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PubMed2005

A retrospective study of periodontal disease severity in smokers and non-smokers.

BACKGROUND: Smoking has been associated with increased risk of periodontitis. The aim of the present study was to compare the periodontal disease severity of adult heavy smokers and never-smokers referred for assessment and treatment of chronic periodontitis. METHODS: A random sample of patients with at least 20 teeth, stratified for smoking and age (5-year blocks, 35 to 55 years), was selected from an original referral population of 1,221 subjects with chronic adult periodontitis. Adequate records for 59 never-smokers and 44 subjects who smoked at least 20 cigarettes per day were retrieved. The percentage of alveolar bone support was measured from dental panoramic radiographs with a Schei ruler at x3 magnification with the examiner unaware of the smoking status. Probing depths at six sites per tooth were obtained from the initial consultation. RESULTS: There was no significant difference in age between groups. Smokers had fewer teeth (p<0.001), fewer shallow pockets (p<0.001) and more deep probing depths (p<0.001). The differences were greater in subjects 45 years of age and over. In this age group, smokers had approximately 13% more bone loss, 15% more pockets in the 4-6 mm category and 7% more pockets in the >/= 7 mm category than the never-smokers. CONCLUSIONS: This study confirmed that smokers had evidence of more severe periodontal disease than never-smokers. The differences increased with age confirming an exposure-related response.

Adult↗
PubMed2006

Periodontal diseases in Asians.

Asia encompasses three of the four most populous nations in the world (China, India and Indonesia), accounting for nearly two-fifths of the worlds' total population. Over half of the world's population now inhabits Asia, which by definition includes countries of the Middle East and some former Socialist Soviet Republics. There has been a generally held view that Asians are particularly susceptible to periodontitis. The aim of this review is to consider the reasons for this view having become entrenched and to examine the evidence on which it could have been established and sustained. This view of a particularly high prevalence of periodontal diseases in Asians appears in retrospect to have originated from early epidemiological studies using an index system which gives weight to gingivitis and moderate periodontitis resulting from poor oral hygiene and calculus deposition, very commonly encountered in Asian populations. Studies that have been conducted comparing Asians immigrants with native Caucasians in industrialized northern hemisphere nations broadly concluded that Asians displayed worse periodontal conditions than Caucasians. Similarly, a classic study comparing Norwegian males with Sri Lankan Tamil males demonstrated worse periodontal conditions in the Asian males. A recent review (Albander and Rams, 2002) has stated that those of African origin display the highest prevalence of periodontitis followed by Hispanics and Asians. Studies of the natural history of periodontal disease in Asians, of perio-dontopathogens in Asians, of risk for periodontal destruction, and of reasons for extraction do not appear to explain increased susceptibility of Asians to periodontal destruction. Poor oral hygiene and calculus deposits are widespread, however. Traditional assessments of periodontitis focus on destruction of the periodontal attachment in terms of attachment loss and probing pocket depths, with no consideration being given to the morphological features of the dentition from which the periodontal attachment is being lost, features that may predispose to or complicate the management of periodontal destruction. The Mongoloid dentition shows a high prevalence of such features, which adds a further dimension to the consideration of periodontal diseases among many Asian peoples. Appropriate strategies for the prevention and management of periodontal disease should focus upon improvements in the oral hygiene situation in the diverse continent of Asia.

Asian People↗
PubMed1983

Microbiological and clinical effects of topical subgingival antimicrobial treatment on human periodontal disease.

This study was undertaken to evaluate the microbiological and clinical effects of a subgingivally applied mixture of H2O2-NaCl and NaHCO3 followed by subgingival irrigation with 1% Betadine in the treatment of periodontal disease. 20 adults with moderate to severe periodontal disease were included in a split mouth design study. All patients were given oral hygiene instruction and were subjected to supragingival scaling in all 4 quadrants, and subgingival scaling and root planing of half the dentition. 10 patients were instructed to use the chemical antimicrobial mixture twice a day instead of dentifrice, and also received professional application of the mixture once every 14 days for 3 months in connection with reinstruction in oral hygiene procedures. The remaining 10 patients received oral hygiene instructions combined with professional tooth cleaning without use of chemicals once every 14 days during a 3-month period. The effect of treatment was evaluated by monitoring the subgingival microflora, clinical periodontal parameters, and by computer assisted subtraction analysis of serial standardized radiographs to determine changes in mass of the supporting alveolar bone. The present study revealed that subgingival debridement combined with mechanical plaque control resulted in decreased numbers of subgingival microorganisms including spirochetes and motile rods, and arrested the progressive breakdown of the periodontal tissues. Topical antimicrobial agents used in combination with subgingival scaling further reduced the subgingival microflora and substantially improved early periodontal healing including gain of probing attachment level and gain in radiographic alveolar bone mass during the 12 months of observation. No clinical improvement but a tendency to further periodontal breakdown was found in the unscaled quadrants, even in those which were subjected to a personal application of the topical antimicrobial mixture. This study indicates that professional and personal subgingival application of a mixture of H2O2-NaCl and NaHCo3 will significantly enhance the microbiological and clinical effects of periodontal scaling and root planing. These agents, and the topical mode of antimicrobial therapy seem promising in the management of human periodontal diseases.

Administration, Topical↗
PubMed1975

[Prosthetics and prevention of periodontal diseases].

This paper gives a survey of the present knowledge regarding prosthetical treatment under the aspects of preventing periodontal disease. This survey is based on the German publications mainly of the past ten years. In the beginning, the prevention of periodontal disease is weighed against the requirements of caries prophylaxis. Then the requirements of periodontal hygiene are described that are inevitable for the beginning of treatment as well as for the dentures themselves. The marginal periodontium that is in contact with the margin of the crown is generally regarded as an area of minor resistance, therefore particular attention should be given to this point of contact. Construction of removable, partial dentures for partially edentulous jaws is also discussed in detail. Final conclusions show that our knowledge in this specific field has been broadened.

Denture Design↗
PubMed2002

Relationship between stress factors and periodontal disease.

AIMS: In addition to bacterial infections, adverse effects of immunological changes, in particular, stress factors may represent precipitating parameters of inflammatory periodontal diseases. The purpose of the present clinical study was to identify a possible relationship between an increase in life stress and the development of the loss of periodontal attachment. METHODS: A total number of 120 patients with chronic periodontitis (PA group) were examined and compared with a control group of 122 patients (exclusion criterion: pathological periodontal changes) matched for age and gender. The individual life situation and possible stress factors were evaluated by the use of a questionnaire, which comprised questions on various aspects of everyday life. RESULTS: The comparison of the results obtained for the two groups yielded statistically significant differences on all except one question. The control group achieved substantially lower scores on a scale from 0 (positive attitude) to 10 (negative attitude) in the evaluation of the degree to which a life event was perceived as stressful than the group with periodontal disease. For example, the average intensity score on the subjective assessment of emotional equilibrium ranged at 5.8 +/- 2.2 in the group of patients with periodontal disease (PA group) compared to 3.6 +/- 2.0 in the control group. The question regarding significant familial changes was answered positively by 37.5% of patients in the PA group, and by 22.9% of the controls. From among the questions designed to provide information on specific dental problems, those regarding clenching or grinding of the teeth were answered positively by 45.0% of the PA group and by 22.3% of the patients from the control group. CONCLUSION: The results of the present study suggest that life event stress may exert an unfavourable effect on the course of chronic periodontitis.

Adult↗
PubMed1987

Cost-effectiveness analysis of periodontal disease control.

Cost-effectiveness analysis was used to evaluate alternative methods of periodontal disease control. The alternatives considered included non-surgical and surgical procedures as well as the use of antimicrobial agents. Data on costs were obtained from American Dental Association publications of average charges for periodontal services. The concept of quality-adjusted tooth-years (QATYs) was developed to provide an outcome measure which could be compared across treatments. The conclusions of this analysis are as follows: (1) Conservative non-surgical treatments for periodontal disease control not only have costs lower than surgical alternatives, as would be expected, but also maximize expected quality-adjusted tooth-years over a wide range of estimates; (2) antimicrobial therapy used as an adjunct to non-surgical treatment is likely to be both effective and cost-effective; and (3) quality of tooth-years is a critical consideration in the determination of outcome of periodontal treatment. For example, when tooth-years are not adjusted for quality, differences between treatments are diminished, and surgical treatment becomes as good as or better than more conservative treatments for some levels of disease severity.

Alveoloplasty↗
PubMed1994

Neutrophil function and dysfunction in periodontal disease.

The polymorphonuclear leukocyte or neutrophil is an integral part of the acute inflammatory response. Its function as a protective cell in the pathogenesis of periodontal disease has been studied extensively. Abnormal neutrophil function has been associated (directly or indirectly) with the pathogenesis of early onset periodontal disease. This paper reviews the recent developments in neutrophil function and dysfunction as they relate to periodontal disease progression.

Cytotoxicity, Immunologic↗
PubMed2000

Analysis of human gingival tissue and gingival crevicular fluid beta-glucuronidase activity in specific periodontal diseases.

BACKGROUND: Beta-glucuronidase (betaG) is one of the enzymes involved in the destruction of non-collagenous components of the extracellular matrix. It is also considered an indicator or predictor of periodontal disease activity. The present study was conducted to determine the presence and the levels of betaG activity in gingival tissue and gingival crevicular fluid (GCF) in periodontal disease and health status. The validity of 2 expressions of data, total betaG activity versus betaG concentration, and the correlations between clinical periodontal status and betaG profile was also evaluated. METHODS: betaG activities in gingival tissues and GCF samples from 57 individuals, divided into 3 equal groups of adult periodontitis (AP), early-onset periodontitis (EOP), and periodontally healthy subjects were spectrophotometrically examined. RESULTS: Both patient groups had higher betaG levels in both gingiva and GCF than controls. Significant differences were observed among all groups when total GCF betaG activities were examined (P <0.05). However, the difference between AP and controls was not significant when concentration values were compared (P >0.05). The highest GCF betaG activity, with both expressions, was detected in EOP group. No absolute correlations between clinical parameters and betaG activity were observed, except for random correlations in the patient groups with mean total betaG activities. Also GCF/gingiva betaG levels and the 2 expressions did not show absolute correlations. CONCLUSIONS: The findings of the present study confirm the relationship between betaG activity and periodontal diseases. The differences in data concerning GCF total betaG activity and betaG concentration may suggest that they are not matching measures. Data presentation seems to be an important factor in GCF/enzyme profile studies.

Adolescent↗
PubMed2001

Smoking and subgingival microflora in periodontal disease.

AIM: The present investigation was undertaken to analyze the influence of smoking on the periodontal disease associated subgingival microflora. The population included 33 smokers and 31 non-smokers in the age range 36-86 years. METHODS: Microbial samples were obtained from 4 sites per patient. The checker-board DNA-DNA hybridization technology was used for detection of the bacterial species P. gingivalis, P. intermedia, P. nigrescens, B. forsythus, A. actinomycetemcomitans, F. nucleatum, T. denticola, P. micros, C. rectus, E. corrodens, S. noxia and S. intermedius. RESULTS: Using score 1 as cutoff, contrasting colonized versus non-colonized patients, 8 out of 12 species were detected in > or = 90% of both smokers and non-smokers. Using score 4 as cutoff, contrasting heavily colonized patients versus non-colonized and less heavily colonized patients, the detection rates decreased in both smokers and non-smokers. No significant differences in detection rates were observed between smokers and non-smokers. Logistic regression analysis indicated that neither smoking, probing depth nor gingival bleeding influenced the occurrence of the species analyzed. The lack of a smoking exposure dose-response further supported the indication of a limited influence of smoking. CONCLUSION: Smoking exerts little, if any, influence on the subgingival occurrence of several of the bacteria most commonly associated with periodontal disease.

Adult↗
PubMed2005

Periodontal disease -- the emergence of a risk for systemic conditions: pre-term low birth weight.

This paper addresses the problem of adverse pregnancy outcome in relation to periodontal disease. There is compelling evidence that a link exists between pre-term low birth weight (PLBW) and periodontitis. Although 25% to 50% of PLBW deliveries occur without any known aetiology, there is increasing evidence that infection may play a significant role in pre-term delivery. A model explaining the plausible relationship is proposed based upon the concept of infection leading to a cascade of inflammatory reactions associated with pre-term labour and periodontal disease. Current evidence has pointed to an interest in dental intervention studies to control periodontal disease as one of the potential strategies to reduce pre-term labour. This paper reviews the potential association between periodontal infection and adverse pregnancy outcomes.

Animals↗
PubMed1999

Cysteine protease inhibitory activity and levels of salivary cystatins in whole saliva of periodontally diseased patients.

The 3 human salivary cystatins S, SA and SN are multifunctional proteins that possess a cysteine protease inhibitory property, but their ability to act as such is very different (SN > SA >> S). One form, S, also appears to possess antibacterial properties towards the bacterium Porphyromonas gingivalis, often associated with periodontal diseases. In this study we measured the total cystatin inhibitory activity and the levels of each salivary cystatin in the whole saliva of 8 periodontally diseased patients and 2 groups of control subjects (n = 6 and n = 10). The total cystatin inhibitory activity and the total salivary cystatin concentration in the periodontally diseased patients were found to be lower than the controls (p < or = 0.005). The concentration of S was depleted to levels that would not allow it to be an effective antibacterial agent, and the concentration of SA, although depleted in some cases, was still present at sufficient levels to allow it to act as an effective physiological inhibitor of cathepsin L. The concentration of cystatin SN was also depleted in the periodontally diseased patients, but was still present in sufficient quantities to act as an effective physiological cysteine protease inhibitor of cathepsins H and L. In comparison, the concentration of all 3 salivary cystatins in the control subjects were sufficient to enable these proteins to be both effective physiological cysteine protease inhibitors and antibacterial agents.

Adult↗
PubMed2004

Lack of association between the TNF alpha G -308 A promoter polymorphism and periodontal disease.

BACKGROUND: Immunorelevant gene polymorphisms might influence the susceptibility for periodontal disease. The present study assessed the frequency of a promoter polymorphism (-308G-to-A) of the tumour necrosis factor (TNF)alpha gene in patients with periodontitis and controls. METHODS: Eighty-one patients with generalized chronic periodontitis and 80 healthy controls were genotyped for the -308 polymorphism of the TNF alpha gene by PCR amplification and subsequent restriction fragment length polymorphism analysis. The diagnosis of chronic periodontitis was made for each subject on basis of standardized clinical and radiographic criteria. RESULTS: In patients with peridontitis and controls, the frequency of the TNF alpha-308 A allele was comparable (19.1% [31/162] versus 13.8% [22/160]; p=0.193). CONCLUSION: The present study revealed no association between the -308 TNF alpha gene polymorphism and periodontal disease.

Adenine↗
PubMed1992

[A clinico-histological study for the diagnosis and classification of spontaneous periodontal diseases in the dog].

Using standardized investigation methods periodontal parameters were proved for diagnostic application of spontaneous periodontal diseases in dogs. The diseases are classified in gingivitis simplex, g. granulomatosa, g. ulcerosa, g. hyperplastica, g. desquamativa, juvenile periodontitis, rapidly progressive p. and chronic p. This proposal can be used for further investigations in experimental dentistry and for therapeutic purposes in veterinary dentistry.

Animals↗
PubMed1986

Periodontal health and periodontal disease in young people: global epidemiology.

A review of epidemiological surveys of the periodontal conditions of young people has shown that chronic marginal gingivitis associated primarily with plaque, is global, very common and even endemic in some population groups. Data on the prevalence of transient gingival conditions associated with tooth eruption, puberty and systemic factors are lacking and therefore their contribution to the prevalence of periodontal disease is unknown. Reports of periodontitis in young people are relatively uncommon except in a few populations where it appears as an adult-type of chronic marginal periodontitis. Juvenile periodontitis and other more destructive forms of periodontitis are not common. However, problems in epidemiological methodology and clinical differential diagnosis make comparative evaluation of survey data difficult and subjective. Two epidemiological indices, the Periodontal Index and the Community Periodontal Index of Treatment Needs (CPITN) have been used for many surveys in varied population groups. They provide data which agree on the ubiquity of gingivitis, whether identified visually or by bleeding-on-probing, and the low frequency of periodontitis. Data from CPITN surveys reveal a higher prevalence of calculus (sub-gingival) associated with gingivitis in young people than previously reported. All the epidemiological data reviewed point to plaque as the primary aetiological agent in gingivitis. There is little evidence of the involvement of other factors except that host resistance/susceptibility in this age group may modify the microbial effect.

Adolescent↗
PubMed2002

Gingival recession in smokers and non-smokers with minimal periodontal disease.

BACKGROUND/AIMS: Smoking is a major risk factor for destructive periodontal disease. There is limited information with regard to effects of smoking in subjects with minimal periodontal destruction. The aim of the present investigation was to assess the development of gingival recession in young adult smokers and non-smokers. METHODS: 61 systemically healthy young adults, 19 to 30 years of age completed the final examination. 30 volunteers smoked at least 20 cigarettes per day, whereas 31 subjects were non-smokers. Clinical periodontal conditions were assessed 4x within a time period of 6 months. Site-specific analyses considering the correlated structure of data were performed. RESULTS: At the outset, 50% of subjects presented with gingival recession at 1 or more sites. There was no significant difference in the prevalence of gingival recession between non-smokers and smokers. Severe recession in excess of 2 mm affected about 23% non-smokers but only 7% smokers. Some further gingival recession developed during the 6-month observation period. In a multivariate logistic regression analysis, the risk for recession development appeared not to be influenced by smoking status after adjusting for periodontal probing depth, recession at baseline, tooth brushing frequency, gender, jaw, tooth type and site. CONCLUSIONS: Present data did not support the hypothesis that smokers are at an increased risk for the development of gingival recession.

Adult↗
PubMed1985

Current concepts of the pathogenesis of periodontal disease. Microbiology emphasis.

A summary of the major highlights of periodontal pathogenesis research with particular emphasis on periodontal microbiology is presented. Bacteriologic specificity, periodontal disease activity, anatomical plaque research, bacterial recolonization and the concept of bacterial succession are discussed. Periodontal immunology, gingival fluid, histopathology as well as clinical research are briefly mentioned as they interrelate with periodontal microbiology.

Adult↗
PubMed2001

[Key components of pathogenesis of periodontal diseases in light of cytomorphological findings].

A new cytomorphometrical method for evaluation of periodontal status by cytograms of gingival impressions is based on estimation of destruction index and inflammatory destructive index. This method will be helpful in the diagnosis of periodontal diseases, monitoring of the pathological process after treatment, and in solution of theoretical problems, e.g. investigation of the key factors in the pathogenesis of periodontal diseases. The authors analyze the relationship between the two major components of pathogenesis of periodontal inflammation-inflammatory infiltrative process and destructive changes.

Humans↗
PubMed1988

Use of antimicrobial containing acrylic strips in the treatment of chronic periodontal disease. A three month follow-up study.

Local antimicrobial therapy has been considered for use in the treatment of chronic periodontal disease. This study evaluated chlorhexidine, metronidazole, and tetracycline delivered into periodontal pockets in an acrylic resin vehicle and compared the results with root planed and untreated sites over a three-month follow-up period. One site per patient where pocketing greater than or equal to 6 mm associated with a single rooted tooth was randomly allocated to one of the five possible regimens. Baseline and follow-up measurements included probing depth, loss of attachment, bleeding on probing, crevicular fluid flow, and dark-field microscopy of a subgingival plaque sample. Intratreatment evaluations revealed no significant changes in any parameter for untreated sites. Significant improvements in many parameters occurred with all four therapies although the magnitude and duration were greater in metronidazole and root planing groups. The more important intertreatment comparisons indicated that most treatments produced significant benefits compared with the control group; however, again these were greater with metronidazole and root planing. Furthermore, significantly greater effects were noted for metronidazole and root planing compared with tetracycline and more particularly chlorhexidine. It is concluded that some locally delivered antimicrobials alone may be useful in the treatment of chronic periodontal disease. However, at this time local antimicrobial therapy should be considered as adjunctive to conventional debridement techniques.

Adult↗