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PubMed1993

Is periodontal disease on the increase in Kenya? A review.

During a recent scientific meeting held in Botswana (16th-19th October 1991), it was reported that the oral health situation in developing countries was typified by an increase in the prevalence of dental diseases. Kenya was cited as one of the typical examples of this worrying trend. For there to be an increase in dental diseases, there must be a concomitant increase or an upward shift in the main aetiological factor(s) or factors associated with dental diseases. This paper looks at these factors in relation to periodontal disease and reviews some of the major prevalence studies of periodontal disease that have been carried out in Kenya. It also presents some arguments to show that there is no unequivocal evidence that periodontal disease is on the increase in Kenya.

Adolescent↗
PubMedDate not supplied

[Periodontal disease and prevention in children and adolescents].

Clinical and epidemiological studies have shown that: 1. Bacterial plaque which accumulates around the teeth is responsible for chronic periodontal inflammation. From adolescence on, this inflammation is almost universal. 2. Gingivitis prepares the periodontitis, which is characterized by a migration of the epithelial attachment, pocket formation and progressive bone loss. 3. Calculus is formed by plaque calcification. Its rough surface allows bacterial retention and proliferation in contact with the epithelial covering. 4. The mechanisms of host resistance to parasitic plaque are mostly unknown. This resistance is variable and seems to decrease with age. 5. Periodontal disease in children and adolescents is a real problem in preventive medicine, because of its immediate or remote consequences on tooth loss. Thanks to fluoride, the prevention of dental caries is quite effective; the prevention of periodontal disease is on the contrary much more difficult. Mechanical removal of plaque is tedious and must be done again and again; however, it is not logical to separate prevention of caries from that of periodontal disease. Information of the public at large on oral health is of utmost importance, as well as a good cooperation of the teachers in preventive programs for schoolchildren. Every health department or service should try to apply the following measures: -Permanent employments for "school dental nurses" should be created, on a part-time or full-time basis. They should take care of the organisation and supervision of oral health programs. -In each school dental service, a dentist should be responsible for teaching the theoretical and practical aspects of periodontal prevention. -Caries reduction obtained by fluorides is no excuse to reduce the "treatment staff". This staff should be devoted to prevention at large and to refreshing courses. In a young population with regular supervision, prevention of periodontal disease can meet with considerable success. Initial periodontal disease is reversible: it is possible to avoid the degradation of gingivitis in progressive periodontitis, and this helps maintaining dental and periodontal health throughout life.

Adolescent↗
PubMed1991

The role of complement in periodontal diseases.

The complement system has been implicated as both a pathogenic mechanism and a means of protection in periodontal diseases. It is well known that bacteria activate complement; such activation can initiate a number of events, including bacterial opsonization and killing, release of inflammatory agents, and modulation of other immune reactions. Cleavage of complement proteins has been observed in gingival fluids from individuals with periodontal disease and some investigators have observed complement deposition in diseased gingival tissues. Furthermore, a number of bacterial from individuals with periodontal diseases have been found to activate complement in vitro; some of these organisms appear to have the capacity to evade opsonization due to their proteolytic capacity. However, concrete evidence is not yet available that indicates that complement activation occurs in human periodontal disease and is important in either its pathogenesis or in protection against bacterial virulence factors.

Animals↗
PubMedDate not supplied

[Implication of calcium deficiency in the progress of periodontal diseases and osteoporosis].

Several authors have established a relationship between osteoporosis and periodontal disease. The ageing process is associated with a loss of both oral and total bone mass. It has been shown that a reduction of bone mineralization aggravates pathological periodontal changes, resulting in less support for the teeth. The present study investigates the nutritional influences that may condition the appearance of both pathological process. Insufficient dietary calcium and a reduction in the calcium: phosphorous ratio may favour the appearance of both these conditions by promoting bone reabsorption. Bone loss affects the following in descending order: jaw bones (especially alveolar bone), cranial bones, ribs, vertebrae and long bones. Alveolar bone which has the highest rate of renewal, is affected first and consequently is the most severely affected in the long term. The role of calcium in the etiology of osteoporosis is a controversial issue. Nevertheless, its implication has been proven in numerous investigations. The effect of adequate calcium intake on dental health has formed the basis of several recent studies. These investigations have demonstrated that increased calcium intake improves the suffering of inflammatory processes and tooth mobility in patients suffering from gingivitis with haemorrhaging. Based on the results of studies which link dietary calcium and phosphorous to the risk of osteoporosis and periodontal disease, and bearing in mind that in a large proportion of the Spanish population calcium intake is below that recommended, there is a need for a general improvement of the diet. It may be of special interest to increase the calcium intake of patients suffering periodontal disease. It may also help in the prevention of osteoporosis.

Aging↗
PubMed1990

Changes in periodontal disease indicators in 35-year-old Oslo citizens from 1973 to 1984.

Periodontal disease indicators were evaluated according to the periodontal treatment need system (PTNS) in random samples of 35-year-old citizens of Oslo in 1973 and 1984. The study indicated that although periodontal disease was a common finding in both samples, there was a significant reduction in score C (indicating need for complex periodontal treatment) in 1984 compared to 1973. Whereas 37.9% of the subjects showed inflamed pockets deeper than 5 mm (score C) in 1973, only 22.9% scored C in 1984 (non-Caucasians excluded). This reduction was most pronounced in females. The mean number of C-quadrants in subjects needing complex periodontal treatment was also reduced from 2.0 in 1973 to 1.7 in 1984. Further analyses of the 1984 sample showed that the mean number of C-quadrants was significantly lower in subjects with low OHI-S scores and in regular dental visitors, whereas sex, years at school, toothbrushing frequency, interdental cleaning habits, previous periodontal therapy, self-experienced need for treatment, health attitude or smoking habits, did not seem to influence the prevalence of score C.

Adult↗
PubMed1993

Dental caries experience and periodontal disease in institutionalised male psychiatric patients.

The prevalence of caries and the periodontal disease in 240 adult male psychiatric patients was determined in order to recommend appropriate treatment strategies. Twenty seven per cent of the sample were fully dentate and 12 per cent were caries free. The mean DMFT was 7.92 with the D component reflecting many untreated carious teeth. All age groups require simple restorative care for the treatment of dental caries. None of the subjects were totally free from periodontal disease. Calculus and moderate periodontal pocket formation was the most common manifestation. Seventeen per cent of the sample needed complex periodontal care. Health education aimed at professional and lay staff, the implementation of a suitable plaque removal regimen and the removal of subgingival calculus by auxiliary personnel were seen as important therapeutic measures to enhance the oral health of this population.

Adult↗
PubMedDate not supplied

[The dental component of the integrated program of preventing chronic noninfectious diseases in the Latvian SSR. I. Epidemiologic study of dental caries and periodontal diseases in the whole population of the Latvian SSR].

The frequency and severity of dental caries and periodontal diseases among the population of the Latvian SSR, as well as the risk factors which contribute to the development of these morbid processes were studied. It was found that dental caries are present in 98 per cent of pupils aged 12 years, the CFE index (Caries Filling Extraction Index) representing 6.7. Among adolescent aged 15 years, a healthy periodontium and a good hygienic state of the oral cavity were found only in 2 per cent. Taking into account the high frequency of these diseases, the primary prophylaxis programme of dental caries and periodontopathies was included as a component in the integrated WHO programme of prevention and control of noninfectious chronic diseases in the Latvian SSR.

Age Factors↗
PubMed2001

Infection-mediated early-onset periodontal disease in P/E-selectin-deficient mice.

BACKGROUND: Retrospective and correlation studies suggest that early-onset periodontal disease may be due to a deficiency in phagocyte function, a pathogenic oral biofilm, and/or dysregulated gingival cytokine expression. Increased susceptibility to periodontal disease is therefore thought to result from multiple risk factors. METHODS: We tested this hypothesis prospectively using P/E-selectin adhesion molecule deficient mice that mimic the human syndrome leukocyte adhesion deficiency II. RESULTS: Our studies demonstrate that, in comparison to wild type animals, P/E-/- mice exhibit: spontaneous, early onset alveolar bone loss which is significant by 6 weeks of age; a 10-fold elevation in bacterial colonization of their oral cavities; and elevated gingival tissue levels of the bone resorptive cytokine IL-1alpha. Alveolar bone loss is completely prevented by prophylactic antibiotic therapy. CONCLUSIONS: These experiments provide the first prospective evidence for the multiple risk factor hypothesis of periodontal disease, and validate the first animal model for early onset periodontitis in which both the microbiota and host response can be systematically manipulated. P/E-/- animals should be useful in testing the virulence of putative periodontal pathogens, in determining the role of host resistance factors in periodontitis, in exploring the proposed relationship(s) between infection mediated alveolar bone loss and systemic health disorders, and exploring their genetic relationships.

Alveolar Bone Loss↗
PubMed1990

Epidemiology of periodontal disease.

The epidemiological studies of the 50s and 60s have used visual diagnosis for gathering data to describe prevalence and severity of periodontal diseases within a population. Well-defined index systems were developed and loss of connective tissue attachment from a fixed landmark was established. More recently, the CPITN which had been designed to examine treatment needs in populations was also used erroneously to assess information about prevalence and severity. While data gathered on the basis of the CPITN are rather inconclusive, all the recent epidemiological surveys which used the full spectrum of clinical measurements yielded a rather low proportion of the population of industrialized countries affected by severe periodontal disease. Apparently, quite a large proportion of most populations show signs of gingivitis, but little loss of connective tissue attachment. Only a low percentage is at risk from periodontal disease progression and hence, would need advanced periodontal therapy. While epidemiological surveys used to determine signs and symptoms of inflammation and hence, treatment goals had been defined towards eliminating these symptoms, more recent decision making models for treatment planning have redefined treatment goals: the maintenance of all natural teeth in the dentition in a state of function throughout life. These proposed models are the first attempts to identify subjects at high risk from periodontal disease progression using conventional, but standardized radiography and hereby supplementing clinical data. One of these models is discussed in detail.

Adult↗
PubMed2006

Novel rinse assay for the quantification of oral neutrophils and the monitoring of chronic periodontal disease.

BACKGROUND AND OBJECTIVES: The aim of this study was to develop a single, rapid, noninvasive oral rinse assay to enable the accurate quantification of oral neutrophils. Products released by neutrophils are partly responsible for the destruction observed in periodontitis. Quantification of oral neutrophil levels is important for understanding their role in periodontal diseases. Previous studies have relied on time-consuming serial rinses and cumbersome counting techniques for the collection and quantification of oral neutrophils. MATERIAL AND METHODS: Patients with chronic periodontal disease provided rinse samples before and after phase I periodontal treatment. Cells in the rinse samples were stained with acridine orange, and neutrophil counts were carried out using a fluorescence microscope and a hemocytometer. RESULTS: This assay allowed us to detect a significant difference in pretreatment oral neutrophil counts between periodontal disease and healthy control groups (p < 0.001). Patients who responded favorably to phase I therapy demonstrated a 43% reduction in oral neutrophil counts compared with their pretreatment levels (p = 0.019). Patients who did not respond to phase I periodontal treatment showed no significant difference in oral neutrophil levels (p = 0.39). CONCLUSION: Oral neutrophil levels, as determined by a rapid oral rinse, reflect the severity of periodontal disease and treatment response. A single, rapid, oral rinse assay is an effective means of collecting and quantifying oral neutrophil levels and may serve as an excellent research tool for further study of the role of neutrophils in periodontal diseases.

Acridine Orange↗
PubMed2004

A prospective study to investigate the relationship between periodontal disease and adverse pregnancy outcome.

OBJECTIVE: This study aimed to investigate a relationship between maternal periodontal disease and preterm birth, low birth weight and late miscarriage. DESIGN: Prospective study in a single centre. SETTING: Guy's and St Thomas' Hospital Trust, London, UK between August 1998 and July 2001. SUBJECTS AND METHODS: Pregnant women were recruited on attending an ultrasound scan at approximately 12 weeks of pregnancy. Subjects completed a questionnaire and underwent periodontal examination. MAIN OUTCOME MEASURES: Plaque and bleeding scores, pocket probing depth and loss of attachment. Pregnancy outcome data was collected retrospectively, including gestational age and birth weight at delivery. RESULTS: Data were collected for 3,738 subjects. Regression analysis indicated that there were no significant relationships between the severity of periodontal disease and either preterm birth (PTB) or low birth weight (LBW). In contrast, there did appear to be a correlation between poorer periodontal health and those that experienced a late miscarriage. CONCLUSIONS: There was no association between either preterm birth or low birth weight and periodontal disease in this population. There is evidence of a correlation between markers of poorer periodontal health and late miscarriage.

Abortion, Spontaneous↗
PubMed1991

Epidemiology of periodontal disease.

The year covered in this review was marked with significant reports related to the prevalence and severity of periodontal disease in the United States and throughout the world. A series of well-conducted studies reported in peer-reviewed journals examined risk factors related to the high severity of periodontal disease as measured by progressive attachment loss. An interesting development during the year is the increased attention paid to collaborative international studies that document periodontal disease prevalence and severity in six different countries, thus providing a broader understanding of periodontal disease on a worldwide basis. Importantly, several papers discuss the policy implications of the periodontal literature for educational programs and clinical practice. These papers include major reports on national treatment needs in the United States, the use of statistical models and problems related to statistical analysis of periodontal data, and finally, a call for the use of epidemiologic data in program planning, implementation, and evaluation.

Global Health↗
PubMed1994

Diagnosis, progression, prognostic indication and classification of periodontal disease: a review (Part 1).

This review is divided into a series of three papers. In the first, the prevalence of periodontal disease and the diagnostic problems in screening for high risk groups of patients will be reviewed. The difficulties encountered in differentiating between disease activity and historical evidence of past disease will also be considered along with the wide variation in disease progression rates. Having discussed diagnosis and disease activity markers, an accepted classification of periodontal diseases will be described. In the second paper, those periodontal diseases described as Gingivitis will be discussed. Finally in the third paper, Periodontitis will be reviewed with some emphasis being placed on the involvement of the periodontal tissues in systemic diseases.

Diagnosis, Differential↗
PubMed1996

CPITN and the epidemiology of periodontal disease.

This paper discusses the purposes of collecting epidemiological data on periodontal disease, and concludes that the severe shortcomings of the CPITN makes it unsuited as a tool for assessing the prevalence and severity of periodontal disease.

Dental Research↗
PubMed1983

[Analysis of the oral bacterial flora in subjects with periodontal diseases].

A bacterioscopic study of the bacterial flora of 15 healthy and 15 periodontal disease carriers is presented in relation to the possibly pathogenetic role of oral bacterial flora in the development of human periodontal disease. Study samples taken from sulcus and gingival pockets were examined by darkfield microscopy. Results show that bacterial flora from periodontal disease subjects differs from that in healthy subjects in that spirochetes are present and the incidence of straight and motile rods is higher than of coccoid cells.

Adult↗
PubMed1997

The effect of chronic periodontal disease on human jaw muscles: a pilot study using computed tomography.

Patients with chronic periodontal disease sometimes complain of difficulty in masticating hard foods. Computed tomography (CT) was used to investigate the cross-sectional area (CSA) and density of the masseter and medial pterygoid muscles in a pilot study of 12 healthy female subjects aged 30-39 years. Six subjects (the 'diseased' group) had suffered from chronic periodontal disease and had, on average, 40% bone loss. Their disease had been treated by scaling and root planning and had remained clinically stable for at least 6 months before their inclusion in the study. The six age-matched 'control' subjects had no history of periodontal disease. All bone-loss measurements were evaluated as a percentage of root length. At defined scan planes, sections of both muscles were readily identified. Results from the 'diseased' group as compared with the 'control' group revealed that in the former the CSA of masseter and medial pterygoid was reduced significantly by 25% and 10%, respectively. There were no significant differences in the X-ray density of both muscles between the two groups, which indicated a similar fibro-fatty content. These findings indicate a reduction in the masticatory force that may be utilized by patients with reduced periodontal support and may help explain their masticatory difficulties.

Adult↗
PubMed1999

Smoking and crevicular fluid levels of IL-6 and TNF-alpha in periodontal disease.

Smoking is a well-documented risk factor for periodontal disease, although the mechanisms of its negative influence are not well understood. In the present study, the influence of smoking on the gingival crevicular fluid (GCF) content of the pro-inflammatory cytokines IL-6 and TNF-alpha was investigated in patients with moderate to severe forms of the disease. The study base consisted of 108 patients including 45 current smokers, 28 former smokers and 35 non-smokers. The median GCF sample levels of IL-6 and TNF-alpha were 5.0 pg/ml and 61.0 pg/ml, respectively, for current smokers, 13.0 pg/ml and 51.0 pg/ml, respectively, for former smokers, and 10.0 pg/ml and 12.0 pg/ml, respectively, for non-smokers. The differences between smoking groups with regard to IL-6 were not significant suggesting that the IL-6 content was not influenced by smoking. In contrast, the TNF-alpha content was significantly increased in current smokers as compared to non-smokers confirming our previous observations. The present results in patients with moderate to severe periodontal disease may indicate different mediator functions of IL-6 and TNF-alpha in response to smoking.

Adult↗
PubMed2006

Periodontal disease and coronary heart disease.

BACKGROUND: Several epidemiological studies have demonstrated an association between periodontal disease and coronary heart disease (CHD). The association could be a result of confounding by mutual risk factors. The present study was undertaken in a Danish population to reveal the significance of common risk factors. METHODS: The investigation was conducted as a case-control study comprising 250 individuals: 110 individuals with verified CHD from a Department of Cardiovascular Medicine and 140 control individuals without CHD from the Copenhagen City Heart Study. Information on diabetic status, smoking habits, alcohol consumption, physical activity, school attendance, household income, body weight and height, triglyceride, and serum cholesterol was obtained. Full-mouth probing depth (PD), clinical attachment loss (CAL), bleeding on probing (BOP), and alveolar bone level (ABL) on radiographs were registered. ABL was stratified into ABL1=ABL 2 to 4 mm. Multiple logistic regression models with stepwise backward elimination were used allowing variables with P<0.15 to enter the multivariate analysis. RESULTS: The CHD group had a significantly lower outcome with respect to PD, BOP, CAL, and ABL. For participants<60 years old, only risk factors such as smoking and diabetic status entered the multivariate analysis. For the ABL3 group, there was a significant association with CHD for participants<60 years old, the odds ratio being 6.6 (1.69 to 25.6). For participants>or=60 years old, there was no association. CONCLUSIONS: The present study showed a positive association between periodontal disease and CHD in agreement with several other studies. The association was highly age dependent and could only be attributed to diabetes and smoking to some extent.

Age Factors↗