was to detect leukotrienes in gingival crevicular fluid (GCF) from subjects with atherosclerosis. Carotid ultrasonography and oral clinical examination were performed in 19 periodontitis patients and 16 healthy subjects. Atherosclerotic plaques were detected on ultrasound examination in 13 subjects with periodontis, and in 5 of the healthy subjects. Elevated concentrations of leukotriene B(4) and cysteinyl-leukotrienes were detected in GCF from subjects with a high dental plaque index (PLI>0.3), supporting an increased leukotriene formation in periodontitis. In addition, subjects with atherosclerotic plaques had significantly elevated concentrations of cysteinyl-leukotrienes in their GCF as compared with subjects without a visible plaque. Finally, the increased cysteinyl-leukotriene concentrations in GCF from atherosclerotic subjects were observed also when sub groups of periodontis patients and healthy subjects were compared separately. In summary, increased GCF concentrations of cysteinyl-leukotrienes were correlated to measures of both periodontitis and atherosclerosis. These results suggest that increased leukotriene formation may represent a possible link between periodontitis and atherosclerosis and a risk factor marker for both diseases.

Atherosclerosis↗
PubMed1993

Neuropsychiatric disorders and periodontal disease.

The purpose of this study was to compare the severity of periodontal disease among subjects with neuropsychiatric disorders with that of a control group of normal subjects in order to determine the association between emotional disturbances and periodontal disease. One hundred and sixty-three subjects hospitalized for neuropsychiatric conditions (NP) and 78 control subjects with no emotional problems were examined. Periodontal attachment loss was measured using Russell's index (PI), and the oral hygiene status was evaluated with the Oral Hygiene Index (OHI) of Green and Vermillion by a single examiner. Full mouth radiographs were also evaluated. The results showed that mean PI, debris, calculus, and OHI scores were generally higher in NP subjects compared to controls. When the effects of severity of debris, calculus, and OHI scores, and daily tooth brushing frequency were controlled, NP subjects had statistically significantly higher mean PI scores than controls. These findings suggest that emotional problems may be associated with the severity of periodontal disease.

Adult↗
PubMed1990

Dental health behaviors and periodontal disease indicators in Danish youths. A 10-year epidemiological follow-up.

The purpose of the present study was to analyse the epidemiologic relationship between dental health behaviors and periodontal disease. Indicators of periodontal disease in terms of bleeding and calculus were measured dichotomously (absence/presence). Periodontal pockets were as follows: normal pockets (0-3 mm), shallow pockets (4-5 mm), and deep pockets (6+ mm). The indicators were measured on 4 surfaces on 6 index teeth (16, 11, 26, 36, 31, 46) in 1984-85. The highest value for each tooth of bleeding (0/1), calculus (0/1) and pockets (0/1/2) was used for calculation of the bleeding index, the calculus index and the pocket index. The participation rate in 1984-85 was 86%, and the study population involved 368 males and 388 females. Information concerning dental health behavior was obtained both in childhood (1974) when the individuals were 9-10 years of age, and in adulthood (1984-85) when the individuals were 20-21 years of age. Information concerning dental health behaviors in adulthood, i.e., regularity of dental visits, frequency of tooth brushing, and regular use of interdental aids, was obtained through a self-administered questionnaire (1984-85). Dental health behaviors in childhood (1974) was operationalized as level of plaque, gingivitis, and dmfs. The results showed that dental health behaviors in childhood and in adulthood were together responsible for 9.4-13.8% of the variance in level of periodontal disease indicators. Determinants of early dental health behaviors in terms of plaque and dmfs at age 9-10 years were significant predictors in pocket index at age 20-21.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed2005

Prevalence of oral lesions and periodontal diseases in HIV-infected patients on antiretroviral therapy.

A cross-sectional study examining oral manifestations was carried out in HIV-infected patients of a general HIV-specialized unit to provide prevalence data on oral lesions and periodontal diseases. The occurrence of oral lesions was correlated with demographic and clinical characteristics, immunologic and virologic parameters. Among 139 patients 86% presented any oral lesions with a prevalence of 76% of any periodontal diseases. Most periodontal lesions were classified as conventional gingivitis (28%) or periodontitis (30%). Dental plaque formation was associated with a higher prevalence of periodontal diseases (p = 0.01) and periodontal inflammation scores were higher in patients with more reduced CD4-counts (p = 0.03). Prevalence for HIV-specific oral lesions was 29% with a proportion of 9% of linear gingival erythema (LGE), 3.6% of necrotizing and ulcerative gingivitis (NUG) or periodontitis (NUP), 7% of oral candidiasis, 3.6% of oral hairy leucoplakia (OHL) and single other lesions. HIV-specific lesions (NUG/NUP, oral candidiasis and OHL) were found predominantly in patients with advanced immunosuppression and elevated viral load. Compared with data of oral diseases of the pre-HAART era prevalence of HIV-specific lesions was markedly reduced. Especially frequently known lesions such as oral candidiasis and OHL were less common seen. We noticed a shift of prevalence towards periodontal diseases. Lack of oral hygiene determined by plaque formation and reduced CD4-counts with pronounced periodontal inflammation can be seen as risk factors for periodontal disease. Overall high prevalence of manifestations underlines the importance of oral examination for the general practitioner and visits by oral specialists should become a routine procedure in HIV-patients care.

Adult↗
PubMed1986

Is antibiotic therapy justified in the treatment of human chronic inflammatory periodontal disease?

New insight into the possible involvement of specific bacteria in the etiology of periodontal disease has stimulated interest in antibiotic therapy. However, current knowledge does not allow the designation of one or more pathogens in periodontal diseases. Some bacteria are considered suspected periodontal pathogens due to their predominance in the pocket and their potential pathogenicity, yet they all appear to be indigenous bacteria. For this reason, one can question the rationale for the use of antibiotics in the treatment of periodontal disease since the theoretical basis for their application seems small. Several reports of clinical trials in which antibiotics were administered as an adjunct to scaling and rootplaning in adult periodontitis conclude with encouraging statements concerning bacterial inhibition and the cure of inflammatory periodontal disease. However, the data are conflicting and mostly negative. Antibiotic treatment in combination with scaling and rootplaning in juvenile periodontitis and refractory adult periodontitis has shown some benefit, but the clinical trials were not sufficiently controlled to permit conclusions. So far, antibiotics have been applied as a last resort in order to supplement the non-specific approach of mechanical root debridement, but it can be doubted whether this approach offers any benefit in the long run.

Anti-Bacterial Agents↗
PubMed1981

The treatment of periodontal disease in the mixed dentition.

Treatment of periodontal disease in children comprises: 1. Dental health education emphasizing the role of oral hygiene in the prevention of periodontal disease. Inter-dental cleaning procedures should be taught to children as early as possible. 2. Early diagnosis of disease. Severe gingivitis indicates a poor oral hygiene and proper treatment will be to teach the patient daily plaque control procedures. Early diagnosis of destructive periodontitis may be performed on bite-wing X-rays. 3. Removal of sub- and supragingival plaque and plaque retentive factors as calculus and overhanging margins of restorations. If necessary, periodontal surgery may be performed in order to get access to deep subgingival plaque. This may particularly be the case when treating juvenile periodontitis. 4. Establishment of a plaque control programme preferably performed by the individual patients. If required, professional toothcleaning at adequate intervals must be instituted in order to prevent recurrence of disease after treatment. 5. Establishment of a maintenance schedule for regular dental examination so that recurrence of the disease can be detected and dealt with as soon as possible.

Adolescent↗
PubMed1996

Medical status and complications in relation to periodontal disease experience in insulin-dependent diabetics.

The aim of this study was to define a population of diabetics exhibiting an increased risk of developing severe periodontitis by comparing the medical status of 2 groups of diabetics, 1 with no/minor periodontal disease and 1 with severe periodontal disease. The case-control study consisted of 2 parts, a baseline study and a follow-up study. 39 case-control pairs were selected. They were adult, long-duration, insulin-dependent diabetics matched according to sex, age and diabetes duration. One individual in each pair (the CASE) exhibited severe periodontal disease while the other (the CONTROL) exhibited gingivitis or only minor alveolar bone loss. The median age of the cases was 58 years (range 36 to 70 years) and of the controls 59 years (range 37 to 69 years). The median disease duration in cases and controls was 24 years and 25 years, respectively. The median follow-up time was 6 years. The medical variables analysed were weight, insulin dose, systolic and diastolic blood pressure, vibratory threshold, triglycerides, total-cholesterol, HDL-cholesterol, creatinine, HbA1, proteinuria, ECG, retinopathy, stroke, transient ischemic attacks (TIA), angina, myocardial infarct, heart failure, hypertension, intermittent claudication, foot ulcer, death, cause of death, and smoking habit. Biochemical analyses and clinical variables used as a routine in the monitoring of diabetics failed to differentiate between diabetics with severe and minor periodontal disease. In the follow-up study, significantly higher prevalences of proteinuria and cardiovascular complications such as stroke, TIA, angina, myocardial infarct and intermittent claudication were found in the case group. An association between renal disease, cardiovascular complications and severe periodontitis seems to exist. This indicates that a closer cooperation between the diabetologist and the dentist is necessary in monitoring the diabetic patient.

Adult↗
PubMed2005

Longitudinal study of periodontal disease and edentulism with rates of bone loss in older women.

BACKGROUND: Previous cross-sectional studies have suggested a link between periodontal disease and osteoporosis. The purpose of the present study is to evaluate the association between changes in bone mineral density (BMD) and clinical signs of periodontal tissue destruction and tooth loss over a 2-year period. METHODS: A total of 398 women (mean age 75.5 years) were randomly selected for an ancillary study of periodontal disease; osteoporosis in association with the presence or absence of teeth was evaluated. Osteoporosis in association with periodontal disease was also evaluated. All subjects were participants at the Pittsburgh Clinical Center for the Study of Osteoporotic Fractures (SOF), a prospective cohort study of women 65 years of age or older designed to determine risk factors for fractures. Oral health examinations, including periodontal probing and attachment loss, were performed at the fourth clinical visit, an average of 6 years after baseline. BMD of the total hip and its subregions was measured using dual energy x-ray absorptiometry at the time of dental examination and 2 years later. Results are expressed as annual percentage change. RESULTS: A total of 145 (36.4%) women were edentulous and 163 (80.7%) of the dentate women (N = 253) had periodontal disease. Dentate women reported higher education (P <0.001) and a higher calcium intake (P= 0.002). Absolute BMD and percentage change in BMD were similar in dentate and edentulous women. We found no difference in BMD or in absolute or percentage change in BMD between women with or without periodontal disease. CONCLUSION: Little evidence exists for an association between edentulousness, periodontal disease, and longitudinal changes in BMD.

Aged↗
PubMed1982

The relationship between tooth vibratory sensation and periodontal disease.

Forty subjects both with and without periodontal disease were studied. Tooth proprioception was tested in regard to vibratory stimuli and the sensory perception thresholds were measured. A link was found between the quantitative diminution of the periodontal ligament and alveolar bone and the perception thresholds relative to vibratory stimuli. These thresholds are elevated in subjects with periodontal disease and are dependent on the region of the dental arch to which the stimulus is applied. Modification of these afferent sensory impulses leads to a change in the occlusal stroke pattern and possible exacerbation of the initial insult.

Adult↗
PubMed2000

The effect of interleukin-11 on the progression of ligature-induced periodontal disease in the beagle dog.

BACKGROUND: The rate of progression of periodontal disease is dependent on the complex regulatory interactions between bacteria and the immune modulators of the host response. The purpose of this investigation was to determine if recombinant human interleukin-11 (rhIL-11), known to downregulate several inflammatory modulators, has the ability in subcutaneous administration to reduce the rate and/or extent of periodontal attachment loss and radiographic bone loss in a ligature-induced periodontal disease beagle dog model. METHODS: Twenty 18-month-old female beagle dogs were brought to optimal periodontal health over a 2-week period. Periodontal disease was induced by placing 2.0 silk ligatures around the mandibular first molar and premolar teeth. The dogs were divided into 3 treatment groups and one control group. The 3 treatment groups received subcutaneous injections of either 15, 30, or 80 microg/kg of rhIL-11 in saline buffer twice a week. The placebo group received buffer only subcutaneously twice a week. The gingival health of each animal was measured by recording the presence or absence of gingival inflammation, plaque, and bleeding upon probing. Attachment levels and bone height were also measured. Treatment administration and clinical and radiographic evaluations were performed in a masked fashion. RESULTS: At week 8, the placebo group had 3.89 mm of attachment loss and 73.8% radiographic bone remaining. The 15 microg/kg group had 1.99 mm attachment loss and 89.5% bone remaining; the 30 microg/kg group had 0.84 mm attachment loss and 92.5% bone remaining; and the 80 microg/kg group had 1.05 mm attachment loss and 85.5% bone remaining. All 3 treatment groups lost significantly less attachment and retained significantly more bone than did the placebo group. CONCLUSIONS: The study indicates that subcutaneous injections of rhIL-11 were able to slow the progression of attachment and radiographic alveolar bone loss in a ligature-induced beagle dog model.

Alveolar Bone Loss↗
PubMed1997

Tooth mobility and periodontal disease.

Tooth mobility (TM) is an important feature of periodontal disease. This is evidenced by the large number of devices and methods of TM assessment that have been developed and tested. TM had been considered and investigated as an indirect measure of the functional condition of the periodontium as well as possible aggravating co-factor for periodontal disease.

Disease Progression↗
PubMed2003

Position paper: periodontal diseases of children and adolescents.

Children and adolescents are subject to several periodontal diseases. Although there is a much lower prevalence of destructive periodontal diseases in children than in adults, children can develop severe forms of periodontitis. In some cases, this destructive disease is a manifestation of a known underlying systemic disease. In other young patients, the underlying cause for increased susceptibility and early onset of disease is unknown. These diseases are often familial, suggesting a genetic predisposition for aggressive disease. Current modalities for managing periodontal diseases of children and adolescents may include antibiotic therapy in combination with non-surgical and/or surgical therapy. Since early diagnosis ensures the greatest chance for successful treatment, it is important that children receive a periodontal examination as part of their routine dental visits.

Adolescent↗
PubMed2006

Factors associated with periodontal diseases in Jordan: principal component and factor analysis approach.

This study was conducted to identify factors associated with periodontal disease in a Jordanian population using principal component and factor analysis techniques. Subjects were 603 dentate patients aged 15-65 years attending dental teaching clinics at the Jordan University of Science and Technology. Their oral hygiene and periodontal status were assessed using plaque index, gingival index, probing pocket depth, clinical attachment level, gingival recession, and number of missing teeth. Factor and principal component analysis and binary logistic regression were conducted to identify factors related to periodontal disease. Probing pocket depth, clinical attachment level, gingival recession, and number of missing teeth were sorted as the same factor and could be combined in one scale to measure the severity of periodontal disease. On the other hand, plaque index and gingival index were sorted as another factor and could be combined in another scale to correlate between oral hygiene and gingival status. The results demonstrated that increased age, low level of education, increased plaque index score, not brushing teeth, smoking more than 15 pack-years, and having diabetes were significantly associated with increased severity of periodontal disease. In conclusion, it was possible to form a standard scale, based on linear combinations of periodontal indices and parameters, to measure the severity of periodontal disease and determine its risk indicators.

Adolescent↗
PubMed1993

Technological advances in the clinical diagnosis of periodontal diseases.

Traditional diagnostic procedures for periodontal disease, such as probing and radiographic assessment, supply information on previous disease experience but not of present site-specific activity nor of possible future attachment loss. Although the newer automatic probes which record data electronically give higher resolution and accuracy than their manual counterparts, their use in clinical practice is only of value in longitudinal clinical trials. In general clinical practice, manual probing is adequate provided probing technique and probe tine characteristics are within acceptable limits. It is suggested that the general practitioner could use the CPITN method for screening purposes because of its relative speed and ease. This must, however, be supplemented by comprehensive probing in each sextant with advanced disease. The humble bitewing radiograph is likewise adequate for the assessment of alveolar bone loss in normal clinical practice but if refined data of bone loss over time is required, subtraction radiography is recommended. Currently, other forms of imaging technology have limited value in clinical practice because of technical complexity, access and cost. A number of other electronic devices are available which make the accurate assessment of mobility and occlusal function possible but, because the relationship between these signs and periodontitis is still equivocal, the general use of such apparatus is not indicated. The advent of a battery of easily performed chairside tests shows considerable promise for the future, particularly those tests that are becoming commercially available for the assay of host and bacterial markers of site-specific disease in the crevicular fluid. The clinical value and the cost-benefit of these assays need further investigation before they can be recommended for general use. Clinical practice objectives differ from those required for research projects and therefore the required sensitivity, specificity and predictive value of diagnostic tests must be in keeping with the intended purpose to justify the cost involved.

Cost-Benefit Analysis↗
PubMed2007

A prospective study of periodontal disease and pancreatic cancer in US male health professionals.

Two previous cohort studies reported positive associations between tooth loss or periodontitis and pancreatic cancer risk. Data on periodontal disease were obtained at baseline and every other year thereafter in a cohort of 51,529 male health professionals aged 40-75 years. A total of 216 patients were diagnosed with incident pancreatic cancer during 16 years of follow-up. Multivariable relative risks (RRs) and 95% confidence intervals (CIs) were estimated using Cox proportional hazards models controlling for potential confounders, including detailed smoking history. All statistical tests were two-sided. Compared with no periodontal disease, history of periodontal disease was associated with increased pancreatic cancer risk (overall, multivariable RR = 1.64, 95% CI = 1.19 to 2.26; P = .002; crude incidence rates: 61 versus 25 per 100,000 person-years; among never smokers, multivariable RR = 2.09, 95% CI = 1.18 to 3.71; P = .01; crude incidence rates: 61 versus 19 per 100,000 person-years). In contrast, baseline number of natural teeth and cumulative tooth loss during follow-up were not strongly associated with pancreatic cancer. The association between periodontal disease and increased risk of pancreatic cancer may occur through plausible biologic mechanisms, but confirmation of this association is necessary.

Adult↗
PubMed2001

Bidirectional interrelationships between diabetes and periodontal diseases: an epidemiologic perspective.

This review evaluates evidence for a bidirectional relationship between diabetes and periodontal diseases. A comprehensive Medline search of the post-1960 English language literature was employed to identify primary research reports of relationships between diabetes and periodontal diseases. Reports included in the review on the adverse effects of diabetes on periodontal health (DM-->PD) were restricted to those comparing periodontal health in subjects with and without diabetes. Review of adverse affects of periodontal infection on glycemic control included reports of periodontal treatment studies and follow-up observational studies in which changes in glycemic control could be assessed. Observational studies reporting DM-->PD provided consistent evidence of greater prevalence, severity, extent, or progression of at least one manifestation of periodontal diseases in the large majority of reports (supportive evidence in 44/48 total reviewed; 37/41 cross-sectional and 7/7 cohort). Additionally, there were no studies reviewed with superior design features to refute this association. Treatment studies provided direct evidence to support periodontal infection having an adverse, yet modifiable, effect on glycemic control. However, not all investigations reported an improvement in glycemic control after periodontal treatment. Additional evidence to support the effect of severe periodontitis on increased risk for poorer glycemic control comes from 2 follow-up observational studies. The evidence reviewed supports viewing the relationship between diabetes and periodontal diseases as bidirectional. Further rigorous, systematic study is warranted to establish that treating periodontal infections can be influential in contributing to glycemic control management and possibly to the reduction of the burden of complications of diabetes mellitus.

Age Factors↗
PubMed1984

Corticosteroid therapy and periodontal disease.

In the present investigation, the frequency and severity of periodontal disease was assessed in a group of patients with multiple sclerosis receiving corticosteroid hormone therapy for neurological disease. Age-matched patients with multiple sclerosis but without hormone therapy as well as healthy subjects served as controls. Individuals suffering from multiple sclerosis or polyneuropathies were selected from a pool of patients who were under treatment at the Department of Neurology, The Central Hospital of Kuopio, Finland. 27 individuals were identified who had received more than 1.5 g prednisone over a 1-4 year period. The average amount of steroid given to these patients was 3.5 g. 26 individuals also suffering from neurologic disease had received no or only negligable amounts of hormone therapy and were used as diseased controls. Another control group comprised age- and sex-matched healthy individuals from the city of Kuopio. The dental examination which was performed by one dentist comprised assessments of the following parameters: oral hygiene status, gingival conditions, probing depth, gingival recession and height of the alveolar bone. The findings clearly demonstrated that patients with neurological disease who received corticosteroid therapy had the same frequency of gingivitis as non-treated diseased controls. Furthermore, data describing probing depth, gingival recession and height of the alveolar bone revealed that there was no difference regarding the frequency and severity of periodontal disease between the 2 groups of neurological diseased patients. It was concluded that corticosteroid therapy maintained over 1-4 years had no obvious influence on clinical parameters of periodontal disease in patients suffering from neurological disease.

Adolescent↗
PubMed1984

Periodontal disease awareness.

New forms of patient education are needed to increase the periodontal disease awareness of the general public. Patients are more likely to seek professional treatment for periodontal disease when they are aware of its existence. The general practitioner should be encouraged, through the dental literature and continuing education courses, to assume responsibility for the diagnosis and management of the majority of periodontal problems. Increased periodontal awareness by the dentist would be beneficial in three areas: increased periodontal diagnosis and treatment planning would help reduce the number of lawsuits that can result from existing undiagnosed periodontal disease, the number of failures in restorative treatment would be reduced and longevity of existing restorative dentistry increased, and unfilled appointment time in the dentist's schedule could be filled by patients who need periodontal therapy.

Adolescent↗