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PubMed2002

Risk factors for periodontal disease progression among elderly people.

The aim of this study was to identify the risk factors for periodontal disease progression by individual characteristics at baseline among elderly people over a 2-year period. Subjects were selected from 4542 people aged 70 years residing in Niigata who were in good general health and who did not require special care for their daily activities. Gender, smoking and alcohol drinking habits were obtained using a questionnaire, while serum levels of disease markers were investigated and attachment levels were clinically recorded. For the assessment of periodontal disease progression, additional attachment loss was used if one or more sites had a 3-mm or more increase in probing attachment level over a 2-year period. In all, 394 subjects (208 males and 186 females) were surveyed. Approximately 75% of subjects exhibited additional attachment loss over a 2-year period. Significant associations were found between additional attachment loss and smoking, and attachment level of 6 mm or more at baseline, with odds ratios of 3.75 and 2.29, respectively. Smoking habit and baseline attachment level of 6 mm or more may be considered risk factors for further attachment loss among healthy elderly people.

Aged↗
PubMed1991

Spirochetes in periodontal disease in the dog: a review.

The importance and the role of spirochetes in periodontal disease is controversial since the means to study these particular bacteria are limited. Because of specific requirements for growth, spirochetes are difficult to culture. Spirochetes could have profound effects on the perpetuation of periodontal disease. A review of the literature related to spirochetes is described.

Animals↗
PubMed1985

Partial indices as indicators of the severity and prevalence of periodontal disease.

The purpose of this study was to analyse the reliability of partial examination in the assessment of the average severity and the prevalence of periodontal disease. A total of 126 subjects aged 15-30 years and 160 subjects aged 31-68 years were examined for the presence or absence of gingival bleeding, supra- and subgingival calculus and pocket depths of 4-5 mm or 6 mm and over on six surfaces of each remaining tooth. From this pool of data three sets of average severity and prevalence scores were extracted. One was based on the full mouth examination; one on observations made from the ten index teeth of the Community Periodontal Index of Treatment Needs (CPITN); and one on the six index teeth of the Periodontal Disease Index. Average severity scores were obtained as accurately from the six Ramfjord teeth as from full mouth examinations for all periodontal disease indicators except for 6 mm or deeper pockets. When the assessments were based on the ten CPITN index teeth, the average severity scores exceeded those based on full mouth examinations for all indicators recorded and the prevalence figures were higher than those based on the six Ramfjord teeth. Even with the CPITN there was an under-estimate of the proportion of individuals affected, ranging from 16 per cent for 4-5 mm pockets to 21 per cent for 6 mm and deeper pockets in the older age group.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1999

Current and future approaches for diagnosis of periodontal diseases.

Our understanding of the etiology and pathogenesis of periodontal diseases has grown in the recent past, and new findings have led to advances in patient management. This article summarizes important new knowledge and offers a description of traditional and novel diagnostic approaches. These include clinical and radiographic assessments of the periodontal tissues, evaluation of the microbial challenge and the host response, and certain elements of the host genotype that may confer susceptibility to destructive periodontal diseases.

Bacterial Typing Techniques↗
PubMed1993

Modulation of host PGE2 secretion as a determinant of periodontal disease expression.

An increasing body of evidence supports the concept that host-produced PGE2 mediates much of the tissue destruction that occurs in periodontal disease. PGE2 levels within the crevicular fluid can serve as a static assessment of ongoing disease activity; i.e., rate of attachment loss and bone resorption. New insights into the mechanisms that regulate PGE2 synthesis provide an altered paradigm of periodontal disease which places the emphasis on host response, rather than the bacterial etiology, as the principal determinant of disease expression. We described a PGE2 host response model as a hypothetical framework to discuss new, possible explanations for host susceptibility to periodontal disease.

Animals↗
PubMed2002

Smoking and polymorphisms of the interleukin-1 gene cluster (IL-1alpha, IL-1beta, and IL-1RN) in patients with periodontal disease.

BACKGROUND: Polymorphisms within the interleukin-1 cluster are known to be associated with adult periodontal disease. However, interactions of genetic with other risk factors, especially smoking, remain questionable. The aim of this cross-sectional study was to evaluate the genetic influence on periodontal variables in relation to environmental factors. METHODS: One-hundred fifty-four (154) Caucasian subjects were clinically and radiographically assessed for their periodontal status, their smoking history recorded, and their allelic pattern of IL-1alpha, IL-1beta, and IL-1RN polymorphisms determined by genotyping. RESULTS: In assessing periodontitis with mean probing depth, mean attachment loss, or mean bone loss, no differences were found in allele frequencies or combined allotypes between subjects with mild or moderate versus those with severe signs of periodontitis. However, the extent of attachment loss defined as percentage of sites >4 mm was significantly associated with the composite genotype of IL-1alpha/1beta in smokers (odds ratio [OR] = 4.00; 95% confidence interval [CI] 1.03 to 16.70; P= 0.02). No differences were found in genotype negative subjects irrespective of their smoking status. They had nearly identical attachment loss as genotype positive non-smokers. Similar non-significant results were found with respect to extent of bone loss. An increased risk of more extended attachment loss was observed also in individuals carrying mutations of the combined genotype IL-1alpha/IL-1RN, again showing enhanced risk only in genotype-positive and smoking subjects. CONCLUSIONS: The results provide evidence that the composite genotypes studied show interaction with smoking, the main exposition-related risk factor of periodontal disease. Non-smoking subjects are not at increased risk, even if they are genotype-positive.

Adult↗
PubMed1979

Developmental variations of tooth morphology and periodontal disease.

Some developmental variations of tooth morphology may influence the potential for periodontal disease by allowing accumulation of bacterial plaque and calcified deposits. Mechanical plaque control becomes difficult even for the conscientious patient. Periodontal disease may be hastened in these cases. The therapist must be aware of these variations and their significance in the etiology of isolated periodontal lesions. Recognition of these anomalies and early diagnosis may improve the prognosis of the involved tooth.

Dental Cementum↗
PubMed1990

[The surgical verification of the periodontal probe and endoral radiography in assessing the bone substance loss in periodontal disease. A proposal for optimizing the methods].

It is difficult to compare levels of bone loss in periodontal disease measured by periodontal probe and X-ray and to verify them versus surgical techniques. In fact, there are relatively few published reports on the subject. To this purpose the Authors describe their personal experience using plates equipped with guide tracks and center-film boxes with personalized bites. The suitability of the two methods (probe, intraoral X-ray) to determine levels of bone loss similar to those revealed by surgical verification was assessed on the basis of an analysis of the respective bone loss in 44 sites surrounding 19 dental elements. This method, which is accurate but time-consuming, demonstrated an broadly analogous underestimate (approx. 20%) using both preoperative probe and X-ray techniques in comparison to the true level of bone loss measured during surgery.

Adult↗
PubMed2004

The long-term effect of a plaque control program on tooth mortality, caries and periodontal disease in adults. Results after 30 years of maintenance.

BACKGROUND: The biofilm that forms and remains on tooth surfaces is the main etiological factor in caries and periodontal disease. Prevention of caries and periodontal disease must be based on means that counteract this bacterial plaque. OBJECTIVE: To monitor the incidence of tooth loss, caries and attachment loss during a 30-year period in a group of adults who maintained a carefully managed plaque control program. In addition, a comparison was made regarding the oral health status of individuals who, in 1972 and 2002, were 51-65 years old. MATERIAL AND METHODS: In 1971 and 1972, more than 550 subjects were recruited. Three hundred and seventy-five subjects formed a test group and 180 a control group. After 6 years of monitoring, the control group was discontinued but the participants in the test group was maintained in the preventive program and was finally re-examined after 30 years. The following variables were studied at Baseline and after 3, 6, 15 and 30 years: plaque, caries, probing pocket depth, probing attachment level and CPITN. Each patient was given a detailed case presentation and education in self-diagnosis. Once every 2 months during the first 2 years, once every 3-12 months during years 3-30, the participants received, on an individual need basis, additional education in self-diagnosis and self-care focused on proper plaque control measures, including the use of toothbrushes and interdental cleaning devices (brush, dental tape, toothpick). The prophylactic sessions that were handled by a dental hygienist also included (i) plaque disclosure and (ii) professional mechanical tooth cleaning including the use of a fluoride-containing dentifrice/paste. RESULTS: Few teeth were lost during the 30 years of maintenance; 0.4-1.8 in different age cohorts. The main reason for tooth loss was root fracture; only 21 teeth were lost because of progressive periodontitis or caries. The mean number of new caries lesions was 1.2, 1.7 and 2.1 in the three groups. About 80% of the lesions were classified as recurrent caries. Most sites, buccal sites being the exception, exhibited no sign of attachment loss. Further, on approximal surfaces there was some gain of attachment between 1972 and 2002 in all age groups. CONCLUSION: The present study reported on the 30-year outcome of preventive dental treatment in a group of carefully monitored subjects who on a regular basis were encouraged, but also enjoyed and recognized the benefit of, maintaining a high standard of oral hygiene. The incidence of caries and periodontal disease as well as tooth mortality in this subject sample was very small. Since all preventive and treatment efforts during the 30 years were delivered in one private dental office, caution must be exercised when comparisons are made with longitudinal studies that present oral disease data from randomly selected subject samples.

Adult↗
PubMed1995

Smoking and periodontal disease. A review.

From the many epidemiological and clinical studies we have looked at there is considerable evidence supporting a positive association between smoking and periodontal disease. In conclusion therefore we can see that smoking can cause a number of changes within the periodontium which can predispose an individual to the progression of periodontal disease. Both the frequency and severity of periodontal disease appears to be greater among smokers than non-smokers. The smoking habit is associated with a variety of deleterious changes in the oral cavity. The periodontal tissues are firstly compromised by the initial vasodilatation and then the decreased blood flow to the gingiva, due to the vasoconstricting actions of nicotine. This also acts to decrease the crevicular fluid flow, which increases the susceptibility of the host to bacterial growth. The vasoconstriction also acts to inhibit what are normally early signs of periodontal problems by decreasing gingival inflammation, redness and bleeding. Evidence suggests that smoking is consistently associated with poorer levels of oral hygiene and consequently smokers have increased accumulations of plaque and calculus. The immune response of smokers is also impaired where the chemotactic and phagocytic ability of combination of these factors which enhances the breakdown of periodontal tissues in smokers. I believe that the dentist has an important role in making patients aware of the detrimental effects that smoking has on periodontal tissues and health in general. The smoking habits of all patients should be inquired about during an oral examination and the patient should be strongly advised to stop smoking by pointing out the risks involved and the positive benefits gained from breaking this habit. It is essential that the dentist is supportive in this role in an attempt to improve the oral status of the individual.

Humans↗
PubMed1991

Role of anaerobic bacteria in periodontal disease.

Microscopic examination and cultural studies of subgingival dental plaque have indicated that a complex, predominantly anaerobic flora is associated with periodontal disease. About 10 to 15 bacterial species, all of them anaerobic with the exception of A actinomycetemcomitans, have been suggested to be periodontal pathogens. These data indicate that most forms of periodontal disease are chronic anaerobic infections. This possibility has been evaluated by the systemic use of metronidazole, an antimicrobial whose spectrum of activity is limited to anaerobes. These six metronidazole double-blind studies demonstrate that metronidazole, given for periods of time as short as 1 week, can lead to a significant improvement in periodontal health. Maximal benefits are obtained when the metronidazole is given after the tooth surfaces are debrided of plaque and calculus. The best response is often noted in the more advanced cases, in which an anaerobic flora including spirochetes and black-pigmented Bacteroides usually predominates in the subgingival plaque. The success of short-term metronidazole treatment in these investigations indicates that the overgrowth of certain anaerobes in the plaque is responsible for most forms of periodontal disease.

Bacteria, Anaerobic↗
PubMed1984

The role of bleeding upon probing in the diagnosis of periodontal disease. A literature review.

Assessment of bleeding upon probing is an integral part of a periodontal examination. Recent investigations have indicated that bleeding reflects histological, clinical and bacteriological alterations associated with periodontal disease. Furthermore, clinical and histologic data suggest that bleeding is an earlier sign of gingivitis than visual signs of inflammation (redness and swelling). The current literature referring to the role of bleeding upon probing in the diagnosis of periodontal disease is reviewed, and its limitations as a clinical parameter are discussed.

Bacteria↗
PubMed2002

Importance of periodontal disease in the kidney patient.

End-stage renal disease (ESRD) patients on hemodialysis experience a greatly increased rate of atherosclerotic complications. In both hemodialysis and general populations, it has become evident that inflammation plays a central role in the pathogenesis of atherosclerotic complications. C-reactive protein (CRP), the major acute phase protein in man, has been found to predict all-cause and cardiovascular mortality in ESRD patients on hemodialysis maintenance therapy. Hepatic CRP synthesis is upregulated by proinflammatory cytokines released locally at sites of infection or inflammation, although many patients experience elevated CRP values in the absence of overt infection or inflammation. Destructive periodontal diseases in the general population have been associated with both an increased prevalence of atherosclerotic complications and an elevation in serum CRP values. In view of the prevalence of destructive periodontal diseases in the general population, and since periodontal evaluations are normally not performed as part of a medical assessment, destructive periodontal diseases may be an over looked source of inflammation in ESRD patients on hemodialysis therapy. The intent of this report is to review the possible role destructive periodontal diseases and associated periodontal infections may play in the management of the ESRD patient on hemodialysis maintenance therapy.

Acute-Phase Reaction↗