Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “Chronic Periodontitis”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 109 records · Page 6Linked to original sources
PubMed2004

Effectiveness of adjunctive low-dose doxycycline therapy on clinical parameters and gingival crevicular fluid laminin-5 gamma2 chain levels in chronic periodontitis.

BACKGROUND: Laminin-5 (Ln-5) is involved in the apical migration of epithelial cells during the development of periodontal pockets. Low-dose doxycycline (LDD) can therapeutically modulate the host response with its non-antimicrobial properties. In the present randomized, double-blind, placebo-controlled, parallel arm study, the effectiveness of LDD in combination with non-surgical periodontal therapy on gingival crevicular fluid (GCF) Ln-5 gamma2 chain fragment levels and clinical parameters in patients with chronic periodontitis was examined over a 12-month period. METHODS: GCF samples were collected and clinical parameters including probing depth (PD), clinical attachment level, gingival index (GI), and plaque index were recorded. Thirty chronic periodontitis patients were randomized either to low-dose doxcycline or placebo groups. LDD group received doxycycline (20 mg, b.i.d.) for 3 months plus scaling and root planing (SRP), while placebo group was given placebo capsules b.i.d. for 3 months plus SRP. The patients were evaluated every 3 months during the 12-month study period. All clinical parameters and GCF sampling were repeated at each visit. GCF Ln-5 gamma2 chain fragment levels were determined by Western immunoblotting using specific antibody and quantitated by computerized image analysis. Friedman test was used for intragroup comparisons followed by Wilcoxon signed rank test to analyze significance of changes over time. The Mann-Whitney test was used to determine differences between both LDD and placebo groups. RESULTS: Both groups revealed significant improvements in all clinical parameters over the 12-month period (P < 0.0125). LDD group showed a significantly greater reduction in the mean PD scores at 9 and 12 months and in the mean GI scores at all time points than the placebo group (P < 0.05). In the LDD group, GCF Ln-5 gamma2 chain fragment levels were significantly reduced at 3 months (P < 0.0125) and then slightly increased during the rest of the study period. In the placebo group, GCF 45 and 70 kDa Ln-5 gamma2 chain fragments tended to decrease at 3 months compared to baseline, but did not reach significance; these levels continued to increase throughout the remainder of the study period. GCF Ln-5 gamma2 chain fragment levels in LDD group were significantly lower than those of the placebo group during the study period (P < 0.05). CONCLUSIONS: The present data indicate that LDD therapy in combination with SRP therapy can reduce GCF Ln-5 gamma2 chain fragment levels and improve clinical periodontal parameters in patients with chronic periodontitis. Since matrix metalloproteinases (MMP)-mediated fragmentation of laminin-5 can contribute to pocket formation by stimulating epithelial cell migration, the reduction of Ln-5 gamma2 chain fragment levels could provide a new mechanism by which LDD, adjunctive to SRP, inhibits periodontal disease more effectively than SRP alone. Thus, these results provide extended and additional information about the effectiveness of the LDD therapy as an adjunct to non-surgical periodontal therapy in the long-term management of periodontal disease.

Adult↗
PubMed2004

Rate of cultivable subgingival periodontopathogenic bacteria in chronic periodontitis.

Although microbiological studies have identified more than 400 bacterial species in periodontal pockets, only a limited number have been implicated as periodontal pathogens. The purpose of this study was to investigate the incidence of cultivable subgingival periodontopathogenic bacteria in chronic periodontitis. Bacterial samples were collected with sterile paper points from the deepest periodontal pockets ((5 mm) of 203 patients: 92 males and 111 females, aged 35-55 years. The samples were cultured under anaerobic and capnophilic conditions using selective and non-selective media. Isolates were characterized to species level by conventional biochemical tests and a commercial rapid test system. The isolates were Actinobacillus actinomycetemcomitans (26.8%), Porphyromonas gingivalis (21.9%), Capnocytophaga sputigena (16.7%), Eikenella corrodens (13.2%), Prevotella intermedia (10.5 %), Prevotella disiens (3.1%), Peptostreptococcus micros (2.9%), Capnocytophaga gingivalis (2.2%), Prevotella corporis (1.8%), Peptostreptococcus magnus (1.3%) and Fusobacterium nucleatum (0.4%). No periodontopathogenic bacterial growth was observed in 14 of the samples (6.2%). The number of samples associated with monobacterial growth and polybacterial growth were 74.9% and 18.2% respectively. It is concluded that the bacterial composition associated with a number of patients' samples is quite complex, and that some of cultivable anaerobic and capnophilic bacteria act as periodontal pathogens in chronic periodontitis.

Adult↗
PubMed2002

A systematic review of the effect of surgical debridement vs non-surgical debridement for the treatment of chronic periodontitis.

OBJECTIVE: To systematically review the evidence of effectiveness of surgical vs. non-surgical therapy for the treatment of chronic periodontal disease. METHODS: A search was conducted for randomized controlled trials of at least 12 months duration comparing surgical with non-surgical treatment of chronic periodontal disease. Data sources included the National Library of Medicine computerised bibliographic database MEDLINE, and the Cochrane Oral Health Group (COHG) Specialist Trials Register. Screening, data abstraction and quality assessment were conducted independently by multiple reviewers (L.H., F.H., L.T.). The primary outcome measures evaluated were gain in clinical attachment level (CAL) and reduction in probing pocket depth (PPD). RESULTS: The search provided 589 abstracts of which six randomized controlled trials were included. Meta-analysis evaluation of these studies indicated that 12 months following treatment, surgical therapy resulted in 0.6 mm more PPD reduction (WMD 0.58 mm; 95% CI 0.38, 0.79) and 0.2 mm more CAL gain (WMD 0.19 mm; 95% CI 0.04, 0.35) than non-surgical therapy in deep pockets (>6 mm). In 4-6 mm pockets scaling and root planing resulted in 0.4 mm more attachment gain (WMD -0.37 mm; 95% CI -0.49, -0.26) and 0.4 mm less probing depth reduction (WMD 0.35 mm; 95% CI 0.23, 0.47) than surgical therapy. In shallow pockets (1-3 mm) non-surgical therapy resulted in 0.5 mm less attachment loss (WMD -0.51 mm; 95% CI -0.74, -0.29) than surgical therapy. CONCLUSIONS: Both scaling and root planing alone and scaling and root planing combined with flap procedure are effective methods for the treatment of chronic periodontitis in terms of attachment level gain and reduction in gingival inflammation. In the treatment of deep pockets open flap debridement results in greater PPD reduction and clinical attachment gain.

Chronic Disease↗
PubMed2006

MMP-1 promoter gene polymorphism and susceptibility to chronic periodontitis in a Chinese population.

A single nucleotide polymorphism in the promoter region of -1607 bp of the human MMP-1 gene has been found to be associated with an increased risk of various inflammatory diseases and cancer metastasis. This study aimed to evaluate the association between the MMP-1 promoter gene polymorphism and chronic periodontitis susceptibility and/or severity in a Chinese population. Genomic DNA was obtained from whole blood samples in 60 Chinese subjects with chronic periodontitis and 50 periodontally healthy subjects as controls. MMP-1 promoter fragment was amplified by polymerase chain reaction, and the polymorphism was analyzed by restriction endonuclease cleavage. In the control subjects, the 2G allele was observed a frequency of 49%, while in severely diseased patients, the 2G allele was seen in 73.4%. The individuals with the 2G allele seem to be approximately three times at greater risk for developing the severe chronic periodontitis (chi(2) = 12.148, P = 0.000). The genotype of 2G/2G was found in 58.5% of the severe periodontitis and 24% of the control group (chi(2) = 11.779, P = 0.003). This study suggests that a single nucleotide polymorphism in the MMP-1 promoter region of -1607 bp may be associated with severe chronic periodontitis in a Chinese population.

Adult↗
PubMed2005

Association of the -159 CD14 gene polymorphism and lack of association of the -308 TNFA and Q551R IL-4RA polymorphisms with severe chronic periodontitis in Swedish Caucasians.

BACKGROUND: Severe forms of periodontitis are suggested to have a genetic basis. OBJECTIVE: The aim of the present investigation was to study the association of gene polymorphisms related to some immune regulation components (G-308A TNFA, Q551R IL-4RA and C-159T CD14) with severe chronic periodontitis. MATERIALS AND METHODS: Sixty patients (aged 36-74 years; mean 54.5+/-8.5) with severe and generalized chronic periodontitis were included. The patients exhibited bone loss >50% at all teeth. Thirty-nine periodontally healthy subjects between 35 and 78 years of age (mean 51.0+/-10.9) were recruited as controls. DNA was isolated from peripheral blood cells and genotyping was performed by combination of PCR and restriction endonuclease mapping. RESULTS: While gene polymorphisms for TNFA and IL-4RA did not show any association with severe chronic periodontitis, the analysis of the -159 CD14 gene polymorphism revealed significant differences between test and control groups. The proportion of subjects that exhibited the TT genotype was significantly smaller in the group with severe periodontitis than in periodontal healthy group (p=0.028; Fisher's exact test). The C allele carriage was 90% in the periodontitis group and significantly higher than in the healthy control group (72%). CONCLUSION: It is suggested that the -159 CD14 gene polymorphism is associated with chronic periodontitis in Caucasian subjects of a north European origin.

Adult↗
PubMed2004

Endothelial dysfunction in patients with chronic periodontitis and its improvement after initial periodontal therapy.

BACKGROUND: Recent epidemiological data suggested that there is a relationship between periodontal health and atherosclerotic coronary heart disease. Although hypothetical models were proposed, the exact mechanism of this association has not been clarified. The aim of this study is to investigate whether there is an endothelial dysfunction in patients with chronic periodontitis and, if present, whether recovery is possible with therapy. METHODS: The study groups consisted of 28 patients (mean age: 45.5 +/- 8.6 years) with chronic periodontitis and without any atherosclerotic vascular disease, and 26 healthy controls (mean age: 43.7 +/- 6.8 years). Cardiovascular risk factors were investigated in both groups. Brachial artery responses to reactive hyperemia (endothelium-dependent dilatation [EDD]) and sublingual nitroglycerin (endothelium-independent dilatation [EID]) were measured using high-resolution vascular ultrasound in both groups. Measurements were taken before and after initial periodontal therapy in the periodontal patients. RESULTS: There was no significant difference between the groups with regard to cardiovascular risk factors. In the baseline measurements, EDD and EID were significantly impaired in patients with chronic periodontitis when compared with the controls (8.4% +/- 4.0% versus 19.4% +/- 8.1%, P<0.0001; 13.3% +/- 6.3% versus 29.5% +/- 10.0%, P<0.0001 for EDD and EID, respectively). After non-surgical periodontal therapy, EDD and EID improved significantly (from 8.4% +/- 4.0% to 17.7% +/- 5.7%, P<0.0001; and from 13.3% +/- 6.3% to 24.9% +/- 7.3%, P<0.0001 for FMD and EID, respectively). The EDD and EID changes in the controls were insignificant. CONCLUSION: This study showed that endothelial functions were impaired in patients with chronic periodontitis and that they improve following initial periodontal therapy.

Arteriosclerosis↗
PubMed2006

Association of matrix metalloproteinase-9 promoter gene polymorphism with chronic periodontitis.

BACKGROUND: Matrix metalloproteinases (MMPs) are related to tissue destruction and remodeling events in periodontal diseases. A single nucleotide polymorphism in the promoter region of human MMP-9 gene is associated with the risk of some inflammatory diseases. Therefore, the aim of this study was to investigate the association between MMP-9 promoter polymorphism and severe generalized chronic periodontitis in a Turkish population. METHODS: Samples of venous blood and DNA were obtained from 70 severe generalized chronic periodontitis patients and 70 healthy subjects. The alleles of the C/T polymorphism at position -1562 in the promoter region of the MMP-9 gene were distinguished by cutting with the SphI restriction enzyme. Genotype and allele frequencies were calculated, and data were analyzed by the chi2 test. RESULTS: There was a significant difference in MMP-9 genotypes between chronic periodontitis patients and healthy controls. The odds ratios for the CT genotype and the combination of CT and TT genotypes were 0.4 (95% confidence interval, 0.17 to 0.93; P=0.02) and 0.37 (95% confidence interval, 016 to 0.85; P=0.01) relative to the subjects with the CC genotype, respectively. CONCLUSION: MMP-9 promoter gene polymorphism seems to be associated with severe generalized chronic periodontitis.

Adult↗
PubMed2001

Distribution of the receptor for advanced glycation end products gene polymorphisms in patients with chronic periodontitis: a preliminary study.

BACKGROUND: Periodontal diseases are viewed today as multifactorial problems initiated and sustained by bacteria but significantly modified by the body's response to bacterial plaque. A recent study suggested that receptor for advanced glycation end products (RAGE) could be involved in the pathophysiology of periodontitis. The aim of this study was to investigate a possible association of 3 common polymorphisms in the RAGE gene with chronic periodontitis. METHODS: We studied 101 Caucasian patients with chronic periodontitis together with 162 orally healthy subjects. Three polymorphisms, one in intron 7 (1704G/T), second in intron 8 (2184A/G), and the third in exon 3 (G82S) of the RAGE gene, were investigated by polymerase chain reaction methods (PCR) with subsequent enzymatic restriction with Bfal, BsmFI, or Alu Il, respectively. RESULTS: A statistically significant difference in allele frequencies between patients and the reference group was found for intron variant 1704G/T (P= 0.02, Pcorr >0.05). There was no significant difference in genotype or allele frequency distributions between groups for intron variant 2184A/G or for the exon variant exchanging amino acid Gly for Ser at position 82 (G82S). CONCLUSIONS: We can speculate that susceptibility to the development of chronic periodontitis could be influenced by the 1704G/T polymorphism of the RAGE gene, independently of diabetes.

Adult↗
PubMed2006

Analysis of the interleukin-1 and interleukin-6 polymorphisms in patients with chronic periodontitis. A pilot study.

The aim of this study was to analyse whether the interleukin-1 (IL-1) and IL-6 gene polymorphisms were associated with the susceptibility of chronic periodontitis. Genomic DNA was obtained from 20 patients with chronic periodontitis and 31 periodontally healthy subjects. All subjects were of North European heritage. The test subjects were kept in a maintenance program after periodontal treatment but yet showing signs of recurrent disease. Genotyping of the IL-1alpha [+4845C>T], IL-1beta [-3954C>T] and IL-6 [-174G>C] polymorphisms was carried out using an allelic discrimination Assay-by-Design method on ABI PRISM 7900 Sequence Detection System. All genotypes were analyzed using the GeneMapper 2.0 software. A similar distribution of Single Nucleotide Polymorphism (SNP) was seen in both groups. Analysis by logistic regression including gender, IL-1alpha [+4845C>T], IL-1beta [-3954C>T], IL-6 [-174G>C] genotypes, the composite IL-1 genotype, the combination of the composite IL-1 genotype and the IL-6 -174G>C genotype and adjusting for smoking did not result in any statistically significant difference. SNPs in IL-1alpha [+4845C>T], IL-1beta [-3954C>T] and IL-6 [-174G>C] do not seem to increase the susceptibility to chronic periodontitis in this group of subjects.

Adult↗
PubMed2002

Clinical utility of a genetic susceptibility test for severe chronic periodontitis: a critical evaluation.

BACKGROUND: A genetic susceptibility test for severe chronic periodontitis is now commercially available. It detects the simultaneous presence of a specific form of two interleukin genes--allele 2 at the IL1A+4845 and IL1B+3954 loci. Patients are referred to as being "genotype-positive" if both of these alleles are present. A fundamental premise of the test is that a combination of these alleles is responsible for increased secretion of IL-beta, which results in a hyperinflammatory response to a bacterial challenge, thereby predisposing a person to develop severe chronic periodontitis. TYPES OF STUDIES REVIEWED: The authors reviewed controlled clinical trials that assessed the association between specific genotypes and the patient's susceptibility to increased bleeding on probing, periodontitis and loss of teeth or dental implants. RESULTS: The relationship between specific IL-1 genotypes and the level of IL-1beta in the gingival crevicular fluid is unclear. Similarly, the ability of the genetic susceptibility test to forecast which patients will develop increased bleeding on probing, periodontitis, or loss of teeth or dental implants is ambiguous. CLINICAL IMPLICATIONS: Additional prospective clinical trials are needed to determine the risk of developing periodontitis or peri-implantitis when allele 2 at the IL1A+4845 and IL1B+3954 loci is present. Therefore, it is unclear how results of the genetic susceptibility test can be used to alter patients' periodontal maintenance schedules or to change treatment regimens in periodontally symptomatic or asymptomatic patients.

Alleles↗
PubMed1978

Prevalence of chronic periodontitis in 13-15-year-old children. A radiographic study.

The bitewing radiographs of 1,731 English and Danish schoolchildren aged 13--15 years were examined to assess the prevalence of chronic periodontitis. Only one child (0.06%) was found to be affected in comparison with the high prevalence of 51.5% reported by Hull et al. (1975). Minute qualitative changes in the radiographic appearance of the alveolar crest, or changes in the visual representation of the width of the periodontal ligament space are not reliable or valid criteria for assessing chronic periodontitis. Horizontal bone loss observed on radiographs, which can be accurately measured using the cemento-enamel junction as a reference point, is a useful diagnostic criterion for the measurement of chronic periodontitis.

Adolescent↗
PubMed1975

A radiographic study of the prevalence of chronic periodontitis in 14-year-old English schoolchildren.

The prevalence of chronic periodontitis was investigated in six hundred and two 14-year-old English schoolchildren using a standardised radiographic technique. The interproximal spaces on the mesial and distal aspects of the first molar teeth were examined. Oral cleanliness and gingivitis for the anterior teeth and caries prevalence were also recorded. Radiographic evidence of chronic periodontitis was detected in 51.5% of the children examined. No significant relationship was demonstrated between bone loss associated with the first molars and any of the other parameters measured.

Adolescent↗
PubMed2002

A systematic review on the clinical efficacy of subgingival debridement in the treatment of chronic periodontitis.

OBJECTIVE: The purpose of this study was to perform a systematic review of the literature and to evaluate, in patients with chronic periodontitis, what the effect is of subgingival debridement (SGD), in terms of bleeding on probing, pocket depth and probing attachment level. MATERIAL AND METHODS: An electronic search of the Cochrane Oral Health Group specialized register and MEDLINE were performed using specific search terms to identify studies assessing in patients with chronic periodontitis the effect of subgingival debridement with regard to clinical outcomes. This was performed on titles registered up to 2001. The only papers included were those which utilized data based on the patient as unit of observation. RESULTS: The searches identified 702 abstracts. Titles and abstracts were independently screened by two reviewers (G.A.W. & M.F.T.) to identify publications that met specific inclusion criteria. The agreement between the two reviewers was assessed. The kappa score for agreement was 0.80. Review of these abstracts resulted in 114 publications for detailed review. Finally, 26 papers which met the criteria of eligibility were independently selected by the two reviewers. The kappa score for agreement on this decision was 0.92. Disagreement regarding inclusion of both abstracts and full papers was resolved by discussion between the reviewers. No randomized controlled trials (RCT) could be retrieved that were specifically designed to answer the question formulated at the outset of this systematic review. From the 10 controlled studies, four provide a definitive 'yes' that SGD is effective with regard to clinical outcomes. In the one study where subgingival debridement was not supported by oral hygiene instruction, the paper provided a definitive 'no'. The weighted mean of attachment gain of SGD in pockets initially >or=5 mm was 0.64 mm as compared with 0.37 mm for supragingival plaque control only (SPC). The reduction of pocket depth was 0.59 mm and 1.18 mm for SPC and SGD, respectively. Of the 18 papers that provided only information on the effect of treatment as compared with the baseline values, eight showed SGD to be beneficial with regard to clinical attachment level change while the remaining 10 provided no such an analysis. The weighted mean of this effect was a 0.74-mm gain of attachment as a result of treatment in pockets initially >or= 4 mm. CONCLUSIONS: In patients with chronic periodontitis, subgingival debridement (in conjunction with supragingival plaque control) is an effective treatment in reducing probing pocket depth and improving the clinical attachment level. In fact it is more effective than supragingival plaque control alone.

Adult↗
PubMed1999

Endothelial cell adhesion molecules in human dental pulp: a comparative immunohistochemical study on chronic periodontitis.

Migration of leukocytes to inflammation sites through vascular endothelium is controlled by the interactions of adhesion molecules expressed on both endothelial cells and leukocytes, most of which are already covered by cluster of differentiation (CD) codes. We examined the expression of a variety of endothelial cell adhesion molecules in human dental pulp vasculature to obtain further evidence on the tissue distribution and function of these molecules by using an indirect immunoperoxidase technique. We obtained the pulp tissue samples from teeth extracted due to orthodontic reasons as controls and compared with those extracted due to chronic periodontitis. In all samples, both CD31 and CD146 were expressed by arterial, venous, and capillary endothelia. There was no significant difference between the staining intensity of normal and inflamed pulp tissues. CD102 expression on the endothelium was significantly stronger in chronic periodontitis pulp samples. CD106, CD62-E, CD62-P, CD105, and CD54 were variably expressed in control and chronic periodontitis groups. Our results indicate that CD102 represents the major endothelial cell adhesion molecule probably involved in the inflammatory reactions in chronic periodontitis.

Antigens, Differentiation↗
PubMed2004

The effect of adjunctive low-dose doxycycline therapy on clinical parameters and gingival crevicular fluid matrix metalloproteinase-8 levels in chronic periodontitis.

BACKGROUND: Low-dose doxycycline (LDD) is recognized to have non-antimicrobial properties that can therapeutically modulate the host response. The aim of the present randomized, double-blind, placebo-controlled, parallel-arm study was to examine the effectiveness of LDD in combination with non-surgical periodontal therapy, compared to non-surgical periodontal therapy alone, on gingival crevicular fluid (GCF) matrix metalloproteinase-8 (MMP-8) levels and clinical parameters over a 12-month period in patients with chronic periodontitis. METHODS: GCF samples were collected, and clinical parameters including probing depth (PD), clinical attachment level, gingival index (GI), and plaque index were recorded. Thirty chronic periodontitis patients were randomized either to a low-dose doxycycline (LDD) or placebo group. The LDD group received low-dose doxycycline (20 mg) b.i.d. for 3 months plus scaling and root planing (SRP), while the placebo group was given placebo capsules b.i.d. for 3 months plus SRP. The patients were evaluated every 3 months during the 12-month study period. At each visit, all clinical measurements and GCF sampling were repeated. GCF MMP-8 levels were determined by a time-resolved immunofluorescence assay. Intragroup comparisons were tested by the Friedman test followed by Wilcoxon signed-rank test to analyze significance of changes over time. The Mann-Whitney test was used to determine differences between the LDD and placebo groups. RESULTS: Significant improvements were observed in all clinical parameters in both groups over the 12-month period (P < 0.0125). The LDD group showed a significantly greater reduction in mean PD scores at 9 and 12 months and in mean GI scores at all time points than the placebo group (P < 0.05). From baseline to 12 months, GCF MMP-8 levels were significantly reduced in both groups (P < 0.0125). The GCF MMP-8 level in the LDD group was significantly lower than that of the placebo group at 6 months (P < 0.05). CONCLUSIONS: The present results indicate that low-dose doxycycline therapy in combination with scaling and root planing can reduce GCF MMP-8 levels and improve clinical periodontal parameters in patients with chronic periodontitis. These results provide additional information about the usefulness of low-dose doxycycline therapy as an adjunct to non-surgical periodontal therapy in the long-term management of periodontal disease. The effectiveness and course of low-dose doxycycline therapy can be monitored conveniently by assessing GCF MMP-8 levels.

Adult↗
PubMed2004

Subgingival microbiota of chronic periodontitis subjects from different geographic locations.

BACKGROUND: Most clinical studies assume that the subgingival microbiota is similar from one geographic location to another. The purpose of the present investigation was to examine the composition of the subgingival microbiota in chronic periodontitis subjects from four countries. METHOD: Subjects with chronic periodontitis (N, Sweden=101; USA=115; Brazil=58; Chile=26) were recruited. Subjects were measured at baseline for plaque, gingivitis, bleeding on probing (BOP), suppuration, pocket depth (PD) and attachment level (AL) at six sites per tooth. Subgingival plaque samples taken from the mesial aspect of each tooth at baseline were individually analyzed for their content of 40 bacterial species using checkerboard DNA-DNA hybridization (total samples=6036). % DNA probe counts comprised by each species was determined for each site and averaged across sites in each subject. Significance of differences in proportions of each species among countries was determined using ancova adjusting for age, mean pocket depth, gender and smoking status. p-Values were adjusted for multiple comparisons. RESULTS: On average, all species were detected in samples from subjects in the four countries. Thirteen species differed significantly in adjusted mean proportions among countries even after adjusting for multiple comparisons. Porphyromonas gingivalis, one species that differed in proportions among countries, comprised adjusted means of 7.5, 11.9, 1.6 and 6.6% of the microbiota in subjects from Brazil, Chile, Sweden and USA (p<0.001), while mean proportions of Treponema denticola were 6.7, 4.2, 0.8 and 2.3, respectively (p<0.001). In contrast, a key periodontal pathogen, Tannerella forsythensis, exhibited mean proportions ranging from 6.2-8.5% and did not differ significantly among countries. Besides these species, prominent species in Brazil were Actinomyces naeslundii genospecies 1 and 2 (8.4%, 7.2%) and Prevotella intermedia (6.5%); in Chile, Prevotella melaninogenica (6.4%) and Neisseria mucosa (5.3%); in Sweden A. naeslundii genospecies 2 (8.4%), Capnocytophaga gingivalis (7.1%) and Peptostreptococcus micros (5.0%); in USA A. naeslundii genospecies 2 (7.5%), P. intermedia (6.8%) and C. gingivalis (6.1%). CONCLUSIONS: The microbial profiles of subgingival plaque samples from chronic periodontitis subjects in four countries showed surprisingly marked differences. These differences persisted after adjusting for age, mean pocket depth, gender and smoking status.

Adult↗
PubMed2003

Systemic antimicrobials in the treatment of chronic periodontal diseases: a dilemma.

The use of systemic antimicrobials in the treatment of acute and chronic periodontal diseases must be viewed as a dilemma. On the one hand, the approach is attractive because of the microbial nature of periodontal diseases but, on the other hand, evidence of benefit of these agents is equivocal for the majority of periodontal diseases and antimicrobials have the potential to cause harm. The disadvantages of systemic antimicrobials can be grouped under the headings of allergic reactions, superinfection, toxicity, drug interactions, patient compliance and, perhaps of most widespread importance, bacterial resistance. Mechanical debridement methods, including drainage of pus for acute periodontal abscesses, should be considered the first line treatment for most periodontal diseases. Systemic antimicrobials should be considered as adjuncts to mechanical debridement methods and, in chronic disease, never used alone as they can predispose to abscess formation. Adjunctive systemic antimicrobials may be considered in acute disease where debridement or drainage of pus is difficult, where there is local spread or systemic upset. In chronic periodontal diseases, adjunctive antimicrobials should be considered in early onset or rapidly progressive disease or in advanced chronic adult disease where mechanical therapies have failed or surgery is not a preferred option. Inadequate oral hygiene and tobacco smoking are contraindications to the use of antimicrobials. The value of systemic antimicrobials, where other systemic risk factors co-exist, has still to be established. The role of microbial diagnosis and sensitivity testing for antimicrobial selection at this time must be questioned.

Adult↗
PubMed2001

Utilisation of locally delivered doxycycline in non-surgical treatment of chronic periodontitis. A comparative multi-centre trial of 2 treatment approaches.

AIM: In the present 6-month multicentre trial, the outcome of 2 different approaches to non-surgical treatment of chronic periodontitis, both involving the use of a locally delivered controlled-release doxycycline, was evaluated. MATERIAL AND METHODS: 105 adult patients with moderately advanced chronic periodontitis from 3 centres participated in the trial. Each patient had to present with at least 8 periodontal sites in 2 jaw quadrants with a probing pocket depth (PPD) of > or =5 mm and bleeding following pocket probing (BoP), out of which at least 2 sites had to be > or =7 mm and a further 2 sites > or =6 mm. Following a baseline examination, including assessments of plaque, PPD, clinical attachment level (CAL) and BoP, careful instruction in oral hygiene was given. The patients were then randomly assigned to one of two treatment groups: scaling/root planing (SRP) with local analgesia or debridement (supra- and subgingival ultrasonic instrumentation without analgesia). The "SRP" group received a single episode of full-mouth supra-/subgingival scaling and root planing under local analgesia. In addition, at a 3-month recall visit, a full-mouth supra-/subgingival debridement using ultrasonic instrumentation was provided. This was followed by subgingival application of an 8.5% w/w doxycycline polymer at sites with a remaining PPD of > or =5 mm. The patients of the "debridement" group were initially subjected to a 45-minute full-mouth debridement with the use of an ultrasonic instrument and without administration of local analgesia, and followed by application of doxycycline in sites with a PPD of > or =5 mm. At month 3, sites with a remaining PPD of > or =5 mm were subjected to scaling and root planing. Clinical re-examinations were performed at 3 and 6 months. RESULTS: At 3 months, the proportion of sites showing PPD of < or =4 mm was significantly higher in the "debridement" group than in the "SRP" group (58% versus 50%; p<0.05). The CAL gain at 3 months amounted to 0.8 mm in the "debridement" group and 0.5 mm in the "SRP" group (p=0.064). The proportion of sites demonstrating a clinically significant CAL gain (> or =2 mm) was higher in the "debridement" group than in the "SRP" group (38% versus 30%; p<0.05). At the 6-month examination, no statistically significant differences in PPD or CAL were found between the two treatment groups. BoP was significantly lower for the "debridement" group than for the "SRP" group (p<0.001) both at 3- and 6 months. The mean total treatment time (baseline and 3-month) for the "SRP" patients was 3:11 h, compared to 2:00 h for the patients in the "debridement" group (p<0.001). CONCLUSION: The results indicate that simplified subgingival instrumentation combined with local application of doxycycline in deep periodontal sites can be considered as a justified approach for non-surgical treatment of chronic periodontitis.

Adult↗