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At least 613 records · Page 34Linked to original sources
PubMed1989

Clinical effects of local application of collagen film-immobilized tetracycline.

Tetracycline-containing cross-linked collagen film (TC film), or tetracycline-free placebo film, were locally applied 4 times, at 1-week intervals, to 33 teeth with periodontal pockets larger than 4 mm, in 11 patients with periodontal disease. The clinical and microbiological effects are summarized, as follows. In the group treated with the TC film, (1) the clinical indices were significantly decreased at the 4th and 7th weeks in comparison with those at the beginning of treatment. In particular, this group showed a significant decrease in the incidence of bleeding as compared with the placebo group at the 4th week. (2) Total counts of bacteria in the periodontal pockets showed an obvious tendency to decrease with time. The proportion of black-pigmented bacteroides was significantly decreased at the 4th and 7th weeks when compared with the pretreatment value. The extent of decrease in the proportion of spirochetes at both the 4th and 7th weeks was significant compared with the placebo group and the pretreatment value.

Bacteroides↗
PubMed1989

Reproducibility of microscopic and cultural data in repeated subgingival plaque samples.

In association studies, micro-organisms can only be recognized as suspects for playing a major rôle in the development of a pathological environment, if their destructive action goes along with a marked proportional increase of their numbers or if their first detection can be related to the clinical onset of the disease. Limitations in the reproducibility of repeated samples have to be taken into account, when changes of the microbial composition of subgingival environments are to be studied, and when local clinical changes are to be related to shifts in the composition of the pertaining microbiological compartment. To study reproducibility, a total of 109 sites was sampled repeatedly with sterile paperpoints at an interval of 7 to 10 days in 24 patients suffering from periodontal disease and 12 edentulous patients wearing successful and failing osseointegrated titanium implants. Using continuous anaerobic techniques, the samples were cultured on nonselective and selective media and were studied by darkfield microscopy. Both the intertest-agreements of frequencies of detection (kappa-statistics) as well as the discrepancies of proportions of bacterial groups and selected bacterial species were determined. The standard deviation of proportional differences between first and second samples ranged between 6.4% (fusiform organisms) and 17.2% (coccoid cells) for darkfield parameters, between 4.3% (B. melaninogenicus on ETSA/Kana.) and 14.0% (B. gingivalis on ETSA/Kana.) for selected bacterial species and between 6.9% (gram-negative anaerobic cocci) and 24.0% (gram-positive facultative cocci) for bacterial groups classified according to gram stain characteristics and atmospheric growth conditions.(ABSTRACT TRUNCATED AT 250 WORDS)

Bacteria↗
PubMed1989

Systemic metronidazole in the treatment of periodontitis.

The present study evaluated the effect of systemic metronidazole on advanced periodontitis in 10 patients with inadequate oral hygiene. Clinical and microbiological observations were made at a total of 173 bleeding pockets of 5 mm depth or more. The clinical observations comprised plaque index scores, dichotomous measurements of gingival redness and suppuration, pocket depths and attachment levels. The microbiological variables investigated were the % spirochaetes, % black-pigmented Bacteroides species, % facultative streptococci and presence of absence of Bacteroides gingivalis. At baseline, after clinical measurements and microbiological samples had been taken, each patient received a thorough scaling and root planing. After 3 months, the clinical measurements and microbiological sampling were repeated and a 5-day course of metronidazole was administered while one side of the mouth was scaled and root planed. After a further 3 months, the final measurements and samples were taken. In comparing pre- and post-treatment data, the following significant differences were observed: for debridement alone, a reduction in mean % spirochaetes from 11.5% to 4.9% and an increase in mean % streptococci from 4.7% to 8.8%; for metronidazole alone, a 0.3 mm gain in mean attachment level, a 0.4 mm reduction in mean pocket depth and a reduction in the frequency of suppurating sites from 32% to 16%; for debridement plus metronidazole, a 0.2 mm gain in mean attachment level, a 0.5 mm reduction in mean pocket depth and a reduction in mean % spirochaetes from 5.6% to 2.5%. Thus systemic metronidazole, either alone or accompanied by debridement, produced a modest clinical improvement after debridement alone had failed.(ABSTRACT TRUNCATED AT 250 WORDS)

Administration, Oral↗
PubMed1990

Darkground microscopy of subgingival plaque from the top to the bottom of the periodontal pocket.

Part of the results of a study of subgingival plaque by darkground microscopy was used to investigate morphotype distribution at different levels within the periodontal pocket. Subgingival plaque was sampled at coronal, middle and apical levels from each of 28 approximal surfaces on 28 teeth extracted from 28 adults with untreated moderate to advanced periodontitis. Sample preparation and darkground microscopy were as described previously. The data recorded only the subgingival level at which the maximum count occurred for a given morphotype and subject. It was found that the maximum count of spirochaetes occurred most frequently at the apical level (p less than 0.05) and the maximum count of 'others' at the coronal level (p less than 0.05). Also, coccal counts showed a trend to increase the more apical the sample. Standardised darkground microscopy was able to show that the sampled subgingival level had a significant influence on plaque bacterial morphotype distribution, indicating the importance of accurate sampling of subgingival plaque at the most apical level.

Adult↗
PubMed1990

Suspected periodontopathogens in erupting third molar sites of periodontally healthy individuals.

29 periodontally healthy subjects (11 female and 18 male) with a mean age of 24 years (range 19 to 38 years) and with partially erupted lower third molars participated in this study. 18 subjects demonstrated no signs or symptoms of acute inflammation and were without pain (group A). 5 subjects showed redness of the pericoronal tissues and experienced pain upon palpation (group B). 6 subjects suffered from acute pain and exhibited formation of pus (group C). Microbiological samples were taken from the lateral aspect of the pericoronal space using the paperpoint-method. Continuous anaerobic techniques were utilized for microbiological processing. The samples were cultivated on ETSA and on selective media and were studied by darkfield microscopy. Gram-negative anaerobic rods accounted for 27% (group A), 34% (group B) and 39% (group C) of all organisms growing on ETSA. Bacteroides intermedius was detected in 61% (group A), 80% (group B) and 83% (group C) of the samples. B. gingivalis was found in 1 sample of group A only. Fusobacterium sp. was detected in 56% (group A), 80% (group B) and 33% (group C) of the samples. Capnocytophaga were seen in 67% (group A), 20% (group B) and 50% of the samples. Actinobacillus actinomycetemcomitans was found in 44% (group A), 40% (group B) and 17% (group C). 72% of the group A and 100% of the group B and C samples contained spirochetes. In all of those positive samples, small spirochetes were present, but only 78% contained medium and only 48% large spirochetes.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1990

Comparison of plaque microflora between Chinese and Caucasian population groups.

This investigation was designed to compare the predominant plaque micro-organisms from a Chinese group of patients exhibiting periodontitis with an age-, sex- and periodontal disease-matched Caucasian group of patients. In addition to race, the 2 population groups differed with respect to diet and oral hygiene habits, or effectiveness at removing plaque. Clinical measurements were determined along with an evaluation for micro-organisms in supragingival and subgingival plaque. Although the Chinese and Caucasian population groups were similar with respect to composition of micro-organisms in subgingival plaque, notable differences were observed in supragingival plaque. The Chinese group had higher mean proportions of spirochetes, motile rods. Fusobacterium spp. and dark-pigmented Bacteroides species, while the Caucasian group had higher mean proportions of cocci, total Actinomyces spp., A. viscosus and total Streptococcus spp. in supragingival plaque. The microbial differences observed in supragingival plaque may be explained at least in part, if not totally, by the higher plaque index scores of the Chinese versus Caucasian population groups.

Actinobacillus↗
PubMed1991

Associations between subgingival plaque bacterial morphotypes and clinical indices?

The aim of the present study was to evaluate possible associations between subgingival plaque bacterial morphotypes, as assessed by darkground microscopy, and clinical indices of routine adult chronic periodontitis. Clinical indices were plaque index (PlI), gingival index (GI), sulcus bleeding index (SBI), papilla bleeding index (PBI), attachment loss (AL), pocket depth (PD) and probeable pocket depth (PPD). Apical border plaque was sampled in vivo and after extraction to test whether direct or indirect sampling affected any such associations. Similarly, pocket depth and attachment loss were also assessed directly and indirectly on the same teeth, in vivo or after extraction. The influence of the type of index used to record inflammation (GI, SBI, PBI) was also assessed, as were the effects of the numbers of sampled subjects and the method of analysis, which comprised the use of transformed and untransformed data and of parametric and non-parametric tests. Data were collected in relation to the approximal surfaces of 44 teeth extracted from 22 adults (2 teeth each) and from 1 pair of contralateral upper anterior or premolar teeth in each of 100 adults, all which untreated routine chronic periodontitis. Selected subjects had greater than or equal to 4 mm probeable pocket depth and/or attachment loss, and radiographic evidence of bone loss in relation to 1 approximal surface on each of 1 pair of contralateral anterior or premolar teeth, or to 2 teeth scheduled for extraction. Plaque preparation and darkground microscopy were as described previously. Insignificant associations (p greater than 0.05) were demonstrated between supragingival plaque (PlI) and periodontal inflammation (GI, SBI, PBI) or destruction (PPD and AL), as well as between inflammation and attachment level. In contrast, significant moderate associations (r = 0.5-0.77) were demonstrated between each of the 3 morphotype groups; spirochaetes, other motiles and cocci. Spirochaetes showed a significant moderate (r = 0.5) positive association with pocket depth with a 2.43% mean increase of spirochaetes for each 1 mm increase of PPD. Although highly significant associations (r = 0.9) were demonstrable between the 3 inflammation indices (GI, SBI, PBI) themselves, only PBI showed significant positive associations (r = 0.3) with spirochaetes and other motiles. Also, PlI showed significant associations with each of the 4 morphotypes (r = 0.3-0.5). The heterogeneity of spirochaetes and other motiles as well as the multiplicity of possible aetiological microbial agents in plaque may have resulted in underestimated associations between subjects as well as undetectable association within a given mouth using only 4 morphotype groups.(ABSTRACT TRUNCATED AT 400 WORDS)

Adult↗
PubMed1991

Evaluation of stannous fluoride and chlorhexidine sprays on plaque and gingivitis in handicapped children.

The objective of this study was to evaluate the effect of twice-daily oral sprays of 2 ml chlorhexidine (0.2%) and 2 ml stannous fluoride (0.2%) as the sole oral hygiene measure on plaque and gingivitis in handicapped children. 52 institutionalized mentally handicapped individuals (aged 10-26 years) were divided into 4 groups to participate in a 9-week, double-blind, randomized clinically controlled trial, which included a cross-over. For the first 3 weeks, groups 3 and 2 had their mouths sprayed with chlorhexidine and stannous fluoride, respectively. Following a 3-week wash-out interval, groups 1 and 4 were sprayed with chlorhexidine and stannous fluoride, respectively. The alternate groups received a placebo, water. Plaque (PI) and gingival indices (GI) were recorded. Subgingival plaque samples were collected and counts of spirochaetes, motile rods and cocci were taken using darkfield microscopy. By the 9th week of trial, the PI and GI were reduced by 48% and 52% for the stannous fluoride group. In the chlorhexidine group, reductions of 75% (PI) and 78% (GI) were achieved. Pair-wise comparisons of placebo, stannous fluoride and chlorhexidine using the U-test of Mann-Whitney revealed significant (p less than 0.05) differences for both PI and GI scores in the placebo/stannous fluoride and placebo/chlorhexidine pair by the 9th week of the trial. In the stannous fluoride/chlorhexidine pair, only the PI was significantly reduced for those on chlorhexidine. Coccoid cells were more dominant at sites with low PI and GI scores (stannous fluoride and chlorhexidine groups), while spirochaetes and motile rods were more frequent at sites with high PI and GI scores (placebo group).

Adolescent↗
PubMed1991

Therapeutic effects of combined treatment using tetracycline-immobilized collagen film and root planing in periodontal furcation pockets.

46 upper and lower molars with furcation grade II involvement were selected from 16 patients with periodontal disease. The teeth were randomly allocated to the following groups according to treatment; (1) 4 consecutive administrations of tetracycline-immobilized cross-linked collagen film (TC film) at intervals of 1 week (TC group); (2) 1 root planing treatment (RP group); (3) combination treatment (TC + RP group); (4) no treatment (control group). The therapeutic effects of each treatment were compared both clinically and microbiologically. Records of plaque index, gingival index, bleeding on probing, probing depth, probing attachment level and microscopic counts were obtained at 0, 4, 6 and 8 weeks. The results showed marked decreases in probing depth and density of micro-organisms in both the RP and TC + RP groups. In particular, the TC + RP group was characterized by a decreased rate of bleeding on pocket probing and an increased probing attachment gain. The above findings demonstrated that root planning is effective in the treatment of furcation involvement and that the effects are enhanced by the local administration of TC films.

Collagen↗
PubMed1991

A 2-year follow-up on the clinical and microbiological conditions of periodontium in teenagers.

87 teenagers were included in a 2-year follow-up study on clinical and microbiological conditions of the periodontium. The clinical status was determined according to the Community Periodontal Index of Treatment Needs (CPITN) for subjects under 20 years of age. 59% of the subjects had at least 3 healthy sextants at the baseline and 68% at the 2-year examination. The microbiological conditions were assessed by using direct dark-field microscopy, and the culture of Actinobacillus actinomycetemcomitants (A.a.). Subgingival bacterial samples were taken, 2 for the microscopy and 2 for the culture, from the mesial surfaces of the first molars of each subject. The presence of gingival bleeding after probing was separately recorded from the 2 sites sampled for dark-field microscopy. No gingival bleeding at these 2 sites was found at the 2-year examination in 55% of those subjects who were non-bleeding at baseline, in 46% of the subjects initially with 1 bleeding site and in 13% of the subjects with both sites bleeding at baseline. 55% of the subjects with neither fusiforms, motile rods nor spirochetes at baseline maintained their healthy flora for 2 years. A.a. was recovered in 4 subjects at baseline and in 5 subjects 2 years later, in 3 of them at both examinations. Longer follow-up periods are needed to reveal the significance of the constant recovery of A.a. from the same subjects.

Actinobacillus↗
PubMed1991

Fluctuation of the microbiota of the tongue in humans.

The purpose of this study was to examine whether variations occur in the % of motile micro-organisms on the dorsum of the tongue during a 1-month time-period and further to examine 2 transport fluids: the growth medium BM and reduced transport fluid (RTF), for their ability to conserve motility of microorganisms in comparison to sterile saline. Both transport fluids showed a significant reduction in the % of motile micro-organisms within 15 min. The use of RTF resulted, during a 60-min period, in a significantly higher % of motile micro-organisms compared to sterile saline. Results showed that the % of motile micro-organisms on the dorsum of the tongue was not constant. A significant reduction in the % of motile micro-organisms was observed in the course of the month involved in this study.

Analysis of Variance↗
PubMed1992

Metronidazole in periodontitis: reduced need for surgery.

A considerable amount of circumstantial evidence indicates that most forms of periodontitis are due to the presence or dominance of a finite number of bacterial species in the subgingival plaque. Almost all of the putative pathogens are anaerobic species, indicating that most forms of periodontitis could be diagnosed as anaerobic infections. In this double-blind investigation, patients with elevated proportions or levels of spirochetes in 2 or more plaque samples, i.e., 60% spirochetes, were randomly assigned to receive either metronidazole, 250 mg 3 x a day for 1 week, or placebo (positive-control) after the completion of all debridement procedures. When the patients were re-examined 4 to 6 weeks later, the patients in the metronidazole group (n = 15) exhibited a highly significant (p less than 0.01) reduction in probing depth and apparent gain in attachment levels relative to the patients (n = 18) in the positive-control group about those teeth that initially had probing depths of 4 to 6 mm. This pattern was also observed about teeth that initially had probing depths greater than or equal to 7 mm. This reduction in probing depths and apparent gain in attachment was associated with a significant reduction in the need for periodontal surgery in the metronidazole-treated patients (difference 8.4 teeth per patient) compared to the positive-control patients (2.6 teeth per patient). These clinical improvements in the metronidazole group were associated with significantly lower proportions of spirochetes, selenomonads, motile rods, and P. intermedius, and a significantly higher proportion of cocci in the plaques. These findings indicate that systemic metronidazole, when given after all the root surface debridement is completed, leads to additional treatment benefits, including a reduced need for surgery, beyond that which can be achieved by debridement alone.

Adult↗
PubMed1992

Supragingival cleaning 3 times a week. The microbiological effects in moderately deep pockets.

It is generally believed that supragingival plaque control has little effect on the subgingival microflora of deep periodontal pockets. However, this may not be true for moderately deep pockets (4-5 mm), which may represent a pathological state between gingivitis and marginal periodontitis. In 6 patients with poor oral hygiene and severe gingival inflammation, 4 matched sites (1 in each quadrant), were chosen which demonstrated at least 20% spirochetes and 15% black-pigmented Gram-negative bacilli. During the first 12 weeks (phase 1), supragingival calculus was removed from the right half of the mouth and then the teeth were professionally cleaned three times a week. At the beginning of phase 2, supragingival calculus was also removed from the left quadrants and the entire mouth was subjected to the same protocol used in phase 1. At no time did patients receive oral hygiene instructions. Clinical parameters were assessed and microbiological samples were taken at 3-week intervals. Samples were submitted to darkfield microscopy and anaerobic culturing. Analysis by multiple linear regression and the Wilcoxon signed-rank test revealed significant changes in the composition of the subgingival microbiota at cleaned sites. While Gram-positive organisms increased proportionally, a number of putative periodontal pathogens, such as P. gingivalis and spirochetes decreased.

Adult↗
PubMed1992

Clinical effects of simultaneous ultrasonic scaling and subgingival irrigation with chlorhexidine. Mediating influence of periodontal probing depth.

The clinical and microbial effects of a single episode of simultaneous ultrasonic scaling and subgingival irrigation with chlorhexidine (CHX) were studied as a function of clinical probing depth in patients with adult periodontitis. 60 patients were randomly assigned to receive subgingival irrigation under cavitation with either sterile water or 0.12% CHX delivered through the tip of an ultrasonically activated scaler as part of initial periodontal therapy in a double-blind study design. 3 periodontal sites were randomly selected for examination from each patient on the basis of clinical probing depth, with 1 site being selected within each of the following ranges: 1-3 mm, 4-6 mm, and 7-9 mm. Pretreatment and post-treatment (days 14 and 28) clinical assessments included a plaque index (PI), gingival index (GI), and clinical probing depth (CPD). Subgingival specimens also were collected from 1-3 mm and 4-6 mm sites on a random subset of patients (15 per group). Plaque counts of spirochetes and motile organisms were made by darkfield microscopy. Significant reductions in PI, GI, and CPD were observed among all sites within both treatment groups at 14 and 28 days post-treatment. CHX irrigation resulted in a significantly greater reduction in CPD than did water among sites initially probing 4-6 mm at both 14 and 28 days post-treatment (25% versus 13% and 31% versus 18%, respectively). Spirochete counts were modestly but nonsignificantly reduced at 14 days post-treatment among sites 4-6 mm within both treatment groups. These results suggest that subgingival irrigation with CHX during ultrasonic scaling provides differential clinical benefits that are site-dependent.

Adult↗
PubMed1992

Effects of ultrasonic and sonic scalers on dental plaque microflora in vitro and in vivo.

The effects of ultrasonic and sonic scalers on the subgingival microflora were investigated in vitro and in vivo. In the in vitro investigation, 27 plaque samples collected from periodontal pockets were submitted to ultrasonic and sonic vibrations for 10, 30 and 60 s. Bacterial suspensions were examined by darkfield microscopy to detect qualitative changes and cultured to evaluate the total number of cultivable bacteria. Microscopic counts following both instrumentations showed a decrease in the proportions of spirochetes and motile rods and an increase in the % of coccoids and rods. The changes were directly related to the time-period of instrumentation. Comparison between both types of instrumentation showed significant differences and more pronounced changes were observed with the ultrasonic than the sonic scaler. Spirochetes and motile rods were reduced to approximately 0.1% after ultrasonic treatment versus 24.7% after sonic instrumentation. Cultural observations showed a marked increase in total number of colony-forming units following both treatments. The clinical investigation included 66 periodontal pockets which were instrumented subgingivally for 10 and 30 s with ultrasonic or sonic scalers. Qualitative changes were similar to those observed in vitro, i.e., reduction in spirochete and motile rod counts as well as the other morphotypes with an increase in coccoid cells. Total counts of bacteria were reduced following debridement. No difference in the microscopic or cultural data was found between ultrasonic and sonic instrumentation.

Adult↗
PubMed1992

The effect of supragingival plaque control on the composition of the subgingival flora in periodontal pockets.

The effect of mechanical supragingival plaque control on the composition of the subgingival microflora in untreated 4-6 mm deep periodontal pockets was investigated. 13 subjects with chronic periodontitis were recruited for the study. Periodontally-diseased sites were subjected to professional plaque control 3 x weekly for a period of 3 weeks. Contralateral sites received no prophylaxis and served as controls. No instructions in oral hygiene procedures were given to the patients who maintained their habitual oral hygiene regime during the observation period. Clinical examination and darkfield microscopic analysis of bacterial samples were performed every week. The PlI scores for the experimental sites were reduced markedly, while those for the control sites remained stable throughout the observation period. No changes in the other clinical parameters were detected during the study. The composition of the subgingival microflora at the control sites did not change during the experimental period. In contrast, at the test sites, the proportion of spirochetes+motile rods decreased continuously. This decrease reached statistical significance at the end of the experiment. The results indicate that at periodontally diseased sites with an established subgingival ecosystem, supragingival plaque removal may influence the composition of the subgingival microflora.

Adult↗
PubMed1992

The effect of topical metronidazole therapy on experimentally-induced periodontitis in the beagle dog.

The present study was performed to assess the effect of topical metronidazole therapy on ligature-induced periodontitis in beagle dogs. 6 beagle dogs with experimentally-induced periodontitis on the mandibular 2nd, 3rd and 4th premolars were treated with metronidazole 10% dental paste 2 x daily for 4 weeks in an open placebo-controlled study using a split-mouth design. Recordings of probing pocket depth, bleeding on probing and gingival index were performed before commencement of treatment and repeated weekly during the 4-weeks treatment period. Concurrently, samples for microbiological analysis were collected from 2 of the dogs. The results demonstrated that probing pocket depth, bleeding on probing and gingival index had improved significantly in the metronidazole-treated side compared with the placebo-treated side. Black pigmented Bacteroides spp. and Spirochetes, present in all samples before treatment, were eliminated from the metronidazole-treated side after the 1st week of treatment and throughout the treatment period, whereas they were present in all samples from the placebo-treated side. The result of the present study demonstrates that topical application of metronidazole in a dental paste, improves the clinical features of the experimentally-induced periodontitis and eliminates some of the micro-organisms associated with the disease.

Animals↗
PubMed1993

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

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.

Alveolar Bone Loss↗