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PubMed2003

Are there HLA combinations typical supporting for or making resistant against aggressive and/or chronic periodontitis?

OBJECTIVE AND BACKGROUND: Human leukocyte antigens (HLA)/alleles have been considered as risk factors for periodontal disease. However, data from HLA associations is not consistent. Diversity of HLA antigen combinations and en bloc inherited HLA alleles (haplotypes), as known in systemic diseases, can be variable factors in disease association. Therefore, the aim of this study was to investigate the incidence of HLA homozygosities, heterozygosities and estimated haplotypes in German Caucasian groups with generalized aggressive (N = 50) and chronic (N = 102) periodontitis in comparison to control probands without periodontitis (N = 102). METHODS: HLA-A, -B, -Cw, -DRB1, -DRB3/4/5, -DQB1 typing was carried out using both serologic (microlymphocytotoxicity test) and genomic (PCR-SSP: PCR with sequence specific primers) techniques. Frequencies of all homozygosities, heterozygosities and haplotypes were determined in all patients and controls. RESULTS: In both patient groups, associations to HLA homozygosities and heterozygosities were found. Most striking was the significantly lower frequency of HLA-DRBblank* homozygosity (non-DRB3*/DRB4*/DRB5*) in chronic periodontitis (p < 0.05), whereas HLA-DRB1*15 : DRB5*(DR51) : DQB1*06 showed a slightly higher homozygosity rate in all patients. As the combination HLA-A*02,A*03 was significantly decreased in aggressive periodontitis (p < 0.05), HLA-A*01,A*03 heterozygosity was significantly lowered in chronic periodontitis (p < 0.05). Among others, the known positive associations for HLA-A*68/69 (A28) and HLA-DRB1*04 were confirmed by the haplotypes HLA-A*68/69 : Cw*07 : B*18 in aggressive periodontitis (p < 0.05) and HLA-Cw*08 : B*14 : DRB1*04 in chronic periodontitis (p < 0.05). CONCLUSION: The present study elucidates the variety of HLA associations and therefore the difficulty to assign single HLA markers to periodontal disease. Susceptibility/resistance of both aggressive and chronic periodontitis may rather be influenced by particular HLA marker combinations. Associated HLA haplotypes may be of further importance for unknown gene loci representing a part of the genetic background for periodontitis. The different associations in aggressive and chronic periodontitis indicate different susceptibility/resistance factors for both diseases.

Adult↗
PubMed1993

Black-pigmented gram-negative anaerobes in periodontitis.

Black-pigmented Gram-negative anaerobes have been associated with periodontal disease and tooth loss since they were first isolated by Burdon in 1928. Porphyromonas gingivalis, which is usually not isolated from children, adolescents or adults with no periodontal breakdown, has been recognized as one of the most important periodontopathogens. Its presence is strongly correlated with deep periodontal pockets, which are assumed to be its main habitat. Correlations have been shown also with attachment loss, clinical inflammation and serum antibody levels, indicating an aetiological role in the periodontal disease. Their pathogenicity in animal models resembling periodontal disease is documented. They are frequently isolated from periodontal abscesses. The relationship between Prevotella intermedia and periodontal disease is not clear. It is frequently isolated from advanced periodontitis, often as the only black-pigmented Gram-negative anaerobic species; however, the prevalence in adults with no periodontal breakdown is high. It is found frequently in periodontal abscesses and in acute necrotizing and ulcerative gingivitis. Serogroup I is found predominantly in deep periodontal pockets, whereas all serogroups (I-III) are found in shallow pockets and gingivitis. No conclusive difference in pathogenicity between serogroups has been found. Pr. melaninogenica, Pr. denticola and Pr. loescheii are frequently found in the gingival crevice in preschool children and other age groups with gingivitis, but are seldom found in deep periodontal pockets.

Adolescent↗
PubMed1986

Probing considerations in relation to susceptibility to periodontal breakdown.

Both epidemiological and clinical studies indicate that not all individuals are equally susceptible to periodontal breakdown. Therefore, the clinical differences were investigated between subjects highly susceptible and subjects insusceptible to periodontal breakdown. The highly susceptible group consisted of patients with a diagnosis of juvenile periodontitis. The insusceptible group consisted of older individuals with gross amounts of plaque and no periodontal breakdown. Results indicated that a high value of the bleeding/plaque ratio may possibly act as a prognostic indicator for periodontal breakdown. However, longitudinal data are indispensable for substantiation of this hypothesis. Since longitudinal research takes many years, the experimental gingivitis model was chosen for further investigation. 4 groups of individuals were selected on the basis of a different history of inflammatory periodontal disease: 2 younger age groups without periodontal breakdown, having either a low or a high bleeding/plaque ratio--a hypothetically susceptible and a hypothetically insusceptible group, respectively; one older age group with presence of gross amounts of plaque, no periodontal breakdown and a low bleeding/plaque ratio--an insusceptible group; and an adult group who previously suffered from severe periodontal disease--a susceptible group. Results of the experimental gingivitis studies indicated that the older insusceptible group developed only small amounts of bleeding, whereas the younger hypothetically insusceptible group developed a comparable low bleeding index. The younger hypothetically susceptible group developed a much higher bleeding index comparable to that of the susceptible group, the periodontal patients. In conclusion, comparison of the results of the experimental gingivitis studies in subjects with differing histories of inflammatory periodontal disease supports the concept that the bleeding/plaque ratio may act as a prognostic indicator for periodontal breakdown.

Adolescent↗
PubMed2005

Re-treatment profiles during long-term maintenance therapy in a periodontal practice in Norway.

BACKGROUND: Periodontal therapy coupled with active maintenance has been shown to be effective in maintaining periodontal health, however, the question of re-treatment is rarely alluded to in the literature. AIM: To quantify the type and extent of re-treatment in a group of patients who had completed a definitive course of periodontal treatment in a Norwegian specialist periodontal practice. The study also investigated factors associated with the provision of periodontal surgery as a re-treatment modality. METHODS: A consecutive group of patients who had comprehensive periodontal treatment, which included periodontal surgery, and were subsequently maintained for between 10 and 17 years were studied. RESULTS: One hundred and one patients with an average age at reassessment of 59.4 (standard deviation (SD) 9.0) years were studied. The average length of the review period was 13.1 (SD 1.9) years. In addition to routine maintenance, 50 patients had further re-treatment and 40 of those who were re-treated had periodontal surgery in the study period. Logistic regression showed that independent predictors of surgical re-treatment, with the effects adjusted for other variables in the model, were uncertain or poor prognosis at baseline, erratic or poor post baseline compliance and a family history of periodontal disease. CONCLUSION: Considerable amounts of re-treatment, including in many cases extensive non-surgical treatment or periodontal surgery, were provided for patients who had surgical periodontal treatment and were subsequently maintained for least 10 years in a specialist periodontal practice.

Adult↗
PubMed2006

Actinobacillus actinomycetemcomitans and Porphyromonas gingivalis subgingival presence, species-specific serum immunoglobulin G antibody levels, and periodontitis disease recurrence.

BACKGROUND AND OBJECTIVE: The biological and clinical effects of antibody against periodontal pathogenic bacteria are incompletely understood. This study evaluated the inter-relationships among periodontal levels of cultivable Actinobacillus actinomycetemcomitans and Porphyromonas gingivalis, species-specific serum immunoglobulin G (IgG) antibody levels, and periodontitis disease activity. MATERIAL AND METHODS: Forty-three adults who had previously been treated for periodontitis and who also harbored cultivable A. actinomycetemcomitans or P. gingivalis were evaluated semiannually for clinical disease recurrence over a 36-month period. Each patient provided subgingival microbial samples, for the recovery of A. actinomycetemcomitans and P. gingivalis, from the two deepest pockets in each dentition sextant. A. actinomycetemcomitans and P. gingivalis serum IgG antibody levels were assessed using enzyme-linked immunosorbent assay (ELISA), together with whole-cell sonicate extracts from A. actinomycetemcomitans serotypes a-c and P. gingivalis ATCC 33277. Data were analyzed using the Mantel-Haenszel chi-square and Fisher exact two-tailed tests. RESULTS: Eighteen (60.0%) of 30 A. actinomycetemcomitans-positive subjects, and 10 (76.9%) of 13 P. gingivalis-positive subjects, exhibited recurrent periodontal breakdown within 36 months of periodontal therapy. Nineteen (67.9%) of the 28 patients with active periodontitis had A. actinomycetemcomitans or P. gingivalis serum antibody levels below designated threshold values. In comparison, 10 (66.7%) of 15 culture-positive clinically stable subjects showed A. actinomycetemcomitans or P. gingivalis serum antibody levels above threshold values. The difference between specific antibody levels in periodontitis-active and periodontitis-stable patients was statistically significant (p = 0.032). CONCLUSIONS: Serum levels of IgG antibodies against A. actinomycetemcomitans or P. gingivalis in periodontitis-stable patients were higher than those in patients with active periodontitis. The results suggest that elevated levels of IgG antibody against A. actinomycetemcomitans and P. gingivalis have a detectable protective effect against periodontal infections with these microorganisms.

Adult↗
PubMed2005

The effect of periodontal therapy on uncontrolled type 2 diabetes mellitus in older subjects.

OBJECTIVE: The purpose of this study was to examine the effect of periodontal therapy on glycemic control in older type 2 diabetic patients. METHODS: Fifty-two diabetic patients, age 55-80 years (mean age = 61 years), with glycated hemoglobin (HbA1c) 7.5-11.0% (mean +/- s.d. = 8.98 +/- 0.88) and severe periodontitis were included in the present study. The treatment group received mechanical periodontal treatment combined with systemic doxycycline, 100 mg day(-1) for 14 days. The control group received neither periodontal treatment nor systemic doxycycline. Clinical periodontal parameters, fasting plasma glucose (FPG), and HbA1c levels were measures at baseline and 3 months. RESULTS: Periodontal treatment significantly improved periodontal status of the treatment group (P < 0.05), however the reduction in the level of FPG and HbA1c did not reach significance. In the control group, no significant changes in clinical periodontal parameters, FPG and HbA1c levels were observed, except for significant increase in attachment loss (P < 0.05). Comparing the two groups, although the 3-month level of HbA1c of the treatment group was lower than that of the control group, the difference did not reach significance. CONCLUSIONS: The results of the present study indicate that the periodontal condition of older Thais with uncontrolled diabetes is: (a) significantly improved 3 months after mechanical periodontal therapy with adjunctive systemic antimicrobial treatment, and (b) rapidly deteriorating without periodontal treatment. The effect of periodontal therapy on the glycemic control of older uncontrolled diabetics will require further studies that will have to include much larger sample sizes.

Aged↗
PubMed2002

Risk indicators for periodontal disease in a remote Canadian community--a dental practice-based study.

OBJECTIVES: The purpose of this cross-sectional study was to identify risk markers and risk indicators for periodontal attachment loss in a remote Canadian community. Of special interest was the association between smoking and periodontal disease experience. METHODS: Data were collected from a convenience sample of 187 adult patients attending a dental office in a rural community located in Northern Ontario. Information was obtained via a questionnaire and a periodontal examination. The questionnaire included the use of dental services, self-care behaviors, general health status, smoking, and personal characteristics. Periodontal health was assessed using the mean periodontal attachment loss (MPAL), measured at two sites on all remaining teeth and the proportions of sites examined with loss of 2 mm or more and 5 mm or more. Plaque scores and measures of the number of missing teeth also were obtained. The relationships between mean periodontal attachment loss, the proportion of sites with 5 mm or more of loss and independent variables such as age, sex, current smoking status, mean tooth plaque scores, flossing frequency, and regularity of preventive dental visits were examined in bivariate and multivariate analyses. RESULTS: The data revealed a mean periodontal attachment loss of 3.9 mm (SD=1.5). The mean proportion of sites examined with loss of 2 mm or more was 0.89 and the mean proportion with loss of 5 mm or more was 0.35. In linear regression analysis, plaque scores, the number of missing teeth, age, current smoking status, regularity of dental visits, and flossing frequency had statistically significant independent effects and explained 60.0 percent of the variance in mean periodontal attachment loss. Just over 30 percent of subjects had severe periodontal disease, defined as 50 percent or more of sites examined with loss of 5 mm or more. In logistic regression analysis, missing teeth, dental visiting, smoking status, age, and flossing frequency had significant independent effects. The strongest association observed was with smoking, which had an odds ratio of 6.3. The logistic regression model correctly predicted 64.3 percent of cases with severe disease. CONCLUSIONS: The data indicate that the periodontal health of these patients is poor. Risk indicators or markers of poor periodontal health in the population studied included missing teeth, plaque scores, age, current smoking status, regularity of dental visits, and flossing frequency. This supports previous findings that behavioral factors play an important role in periodontal disease.

Adult↗
PubMed2000

A practical approach to the diagnosis and treatment of periodontal disease.

BACKGROUND: Both nonsurgical and surgical periodontal therapies are important in the control of most forms of periodontal disease. Sometimes, nonsurgical therapy is adequate to control the disease in mild cases and to slow progression and maintain periodontal stability in more advanced cases. Other times, both therapies may be indicated to obtain satisfactory results. The author presents treatment guidelines and recommendations for periodontal therapy. METHODS: The author searched the dental literature for information pertaining to periodontal therapy. RESULTS: The author found evidence-based data to support the effectiveness of nonsurgical and surgical periodontal therapy in controlling periodontal disease. Nonsurgical periodontal therapy requires time, effort, and good diagnostic and clinical skills to obtain satisfactory results. The results are determined by evaluating the patient's periodontal disease after active therapy, at which time additional surgical or nonsurgical treatment may be recommended. Evaluation should continue throughout the lifelong supportive phase of periodontal therapy. CONCLUSION: Clinicians should continue to develop and enhance their diagnostic skills, assess factors that affect diagnosis and prognosis, formulate a comprehensive treatment plan, render appropriate treatment, evaluate the outcome and determine when periodontal care is indicated. CLINICAL IMPLICATION: Failure to comply with monitoring the patient's periodontal status may lead to uncontrolled disease and eventually premature tooth loss. Premature tooth loss can be prevented through patient education and application of evidence-based nonsurgical and surgical therapy.

Clinical Protocols↗
PubMed1994

Relationship of oral malodor to periodontitis: evidence of independence in discrete subpopulations.

Associations between oral malodor, measures of periodontal disease, and trypsin-like activity of periodontal pathogens on tongue and teeth were examined in 127 subjects. Volatile sulphur compound (VSC) measurements were made with a portable sulphide monitor; oral malodor was also estimated by organoleptic methods. Measurements repeated one week apart indicated that steady-state VSC levels (r = 0.72; P = 0.0001) and peak VSC levels (r = 0.63; P = 0.0001) were reproducible but these r values were not significantly different (P > 0.1). There was a significant correlation between tongue odor and peak VSC levels (r = 0.40; P = 0.0001) and between tongue odor and whole mouth organoleptic measures (r = 0.55; P = 0.0001). To study the effect of reducing microbial colonization on oral malodor, chlorhexidine gluconate (0.2%) rinsing was prescribed for 7 days. Reductions of VSC levels were significant for both peak (37%) and steady-state (41%) data (P = 0.0001). Anaerobic periodontal pathogens on the tongue estimated by the proportions of positive BANA tests were reduced 19% (P = 0.001) and this was concomitant with a 40% (P = 0.0001) decrease in organoleptic measurement of the tongue dorsum. Mean pH measurements of the tongue dorsum showed large reductions from 6.9 initially to 6.3 post-treatment (P = 0.0001). Subjects were divided into periodontitis/no periodontitis based on periodontal inflammation and probing depth (> or = 5 mm). Of the 37 subjects with periodontitis, 23 had oral malodor whereas 52 out of 90 periodontally healthy subjects exhibited malodor. Chi square analysis comparing halitosis in subjects with and without periodontitis showed no statistically significant association (chi 2 = 0.208; P 0.65) between these two factors although the intensity of malodor as based on VSC concentration in periodontally healthy subjects was 19% less (mean = 111 ppb) than in subjects with periodontitis (mean = 136 ppb). The odds ratio was 1.2, indicating that oral malodor was not associated with periodontitis. These data indicate that a large proportion of individuals with oral malodor are periodontally healthy and that the mucosal surface of the tongue is a major site of oral malodor production.

Adult↗
PubMed1995

Immunohistochemical expression of extracellular matrix components of normal and healing periodontal tissues in the beagle dog.

Periodontal regeneration requires formation of periodontal tissues lost due to periodontal disease. To better understand the formation of new periodontal tissues during periodontal repair and regeneration, immunohistochemical expression of extracellular matrix components of normal as well as healing periodontal tissues was evaluated and compared using the avidin-biotin complex immunohistochemical technique. For this purpose, horizontal furcation defects were created around mandibular P2 and P4 of 6 dogs after extraction of P1 and P3. The root surfaces were conditioned with citric acid and expanded polytetrafluoroethylene (ePTFE) membranes were placed and retained 0.5 mm above the cemento-enamel junction. The mucoperiosteal flaps were sutured in a coronal position. Two animals were sacrificed at 2, 4, and 8 weeks, and mesio-distal tissue slices containing normal or healing periodontal tissues were demineralized, dehydrated, and embedded in paraffin. Immunohistochemical localization of type I collagen (CI), fibronectin (FN), secreted protein, acidic and rich in cysteine (SPARC), vitronectin (VN), and bone sialoprotein (BSP) was performed on 6 microns thick sections. Morphological results demonstrated that at 2 weeks after defect creation, lesions were filled primarily with granulation tissue which was gradually replaced by newly-formed fibrous connective tissue, periodontal ligament (PDL), cementum, and bone between 4 and 8 weeks. The results of immunohistochemical study revealed that at 2 weeks the granulation tissue, especially in the intercellular spaces of inflammatory cells, was intensively stained for FN and VN. At 4 and 8 weeks, staining for CI, FN, and VN was found in fibrous connective tissue, the newly-formed PDL, cementum, and osteoid. Further the attachment zone of the PDL collagen fibers to cementum showed intense staining for FN. Immunostaining for SPARC was positive in the new PDL, cementum, and bone, while staining for BSP was restricted to the new cementum and bone. Interestingly, the PDL, especially in areas adjacent to active bone formation, demonstrated intense staining for BSP. However, fibrous connective tissue and PDL proper were unstained for BSP. These results indicate that FN and VN are involved in the early stages of periodontal repair, and periodontal regeneration is achieved through formation of periodontal tissues that are composed of different matrix components specific to different types of periodontal tissues.

Acid Etching, Dental↗
PubMed2000

Calcium and the risk for periodontal disease.

BACKGROUND: Dietary calcium has long been a candidate to modulate periodontal disease. Animal as well as human studies of calcium intake, bone mineral density, and tooth loss provide a rationale for hypothesizing that low dietary intake of calcium is a risk factor for periodontal disease. METHODS: We evaluated the role of dietary calcium intake as a contributing risk factor for periodontal disease utilizing the Third National Health and Nutrition Examination Survey (NHANES III), which is representative of the U.S. civilian non-institutionalized population. Dietary calcium intake was determined from a 24-hour dietary recall. The U.S. Department of Agriculture Nutrient Database was used as a source of nutrient composition data. Periodontal disease was measured by attachment loss. In addition, serum calcium was assessed using venous blood samples. Logistic regression analysis was used to examine the association between periodontal disease and dietary calcium intake or serum calcium levels after adjusting for covariants including age, gender, tobacco consumption, and gingival bleeding. RESULTS: The association of lower dietary calcium intake with periodontal disease was found for young males and females (20 to 39 years of age), and for older males (40 to 59 years of age). The relationship between low dietary calcium intake and increased levels of periodontal disease showed an estimated odds ratio (OR) of 1.84 (95% CI: 1.36 to 2.48) for young males, 1.99 (95% CI: 1.34 to 2.97) for young females, and 1.90 (95% CI: 1.41 to 2.55) for the older group of males. These odds ratios were adjusted for gingival bleeding and tobacco consumption. The dose response was also seen in females, where there was 54% greater risk of periodontal disease for the lowest level of dietary calcium intake (2 to 499 mg) and 27% greater risk in females who took moderate levels of dietary calcium (500 to 799 mg) as compared to those who took 800 mg or more dietary calcium per day. A statistically significant association between low total serum calcium and periodontal disease was found in younger females aged 20 to 39 with OR = 6.11 (95% CI: 2.36 to 15.84) but not for males or older females, after adjusting for tobacco use, gingival bleeding, and dietary calcium intake. CONCLUSIONS: These results suggest that low dietary intake of calcium results in more severe periodontal disease. Further studies will be needed to better define the role of calcium in periodontal disease and to determine the extent to which calcium supplementation will modulate periodontal disease and tooth loss.

Adult↗
PubMed2000

A 10-year prospective study of tobacco smoking and periodontal health.

BACKGROUND: To date only a few studies have evaluated the long-term influence of smoking and smoking cessation on periodontal health. The present study, therefore, was undertaken with the aim to prospectively investigate the influence of smoking exposure over time on the periodontal health condition in a targeted population before and after a follow-up interval of 10 years. METHODS: The primary study base consisted of a population of occupational musicians that was investigated the first time in 1982 and scheduled for reinvestigation in 1992 and 2002. The 1992 investigation included 101 individuals from the baseline study constituting a prospective cohort including 16 smokers, who had continued to smoke throughout the entire length of the 10-year period; 28 former smokers who had ceased smoking an average of approximately 9 years before the commencement of the baseline study; 40 non-smokers, who denied ever having smoked tobacco; and 17 individuals whose smoking pattern changed or for whom incomplete data were available. The clinical and radiographic variables used for the assessment of the periodontal health condition of the individual were frequency of periodontally diseased sites (probing depth > or =4 mm), gingival bleeding (%), and periodontal bone height (%). The oral hygiene standard was evaluated by means of a standard plaque index. RESULTS: The changes over the 10 years with respect to frequency of diseased sites indicated an increased frequency in continuous smokers versus decreased frequencies in former smokers and non-smokers. Controlling for age and frequency of diseased sites at baseline, the 10-year change was significantly associated with smoking (P <0.001). The differences between current smokers and non-smokers, and between current and former smokers, respectively, were statistically significant (P<0.001). Moreover, the 10-year change increased significantly with increasing smoking exposure controlling for age (P= 0.01). In terms of periodontal bone height, the 10-year changes implied statistically significant reductions within current as well as former smokers (P <0.001 and P <0.05, respectively), but not within non-smokers. The overall change was significantly associated with smoking controlling for age and bone height level at baseline (P<0.01), including statistically significant differences between current smokers and non-smokers and between current and former smokers, respectively (P<0.05). Moreover, the 10-year bone height reduction increased significantly with increasing smoking exposure controlling for age (P <0.05). With regard to gingival bleeding, the 10-year differences between smoking groups were not statistically significant. Plaque index remained low throughout in all smoking groups at an overall average level of about 0.8. CONCLUSIONS: The results suggest that periodontal health is compromised by chronic smoking as evidenced by an increase of periodontally diseased sites concomitant with loss of periodontal bone height, as compared to non-smokers whose periodontal health condition remained unaltered throughout the 10-year period of investigation. The periodontal health condition in former smokers, similar to that of non-smokers, remained stable, suggesting that smoking cessation is beneficial to periodontal health.

Adult↗
PubMed2002

The use of a modified CPITN approach to estimate periodontal treatment needs among adults aged 20-79 years by socio-demographic characteristics in the United States, 1988-94.

AIM: The aim of the study was to ascertain periodontal treatment needs and their socio-demographic determinants among adults in the United States by transforming nationally representative periodontal data into an index routinely used internationally. DESIGN: Data were abstracted from a complex, highly stratified, multistage probability cross-sectional study to create a modified Community Periodontal Index of Treatment Needs (CPITN). PARTICIPANTS: 11,339 persons aged 20-79 who participated in the third US National Health and Nutrition Examination Survey (NHANES III), 1988-94. RESULTS: At least 3% of the adult US population required complex periodontal treatment, 90% needed scaling and prophylaxis, and nearly 5% did not need periodontal treatment or oral hygiene instruction. A multivariate cumulative logistic model indicated that being older, male, non-Hispanic black, having lower education, smoking, or not having had a dental visit in the past year increased the likelihood of needing more complex periodontal treatment. The risk factors that indicated the greatest potential for increasing complexity of periodontal treatment, after controlling for all covariates, were being either non-Hispanic black (OR=2.51; 95% CI=1.98, 3.18), or not completing high school (OR=2.10: 95% CI=1.60, 2.77), or a current cigarette smoker (OR=2.02; 95% CI=1.76, 2.33). CONCLUSIONS: The need for increasingly complex periodontal treatment differs by sociodemographic factors. Most American adults need some type of periodontal treatment; however, the majority of periodontal treatment needs in the US are within the clinical skill range of dental hygienists. There is significant disparity in the distribution of need for periodontal treatment; persons from socially disadvantaged groups are more likely to present with increasing complexity of periodontal treatment needs.

Adult↗
PubMed1988

Diagnosis and classification of the periodontal diseases.

A classification for gingivitis and periodontitis has been proposed based on clinical observations and immunologic parameters (summarized in Table 10). Overlapping clinical situations and exceptions to the rule certainly exist and pose challenges to clinicians during diagnosis, prognosis, and treatment planning. The clinical significance of making the diagnosis of either rapidly progressive periodontitis, juvenile, or prepubertal forms of periodontitis compared with adult periodontitis must be considered. A diagnosis of early-onset disease may (1) modify the periodontal treatment plan and may include the use of systemic antibiotics (for example, tetracyclines) or antiplaque agents (for example, sanguinarine, chlorhexidine); (2) modify the prosthetic treatment plan and require longer periods of monitoring before extensive replacement or splinting is initiated; (3) increase the frequency of periodontal recall appointments (at least four to six times during the first year or two following peridontal therapy); (4) implicate a genetic basis for the disease with the possibility of peridontal involvement of other family members; (5) influence decisions on prognosis; and (6) alert the clinician for potential future rapid periodontal breakdown. Future studies will further define and characterize all forms of periodontal diseases. Clinical, microbial, and immunologic information may permit inclusion of the relatively rare forms of periodontitis such as ANUG periodontitis and refractory periodontitis. Understanding the underlying biologic mechanisms of the pathogenesis of the periodontal diseases, coupled with clinical observations, will permit improved clinical investigations that ultimately will improve therapeutic approaches.

Adolescent↗
PubMed2003

Relationship between clinical parameters and cytokine profiles in inflamed gingival tissue and serum samples from patients with chronic periodontitis.

OBJECTIVE: The purpose of the present study was to assess the relation between clinical parameters and concentrations of the key (IL-1beta, TNF-alpha, IL-2, IFN-gamma, IL-4, IL-10) cytokines, important in the initiation and progression of periodontal diseases, within inflamed gingival tissues and serum samples from patients with severe chronic periodontitis. MATERIAL AND METHODS: Twenty-five patients with severe chronic periodontitis, who had sites with probing depths (PD) > 5 mm, and 25 periodontally healthy persons were included in the study. Clinical examinations including PD, clinical attachment loss, plaque index, and bleeding index were performed before periodontal treatment. Gingival tissue biopsies were collected from one active site of each patient and from healthy individuals, and blood samples were withdrawn on the day of tissue biopsy. The concentrations of cytokines were determined by an enzyme-linked immunosorbent assay, and the relationship between their profiles in situ and in circulation with clinical parameters was analysed. RESULTS: The concentrations of IL-1beta, TNF-alpha, IL-2, IFN-gamma were, on average, significantly higher in serum samples and gingival tissue biopsies from periodontitis patients than in healthy controls. However, serum samples from both groups showed high individual variability of cytokine profiles, and no association between cytokine concentrations and clinical parameters of periodontitis was found. On the contrary, the levels of IL-4 and IL-10 in both kinds of samples obtained from patients and controls were generally low or even undetectable, and remained, on average, on the same level. However, the frequency of IL-4 (88% positive samples) and IL-10 (72%) was much higher in healthy gingival tissues. High concentrations of TNF-alpha, IFN-gamma and IL-2 and, especially, a high ratio of IL-1beta/IL-10 and TNF-alpha/IL-4 found in tissue biopsies from periodontitis patients, strongly correlated with the severity of periodontitis. CONCLUSION: These results indicate that high variability of cytokine concentrations and low frequency of their detection in serum samples from periodontitis patients make these determinations useless for the detection of disease presence and/or its severity. In contrast, high absolute levels of IL-1beta, TNF-alpha, IL-2 and IFN-gamma and, especially their high ratios to IL-4 and IL-10 found in inflamed tissue biopsies, were closely associated with periodontal disease severity.

Adult↗
PubMed1997

Selection of the most accurate method of conventional radiography for the assessment of periodontal osseous destruction.

The purpose of the present study was to compare the radiographic measurements of periodontal osseous destruction with the surgical measurements, which represent the true value of osseous destruction, and to select the most successful method of conventional radiography in detecting and accurately assessing periodontal osseous destruction. A total of 5072 proximal surfaces in 2536 teeth of 100 patients with periodontitis were evaluated surgically during periodontal flap surgery and radiographically by using periapical and panoramic radiography. Comparative evaluation of the measurements obtained by these 3 different methods of osseous destruction assessment revealed the following. (1) The radiographic detection ability of small osseous destruction (1-4 mm) was very low for both methods of assessment and became even lower for the initial osseous destruction (1 or 2 mm). (2) Periapical radiography was more successful than panoramic in the detection of osseous destruction, especially of the small destruction (4.7x). (3) Panoramic radiography underestimated the osseous destruction, whereas periapical radiography was relatively accurate in the osseous destruction assessment. (4) Periapical radiography was more accurate in the osseous destruction assessment than panoramic, regardless of the location of the dental surfaces (jaw, tooth group, mesial or distal) and the degree of osseous destruction. (5) The deviation of the radiographic measurements of osseous destruction from the surgical measurements, as well as the difference between the two radiographic methods, depended on the jaw location, the tooth group and the degree of osseous destruction. (6) The radiographic assessment of osseous destruction underestimated the osseous destruction in initial periodontitis, it was relatively accurate in moderate periodontitis, but overestimated it in severe periodontitis. The radiographic measurements of osseous destruction deviated least from the surgical measurements in the group of moderate periodontitis and most in that of severe osseous destruction. (7) The 2 radiographic methods agreed most in the assessment of osseous destruction in the severe periodontitis group and least in the initial periodontitis group. (8) The indirect Schei method was less successful in detecting the small osseous destruction and less accurate in assessing the osseous destruction than the direct millimetric method of radiographic evaluation. (9) The osseous destruction as assessed from periapical radiographs by the Schei method was not significantly different from that assessed by the radiopaque Fixot-Everett grid. The results of the present study suggest that periapical radiography is more successful in detecting periodontal osseous destruction and more accurate in assessing it than panoramic radiography.

Adolescent↗
PubMed1997

Substance P and neurokinin A in gingival crevicular fluid in periodontal health and disease.

The aims of the present study were to investigate whether the tachykinins substance P and neurokinin A were present in gingival crevicular fluid in both periodontal health and disease and to study the relationship with periodontal inflammation. Gingival crevicular fluid (GCF) was collected from a healthy, a gingivitis and a periodontitis site in 20 subjects with periodontitis and from a healthy site in 20 subjects without periodontitis. The volume of GCF was measured and each sample subsequently analysed for substance P and neurokinin A by radioimmunoassay. There were significantly increased levels of substance P-like immunoreactivity (SP-LI) and neurokinin A-like immunoreactivity (NKA-LI) in gingivitis and periodontitis sites compared with healthy sites. Both tachykinins were significantly elevated in periodontitis affected subjects, with significantly more tachykinin-like immunoreactivity at healthy sites in periodontitis affected compared with periodontally-healthy subjects. Despite the considerable individual variation in the levels of SP-LI and NKA-LI, both tachykinins were present at levels at which they could have biological activity. It is concluded that substance P and neurokinin A may have a rôle in the pathogenesis of periodontal disease and that further investigations could prove useful in clarifying the mechanisms through which neuropeptides could modulate periodontal health and disease.

Adult↗
PubMed1997

Changes in TGF-beta 1 levels in gingiva, crevicular fluid and serum associated with periodontal inflammation in humans and dogs.

Transforming growth factor-beta (TGF-beta) represents a family of polypeptide growth factors, involved in embryogenesis, inflammation, regulation of immune responses and wound healing. To determine whether TGF-beta contributes to the evolution of periodontal disease, we assayed TGF-beta levels in gingiva and crevicular fluid of patients with gingivitis and periodontitis. In parallel, TGF-beta was quantified in gingival fluid and serum of beagles with experimentally-induced periodontitis. Disease was monitored by several clinical parameters including Plaque Index, Gingival Index, probing depth, and epithelial attachment loss. Gingival tissues were obtained from 9 patients at the time of periodontal surgery, and gingival fluid samples were collected from an additional population of 10 periodontal patients. In 14 beagles, experimental periodontitis was induced and gingival fluids collected 6 months later. Fluid was collected by paper strips and volume measured by Periotron. Additionally, sera was collected before and 9 months after the ligature-induced periodontitis in 7 beagles. The levels of TGF-beta 1 were measured by ELISA. In the patients, a significantly higher concentration of TGF-beta 1 was observed both in the gingival tissues and fluid samples obtained from the sites with deeper periodontal pockets than in the less involved sites. In beagles, TGF-beta 1 levels measured in gingival fluid were elevated in moderate disease, declining in fluid samples obtained from the pockets during more advanced experimental periodontitis. Furthermore, with the progression of experimental periodontitis, a decrease in TGF-beta 1 occurred in the sera of the beagle dogs. These data suggest that TGF-beta 1 may play a rôle in the pathogenesis and diagnosis of periodontal disease, and that its actions can be further explored in an animal model.

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