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PubMed1988

Surgical versus non-surgical treatment and recurrent periodontal disease in beagle dogs.

The present study was designed to compare clinical, microbiologic and histometric parameters of recurrent periodontal disease in areas which had been treated either surgically (SU) or nonsurgically (NS). Periodontal disease was induced for 6 months in 3 quadrants in each of 6 beagle dogs. 2 of the 3 diseased quadrants were treated by definitive surgical or nonsurgical therapy followed by plaque control for 4 months. 2 dogs were then sacrificed to provide histometric data. Periodontal disease was reinduced in the remaining 4 dogs by allowing plaque accumulation for 6 months after which the dogs were sacrificed for histometric analysis. Clinical parameters were recorded and darkfield microscopic analysis of subgingival plaque samples was performed at regular intervals. Following 6 months of plaque accumulation during disease reinduction, there were significant changes (p less than 0.05) in the pocket depths, bleeding scores and attachment levels in both the SU and NS areas. These changes were accompanied by significant increases (p less than 0.05) in the proportions of spirochetes and motile rods and decreases in the proportions of coccoid cells in both the SU and NS areas. There were, however, no significant differences between the SU and NS areas when clinical and microbiologic parameters were compared. At the end of disease reinduction phase, the length of inflammatory cell infiltrate and % inflamed connective tissue had increased significantly in both the SU and NS areas.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1983

Periodontal disease in juvenile and adult diabetic patients: a review of the literature.

Epidemiologic studies have suggested that the severity of periodontitis is greater in juvenile and adult onset diabetes. In juvenile diabetic patients, the periodontal disease seems to be initiated around puberty and progresses by age. Reviewing the medical literature indicates a similar age of onset for known systemic complications resulting from diabetes. Angiopathy, abnormal collagen metabolism, abnormal PMN function, and altered sulcular microbial flora have been found to be closely associated with the severity of periodontitis in diabetic patients. The association between abnormal neutrophil function and severity of periodontal disease in diabetic patients provides an opportunity for examining the role of neutrophil in periodontal disease. Future investigation in the function of sulcular PMN may shed light on the complex mechanism of periodontal disease.

Adolescent↗
PubMed2006

A645G (Lys216Glu) polymorphism of the bactericidal/permeability-increasing protein gene in periodontal disease.

Bactericidal/permeability-increasing protein (BPI) is a member of the pattern recognition receptors of the innate immune system and recognizes lipopolysaccharides (LPS), a bacterial component belonging to the pathogen-associated molecular patterns (PAMPs). BPI mediates the neutralization of LPS and increases the phagocytosis and cytotoxicity against bacteria. Recently, the functionally effective polymorphism A645G resulting in the amino acid alteration Lys216Glu has been described. The aim of the study was to investigate the association of the A645G polymorphism with chronic periodontal disease. The study population comprised 123 patients with periodontal disease (36 with mild, 52 with moderate and 35 with severe periodontitis) and 122 healthy, unrelated control individuals. Genotyping of the BPI gene polymorphism A645G (Lys216Glu) was performed by polymerase chain reaction and restriction fragment length polymorphism analysis. Statistical analysis was carried out employing the chi(2) test with Yates correction. Genotype and allele frequencies of the polymorphism tested herein showed no significant differences between periodontal disease as compared to the control group. The frequencies of the G allele were 52.4% in patients with periodontal disease and 49.2% in the control individuals (P = 0.528). Moreover, no significant associations could be detected after stratification for disease severity and according to gender. The present study does not give evidence for the contribution of the BPI gene to the genetic background of chronic periodontal disease.

Adult↗
PubMed1994

Development of a risk profile for periodontal disease: microbial and host response factors.

Advances in our understanding of the relationship between the microbial challenge and the host response in periodontal disease have led to the search for pathogenesis-based risk indicators or risk factors for disease progression. This evaluation is based on analysis of non-invasive or minimally invasive samples that allow measurement of the subgingival plaque microflora or the host response in gingival crevicular fluid (GCF), serum, or saliva. Studies conducted by us have indicated that in GCF, persistently elevated levels of beta-glucuronidase (beta G, a marker for primary granule release from polymorphonuclear leukocytes) are associated with clinical attachment loss in patients with periodontitis. This finding has been confirmed in a multicenter trial. We have also observed that a statistically significant positive correlation exists between beta G in GCF and measures of the subgingival microbial challenge, but the correlation was less than 0.5, suggesting variations in the host response to the challenge. Furthermore, beta G levels in GCF were inversely correlated with the IgG serum antibody titer to a panel of periodontal pathogens, suggesting the essentially protective function of the systemic humoral response in periodontal disease. Data in the literature support this concept. In addition, recent studies of the relationship of antibody isotypes in GCF to progression of clinical attachment loss have suggested that IgA in GCF has a protective function. This may relate to the lack of complement activation by IgA. Alternately, the development of IgA antigen-specific responses are T-cell dependent, and reductions in local levels of IgA may indicate a decrease in T-helper cell function. These data have allowed development of strategies for identifying individual risk profiles for patients with periodontal disease based on the host response to the microbial challenge. With identification of these risk indicators/risk factors for active periodontal disease, the next challenge is to provide clinicians with access to the tests and analyses that are required for this approach to periodontal diagnosis. Improved patient management should result from the incorporation of these tests into clinical practice.

Bacterial Physiological Phenomena↗
PubMed1994

Neutrophil defects as risk factors for periodontal diseases.

There are several hypotheses proposed for the etiologic mechanisms causing periodontal diseases. These include a paradigm in which all individuals are equally susceptible to one or several pathogenic bacteria; a second paradigm that holds that all bacteria are equally virulent and that host susceptibility determines onset of disease; or a combination of the above. In this review, we analyze the role of neutrophil dysfunction as a risk factor for the onset of periodontitis. Both intrinsic or genetically inherited abnormalities of neutrophils and acquired neutrophil abnormalities are considered. While a large body of data implicates neutrophil dysfunction, either intrinsic or acquired (bacterially or extrinsically induced), as a significant risk factor for the periodontal diseases, clear, prospective, longitudinal epidemiologic studies to evaluate this association remain to be performed.

Bacterial Physiological Phenomena↗
PubMed2003

Decrease in the total antioxidant activity of saliva in patients with periodontal diseases.

This study examined the role of free radical-induced tissue damage and the antioxidant defense mechanism of saliva in periodontal disease. Antioxidant activity of saliva was compared in 20 healthy individuals and 17 patients with periodontal diseases. We measured the scavenging capacity of saliva against free radicals generated in vitro by electrolysis, xanthine-xanthine oxidase, or stimulated polymorphonuclear leukocytes. Total protein content and total antioxidant activity of saliva were also determined. The results indicate that stimulated saliva of healthy individuals is significantly more effective (40-50%) than that of patients with periodontal diseases in scavenging a wide variety of free radicals generated in vitro. Under these conditions it appears that the total antioxidant activity of saliva is significantly decreased in these patients despite the fact that the levels of the three main antioxidants (uric acid, ascorbic acid, and albumin) are not significantly affected. We conclude that periodontal diseases are associated with an imbalance between oxidants and antioxidants in favor of the former due to both an increase in free radical production and a defect in the total antioxidant activity of saliva.

Adult↗
PubMed2006

Salivary histamine level as a predictor of periodontal disease in type 2 diabetic and non-diabetic subjects.

BACKGROUND: Some previous investigations underscored the role of histamine in periodontal disease, especially in diabetic patients, but the behavior of this inflammatory mediator in the early phases of periodontal involvement remains unclear. The aim of the present study was to correlate the presence of histamine in saliva with clinical parameters in healthy, periodontitis-affected, and diabetic subjects to ascertain whether this amine may serve as a predictive index of periodontal risk. METHODS: For this purpose, subjects were selected as follows: 1) with newly diagnosed type 2 diabetes mellitus; 2) with neither diabetes nor periodontitis; 3) with no diabetes but with chronic, untreated periodontal disease. Histamine salivary levels were measured at the initial time (T0) and after 6, 12, and 24 months using high-performance liquid chromatography. The main periodontal indexes were recorded at the same time intervals. RESULTS: At T0, a very typical shape of the histamine chromatogram was found for all patients of the three groups; at this time, the salivary histamine levels of diabetic patients were increased and comparable to those of healthy patients with periodontal disease, whereas healthy subjects with no periodontitis showed reduced histamine levels. Further controls at 6, 12, and 24 months showed a statistically significant correlation between the increase of salivary histamine and the worsening of the periodontal indexes in diabetic and non-diabetic subjects. CONCLUSION: These results suggest that salivary histamine may serve as a predictive index in the prevention of periodontal disease.

Aged↗
PubMed1979

The immunopathogenesis of progressive chronic inflammatory periodontal disease.

Natural, humoral and cellular immune mechanisms have all been implicated in the pathogenesis of chronic inflammatory periodontal disease. However, confusion still exists as to the role played by each of these immunological mechanisms. Recently, characterization of the cell types within the progressive lesion has been established, in which four recognizable zones were described. Immediately subjacent to the epithelium lining the periodontal pocket both polymorphonuclear leukocytes (PMN's) and macrophages were seen, while cells deeper in the tissues had the morphological appearance of lymphocytes. The majority of these lymphocytes had a B-cell phenotype although a few T-cells and macrophages were found. On the advancing front of the lesion the cells had the morphological appearance of plasma cells, the majority of which contained IgG. Other cells found in this region had the morphology of plasma cells yet contained no cytoplasmic immunoglobulin, but they did contain substantial amounts of lysosomal enzymes. Similar cells have previously been described in periodontal disease; their frequent association with fibroblasts may suggest that they are important in the pathogenesis. Deposits of IgG and fibrin were found in the fibrous tissue band surrounding the lesion. These results are reviewed and, although the zones described were not anatomically distinct, by describing the lesion in this way it was possible to establish a convenient model to explain the immunopathogenesis of progressive chronic inflammatory periodontal disease. In this respect, progressive chronic inflammatory periodontal disease in man should be considered as a B-cell lesion.

Animals↗
PubMed2002

Association between bone loss in periodontal disease and polymorphism of N-acetyltransferase (NAT2).

BACKGROUND: The individual susceptibility to periodontal disease is probably the result of an interaction of multiple genetic and environmental influences. Polymorphism of the N-acetyltransferase (NAT 2) modifies the individual susceptibility to toxicity from certain therapeutic drugs or heterocyclic amines including substances from cigarette smoke. Subjects are to be classified as 'slow' or 'rapid' acetylators according to how fast their bodies metabolise such xenobiotics. Differences in their ability to detoxify these substances may contribute to an increased risk for periodontitis in subjects exposed to cigarette smoke or other xenobiotics. OBJECTIVE: The purpose of this study was to assess whether the NAT2 genotype is a risk factor for periodontal disease in Caucasian patients suffering from adult periodontitis. MATERIAL AND METHODS: 154 Caucasian subjects were assigned to one of the 3 groups: no, moderate, and severe periodontal disease based on bone and attachment loss. In all subjects, genotyping for mutations on the N-acetyltransferase (NAT2) gene was performed by means of PCR and RFLP analysis. RESULTS: Comparison of frequency distribution of NAT2 acetylation types between the most diseased group and not or moderately affected subjects showed a tendency to over-representation of slow acetylators with severe disease. When using bone loss as measure of periodontitis, this over-representation shows a significant association with the disease (odds ratio=2.13, p=0.025). In the logistic regression analysis, adjusted for age and smoking, NAT2 slow phenotype was significantly associated with the severity of bone loss, the odds ratio being 2.09 (95% C.I. 1.02-4.26, p=0.043). In a case-control analysis (controlled for smoking, gender and age) mean bone loss showed a significant difference between the 2 NAT2-type groups (Mann-Whitney test p=0.041). CONCLUSION: The data suggest that the slow acetylator phenotype may be associated with a higher risk of periodontitis, especially in smokers. Possible explanations regarding the mechanism are discussed; however, such attempts are highly speculative at this time.

Adult↗
PubMedDate not supplied

Dental caries and periodontal disease (prevention and control methods).

There is a compelling need to apply preventive programs in both private and community practice of dentistry. This is to maintain improvements in oral health in developed and industrialized countries, and to stem increases in oral diseases in underserved and developing ones. At the outset, the terms prevention and control must be understood. The former is considered to mean a procedure or course of action that prevents the onset of disease, whereas the latter, implies reversing or stabilizing disease conditions. To be more precise, prevention will refer to the pre-pathologic or pre-clinical stage encompassing the promotive and specific protection levels--primary prevention stage. On the other hand, control will encompass early diagnosis and prompt treatment, disability limitation and rehabilitation levels-termed also collectively, as pathologic, clinical and final stages, or secondary and tertiary prevention. Community-based programs are usually structured to compliment therapeutic interventions of oral diseases, as well as prevention. In this era, and towards the next millennium, preventive and control programs are given high priorities in order to minimize the need for curative, restorative and therapeutic management of oral diseases. This review of the literature will give emphasis on established methods and programs for the prevention and control of the two most common oral diseases, dental caries and periodontal disease. The problems, background, and oral health objectives for the year 2000 as proposed by the World Health Organization (WHO) and the Federation Dentaire Internationale (FDI), as well as the recent advances in oral health relative to these diseases will be discussed. Finally, to better improve the efficacy of existing prevention and control methods, research needs and areas of concern relative to these diseases will be given consideration.

Adolescent↗
PubMedDate not supplied

[Use of intracoronal splints in therapy of periodontal disease].

The study concerns the evaluation of the efficacy of intracoronal composite splints (ICS) in the therapy of periodontal disease in its full clinical state. Maxillar and mandibular front teeth were splinted over the period of 12 weeks as a part of a complex therapy procedure of developed periodontal disease. The results of the therapy were evaluated using periodontal indexes, parameters for oral hygiene and other relevant clinical parameters. Values were processed with Student's t-test. With the use of ICS very good results in the therapy of periodontal disease in a short period of time were obtained. Parameter values decreased, especially the index of tooth mobility: before therapy by 2.84 and after therapy to 1.12. Intracoronal composite splints, in comparison with other type of splinting, satisfy both functional and aesthetic aspects.

Composite Resins↗
PubMed1996

Periodontal diseases in children and adolescents: classification, aetiology and management.

The human periodontal diseases are a complex group of disorders that span the entire length of the human life cycle. They are infective in nature, but are mediated by host parasite interactions that are influenced not only by the nature of the pathogens present but also by a variety of underlying immunological and connective tissue anomalies. Thus, on occasion they may reflect systemic disorders that have previously been undiagnosed. As such abnormalities frequently present in childhood or adolescence, knowledge of the potential implications of this broad group of diseases is important. This paper reviews the current classification of childhood periodontal disease and outlines the clinical presentation and management of the more common disorders.

Acute Disease↗
PubMed2005

Radiographic evaluation of destructive periodontal disease in blue mink in relation to age and blood morphology.

In this study, blood samples and jaws were collected from 2 genotypes of blue mink (n = 289) in order to examine phenotypic expression of specific characteristics of Chediak-Higashi Syndrome (C-HS). Blood samples were subjected to differential counts to assess the proportion of abnormal polymorphonuclear leukocytes characteristic for CH-S (C-HS-leukocytes). Abnormal leukocytes with characteristic signs of C-HS were found in blood smears from all mink included in this study. Four teeth in one half of the mandible (P3, P4, M1, M2) were subjected to quantitative radiographic evaluation of alveolar bone loss and tooth loss. There was a high prevalence of destructive periodontal disease among blue mink included in this study. Mild to moderate periodontal disease (defined by less than 50% alveolar bone loss related to 1 or more teeth) affected 73.7% of young mink (age = 7 mo) and 67.9% of older animals (age > or = 19 mo). Severe periodontal disease (defined by more than 50% bone loss related to one or more teeth) was not detected in mink aged 7 mo, but affected 15.3% of mink aged 19 mo and 39.6% of mink aged 31 mo. The positive relationship between age and periodontal disease was statistically significant (P < 0.01). The prevalence of tooth loss was found to be high among blue mink aged > 19 mo (21.6%) and was also significantly related to age (P < 0.01). A significant positive interaction between alveolar bone loss and tooth loss (P < 0.01), implies that the highly prevalent tooth loss in the mink was related to and possibly caused by destructive periodontal disease. There was no significant difference in the prevalence of periodontal disease between the 2 genotypes and age was found to be the only statistical predictor of poor production results (P < 0.01) in blue mink.

Age Factors↗
PubMed1983

Periodontal disease and oral hygiene among new immigrants to Israel from three regions of origin.

The purpose of the present investigation was to gather information on the prevalence of periodontal disease and oral cleanliness status of new immigrants to Israel. A comparison was made between the different regions of origin. New immigrants, residents of four absorption centers in Israel, who arrived in Israel no more than three months prior to the date of their examination, were included in the study. Altogether, 1031 immigrants (417 Eastern Europeans, 338 Western Europeans/North Americans and 276 South Americans) were examined. During the examination periodontal status and oral hygiene were checked. Periodontal status was recorded according to Russell's Periodontal Index (PI). The oral cleanliness was assessed according to Greene and Vermillion's Simplified Oral Hygiene Index (OHI-S). A markedly lower prevalence of periodontal diseases and a significantly better oral cleanliness were demonstrated by the West European/North American group as compared to the other two groups. The South American group, as intermediate group, exhibited significantly lower mean PI and OHI-S scores as compared to the East Europeans. Generally, the same distribution of prevalence of periodontal diseases between the three groups were found by the respective age groups. The results demonstrated a significant increase in prevalence of periodontal diseases, by age. Oral cleanliness showed a trend to deteriorate by age, but not significantly so. A sex difference was apparent in the prevalence of periodontal diseases and in oral hygiene. Low OHI-S scores (indicating improved oral hygiene) were associated with the low PI scores (indicating better periodontal status) in the whole study population and within the different regions of origin.

Adult↗
PubMed1982

Relationship between the percentage of subgingival spirochetes and the severity of periodontal disease.

The purpose of this study was to determine the correlations between various clinical assessments of inflammatory periodontal disease and the percentage of motile bacteria in the subgingival flora of sites representing widely varying states of periodontal disease. Darkfield microscopy was used to determine the percentage of spirochetes and other motile bacteria at two sites from each of 60 volunteers. For each site the following clinical assessments were recorded: Plaque Index (PII), gingival exudate (GE), Gingival Index (GI), bleeding tendency (BT), pocket depth (PD), connective tissue attachment loss (AL) and Periodontal Disease Index (PDI). Statistically significant (P less than 0.001) positive correlations (r) were found between the percentage of subgingival spirochetes and PII (r=0.54), GE (r=0.61), GI (r=0.57), BT (r=0.59), PD (r=0.56), AL (r=0.56) and PDI (r=0.61). Clinically healthy sites harbored much lower percentages of motile bacteria than did clinically disease sites. Most of the observed variation in the percentage of motile bacteria could be accounted for by variations in the percentage of spirochetes. The most significant increases in the relative percentages of subgingival spirochetes occurred when bleeding upon probing was observed as a sign of inflammation and/or when pocket depth and attachment loss exceeded 3 mm.

Adult↗
PubMed1988

Bacteriology of periodontal disease in the cat.

Subgingival plaque samples were obtained from 32 cats showing different stages of periodontal disease. Correlations were sought between gingival index scores and the prevalence of various microbial groups, and between microbial populations found in sites designated as most-affected and least-affected within individual cats. The tendency with higher gingival index scores, and with the most-affected sites, was toward a microbial population composed to a greater extent of anaerobic Gram-negative rods. The most common organism was an anaerobic Gram-negative rod in the black-pigmented Bacteroides group that was biochemically similar to B. gingivalis but had catalase activity. The black-pigmented Bacteroides group and Peptostreptococcus anaerobius were found in increasing numbers with increasingly severe periodontal disease. Pasteurella multocida was isolated from most samples and appeared to decrease in numbers with increasing periodontal disease.

Animals↗
PubMed2006

Treatment of periodontal disease and the risk of preterm birth.

BACKGROUND: Maternal periodontal disease has been associated with an increased risk of preterm birth and low birth weight. We studied the effect of nonsurgical periodontal treatment on preterm birth. METHODS: We randomly assigned women between 13 and 17 weeks of gestation to undergo scaling and root planing either before 21 weeks (413 patients in the treatment group) or after delivery (410 patients in the control group). Patients in the treatment group also underwent monthly tooth polishing and received instruction in oral hygiene. The gestational age at the end of pregnancy was the prespecified primary outcome. Secondary outcomes were birth weight and the proportion of infants who were small for gestational age. RESULTS: In the follow-up analysis, preterm birth (before 37 weeks of gestation) occurred in 49 of 407 women (12.0%) in the treatment group (resulting in 44 live births) and in 52 of 405 women (12.8%) in the control group (resulting in 38 live births). Although periodontal treatment improved periodontitis measures (P<0.001), it did not significantly alter the risk of preterm delivery (P=0.70; hazard ratio for treatment group vs. control group, 0.93; 95% confidence interval [CI], 0.63 to 1.37). There were no significant differences between the treatment and control groups in birth weight (3239 g vs. 3258 g, P=0.64) or in the rate of delivery of infants that were small for gestational age (12.7% vs. 12.3%; odds ratio, 1.04; 95% CI, 0.68 to 1.58). There were 5 spontaneous abortions or stillbirths in the treatment group, as compared with 14 in the control group (P=0.08). CONCLUSIONS: Treatment of periodontitis in pregnant women improves periodontal disease and is safe but does not significantly alter rates of preterm birth, low birth weight, or fetal growth restriction. (ClinicalTrials.gov number, NCT00066131 [ClinicalTrials.gov].).

Adult↗
PubMed2005

Commentary: clinical implications of periodontal disease assessments using probing depth and bleeding on probing to measure the status of the periodontal-biofilm interface.

Periodontal disease has traditionally been classified based upon history and clinical presentation, but considerable heterogeneity persists within each diagnostic category. Clinical signs have relatively weak sensitivity and specificity for predicting disease outcomes in treated and untreated individuals, suggesting the need for improved periodontal classifications, prognosis, and treatment strategies. Data from an epidemiologic study that included full-mouth clinical periodontal measurements from more than 6700 community-dwelling subjects were analyzed to identify heterogeneity in disease presentation. These analyses were used to create periodontal disease classifications based upon probing depths (PD) and bleeding on probing (BOP) scores. Two distinct disease classifications emerged: i.e. moderate periodontitis (MP) and severe periodontitis (SP). MP was defined as 1 or more sites with a PD of 4 mm or greater and BOP extent scores less than 50%, and SP was defined as 1 or more sites with a PD of 4 mm or greater and BOP extent scores of 50% or higher. These definitions were used to retrospectively analyze data from a pilot study designed to determine the clinical effects of scaling and root planing (SRP) treatment. Examiners evaluated 58 subjects for potential differences in treatment response comparing MP with SP subjects at baseline and 6 weeks after SRP treatment. Plaque scores were associated with greater extent of pocketing (extent PD > or =4 mm) in the MP group, but not in the SP group. Significant clinical improvement in PD and BOP was detected at 6 weeks in the SP group but not in the MP group when using the presented classification to retrospectively compare patient response to SRP treatment using a separate clinical data set. Periodontal disease is a heterogeneous condition, and classifications based upon BOP and PD may be useful considerations in predicting patient clinical response to therapy.

Biofilms↗