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PubMed1990

Diagnosing periodontal diseases.

At present, the diagnosis of periodontal disease requires a clinical evaluation of the patient including visual findings, the use of the periodontal probe, and radiographs. No test is available to evaluate disease activity. In specific cases, adjunctive procedures may also be useful. The identification of pathogenic microorganisms may aid in evaluating the periodontal status of special patients. However, these are not required for an adequate diagnosis of the common adult form of chronic periodontitis.

Humans↗
PubMed1992

Progression of periodontal disease in patients with mild to moderate adult periodontitis.

The aim of the present study was to determine the progression rate of periodontal disease in patients treated for localized or generalized mild to moderate adult periodontitis. 52 patients with a mean age of 53.7 years (S.D. 12.6 years) were instructed in optimal home care procedures and exposed to initial periodontal therapy, before reconstructive therapy was initiated. Following completion of the prosthetic procedures, supportive therapy was offered to a limited extent and maintenance visits were irregularly scheduled corresponding to traditional dental care. Clinical periodontal parameters from 4 sites per tooth were assessed at the initial examination, at the time of reevaluation after initial therapy and at the re-examination after 8-years. Full sets of intraoral radiographs from the initial and the 8-year re-examination were analyzed with respect to changes in the radiographic alveolar bone height as a % of the total tooth length. As the result of the home care instructions, the mean plaque index (plaque control record) amounted to 21% at the end of initial periodontal therapy. 8 years later, the re-examination revealed a mean plaque index of 49% and a mean gingival bleeding index of 24%. At the initial examination, the 52 patients presented with an average of 18.7 teeth. During treatment, 26 teeth were sacrificed and 19 teeth were lost over the 8 years of supportive therapy. Bicuspids were the most frequent teeth to be lost over the observation period. As a result of initial therapy, the mean pocket probing depths decreased significantly. However, after 8 years, only minor differences were found when compared to the initial examination.(ABSTRACT TRUNCATED AT 250 WORDS)

Age Factors↗
PubMed1998

Enhanced interaction of advanced glycation end products with their cellular receptor RAGE: implications for the pathogenesis of accelerated periodontal disease in diabetes.

The prevalence and severity of periodontal disease is increased in patients with both insulin-deficient and insulin-resistant forms of diabetes. While a number of underlying factors likely contribute to enhanced periodontal inflammation and alveolar bone loss in diabetes, a common characteristic of these disorders, regardless of etiology, is the presence of hyperglycemia. A critical consequence of hyperglycemia is non-enzymatic glycation and oxidation of proteins and lipids. After a series of reversible reactions which lead to the generation of Schiff bases/Amadori products, a further series of complex molecular rearrangements ensues which results in the formation of the irreversible advanced glycation end products, or AGEs. AGEs accumulate during the process of normal aging in the plasma and tissues, but to an accelerated degree in patients with diabetes. A central means by which AGEs are believed to impart their pathogenic effects is via interaction with specific cellular receptors; the best-characterized of these is receptor for AGE, or RAGE. RAGE, a member of the immunoglobulin superfamily of cell surface molecules, is present in increased levels on target cells in diabetes, such as endothelial cells and monocytes. One consequence of AGE-RAGE interaction is the generation of enhanced cellular oxidant stress, a means by which cell signaling pathways may be activated, thereby resulting in altered cellular phenotype and cellular dysfunction. In this report, we will review our studies to date on AGEs and RAGE and consider the implications of their enhanced interaction in the pathogenesis of accelerated periodontal disease in diabetes.

Animals↗
PubMed1996

Periodontal disease, diabetes, and immune response: a review of current concepts.

A reasonable interpretation of the present evidence indicates that diabetes, when a complication of periodontitis, acts as a modifying and aggravating factor in the severity of periodontal infection. Diabetics with periodontitis who were young and poorly controlled, those who were long-duration diabetics, especially those over 30 years old, demonstrated more attachment loss, bone loss, and deeper probing pocket depths than their nondiabetic controls. It seems that the earlier the onset of diabetes and the longer the duration, especially without consistent control, the more susceptible the individual will be to periodontal disease. Consequently, once a diabetic contracts periodontal disease, it is usually more destructive. Although plaque scores of diabetics may be comparable to or even less than those of nondiabetics, diabetics often exhibit higher gingival index scores. The elevation of this particular clinical parameter is indicative of the microangiopathy associated with diabetes. Diabetic microangiopathy contributes to compromised delivery of nutrients to surrounding tissues and poor elimination of metabolic waste products. The complications associated with diabetes such as macroangiopathy, microangiopathy (i.e., retinopathy), ketoacidosis, and hyperglycemia result in impaired wound healing, immunosuppression, and susceptibility to bacterial infection. Individuals ages 30 to 40 suffering from diabetic retinopathy had significantly more gingival inflammation than controls or diabetics without complications. Collagen metabolism is defective in diabetics and is one component underlying delayed wound healing. Animal studies have been instrumental in elucidating the details of delayed wound healing. Hyperglycemia was associated with increased collagenase and protease activity in the gingiva of rats. Vascular wound healing in rats, particularly new re-endothelialization across vascular anastomoses, was significantly impaired. Diabetic abnormalities in immune response include impaired neutrophil chemotaxis, phagocytosis, and adhesion. Decreased neutrophilic chemotactic response seems to be attributable to protein factors in diabetic serum that competitively bind neutrophil receptors, thereby preventing complement-mediated phagocytosis. Because diabetics are not able to eliminate circulating immune complexes (CIC) effectively, serum CIC levels are elevated. There are microbiological differences in the characteristic flora of NIDDM patients and IDDM patients with periodontitis. These differences are not associated with diabetic impaired immune response. Ultimately, bacterial plaque is the primary etiology of periodontal diseases. Evidently, the host's response to bacterial plaque and ability to heal following surgery is altered by diabetic disease. Therefore, a thorough history regarding onset of diabetes, duration, and diabetic control would prove useful in the clinical management of diabetics presenting for treatment of periodontal disease.

Animals↗
PubMed1991

Public health aspects of periodontal diseases in Europe.

There is relatively little severe periodontal disease in populations in Europe. The public health significance is therefore debateable. The fact that the costs of treating the disease are high because of the organization of dental care, qualifies it as a dental public problem. In addition, the symptoms of periodontal diseases such as bleeding, halitosis, gingival recession and tooth loss have an impact on many people, and we have sufficient information to control the common forms of the disease. The goals for dental health can be expressed in terms of health, disease, health education and health promotion and training. A reasonable objective is to achieve a rate of loss of attachment compatible with maintaining at least upper and lower shortened arches for a lifetime. 4 strategies are considered: a high risk, a population, a secondary prevention strategy or a combination of the three. A combination of the 3 is needed to achieve the objective of maintaining a functional, aesthetically and socially acceptable natural dentition for the lifespan of most people. The balance of effort should be heavily weighted towards the population strategy. If the strategy is adopted, the need for treatment will be reduced and treatment will be more successful.

Europe↗
PubMed1989

[An attempt to decrease periodontal diseases. A scenario-experiment].

The prevalence of periodontal diseases in the Dutch population is high. Is the employment of a great number of dental hygienists in the future the answer to this problem? With the aid of a computer model of the Dutch dental health care system this question was analysed. Forecasting for the year 2015 showed no considerable decrease of the prevalence of periodontal diseases, despite the employment of 2000 dental hygienists from 1990 on. Time and financial limitations in periodontal treatments were the main reasons for this rather disappointing result.

Dental Hygienists↗
PubMed2007

Influence of the period after ovariectomy on femoral and mandibular bone density and on induced periodontal disease.

BACKGROUND: This study investigated the influence of the period after ovariectomy on femoral and mandibular bone mineral density (BMD) and on induced periodontal disease. METHODS: One hundred and twenty-six female Holtzman rats were divided into nine groups: control, sham surgery (SHAM) with and without induction of periodontal disease for 51 and 150 days, and ovariectomy (OVX) with and without induction of periodontal disease for 51 and 150 days. Periodontal disease was induced by placing ligatures on the first lower molars during the last 30 days of each period. BMD was measured by dual-energy x-ray absorptiometry. Vertical bone loss was determined by measuring the distance from the alveolar bone crest to the cemento-enamel junction on the mesial side of the first lower molar. RESULTS: Statistical analyses (Kruskal-Wallis test) revealed a significant difference between the OVX and SHAM groups' global and femoral proximal epiphysis BMD (P <0.001) for 150 days and in the global evaluation for 51 days. For mandibular BMD, no difference was found between the groups of each period. Influence of the period on femoral BMD was found only for the SHAM groups, with lower BMD for the 51-day period compared to the 150-day period (P <0.05). In the global evaluation of the mandible, a lower BMD was found after 51 days. The period was a contributing factor for the vertical bone loss, and it resulted in higher values for the 51-day period (P <0.05). CONCLUSION: The period influenced the femoral BMD and the vertical bone loss in induced periodontal disease.

Alveolar Bone Loss↗
PubMed2004

Managing the orthodontic treatment of patients with advanced periodontal disease: the lingual appliance.

AIM: Treatment of adult patients with advanced periodontal disease is a challenge to the orthodontist using lingual appliance therapy, which is the preferred technique for many adult patients due to its relative invisibility. The lingual technique has been shown to be capable of correcting severe malocclusions, deep bite as well as open bite cases. However, the treatment mechanics are different from the labial technique and require different considerations. METHODS: The potential problems during lingual orthodontic treatment of patients with advanced periodontal disease are discussed, including esthetics during and after orthodontic treatment, efficacy of treatment, adaptation of biomechanics, etc. Three cases are presented to demonstrate the problems and solutions. CONCLUSION: Successful treatment of patients with advanced periodontal disease using the lingual appliance requires specific considerations and a biomechanical approach.

Biomechanical Phenomena↗
PubMed1993

Current epidemiologic consideration of periodontal disease.

Two interesting populations in periodontology have emerged this year. National and international reports have indicated that inflammatory periodontal disease is widespread in adolescents, although most of the cases of disease are considered to be in a reversible stage. Nevertheless, the attachment loss present portends serious future problems. The rapidly growing elderly population presents a unique problem of assessment. Current indices do not adequately evaluate recession. Thus, there is substantial underestimation of periodontal disease in the elderly. Further insight into the interrelationships between systemic diseases and local inflammatory periodontal diseases has been reported. Methods to improve statistical evaluation of site-specific periodontal data and address the shortcomings of currently available periodontal indices have been suggested. Finally, the major disadvantage of indices in treatment planning is the lack of specific treatment goals. Examples of the potentially misleading information that results from this lack were presented and the inclusion of treatment goals with treatment needs was suggested.

Adolescent↗
PubMedDate not supplied

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.

Acute Disease↗
PubMed2006

Evaluation of t-PA, PAI-2, IL-1beta and PGE(2) in gingival crevicular fluid of rheumatoid arthritis patients with periodontal disease.

AIMS: This study was undertaken to compare periodontal conditions, gingival crevicular fluid (GCF) levels of tissue-type plasminogen activator (t-PA), its inhibitor plasminogen activator inhibitor-2 (PAI-2), interleukin-1beta (IL-1beta), prostaglandin E(2) (PGE(2)) in rheumatoid arthritis (RA) patients and control groups. METHODS: Twenty-three RA patients, 17 systemically healthy patients with periodontal disease (PD), and 17 systemically and periodontally healthy subjects were recruited. GCF samples were obtained from two single-rooted teeth. Full-mouth clinical periodontal measurements were recorded at six sites/tooth. GCF samples were analysed using relevant ELISA kits. Data were tested statistically by appropriate tests. RESULTS: Total amounts of t-PA, PAI-2 and PGE(2) in GCF samples of the healthy control group were significantly lower than the other groups (p<0.05). The RA group exhibited a higher total amount of t-PA in GCF samples than the PD group (p<0.05). PAI-2, IL-1beta and PGE(2) total amounts were similar in RA and PD groups (p>0.05). CONCLUSION: The coexistence of RA and periodontitis does not seem to affect clinical periodontal findings or systemic markers of RA. Similar inflammatory mediator levels in RA and PD groups, despite the long-term usage of corticosteroids, non-steroidal anti-inflammatory drugs, suggest that RA patients may have a propensity to overproduce these inflammatory mediators.

Arthritis, Rheumatoid↗
PubMed1986

Antibody to collagen type I in periodontal disease.

Serum antibody levels to human collagen Type I were measured in 97 patients with periodontal disease (Russell Periodontal Index 1.0-7.0) and 57 control subjects (Periodontal Index less than 1.0) using an enzyme-linked immunosorbent assay, which had been standardized with antisera prepared against human collagen Type I in rabbits. Absorption studies were used to confirm the specificity of antibodies to human Type I collagen. Levels of antibody to Type I collagen detected in patients were higher (P less than 0.001) than in the control subjects.

Adult↗
PubMedDate not supplied

[The use of discriminant analysis for the differential diagnosis of periodontal diseases].

Basing on rheo- and photoplethysmography combined with mathematical methods and computers the authors have developed a method for the differential diagnosis of periodontal diseases (gingivitis, periodontitis). Diagnostic studies carried out in 200 patients have shown a high probability (at least 92 percent) of the method for the differential diagnosis of periodontal diseases.

Adolescent↗
PubMed1998

Relationship between diet, dental calculus and periodontal disease in domestic and feral cats in Australia.

OBJECTIVE: To compare the dental calculus scores and prevalence of periodontal disease in domestic cats eating commercially available canned and dry foods with those in feral cats consuming a diet consisting of small mammals, birds, reptiles and insects. ANIMALS: Twenty-nine feral cats and 20 domestic cats were included in the study. PROCEDURE: A dental chart and dental calculus scores were recorded using the maxillary canine, maxillary third and fourth premolar, mandibular canine, mandibular fourth premolar and first molar teeth on both sides. Periodontal disease was recorded using gingival recession, increased periodontal pocket formation, radiographic alveolar bone loss, osteomyelitis, furcation and root exposure, and the presence of calculus as indicators. RESULTS: Dental calculus scores were significantly higher in domestic cats than in feral cats. There was no statistical difference in the prevalence of periodontal disease between the two groups. CONCLUSIONS: It can be inferred that diet may play a role in the accumulation of calculus, but a diet based on live prey does not protect cats against periodontal disease.

Animal Feed↗
PubMed1991

Phenotypic analysis of B-cells extracted from human periodontal disease tissue.

B-cells extracted from periodontal disease tissue were analyzed for the presence of activation markers using a range of monoclonal antibodies. In adult periodontitis (AP), 6% of B-cells expressed the IL-2 receptor (CD25) compared with 1-2% in peripheral blood and healthy or marginal gingivitis (H/MG) gingival B-cells. There was also an increase in the mean percentage of IgD-positive B-cells and a decrease in CD21 and CD22 expression. In both AP and H/MG lesions, 20-22% of the B-cells expressed CD23 compared with less than 5% in peripheral blood. As B-cells are activated by day 3 in culture and start differentiating into immunoglobulin-secreting cells by day 6, B-cell phenotypes were assayed at these times in this study. Following stimulation with the periodontopathic bacterium Porphyromonas gingivalis, the expression of CD23, CD21 and CD22 on B-cells extracted from AP lesions remained relatively constant over the 6-d culture period. However, with Fusobacterium nucleatum stimulation, there was a significant decrease in CD23, CD21 and CD22 expression after 3 d in culture, which corresponds to the activation time for B-cells. These results show that B-cells extracted from periodontal disease tissue display a range of activation markers and on stimulation, demonstrate differing responses to individual periodontopathic bacteria.

Adult↗
PubMed1995

Flow cytometric approach to human polymorphonuclear leukocyte activation induced by gingival crevicular fluid in periodontal disease.

In gingival pockets of patients with periodontal disease, polymorphonuclear leukocytes (PMN) are in contact with a peculiar exudate, the gingival crevicular fluid (GCF). Because of the pivotal role played by PMN in periodontal disease, we evaluated the ability of GCF in modulating normal human PMN. GCF was obtained from two gingival sites with severe periodontitis (SP) and two gingival sites with only mild periodontitis (MP) in 12 patients. Purified PMN were exposed to GCF from SP and MP sites and, as a control, to sterile culture medium. GCF activity was evaluated by monitoring the modulation of membrane molecules relevant to cell function. Compared to control medium, GCF from SP and MP sites was able to induce an activation status in PMN evidenced by an increased CD11b (62 +/- 9% and 28 +/- 7%, respectively) and f-Met-Leu-Phe (56 +/- 5% and 31 +/- 7%, respectively) receptor expression, with a concomitant reduction of CD62L expression (56 +/- 8% and 23 +/- 7%, respectively). Thus, reflecting the clinical status, GCF from SP sites was significantly more efficient in affecting PMN than GCF from MP sites. Cell size modifications, evaluated as an additional indicator of PMN activation, were consistent with membrane molecule modulation. The difference in PMN-activating capacity between SP and MP was abrogated by the successful completion of an appropriate periodontal therapy that dramatically improved clinical status. This is the first direct demonstration that GCF from periodontitis has the capacity to activate normal resting PMN and that this capacity reflects the magnitude of the inflammatory process that takes place in the gingiva.

Adult↗
PubMedDate not supplied

[Prevalence of dental caries, gingivitis and periodontal disease in pregnant diabetic women].

OBJECTIVE: To determine the difference in the prevalence of dental caries, gingivitis, and periodontal disease among non-diabetic, type-II diabetic and pregnant diabetic women. MATERIAL AND METHODS: In the period from June 1993 to January 1994, a cross-sectional study was carried out at the Instituto Nacional de Perinatología among 160 pregnant women; eighty non-diabetic women were included in the control group, while 40 type-II diabetic and 40 gestational diabetic women conformed the study group. In each patient the following variables were recorded: age, week of pregnancy, the Simplified Oral Hygiene Index, the Decayed, Missing and Filled Teeth Index, the Gingival Index, and the Extent and Severity Index. Statistical analysis was carried out using Analysis of Variance and the Multiple Range Test, with a 95% confidence internal. RESULTS: All of the groups had similar prevalences of dental caries (100%). Type-II diabetic women showed a higher prevalence of gingivitis (42.5%) than non-diabetic (36.25%) and gestational diabetic (10%) women, but the differences were not statistically significant between the non-diabetic and type-II diabetic women. Type-II diabetic women had a statistically significant higher prevalence of periodontal disease (12.5%) than the women in the other groups. CONCLUSIONS: It is very important to establish proper metabolic control and a fitting oral hygiene in pregnant diabetic women, since type-II diabetes was shown to be associated with a higher prevalence of periodontal disease. Besides, gestational diabetes is likely to pose a high risk of periodontal disease in the absence of preventive measures.

Adult↗