Host response in chronic periodontal disease. V. The dental and periodontal status of mink and mice affected by Chediak-Higashi syndrome.
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Aleutian Mink Disease↗
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[The treatment of secondary malocclusion in patients with periodontal disease].
The loss of osseous support resulting from periodontal disease is an etiological factor in the development of secondary malocclusions. Correction of these malocclusions demand a) advanced techniques, b) an understanding of the biological situation present in the patient with periodontal disease and c) adaptation of these techniques and forces to the reduced support. According to the treatment of malocclusion there are improvements in plaque accumulation and the distribution of occlusal forces. These factors, maintain the long term health of the teeth and their periodontium. These kind of treatment requires the maximum interdisciplinary collaboration.
Alveolar Bone Loss↗
[Possibilities and significance of immunological diagnosis for the differential diagnosis of periodontal diseases].
A clearer understanding of the aetiology of periodontal diseases can only be gained by further studies on the effects of plaques on the organism. Furthermore, the pathogenic plaque components must be assessed. It seems worth while maintaining the working hypothesis that periodontal disease is a plaque-induced clinical picture and that its various types are due to variations in the power of resistance of the organism. The better understanding of this changed reactivity and of the pathogenic plaque components must be aimed at.
Cell Migration Inhibition↗
Association of the severity of periodontal disease with organ complications in type 1 diabetic patients.
This study examined the relationship between the severity of periodontal disease and organ complications in long-term Type 1 or insulin-dependent diabetes mellitus patients, taking account of the severity and concomitant existence of these complications. The population studied consisted of 26 Type 1 diabetics 26 to 34 years old, who had had diabetes for at least 10 years. Severity of periodontal disease was shown to increase with severity of organ complications. Patients with advanced complications had significantly more bleeding on probing, pockets > or = 4 mm deep, and more attachment loss than patients with incipient complications or no complications. Stepwise multiple regression analysis showed that the existence of advanced complications was the only diabetes-related factor predicting pockets > or = 4 mm deep. Subgingival calculus, sex, and smoking were other significant variables. Retinopathy was the organ complication most suited to comparison, since it is usually the first to appear and can easily be classified from non-existent to severe. Differences in severity of periodontal disease were less obvious if metabolic balance alone was considered than between subgroups formed on the basis of the existence of advanced complications. Severity of periodontal disease and the existence of complications were more closely related to long-term glucose balance than single, most recent HbA1 values. Prevalence of pockets at sites with subgingival calculus increased with severity of complications.(ABSTRACT TRUNCATED AT 250 WORDS)
Adult↗
[The use of new biologically compatible materials in the combined treatment of periodontal diseases].
The authors analyze various orthodontic constructions used in multiple-modality treatment of periodontal diseases. Special attention is paid to combinations of direct fitting with prostheses and use of the novel osteoinductive and immunomodulating agents. Nineteen patients with periodontal diseases were treated. Removable splints, prosthetic splints, and other devices were employed. Special emphasis is made on the use of biositall M-31-a composition on the basis of hydroxyapatite and Algigel. All these materials were found to be effective at the stage of surgical treatment of periodontal diseases, particularly so in combination with immediate prostheses and sodium alginate-based therapeutic films.
Adult↗
Quantification of mast cells in different stages of human periodontal disease.
OBJECTIVE AND METHODS: Among the cells involved in immune and inflammatory responses in periodontal disease, mast cells have been shown to be capable of generating a large number of biologically active substances. The present study was undertaken to identify and quantify the presence of mast cells in different stages of human periodontal disease using histochemical (toluidine blue) and immunohistochemical (tryptase-positive mast cells) techniques. RESULTS: Mast cell densities (cells per mm(2)) were significantly increased in chronic periodontitis/gingivitis lesions compared with clinically healthy gingival tissues (Health) uniquely by immunohistochemical technique. Interestingly, mast cells were distributed specially in close apposition to mononuclear cells. CONCLUSIONS: In human periodontal disease there is an increase in the number of mast cells that may be participating either in the destructive events or in the defense mechanism of periodontal disease via secretion of cytokines, including perpetuation of the Th2 response, and cellular migration and healing processes.
Analysis of Variance↗
Associations between periodontal disease and systemic disease: evaluating the strength of the evidence.
Much work has been published on the association between periodontal disease and systemic disease, including original reports, narrative reviews, systematic reviews, and meta-analyses. Based on the existent work, one can assign an evidence level and grade, using standard evidence-based criteria, to the data available in the four major categories of medical outcomes studied: cardiovascular/cerebrovascular, pregnancy, pulmonary, and diabetes. We discuss methodologic and conceptual problems in the study of oral-systemic associations, focusing as an example on the association between periodontal disease and cardiovascular/cerebrovascular disease. We argue that the hierarchical ranking of studies by levels of evidence may be misleading. In particular, while randomized controlled trials (RCTs) are needed to determine the efficacy of periodontal treatment to reduce the risk of cardiovascular events, they may be of limited value in determining the etiologic role of periodontal disease on coronary heart disease and stroke. We discuss limitations of RCTs as well as the limitations of currently available data from epidemiologic studies, including study design and confounding and misclassification errors. We conclude that well-designed observational studies into the associations between periodontal disease and systemic disease need to remain an integral component of future research efforts in order to fully understand such associations.
Causality↗
The prevalence and relationship between periodontal disease and pre-term low birth weight infants at King Khalid University Hospital in Riyadh, Saudi Arabia.
The aim of this study was to examine the prevalence and relationship between periodontal disease and pre-term low birth weight (PLBW) among Saudi mothers at King Khalid University Hospital (KKUH) in Riyadh, Saudi Arabia. The periodontal status and the relative risk were also analyzed. The study consisted of 30 cases [infants <37 weeks and/or weighing <2.500 kilograms (kg)] and a daily random sample of 60 controls [> 37 weeks and/or weighing >2.500 kg]. Clinical periodontal indices were measured on the labor wards. Associated risk factors for periodontal disease and PLBW were ascertained by means of a structured questionnaire and maternal notes. The prevalence of the PLBW was found to be 11.3%, and the prevalence of periodontal disease was high among the study population. The risk of PLBW remained high with increasing periodontal disease (odds ratio [OR] 4.21, 95% confident interval [CI] 1.99-8.93) despite controlling the other risk factors such as age, smoking, and social class. In conclusion, there is a correlation between periodontal disease and PLBW in KKUH.
Adolescent↗
[Photoplethysmographic indices of hemodynamics in periodontal diseases].
In 120 patients the periodontal photoplethysmography was performed. Statistical analysis of the frequency-amplitude characteristics of the photoplethysmographic signal was useful for differential diagnosis of various forms and stages in periodontal diseases and for evaluation of the treatment efficiency.
Adolescent↗
Antimicrobial treatment of periodontal diseases disturbs the human ecology: a review.
Periodontal diseases are associated with specific pathogenic microorganisms and therefore antimicrobial agents are often used in the treatment of patients with periodontitis refractory to conventional mechanical therapy. Perorally administered antimicrobial agents often lead to ecological disturbances in the normal oral and intestinal microflora with overgrowth of potentially pathogenic microorganisms, which may spread within the host or from patient to patient, causing infections. The use of antimicrobial agents also promotes the emergence of bacterial drug resistance, both in the periodontal pocket and in the normal oral and intestinal microflora. Topical administration of antimicrobial agents in the periodontal pockets causes restricted disturbances in the intestinal microflora, although there is a substantial risk of development of resistance at the site of application. A number of clinical studies imply that correct use of antimicrobial agents might be beneficial for a subset of patients with adult or juvenile periodontitis. The choice of antimicrobial agent should always be based on accurate microbial analyses of the subgingival microflora and in vitro antimicrobial susceptibility tests of the most important periodontal pathogens. Preferably, agents with low potential of causing ecological disturbances should be used.
Anti-Bacterial Agents↗
Root proximity as a risk marker for periodontal disease: a case-control study.
AIM: The aim of this study is first, to examine the prevalence, symmetry and spread of root proximity using the measurement tools and classification as described in part I of the study, and second to examine whether root proximity is a risk marker for periodontal disease. MATERIAL AND METHODS: The radiographs of 227 patients were examined. The study consisted of a study group of 197 patients with advanced periodontal disease with at least one site with bone loss more than one third of the root length and 30 controls without periodontal disease. Every inter-proximal space was assessed on the full-mouth radiographs and a score was assigned according to severity and location. Consequently prevalence of severity and location, symmetry, spread and an odds ratio and relative risk for periodontal disease was calculated. RESULTS: Root proximity is a symmetrical and localized but widespread phenomenon in periodontal patients and to lesser extend in the non-periodontal control group. In periodontal patients root proximity was most often encountered in the coronal and intervening part whereas subjects without periodontal disease had more root proximity in the apical and intervening part where it is less critical. Subjects with bilateral root proximity had a 3.6 times higher chance to have periodontitis. CONCLUSION: Root proximity must be taken into consideration as a risk marker for periodontal disease.
Adolescent↗
Retrospective analysis of implant survival and the influence of periodontal disease and immediate placement on long-term results.
PURPOSE: The purpose of this study was to investigate the cumulative survival rates of dental implants placed in a private periodontal practice and the effects of periodontal disease and immediate placement on implant survival. MATERIALS AND METHODS: A retrospective chart review was conducted on 149 consecutive patients. Each patient had a single implant placed. For the purpose of analysis, patients were divided into 2 groups: those who were periodontally healthy and those who had periodontal disease. Implants were placed into available bone either immediately or after a healing period. All failed implants were removed and recorded. The effects of periodontal status and placement time on implant survival were evaluated using Cox proportional hazards regression and log-rank tests. RESULTS: Of the 149 implants in the study, 22 failed during the observation period. The 127 censored cases (i.e., implants that had not failed at the end of the observational period) were observed for a mean of 943 days (SD 932, range 35 to 4,030). Failed implants were observed for a mean of 722 days (SD 1,026, range 18 to 3,548). The presence of periodontal disease appeared to be associated with a greater failure rate, but there was no observed effect associated with time of placement. The percentages of censored immediate placement cases and delayed placement cases were nearly identical. Among the 77 implants associated with periodontal disease, placement time was not strongly associated with percentage censored. Forty-three of the 55 immediately placed implants (78.18%) and 18 of the 22 implants (81.18%) whose placement was delayed were censored. Both Cox proportional hazards regression and log-rank tests established that survival was adversely affected by periodontal disease (P < .05) but unaffected by time of placement (P > .50). The lower 1-sided 95% confidence limit for median survival time was 3,548 days for patients without periodontal disease and 1,799 days for patients with disease. DISCUSSION AND CONCLUSION: Implant survival was compromised by a history of periodontitis but not affected by immediate or delayed placement.
Dental Implantation, Endosseous↗
Diagnosis of periodontal diseases.
This paper reviews current (Fall, 1990) information related to the diagnosis of periodontal diseases. As background, principles of diagnostic decision-making and conceptual shifts during the 1970's and 1980's are reviewed in brief. "Diseases" that appeared in many classification schemes for periodontal diseases in the early 1970's--for example, "periodontosis" and "occlusal trauma"--do not appear in most current classifications. A recent (1989a) classification recommended by the American Academy of Periodontology holds that "periodontitis" includes several different diseases. There is, indeed, evidence for several different forms of periodontitis, but the AAP's classification does not conform to the principles of diagnostic decision-making because of the significant overlap between and heterogeneities within its suggested "diseases". An alternative classification is suggested, based on a concept that the periodontal diseases are mixed infections whose outcome is modified by relative effectiveness of host response. This view suggests that the most usual forms, gingivitis and adult periodontitis, normally occur in persons with essentially normal defense systems. Variation in extent or severity of disease can be understood as a function of the local infection in hosts with various degrees of compromised resistance to the infection. Early-onset periodontitis (EOP) cases could be accounted for by those where host response is abnormal to some significant degree. The greater the abnormality, the greater the extent and severity of disease might be. Localized EOP cases would be those where a relatively effective specific response intervenes to ameliorate progress of disease after the initially rapid progression. Other issues are detection of disease activity and assessment of risk for disease progression. Non-cultural bacteriological tests are available, but have not yet been shown to detect or predict activity or risk. One difficulty in reaching such proof for those or other tests has been the lack of an appropriate "gold standard" for disease activity or progression. This is being remedied by development of improved automated probes and imaging technologies. Considerable effort is being devoted to determining whether factors in gingival crevicular fluid may have diagnostic utility. More evidence is needed before clinical utility is known, but several enzymes and cytokines have potential for aiding diagnostic decisions.
Adolescent↗
Social gradients in periodontal diseases among adolescents.
OBJECTIVE: To investigate the association between socioeconomic position and periodontal diseases among adolescents. METHODS: Data were obtained from 9203 Chilean high school students. Clinical examinations included direct recordings of clinical attachment level and the necrotizing ulcerative gingival lesions. Students answered a questionnaire on various dimensions of socioeconomic position. Seven periodontal outcomes were analyzed. Logistic regression analyses were used to identify socioeconomic variables associated with the periodontal outcomes. RESULTS: The occurrence of all periodontal outcomes investigated followed social gradients, and paternal income and parental education were the most influential variables. CONCLUSIONS: The study demonstrates the existence of significant social gradients in periodontal diseases already among adolescents. This is worrying, and indicates a new potential for further insight into the mechanisms of periodontal disease causation.
Adolescent↗
Local and systemic chemotherapy in the management of periodontal disease: an opinion and review of the concept.
Periodontal disease appears to arise from the interaction of pathogenic bacteria with a susceptible host. The main aims of disease management have been to establish a high standard of oral hygiene and to professionally and thoroughly debride the root surface Chemical agents could be considered for both aspects of management. Chemoprevention using supragingivally delivered agents such as chlorhexidine may be questioned for value in the pre-treatment hygiene phase but have well-established efficacy immediately preoperatively and during the post-operative weeks. Long-term maintenance use of chlorhexidine is problematic due to local side effects. Antiplaque toothpastes show modest benefits to gingivitis but are not proven to prevent recurrence of periodontitis. Chemotherapy may be directed at subgingival plaque, using antimicrobials, or at the host response using anti-inflammatory agents. Antimicrobials can be locally or systemically delivered. In most cases antimicrobial chemotherapy should be considered adjunctive to mechanical debridement. The advantages of local and systemic chemotherapy must be balanced against the disadvantages and potential side effects of agents. Antimicrobial chemotherapy offers little or no benefit to the treatment of most chronic adult periodontitis patients and should be reserved for the more rapid or refractory types of disease, and after the debridement phase. Despite the large number of studies there are insufficient comparative data to support any one local delivery system or systemic regimen as superior to another. Systemic versus local antimicrobials have not been compared to date. Host response modifying drugs such as non-steriodal anti-inflammatory drugs (NSAIDS) offer the potential to reduce breakdown and promote healing, including bone regeneration. However until more data are available, NSAIDs should not be used in the management of chronic periodontal diseases, there being no specific agent(s) or regimen established for use. Chemotherapy has an important place in the management of chronic periodontal diseases but routine use must be considered as an over prescription of these valuable agents.
Adult↗
Difficulties encountered in the search for the etiologic agents of destructive periodontal diseases.
The present paper outlines some of the difficulties encountered in the search for the etiologic agents of destructive periodontal diseases. These include technical problems such as acquiring an appropriate microbial sample, as well as difficulties in the dispersion, cultivation and identification of isolates in that sample. Many of these difficulties are currently being successfully addressed. A second set of problems is more conceptual in nature. These include difficulties in distinguishing between periodontal diseases and determining the state of activity of periodontal lesions. In addition, complexes of organisms and/or sequences of species may be involved in the progress of lesions. A further problem is encountered in attempting to distinguish overgrowths of opportunistic species from increases in proportions of true pathogens. Finally, it appears likely that different infections occur at the same time in a single oral cavity. The technical and conceptual difficulties eventually filter down to the data analytical step and present numerous problems to the analyst. With all of these difficulties in mind, it is not surprising that the etiologic agents of destructive periodontal diseases are not clearly defined. However, improvement in technological assessments of the microbiota and clinical evaluation of the disease should permit reasoned approaches to be taken. The delineation of the etiologic agents of destructive periodontal diseases will be, of necessity, a multistage iterative process. Etiologic agents will be suggested by predominant cultivable studies and hypotheses concerning subsets of these agents tested using more specific procedures such as selective media, immunofluorescent techniques or DNA probes.(ABSTRACT TRUNCATED AT 250 WORDS)
Bacteria↗
Periodontal disease in Kuna albinism: a comparative study.
BACKGROUND: In classic albinism, all parts of the body are normal except for the absence of melanin. It is believed that lack of this pigment in periodontal tissues might influence periodontal disease progression. This study was designed to determine the relationship between periodontal diseases and albinism by comparing the clinical periodontal status of a group of native Panamanian Kuna albinos (from San Blas, Panama) to Kuna non-albinos of the same communities. METHODS: An experimental group of 30 subjects (Kuna albinos aged > or =12 years) was selected and divided into three subgroups according to age. Likewise, a control group of 30 subjects (Kuna non-albinos) was selected and divided in subgroups. RESULTS: Assessment of oral hygiene and gingival inflammation in albinos by the Silness and Löe plaque index and Löe and Silness gingival index, respectively, was unremarkable compared to control groups. No statistically significant differences were found for number of teeth present, gingival index, plaque index, clinical attachment loss (CAL), probing depth, or gingival recession. As expected, age was a factor in the severity of the periodontal disease; 58% of individuals aged > or =36 years had at least one site with CAL > or =7 mm. CONCLUSION: Based on the overwhelming similarity of results found between experimental and control groups, albinism does not represent a clinical risk factor in the pathogenesis or exacerbation of periodontal diseases for these individuals.
Adolescent↗
A socio-economic perspective on periodontal diseases: a systematic review.
OBJECTIVE: The aim of this systematic review was to ascertain whether socio-economic conditions increase the risk of periodontal diseases. METHODS: A MEDLINE search was conducted for the period 1965-April 2004. Only original articles were included; 47 studies remained for the final assessment. The studies were analysed regarding the outcome of the association between socio-economic variables and periodontal disease, depending on the study design (cross-sectional survey or longitudinal case-control) and whether smoking was included or not. RESULTS: Twenty-nine out of 36 studies with a cross-sectional design were in favour of the association between socio-economic factors and periodontal diseases. In the studies with a longitudinal or case-control design, there were five in favour of the association, and also six against. When smoking was included in the analysis of cross-sectional studies, a significant association between socio-economic variables and periodontal disease was found in 11 studies and no significance in another five studies. The corresponding figures for case-control studies showed four studies being significant, but also four studies showing no significance. CONCLUSION: Based on relevant study designs and including smoking in the analysis, the socio-economic variables associated with periodontal diseases appear to be of less importance than smoking.
Body Weight↗