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PubMed2004

Diabetes mellitus--a modifier of periodontal disease expression.

The understanding of causes and progression of periodontal disease has increased considerably in recent years making it all the more important to gain knowledge about diabetes and its interrelationship with periodontal disease so as to be able to assess their impact on one another more accurately. Strong evidence exists to support the fact that diabetic patients are at an increased risk for periodontitis. A number of underlying factors are known to contribute to enhanced periodontal destruction in diabetics. There has been intensive research to characterise the mechanisms responsible for the pathogenesis of both microvascular and macrovascular complications. It is also known that there is variability in the rate of development and severity of these complications with some diabetics experiencing none of them. Many of the host response traits that confer susceptibility to periodontitis in otherwise healthy individuals are exaggerated in diabetics. These diabetes associated susceptibility traits include neutrophil dysfunction, abnormal cross-linking and glycosylation of collagen, defective secretion of growth factors and subsequent impaired healing. However it is uncertain which of the hypothesised mechanisms or combinations of mechanisms is directly responsible for the pathogenesis of the complications or whether different mechanisms are operative in different tissues.

Collagen↗
PubMed2004

Effect of alendronate on periodontal disease in postmenopausal women: a randomized placebo-controlled trial.

BACKGROUND: We investigated the effect of oral alendronate (ALN) treatment on radiological and clinical measurements of periodontal disease in postmenopausal women without hormone replacement therapy. METHODS: We evaluated the effect of 6 months of ALN treatment in 40 postmenopausal women, 55 to 65 years old with established periodontal disease, in a controlled, double-masked, prospective study. Volunteers were paired by age and randomized to receive ALN (10 mg/day) or placebo for the study period. Periodontal mechanical treatment was carried out in both groups. At baseline and after treatment, clinical evaluation, hormone blood levels, distance from the crestal alveolar bone (CAB) to the cemento-enamel junction (CEJ), calcaneus bone mineral density (BMD), hormone levels, serum N-telopeptide (NTx), and bone-specific alkaline phosphatase (BSAP) were assessed. RESULTS: Periodontal disease conditions improved in both groups, but greater improvement in probing depth (-0.8 +/- 0.3 mm versus -0.4 +/- 0.4 mm, P = 0.02) and gingival bleeding (-0.3% +/- 0.13% versus -0.2% +/- 0.06%, P = 0.006) was found in the ALN treated group. Calcaneus BMD increased in the ALN treated group (68 +/- 47 mm3 versus -26 +/- 81 mm3, P = 0.0006). CAB-CEJ distance diminished in the ALN group (-0.4 +/- 0.40 mm versus 0.60 +/- 0.53 mm, P = 0.00008). Marginal reduction in both NTx and BSAP levels was found in the ALN group (-9.4 +/- 6.6 nmol versus -4.3 +/- 4.7 nmol bone collagen equivalents, P = 0.08, and -7.7 +/- 8.4 versus -1.5 +/- 5.0 U/l, P = 0.1, respectively). Hormone levels were unchanged after treatment. Similar improvement of calcaneus BMD and CAB-CEJ distance with ALN treatment was found in obese and non-obese women. CONCLUSION: ALN treatment improved periodontal disease and bone turnover in postmenopausal women.

Administration, Oral↗
PubMed1990

Rationale for the use of antimicrobial agents in periodontal disease.

The traditional approach to treating dental decay and periodontal disease has often focused on caries, neglecting periodontal infection. The past 15 years have seen significant advances in the treatment of periodontal disease with antimicrobial therapy, both with and without more traditional debridement or surgery. This article presents an overview of the use of antimicrobials, including an examination of treatment philosophies and the diagnosis of periodontal infection.

Adult↗
PubMed2000

Prevalence and determinants of periodontal disease in Portuguese adults: results from a multifactorial approach.

The purpose of the present investigation was to study prevalence of periodontal disease among 30 to 39-years-old from Oporto in the north of Portugal. In addition, an attempt was made to elucidate possible periodontal disease determinants in this population. A random sample consisting of a total of 322 individuals was drawn based on electoral lists. The attendance rate was 61%. The CPITN index was used and the results indicate a high prevalence of periodontal disease and a substantial need for periodontal treatment in this population, with 41% of the individuals investigated having one or more sites with a CPITN score 4 (pockets deeper than 5.5 mm). Dental visiting habits, gender (lower CPITN scores for females) and oral hygiene were the determinants most significantly associated with variation in CPITN scores.

Adult↗
PubMed1998

Awareness of periodontal diseases: the professional and the civil servant.

Newly qualified dentists and dental hygienists should have a good level of awareness of periodontal diseases. However, for a variety of reasons this knowledge may not be regularly updated or applied in practice. This paper considers how professional awareness can be influenced by such factors as: maintaining an up to date understanding of the nature of periodontal diseases, the routine use of appropriate screening and examination techniques, factors influencing assessment of treatment need, patient records, continuing professional education and an understanding of patient expectations. It goes on to describe how civil servants may help to stimulate improvements in awareness levels to periodontal diseases by promoting continuing education, epidemiological research and national oral health strategies as well as through legislation and regulation. The paper concludes that although a range of organisations can promote improvements in professional awareness, unless simultaneous efforts are made to improve the awareness of the general public to periodontal diseases, it is difficult to see how there can be an improvement in the periodontal health of the population.

Adolescent↗
PubMed2004

Bacterial and viral DNA in periodontal disease: a study using multiplex PCR.

Recent studies have suggested an association between periodontal disease and the presence of Herpesviruses, in particular: Epstein-Barr virus (EBV) and Human Cytomegalovirus (CMV) (Contreras et al., 1999--Contreras et al., 2000--Slots et al., 2000--Ting et al., 2000). In the work reported in this paper, we use a multiplex Polymerase Chain Reaction (PCR) to compare the presence of Herpesviruses and putative bacterial pathogens in patients with periodontal disease and in healthy individuals. Direct detection of microorganisms with PCR is shown to offer significant advantages in terms of time, effort and cost. The study detected no statistically significant differences between the prevalence of EBV and CMV in patients and controls. The failure to replicate previous findings may be due to differences in the age composition and the geographical and social origins of the study groups. The study detected a significant excess of HSV-1 in periodontal patients. This suggests that the role of Herpesviruses in the pathogenesis of periodontal disease deserves further investigation. The bacterial assay confirmed the results of previous studies showing a strong association between periodontitis and the presence of A. actinomycetemcomitans, P. gingivalis and P. intermedia.

Actinobacillus Infections↗
PubMed1991

Prevalence and natural history of periodontal disease in Scotland--the medieval period (900-1600 A.D.).

The periodontal status of a Scottish medieval population was studied. No individual over the age of 11 years had an entirely healthy periodontium. While gingivitis was widespread in the younger age groups, it was essentially a "contained" gingivitis which appeared to progress towards a periodontitis at a fairly constant but slow rate. The pattern of prevalence and distribution of gingivitis and periodontitis was similar to many modern epidemiological studies on natural dentitions but did not support the view that the prevalence of periodontitis in historic material was high. A small proportion of individuals appeared to be either susceptible or resistant to periodontal disease. It was concluded that the study of historic material provides valuable information with regard to the natural history of human periodontal disease.

Age Factors↗
PubMed1988

Is it time to reassess the public health implications of periodontal diseases? A review of current concepts.

In 1981 the American Association of Public Health Dentists' Subcommittee on Preventive Periodontics called for a national initiative toward controlling periodontal disease, including the development of national policy statements from national dental organizations and the development of education programs for the public and the profession. Since the 1981 report, the findings of a diverse group of studies raises a variety of questions about the prevalence of periodontal diseases, the etiology and progression of the diseases, and the feasibility and practicality of controlling them. An examination of this new information leads to the conclusion that it is time to reassess the public health implications of periodontal diseases.

Health Policy↗
PubMed1995

Pharmacological control of periodontal disease. II. Antimicrobial agents.

Antimicrobial agents are of value in the management of certain types of periodontal disease, notably early onset, juvenile and refractory periodontitis. The diagnosis of these conditions is often made on clinical grounds but microbial sampling of the pocket flora is of value in determining the type of antimicrobial therapy. Routine systemic use of these drugs in the management of chronic adult periodontitis is contraindicated, and is no substitute for root surface debridement and thorough supragingival plaque control. Tetracyclines and metronidazole are the agents most frequently used in the management of periodontal disease. Both drugs can be given systemically or applied topically into the periodontal pocket. The latter route is preferred since the dose is reduced considerably, but the local tissue concentration is increased. The efficacy of local drug delivery is dependent upon the release kinetics of the drug from the delivery vehicle. Although local application can be time consuming, it reduces the risk of adverse reactions and drug interactions. The tetracyclines have the additional advantage of inhibiting collagenases. This property may facilitate repair and new attachment formation. Systemic metronidazole appears to be useful as an adjunct to conventional periodontal therapy. The combination of metronidazole 250 mg and amoxycillin 375 mg has been shown to be effective in the treatment of refractory periodontitis, including cases which are resistant to tetracycline. Clindamycin has also been used in the management of refractory periodontitis, but the unwanted effects of this drug must limit its systemic use for this purpose.

Adult↗
PubMed2003

A histomorphometric study of osteocytic lacunae in interradicular bone with periodontal disease.

Previous studies report on the differences in volume of osteocytic lacunae that are associated to different local and systemic bone pathologies. Alterations have also been reported in rats with periodontal disease. The aim of the present study was to assess the histomorphometric pattern of osteocytic lacunae of the interradicular septum in human molars with periodontal disease (PD). We took samples of the interradicular septum of 31 molars with indication of extraction of male and female patients, 18-55 years old, who attend the Department of Surgery II of the Faculty of Dentistry, National University of Cordoba and private centers. Clinical records were prepared for each patient. The corresponding radiographs were taken for all the patients. We studied 11 samples of molars with slight PD and 12 control molars free from PD. Ten samples of healthy bone corticals of vestibular or lingual tables obtained from histopathology archives were also assessed. Following extraction with atraumatic pincers, the interradicular septum was removed. The samples were fixed in buffered formaline, decalcified in EDTA and embedded in paraffin. Ten micrometer sections were stained with H&E and Masson's trichromic technique. The sections were analyzed by light microscopy. A minimum of 50 lacunae were selected at random in each sample for histomorphometric evaluation. Semi-automatic evaluation of the area and diameters of the lacunae was performed employing an image analyzer and the PRO IMAGE PLUS software. The data showed that the volume of osteocytic lacunae of interradicular bone is larger than that of the cortical bone of the vestibular or lingual tables. The latter are more ribbon-shaped and their minor diameter is smaller. No differences were found between the osteocytic lacunae of the interradicular bone of healthy molars and that of molars with slight periodontal disease. Given that the experimental data evidenced volume changes in osteocytic lacunae of severe, inflammatory periodontal lesions, it would be interesting to examine the volume changes in osteocytic lacunae in patients with varying degrees of periodontal disease to examine the role of osteocytes in the development and progression of periodontal disease.

Adolescent↗
PubMed1999

Antiphosphorylcholine antibody levels are elevated in humans with periodontal diseases.

Human immunoglobulin G2 (IgG2) serum concentrations and the IgG2 antibody response to Actinobacillus actinomycetemcomitans can be influenced by genes, by environmental factors such as smoking, and by periodontal disease status. Examination of the IgG2 response to phosphorylcholine (PC), a response thought to be mainly induced by the C polysaccharide of Streptococcus pneumoniae, suggested that periodontal disease status was also associated with this response. This prompted the hypothesis that PC is an important oral antigen associated with organisms in the periodontal flora and that anti-PC antibody is elevated as a consequence of periodontal disease. Subjects in various periodontal disease diagnostic categories in which attachment loss is exhibited were tested for anti-PC in serum. Those with adult periodontitis, localized juvenile periodontitis, generalized early-onset periodontitis, and gingival recession all had similar levels of anti-PC IgG2 serum antibody which were significantly greater than in the group of subjects with no attachment loss. Analysis of plaque samples from subgingival and supragingival sites in all diseases categories for reactivity with the anti-PC specific monoclonal antibody TEPC-15 revealed that a substantial proportion of the bacteria in dental plaque (30 to 40%) bear PC antigen; this antigen was not restricted to morphotypes resembling only cocci but was also present on rods and branched filamentous organisms. We found that S. mitis, S. oralis, and S. sanguis, as well as oral actinomycetes, including A. viscosus, A. odontolyticus, and A. israelii, incorporated substantial amounts of [(3)H]choline from culture media. Further analysis of antigens derived from these organisms by Western blot indicated that S. oralis, S. sanguis, A. viscosus, A. odontolyticus, and A. israelii contained TEPC-15-reactive antigens. The data show that many commonly occurring bacterial species found in dental plaque contain PC antigen and that immunization with plaque-derived PC antigens as a consequence of inflammation and periodontal attachment loss may influence systemic anti-PC antibody concentrations.

Actinomycetales↗
PubMed2002

Relationships among clinical measures of periodontal disease and their associations with systemic markers.

BACKGROUND: Recent investigations of the relationship between periodontitis and systemic disease require that periodontal disease also must be thought of as a disease process that is an exposure for a systemic disease or condition (outcome), rather than as the outcome itself. When viewing periodontal disease as an exposure, investigators must consider the clinical, microbiological, and inflammatory components of periodontitis that potentially convey risk for the systemic outcome of interest, which may or may not be the same as those associated with the assessments used to define tooth-based disease. Another important consideration is the temporal relationship between the exposure and the outcome of interest. METHODS: To explore which definitions of periodontal disease or clustering of clinical signs are important with regards to systemic exposure to inflammatory stress, we examined the relationship between clinical periodontal disease measures and 2 systemic inflammatory markers of increased risk for cardiovascular disease: serum soluble intercellular adhesion molecule (sICAM), which is a measure of vascular stress and serum C-reactive protein (CRP), which is a measure of hepatic acute-phase response. The Dental Arteriosclerosis Risk in Communities (ARIC) study, a cross-sectional study of the relationship between periodontal disease and cardiovascular disease, forms the basis for the examples used in this investigation. RESULTS: Our findings demonstrated that while attachment loss, probing depth, (PD) and bleeding on probing (BOP) are individually associated with sICAM and CRP, only BOP remains significant for sICAM when all 3 are in the model and, for CRP, only PD remains significant. Both of these clinical parameters were more robust in estimating the degree of systemic inflammation than traditional classifications of mild, moderate, and severe periodontitis or other measures of disease severity such as attachment loss. CONCLUSIONS: When selecting a definition of "systemic periodontitis" (periodontal disease that represents an exposure for a systemic condition), it is helpful to think of periodontal disease as a chronic oral infection with a number of clinical signs, rather than as the dento-centrically defined entity, periodontal disease. Thus, "systemic periodontitis" should be defined predicated upon those clinical signs that best represent the underlying mechanisms and temporal sequence that may affect that systemic outcome.

Acute-Phase Reaction↗
PubMed2002

Periodontal disease and cardiovascular disease: epidemiology and possible mechanisms.

BACKGROUND: Many early epidemiologic studies reported an association between periodontal disease and cardiovascular disease. However, other studies found no association or nonsignificant trends. This report summarizes the evidence from epidemiologic studies and studies that focused on potential contributing mechanisms to provide a more complete picture of the association between periodontal and heart disease. TYPES OF STUDIES REVIEWED: The authors summarize the longitudinal studies reported to date, because they represent the highest level of evidence available regarding the connection between periodontal disease and heart disease. The authors also review many of the case-control and cross-sectional studies published, as well as findings from clinical, animal and basic laboratory studies. RESULTS: The evidence suggests a moderate association--but not a causal relationship--between periodontal disease and heart disease. Results of some case-control studies indicate that subgingival periodontal pathogenic infection may be associated with myocardial infarction. Basic laboratory studies point to the biological plausibility of this association, since oral bacteria have been found in carotid atheromas and some oral bacteria may be associated with platelet aggregation, an event important for thrombosis. Animal studies have shown that atheroma formation can be enhanced by exposure to periodontal pathogens. CONCLUSIONS: The accumulation of epidemiologic, in vitro, clinical and animal evidence suggests that periodontal infection may be a contributing risk factor for heart disease. However, legitimate concerns have arisen about the nature of this relationship. These are early investigations. Since even a moderate risk contributed by periodontal disease to heart disease could contribute to significant morbidity and mortality, it is imperative that further studies be conducted to evaluate this relationship. One particularly important study to be carried out is the investigation of a possible clinically meaningful reduction in heart disease resulting from the prevention or treatment of periodontal disease.

Acute-Phase Reaction↗
PubMed1989

Antibodies to Bacteroides gingivalis in patients with treated and untreated periodontal disease.

It is proposed that the development of periodontal disease is associated with rising levels of serum and gingival crevice fluid (GCF) IgG antibodies to specific organisms, while treatment of periodontal disease is associated with a decline in specific IgG antibodies. This study examined the immune response to Bacteroides gingivalis, a suspected periodontal pathogen, in serum and GCF of patients with adult periodontitis. Three groups of subjects were studied: (1) patients with untreated adult periodontitis, (2) patients with treated adult periodontitis, and (3) patients with gingivitis (controls). An enzyme-linked immunosorbent assay was employed using whole formalinized B. gingivalis (ATCC 33277) as antigen. Results showed that the untreated adult periodontitis patients had a humoral immune response to B. gingivalis, producing significantly higher serum levels of IgG antibody to that organism than did patients with treated adult periodontitis (p less than or equal to 0.01) or gingivitis (p less than or equal to 0.005). The untreated patients also demonstrated a local immune response to B. gingivalis in that their GCF levels of IgG antibody to that organism were also significantly higher than levels in treated adult periodontitis patients (p less than or equal to 0.005) and gingivitis patients (p less than or equal to 0.001). These results are consistent with reports by other investigators. However, ratios of GCF antibody to serum antibody in the untreated adult periodontitis group were not significantly higher than ratios in the other two groups.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMedDate not supplied

An emerging new standard of care: initial and continued treatment for patients with signs and symptoms of active periodontal disease.

A growing knowledge of periodontal disease has improved dentists' understanding of the disease's etiology, pathophysiology, and natural history. This increased expertise has allowed treatment strategy and outcomes to improve. General dentists are the first to diagnose and treat the disease and it is important for them to understand both the disease and the new methods of treatment. Locally administered time-released antibiotics target specific microorganisms and may inhibit the action of collagenase, an extremely destructive enzyme that is released into periodontal tissues via the host response. This article reviews the disease process and presents a new standard of care that combines traditional debridement with locally administered antibiotics, offering a variety of treatment modalities to general dentists.

Administration, Topical↗
PubMed1983

Relation between ascorbic acid intake and periodontal disease in the United States.

Only a weak association between periodontal disease and ascorbic acid deficiency has been shown in the analysis of nutritional and periodontal health data collected from a representative sample of the US population. Intake of ascorbic acid in amounts larger than those recommended by the dietary standards does not seem to be associated with better periodontal health. The results of this study also suggest that dental practitioners are better advised to concentrate on plaque control rather than vitamin C supplements to prevent and control periodontal disease in their patients.

Adult↗
PubMed1986

Inhibition of superoxide generation by human polymorphonuclear leukocytes with chlorhexidine. Its possible relation to periodontal disease.

During the acute phase of periodontal disease, as many as 60% of the cells of the junctional epithelium may be accounted for by polymorphonuclear cells (PMNs). It is generally accepted that these cells play a dominant role in the destruction of connective tissue by virtue of the proteinases they release and the free oxygen radicals they generate. Modulation of the proteolytic activity and free radical production seems to be essential for the inhibition of tissue destruction. We have therefore studied the effect of chlorhexidine on the generation of free oxygen radicals and luminol-dependent chemiluminescence (LDCL) by stimulated human PMNs. Nontoxic chlorhexidine concentrations (0.1-1 microgram/ml) were found to inhibit superoxide production but did not affect LDCL. We therefore suggest that in addition to its antiseptic effect, chlorhexidine may also modulate the generation of free radicals by activated PMN cells in the inflamed gingiva.

Acute Disease↗