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[Periodontal diseases. Clinical forms, epidemiology, etiology, prevention].

Periodontal diseases affect the teeth-supporting tissues and are the main causes of tooth loss in subjects older than 40 years. They are characterized by gingival bleeding, bone destruction and dental mobility and are due to bacterial proliferation on dental plaque and tartar. Several forms have been described according to the severity of alveolar bone destruction and to the patient's age. These diseases can be prevented by a strict bucco-dental hygiene applied jointly by the patient and the practitioner.

Adolescent↗

New ideas and advancing technology in prevention and non-surgical treatment of periodontal disease.

Analytical, oral epidemiological studies in adult 'toothbrushing' populations show that the highest prevalence of missing teeth is for molars and maxillary premolars ('key-risk' teeth). The highest prevalence of subgingival microflora, gingivitis (CPITN-1), plaque retentive factors, such as subgingival calculus and restoration overhangs (CPITN-2), and diseased pockets > 3 mm (CPITN-3-4) is found on the approximal surfaces of the same teeth ('key-risk' surfaces). Primary and secondary prevention, as well as treatment of periodontal disease should be focused on these 'key-risk' surfaces. One single, well-executed subgingival scaling and root-planning procedure in deep, diseased periodontal pockets, followed by oral hygiene training and professional mechanical tooth-cleaning (PMTC) at need-related intervals, will prevent further loss of periodontal attachment. However, if the root cementum is removed during instrumentation, and the post-treatment plaque control programme fails, microorganisms will recolonize and invade the rough exposed root dentine, resulting in recurrence of periodontitis and possibly, root caries and pulpitis. Some of these problems may be overcome by the application of new instruments and methods for self-care, PMTC, removal of overhangs, scaling and root-planing without removing 'non-diseased' cementum.

Dental Devices, Home Care↗

The periodontal-systemic connection: implications for treatment of patients with osteoporosis and periodontal disease.

Osteoporosis and osteopenia may influence periodontal disease and tooth loss. Medications such as hormone replacement therapy and nutritional supplements that are used to prevent or treat osteoporosis have been evaluated for beneficial effects on oral health in a small number of human studies. Hormone replacement therapy (HRT), which slows the rate of bone loss at skeletal sites such as the hip and spine, also appears to reduce the rate of alveolar bone loss in postmenopausal women. HRT use is consistently associated with greater tooth retention and a reduced likelihood of edentulism in studies of elderly women. The number of studies on the effects of calcium or vitamin D intake on oral outcomes is limited, but suggest that higher intake levels are associated with reduced prevalence of clinical attachment loss and lower risk of tooth loss. Data from a prospective study of oral health in men show a similar association between higher calcium intake and reduced alveolar bone loss. The number of teeth with progression of alveolar bone loss over a 7-year period was significantly lower among men whose calcium intake was at least 1,000 mg per day, compared to men with a calcium intake below this level. Future studies should confirm these findings and evaluate the oral effects of new medications for osteoporosis. If confirmed, the implications for dental professionals may include an expanded array of medications for the treatment of periodontal disease and a greater emphasis on nutrition education for patients.

Aged↗

Assessment of periodontal disease in an adult population survey in Taipei city using CPITN and GPM/T indices.

The community periodontal index of treatment needs (CPITN) has been recommended for epidemiological surveys of periodontal status and treatment needs. The prevalence of gingivitis, periodontitis and missing teeth in a study population has been determined using the CPITN and GPM/T (gingivitis: periodontitis: missing teeth) indices. In this study, a survey of periodontal disease was performed among the adult population of Taipei City using the CPITN index. A total of 673 dentated persons (male 339, 50.4%; female 334, 49.6%) were examined and surveyed. Data were then divided into five age groups, 15-19, 20-29, 30-44, 45-64 and 64+. The prevalence of periodontal disease was analyzed using the percentage or sextant from all teeth. Treatment needs were determined by the worst periodontal score per sextant. It was found that about 91% of subjects suffered from various degrees of periodontal disease in at least one tooth. Gingivitis and periodontitis were 86.9% and 33%, respectively. Among them 48.9% had missing teeth. The prevalence of periodontitis and missing teeth increased with age. Most of them involved oral hygiene instruction and scaling. About 11.0% of the subjects needed periodontal surgery. Higher proportions of attachment loss with gingival recession caused by destructive periodontal disease were found in older persons who did not require periodontal surgery. It was concluded that endemic gingivitis and calculus, a moderate prevalence of shallow pockets and a low prevalence of deep pockets were observed among adults in this group in Taipei City and that the CPITN is a practical epidemiological and public health method for screening the periodontal status and treatment needs of a population.

Adolescent↗

HIV- periodontal disease. A review of research prospects: a South African and Namibian perspective.

In the course of infection by the human immunodeficiency virus (HIV) typical changes of inflammatory periodontal disease may arise. It is estimated that the prevalence of HIV-associated periodontal diseases may vary between 5% and 12% and can occur in both symptomatic and asymptomatic individuals. These oral lesions are very important either as an initial presentation of AIDS or as a sign of established immunosuppression. For the patients, HIV-associated periodontal diseases can cause pain, severe discomfort and a decreased quality of life. It is therefore important, from both diagnostic and therapeutic aspects, for dentists to be able to distinguish and diagnose HIV-associated periodontal diseases as early recognition and treatment of these oral lesions may reduce morbidity and allow more comfort to the patient during progression of the disease. This paper reviews the current international and regional status of HIV-associated periodontal diseases and highlights research prospects in countries such as Namibia and South Africa, to further analyse periodontal diseases in HIV/AIDS patients.

Acquired Immunodeficiency Syndrome↗

Nonsteroidal antiinflammatory drugs as inhibitors of periodontal disease progression.

Recent interest in the control and modulation of periodontal disease has focused on the potential benefits of blocking the host response mechanisms involved in the progression of the disease. In addition to recent advances in the identification and control of etiologic bacteria, investigators have indicated promising results using nonsteroidal antiinflammatory drugs (NSAIDs) as inhibitors of the inflammatory destruction in periodontal disease. This article examines research efforts over the last 20 years describing the role of prostaglandins in periodontal disease and the effect of NSAIDs on the progression of gingival inflammation and alveolar bone loss.

Alveolar Bone Loss↗

Diet and periodontal disease in dogs and cats.

A review of relevant literature was undertaken because of concerns about a possible relationship between pet foods, development of periodontal disease, and secondary adverse effects on general health. It was concluded that, while changes in feeding methods in recent decades have arguably improved pet health by reducing or preventing diseases associated with nutritional deficiencies and excesses, periodontal disease remains a serious, diet-related problem. There is reasonable evidence that soft diets are associated with increased frequency and severity of periodontal disease, and that harder foods requiring vigorous prehension and mastication are preferable for dogs and cats. While it is plausible that periodontal disease could cause diseases in other organs and tissues, the evidence for this is limited at present. Further research is needed to better define the relationship between diet types and oral health. In the meantime, veterinarians and pet owners should pay attention to the physical qualities (textures, abrasiveness, 'chewiness') of foods they provide for dogs and cats, as well as to their nutrient content, and should consider additional methods to control plaque and prevent periodontal disease where necessary.

Animal Nutritional Physiological Phenomena↗

Predictors of endocarditis in isolates from cultures of blood following dental extractions in rats with periodontal disease.

Rats with periodontitis and catheter-induced aortic valve vegetations underwent dental extractions. Cultures of blood obtained 1 min later showed polymicrobial bacteremia in 19 of 19 rats, mostly due to viridans streptococci (18 of 19), Morganella (15 of 19), group G streptococci (13 of 19), and Staphylococcus aureus (10 of 19). Viridans streptococci circulated in higher numbers than did group G streptococci and S. aureus (P less than .01). Three days after dental extractions, 18 of 20 rats had endocarditis. Fifteen (83%) of 18 infections were due to group G streptococci, 9 (50%) of 18 were due to S. aureus, and 2 (11%) of 18 were due to viridans streptococci (P less than .05). In vitro, adherence to platelet-fibrin matrices of endocarditis strain 8 of group G streptococcus was two times greater than that of endocarditis strain S. aureus 23 and three to four times greater than that of Streptococcus sanguis 44 and Morganella morganii 93 (P less than 10(-5)). The inoculum size that produced endocarditis in 90% of rats after iv challenge was 10(5) cfu for group G streptococcus strain 8 and 10(7) for S. sanguis 44.

Animals↗

Obesity and periodontal disease in young, middle-aged, and older adults.

BACKGROUND: The growing prevalence of increased body weight and obesity in the United States has raised significant public health concerns. Obesity has been implicated as a risk factor for several chronic health conditions, as well as being associated with increased mortality. Recently, an association between obesity and periodontal disease was found in a Japanese population. The purpose of the present study is to examine the relation between body weight and periodontal disease in a representative United States sample. METHODS: Participants in the third National Health and Nutrition Examination Survey (NHANES III) who were > or =18 years and had undergone a periodontal examination were selected for the analysis (n = 13,665). Body mass index (BMI) and waist circumference (WC) were used as measures of overall and abdominal fat content, respectively. Univariable and multivariable logistic regression models were used to estimate the association between increased body weight and periodontal disease. BMI and WC were assessed independently in a multivariable logistic model containing the following variables: gender, race, education, poverty index, smoking, diabetes, and time elapsed since last dental visit. Significant interactions with age were found and analyses were then stratified by age: younger (18 to 34 years old), middle-aged (35 to 59 years old), and older (60 to 90 years old) adults. RESULTS: A significant association between the measures of body fat and periodontal disease was found among the younger adults, but not middle or older adults. The adjusted odds ratios (OR) for having periodontal disease were 0.21 (0.080 to 0.565), 1.00 (0.705 to 1.407), and 1.76 (1.187 to 2.612) for subjects with BMI < 18.5 kg/m2, 25-29.9 kg/m2, and > or = 30 kg/m2, respectively. Young subjects with high WC had an adjusted OR of 2.27 (1.480 to 3.487) for having periodontal disease. CONCLUSIONS: In a younger population, overall and abdominal obesity are associated with increased prevalence of periodontal disease, while underweight (BMI < 18.5) is associated with decreased prevalence. Obesity could be a potential risk factor for periodontal disease especially among younger individuals. Promotion of healthy nutrition and adequate physical activity may be additional factors to prevent or halt the rate of progression of periodontal disease.

Adipose Tissue↗

Correlation of histometric, microbial, and clinical indicators of periodontal disease status before and after root planing.

Effective diagnosis and treatment of periodontal disease requires accurate evaluation of disease status before and after treatment. This study evaluated relationships among multiple parameters that have been used for periodontal disease evaluation. A total of 61 initially deep (greater than or equal to 6 mm) interproximal pockets from 16 patients examined before and after a 3-week course of root planing therapy were evaluated for probing depth, bleeding on probing, darkfield and cultural characterization of subgingival plaque, and histometric indices of infiltrated connective tissue (ICT) and mature plasma cell infiltrate. 36 sites were evaluated before treatment, and 25 after treatment. A comparison of mean scores for pre-treatment sites versus post-treatment sites indicated that there was an average improvement in most disease-related parameters. However, patterns of significant correlations among the parameters differed markedly. Motile bacteria enumerated by darkfield microscopy were significantly correlated with ICT and plasma-cell populations before, but not after treatment. In contrast, probing depth and populations of black pigmented Bacteroides (BPB's), principally B. gingivalis, were significantly correlated with ICT after, but not before, treatment. Bleeding on probing was not significantly correlated with ICT levels before or after treatment. This suggests that different sets of parameters should be used for evaluating periodontal disease status before or after treatment. Our data further suggest that B. gingivalis populations may be related to delayed healing of deep periodontal lesions after instrumentation.

Adult↗

Parameter on systemic conditions affected by periodontal diseases. American Academy of Periodontology.

The American Academy of Periodontology has developed the following parameter on systemic conditions affected by periodontal diseases. It is well known that systemic conditions may affect the onset, progression, and treatment of such diseases (see Parameter on Periodontitis Associated With Systemic Conditions, pages 876-879). The concept of periodontal diseases as localized entities affecting only the teeth and supporting apparatus is increasingly being questioned. Periodontal diseases may have widespread systemic effects. While these effects may be limited in some individuals, periodontal infections may significantly impact systemic health in others, and may serve as risk indicators for certain systemic diseases or conditions. As part of the approach to establishing and maintaining health, patients should be informed of the possible effects of periodontal infection on their overall well-being. Given this information, patients should then be able to make informed decisions regarding their periodontal therapy.

Coronary Disease↗

The association between cumulative periodontal disease and stroke history in older adults.

BACKGROUND: Since the late 1980s, several studies have been conducted to investigate the relationship between periodontal disease and ischemic stroke. The purpose of this study is to investigate the relationship of periodontal disease to the self-reported history of stroke in the elderly (60 years of age and older) by examining the data of the Third National Health and Nutrition Examination Survey (NHANES III). METHODS: Data from NHANES III, a large population-based cross-sectional survey of the United States, were used for this study. Because 1,563 of the 5,123 subjects in the study were edentulous, and periodontal disease is a major cause of tooth loss, it was necessary to account for edentulousness in the statistical analysis to avoid bias. Hence, a new index called the periodontal health status (PHS) index was developed to address this problem. Two measures of PHS were developed: PHS I, based on the median percentage of sites with >/=2 mm clinical attachment loss (CAL), and PHS II, based on the median percentage of sites with >/=3 mm CAL. Multiple logistic regression analysis was used to test for the association of PHS with stroke history. Two types of a multiple logistic regression model were fit: 1) logistic regression modeling with adjustment for age and tobacco use only; and 2) logistic regression modeling with adjustment of all statistically significant confounders. RESULTS: Based on multiple logistic regression analysis of PHS with adjustment for age and tobacco use only, completely edentulous elderly adults (PHS Class 5) and partially edentulous (teeth in one arch) elderly adults with appreciable clinical attachment loss (PHS Class 4) were significantly more likely to have a history of stroke compared to dentate adults (teeth in both arches) without appreciable clinical attachment loss (PHS Class 1). When multiple logistic regression models were fit with adjustment of all significant confounders, no statistically significant association was found between PHS and stroke. CONCLUSIONS: Based on the results of this study, there is evidence of an association between cumulative periodontal disease, based on PHS, and a history of stroke. However, it is unclear whether cumulative periodontal disease is an independent risk factor for stroke or a risk marker for the disease.

Age Factors↗

Periodontal disease and risk of cerebrovascular disease: the first national health and nutrition examination survey and its follow-up study.

BACKGROUND: Periodontal disease has been found to be a potential risk factor for coronary heart disease. However, its association with cerebrovascular accidents (CVAs) is much less studied. METHODS: This study examines the association between periodontal disease and CVA. The study cohort comprises 9962 adults aged 25 to 74 years who participated in the First National Health and Nutrition Examination Survey and its follow-up study. Baseline periodontal status was categorized into (1) no periodontal disease, (2) gingivitis, (3) periodontitis, and (4) edentulousness. All CVAs (International Classification of Diseases, Ninth Revision [ICD-9], codes 430-438) were ascertained by hospital records for nonfatal events and death certificates for fatal events. The first CVA, nonfatal or fatal, was used to define incidence. Relative risks were estimated by hazard ratios from the Cox proportional hazard model with adjustment for several demographic variables and well-established cardiovascular risk factors. Weights were used to generate risk estimates. RESULTS: Periodontitis is a significant risk factor for total CVA and, in particular, nonhemorrhagic stroke (ICD-9, 433-434 and 436-438). Compared with no periodontal disease, the relative risks (95% confidence intervals) for incident nonhemorrhagic stroke were 1.24 (0.74-2.08) for gingivitis, 2.11 (1.30-3.42) for periodontitis, and 1.41 (0.96-2.06) for edentulousness. For total CVA, the results were 1.02 (0.70-1.48) for gingivitis, 1.66 (1.15-2.39) for periodontitis, and 1.23 (0.91-1.66) for edentulousness. Increased relative risks for total CVA and nonhemorrhagic stroke associated with periodontitis were also seen in white men, white women, and African Americans. Similar results were found for fatal CVA. CONCLUSION: Periodontal disease is an important risk factor for total CVA and, in particular, nonhemorrhagic stroke.

Adult↗

Prevalence and treatment needs of periodontal disease in employees of supermarkets in Japan.

In 1987, a survey was carried out to determine the prevalence and treatment needs of periodontal diseases in 2,684 (997 males and 1,687 females) employees of 57 supermarkets in Japan. The aim of this survey was to obtain fundamental data for planning preventive programs for periodontal diseases in the Japanese population. Most of the subjects showed some signs of periodontal disease. The percentages of persons having pathologic pockets 4 mm or deeper increased with age, and reached about 50% in the 45- to 64-year-olds. The percentage of persons affected was similar between the males and females, but the percentage of persons having pathologic pockets tended to be higher in the males than in the females. These findings indicate that the prevalence of periodontal diseases is extremely high among the Japanese population, and that primary prevention of periodontal disease during school days is required in order to maintain the adults' periodontal health.

Adolescent↗

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↗

Current classifications of HIV-associated periodontal diseases.

The occurrence of unusual and severe forms of periodontal disease in HIV-infected individuals is well recognised. Several classification schemes have been proposed in an effort to associate periodontal deterioration with progressive stages of HIV infection and to determine aetiological factors in tissue destruction. No classification to date has proved entirely satisfactory. This paper reviews current classification schemes and suggests an alternative based upon the periodontal status of a cohort of HIV seropositive patients in Edinburgh. The proposed classification includes 'conventional', non-specific gingivitis and adult periodontitis such as occur in HIV seronegative individuals, but which may also be seen in seropositive subjects. However, conditions termed linear gingivitis and necrotising periodontitis may be pathognomonic for HIV infection. It is recommended that the term 'HIV-associated' be dropped in relation to periodontal disease.

Gingivitis↗

Periodontal disease progression.

BACKGROUND: The objective of this investigation is to use noninvasive, state-of-the-art, diagnostic techniques to measure periodontal disease progression and model periodontal disease activity over time. In this investigation, digital subtraction radiography and an electronic controlled force periodontal probe capable of attachment level measurement were used to measure bone loss and attachment loss, respectively. The use of these nearly continuous measures of attachment and bone loss allowed detection of small amounts of disease activity and provided data to be used in modeling of the disease process over time. METHODS: Forty-four patients were studied for 18 months. Examinations used clinical attachment level measures at 1-month intervals and quantitative radiology at 6-month intervals. The sites were analyzed by regression for statistically significant changes. These data were used to determine sites of periodontal disease activity for testing various models of periodontal disease progression. RESULTS: Overall 22.8% of sites lost attachment, 5.4% gained, and 71.7% demonstrated no statistically significant change. The mean time to lose 1 mm of attachment was 8.4 +/- 0.6 months. In the first model tested a step-wise discriminant analysis was used to determine whether or not baseline measurements of plaque (PI), gingival inflammation (GI), attachment loss, and probing depth (PD) could be used to derive a satisfactory model for disease progression. Although the overall model was statistically significant with PI, PD, and GI contributing to the model (Wilks' lambda = 0.859, F = 5.71, P <0.0012), its predictive power was relatively weak. A considerably stronger significant model resulted when the rate of attachment loss over the first 6 months, baseline PI, and baseline GI were included (Wilks' lambda = 0.712, F = 14.17, P<0.00001). A significant model also resulted when bone loss during the first 6 months and baseline probing depth were included (Wilks' lambda = 0.438, F = 61.48, P<0.00001). When the last model was applied to each site, the sensitivity in predicting disease progression was 80.0% and the specificity in ruling out progressive disease was 93.9%. CONCLUSIONS: This study indicates that clinically significant progression of attachment loss in posterior tooth sites occurs as a frequent event in adult periodontitis. The modeling data also suggest that short-term (6 month) measures of periodontal disease progression greatly improve the ability to model attachment loss over a longer period in untreated periodontitis patients.

Calibration↗

Evidence-based veterinary dentistry: a systematic review of homecare for prevention of periodontal disease in dogs and cats.

Successful treatment and prevention of periodontal disease in pet animals requires a multidimensional approach to identify and eliminate exacerbating factors, provide scheduled professional examinations and care, and plan and implement a dental homecare program. Over the years, many therapeutic and preventive interventions have been developed or advocated for periodontal disease, but evidence of efficacy or effectiveness is highly variable. Accordingly, the main objective of this systematic review is to identify and critically appraise the evidence supporting various aspects of homecare for prevention of canine and feline periodontal disease.

Animals↗