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PubMed1975

Dental care and the health maintenance organization concept.

The principal dental diseases, caries and periodontal disease, affect almost the entire population and result in considerable pain and discomfort, with eventual tooth loss, if untreated. These disorders can either be prevented or their effects minimized through dental intervention so that intact functioning dentitions can be maintained. Despite the fact that enough practicing dentists probably exist in the United States to achieve these results, the majority of the population lose all of their natural teeth if they live out their normal life spans. The solo-practice fee-for-service system, even with third-party payment, may reduce the difficulties somewhat but cannot solve the problem. Prepaid dental group practice, either independently or as part of a general health care system, has the potential of virtually eliminating edentulism in populations for which it has responsibility. At present, it is possible to project costs and resource needs with sufficient accuracy to start viable entities. The "health maintenance organization" concept, therefore, applies to dental care.

Adolescent↗

PubMed1994

[Posterior implant-supported single crowns: a new treatment approach].

Up to the present time, the discussions of single crown restorations with dental implants have been focused primarily on the anterior maxilla or mandible. This clinical case presentation illustrates that it is possible to reconstruct the posterior mandible, and, for the first time, even the subantral augmented maxilla after sinus elevation, with single crowns supported by implants. The presented treatment philosophy imitates natural human dentition. After a single tooth loss, an implant is placed immediately in order to provide functional stimulation of the bone, thereby maintaining the activity of the osteoblasts and keeping the alveole bone is sound condition due to the natural function. After extensive bone augmentation, reconstruction, proper healing time, and precise prosthetic planning of the optimal location of the crowns, implants were placed accordingly and later restored with single crowns in the size of premolars. According to the natural dentition, the author placed one implant per molar root, ie, one implant each for the mesial and distal root of the first molar and possibly the mesial root of the second molar. In all the cases restored, the crown/root ratio was smaller than one. The size of the crown is designed in such a way that the masticatory forces are transmitted axially and vertically via crown into the implant. In 16 clinical cases, none of the 96 single crowns and implants (28 of these in the augmented subantral region of the maxilla), have been lost during 6 months to 3 years of use.

Dental Implantation, Endosseous↗

PubMed2026

Effects of Photobiomodulation Therapy in Lateral Luxation of Anterior Permanent Teeth: A Randomized, Double-Blind Clinical Trial.

BACKGROUND: Among the traumatic dental injuries (TDIs), lateral luxation may present poor prognosis due to frequent root resorption and consequent tooth loss. Photobiomodulation therapy (PBMT) modulates cellular activities (proliferation, differentiation, growth factor secretion) and may improve outcomes. OBJECTIVE: This randomized, double-blind, placebo-controlled trial evaluated PBMT (660 vs. 808 nm) for post-operative pain and pulp sensitivity recovery in lateral luxation of permanent anterior teeth. METHODS: Initially, 41 patients were included, with a total of 63 teeth traumatized by lateral luxation and were allocated to G1 (n = 21): Splinting + sham PBM (placebo), G2 (n = 21): Splinting + 808 nm infrared PBM and G3 (n = 21): Splinting + 660 nm red PBM. Four weekly sessions (3 J/point, 3 points) were administered. Pain (by numeric rating scale) and pulp sensitivity (by cold test) were assessed weekly. Pain was analyzed using the Kruskal-Wallis test, followed by multiple comparisons using Dunn's method with Bonferroni correction, and pulp sensitivity by a logistic regression model (p < 0.05). RESULTS: Three participants (total of 5 teeth) were excluded due to loss to follow-up. Fifty-eight teeth were analyzed (G1 = 21, G2 = 17, G3 = 20). Pain: All groups showed a significant reduction in pain over time (p < 0.001). Both G2 and G3 demonstrated a significantly greater reduction in pain compared to G1 (p < 0.001 and p = 0.026, respectively). No significant difference in pain reduction was observed between G2 and G3. Pulp sensitivity: G2 showed a significant improvement over time (p < 0.001), despite starting from a more unfavorable baseline. In contrast, no significant change in pulp sensitivity was observed for G1 or G3 between the initial and final assessments. CONCLUSION: Within the limitations of this clinical study, all intervention groups were effective in reducing pain in lateral luxation of permanent anterior teeth, with superior results for laser groups compared to the placebo. However, only the 808 nm laser irradiation protocol demonstrated a significant improvement in pulp sensitivity, suggesting it may offer a more complete therapeutic response.

Humans↗

PubMed2005

Discrepancies between self-ratings of and satisfaction with oral health in two older adult populations.

OBJECTIVES: General health perceptions, usually measured by means of single-item indicators, are commonly included in health and oral health surveys. The aim of the study reported here was to assess the relationship between self-rated oral health and satisfaction with oral health in two studies of older adult populations. METHODS: Participants in Study 1 were aged 50 years and over, the majority of whom had multiple chronic medical conditions and disabilities and lived within a multi-level geriatric care setting. They were recruited when attending a clinic in that setting for their annual dental screening. Participants in Study 2 were somewhat healthier community dwelling individuals, also aged 50 years and older, who took part. They were originally recruited by means of a telephone survey based on random-digit dialing. For Study 1, data were collected by means of personal interviews and a review of dental clinic charts, while for Study 2 personal interviews, clinical examination and self-completed questionnaires were used. Measures included self-rated oral health, satisfaction with oral health, oral health-related quality of life (OHRQoL) and tooth loss. RESULTS: Data were obtained from 225 persons in Study 1 and 541 in Study 2. In both studies there was a significant association between self-ratings of oral health and satisfaction with oral health. However, also in both studies there was a discrepancy between the measures: approximately 10% of those with favourable oral health ratings were dissatisfied while approximately half of those with unfavourable ratings were satisfied. Those with apparently discordant responses had significantly higher scores on OHRQoL measures such as the GOHAI and the OHIP-14 than those with concordant responses. In Study 2, a similar discrepancy between self-rated general health and satisfaction with general health was also observed. CONCLUSIONS: There is degree of discordance between self-ratings of and satisfaction with both oral and general health status in the older adult populations studied here. This may be because of the expectations concerning health in later life. More needs to be known about the frames of reference people use in constructing their responses to questions designed to assess health perceptions.

Activities of Daily Living↗

PubMed1995

Functionally dependent veterans. Issues related to providing and improving their oral health care.

This article discusses issues related to the quality and effectiveness of new, emerging, and existing oral health delivery mechanisms and models for the functionally dependent veteran. It describes the particular needs and unique qualities of functionally dependent veterans and enumerates the clinical dental interventions and delivery systems available to this group. Barriers specific to The Department of Veterans Affairs (VA) regarding this population and suggestions for improved access to care are summarized. Suggestions for further research are proposed with the intent that limited resources be utilized so that maximum benefits are provided to the functionally dependent veterans who need care most. What we know: Among the veteran population and the general population, the oldest cohort of elderly (those age 85 and older) are growing faster than any other age group. The rate of functional dependency increases dramatically with age, from about 10% at age 65 to 69 to about 57% after age 85. Functionally dependent elderly are the most likely group to be home-bound or in nursing homes. Compared with independent elderly, the oral status of functionally dependent elderly tends to be poorer. Functionally dependent elderly have higher rates of tooth loss, greater prevalence of denture-related problems, greater prevalence and severity of dental caries, higher prevalence of gingival and periodontal disease, and typically not seen a dentist in at least 5 years. The Department of Veterans Affairs has several advantages over non-VA settings in delivering dental care to the functionally dependent including the presence and availability of dental clinics at VA medical centers and outpatient facilities, the fact that they are free to eligible VA patients, and the greater knowledge base of the dentists. Although VA is effective in delivering oral care to a small percentage of the total population, it is likely that demand will increase and resources exhausted if certain anticipated changes occur (eg, greater demand for dental care and/or changing dental status, such as more elderly with teeth). Questions that need to be answered: What quality of oral care is VA providing to the functionally dependent veteran? What delivery systems are the most effective in providing care to the functionally dependent elderly? Is there a difference in oral health outcomes when dental personnel serve on patient care teams? What barriers exist for delivering quality oral care for the functionally dependent elderly? How can we eliminate or minimize these barriers?

Activities of Daily Living↗

PubMed1998

Skeletal evidence of health and disease in pre-contact Alaskan Eskimos and Aleuts.

There have been relatively few paleopathological studies of arctic populations to date, compared to other regions of North America. Studies aimed at elucidating patterns of health and disease in arctic peoples prior to contact and assessing inter- and intraregional differences in disease patterns have been particularly few. In the present study, five pre-contact skeletal samples (N = 193), representing 4 Eskimo populations from northern coastal Alaska and 1 Aleut population from the eastern Aleutian Islands, were examined macroscopically for the following indicators of health status: cribra orbitalia, porotic hyperostosis, trauma, infection, dental caries, abscesses, antemortem tooth loss, periodontal disease, and dental attrition. In addition, archeological and epidemiological data were used to help reconstruct the health of these populations. The goals of the analysis were 2-fold: 1) to assess the pre-contact health of North Alaskan Eskimos and Aleuts in order to provide a baseline comparison for the post-contact health of these groups, and 2) to determine if any differences in disease patterns exist between the Eskimos and Aleuts that might be related to differences in their physical environment, subsistence patterns, and cultural practices. The analysis revealed that both groups suffered from a variety of health problems prior to contact, including iron deficiency anemia, trauma, infection, and various forms of dental pathology. Statistical comparisons of the 2 groups revealed that Eskimos and Aleuts had different patterns of health and disease prior to contact. Most notably, the Aleuts had a significantly higher frequency of cranial trauma and infracranial infection than the Eskimos, while the latter had a significantly higher frequency of enamel hypoplasia. An examination of the physical and cultural environment of the 2 groups reveals several possible explanations for these differences, including warfare, subsistence pursuits, and housing practices. The documentation of these differences indicates that variability in pre-contact disease patterns can be identified between hunter-gatherer populations living in similar environments and exhibiting similar general lifestyles.

Alaska↗

PubMed2006

Periodontitis as a manifestation of chronic benign neutropenia.

BACKGROUND: A subcategory of chronic neutropenia is chronic benign neutropenia, which is characterized by a prolonged non-cyclic neutropenia as the sole abnormality, with no underlying disease to which the neutropenia can be attributed. Chronic neutropenia is defined as a low absolute neutrophil count for >6 months. In this presentation, periodontitis seems to be the sole manifestation of a juvenile patient with chronic benign neutropenia. A 7-year-old white male presented with periodontitis of the primary dentition and early tooth loss. His medical and dental history was otherwise unremarkable. Suspecting some systemic illness as the underlying cause, the patient was referred for a medical consultation and a series of blood tests. METHODS: Blood analyses included a complete blood count (CBC), sequential multiple analyzer 24 (SMA 24), glycated hemoglobin levels, and screening for anti-white blood cell antibodies. Blood levels of calcium, vitamin D, dihydroxyvitamin-D, phosphorus, and alkaline phosphatase were also measured. Liver function tests were performed. RESULTS: Following analysis of recent and previous blood test results, a diagnosis of chronic benign neutropenia was assigned. The patient's periodontal condition was treated with scaling and root planing, oral hygiene instruction, and antimicrobial mouthrinses. Three-month recall visits were recommended as a follow-up protocol. CONCLUSIONS: This case represents the importance of diagnosing periodontal disease as a possible indicator of underlying systemic disease. When a patient presents with an unusual, generalized form of periodontal disease, screening for systemic disorders is required, as the oral condition may be the first or only manifestation of a systemic abnormality. This case also illustrates the reason for the change in classification of such a condition to periodontitis as a manifestation of systemic disease. This condition was previously classified as prepubertal periodontitis, a disease diagnosis that focused on the patient's age at the onset of the disease rather than the etiology.

Aggressive Periodontitis↗

PubMed2007

Continuity or discontinuity of the life-style in central Italy during the Roman Imperial Age-Early Middle Ages transition: diet, health, and behavior.

Dento-alveolar pathologies and alterations (dental wear, caries, abscesses, ante mortem tooth loss (AMTL), calculus, hypoplastic defects, and chipping) and skeletal markers of health (cribra orbitalia and periostitis) were analyzed in two skeletal samples from the necropolises of Quadrella (I-IV c. AD) and Vicenne-Campochiaro (VII c. AD) in the Molise region of central Italy. The aim was to determine if the Roman Imperial Age-Early Middle Ages transition characterized by political, socioeconomic, and cultural transformations affected the biology of these populations, particularly their alimentation and health status. The frequencies of caries and AMTL, similar in the two samples, suggest a high consumption of carbohydrates. The higher levels of heavy wear, calculus, and interproximal chipping in the Vicenne population indicate a greater use of fibrous foods (both meat and others), in line with the dietary model of Germanic peoples. Health conditions do not appear to have been good in either period, as shown by the high frequencies of linear hypoplasia and the presence of cribra orbitalia and periostitis. The diet of the individuals buried with horses of the Vicenne population did not differ from that of the rest of the population, whereas there were evident differences in the use of the teeth for nonmasticatory activities among these individuals. Therefore, from the point of view of alimentation and health status, the profound socioeconomic and cultural transformations during the Late Antiquity-Early Middle Ages transition do not seem to have been translated into a true discontinuity of the two Molisan populations.

Diet↗

PubMed2000

Brånemark System Wide Platform implants for single molar replacement: clinical evaluation of prospective and retrospective materials.

BACKGROUND: The use of oral implants for single tooth replacement has become a predictable treatment modality. As single tooth loss is most common in posterior areas of the jaws, the use of the protocol is of specific interest in those regions. New implant designs aimed at this purpose have also been introduced. PURPOSE: The aim of the study was to present the outcomes for wide diameter implant treatment when being used in posterior areas of the jaws. MATERIALS AND METHODS: This paper presents the 3-year results of a prospective multicenter study (three clinics; n = 38 implants) and the 1-year results from a retrospective multicenter study (two clinics; n = 20 implants) on wide diameter implants for single molar replacement. Based on the hypothesis that dense bone in posterior mandibles would benefit from careful surgery and longer remodeling time, the influences of surgical technique and healing time on implant success and bone resorption were particularly addressed. RESULTS: The outcome demonstrated a good predictability for Brånemark System Wide Platform implants, at least short term, when used as single molar support (prospective group cumulative success rate [CSR] = 92% after 3 years; retrospective group CSR = 95% after 1 year). The increased mechanical strength of the wide platform implant/abutment complex also turned out to be important for mechanical stability. CONCLUSIONS: The study indicated that it was important to carefully perform surgery in posterior mandibles in order to preserve and optimally use the existing dense bone. It was suggested that from bone healing and remodeling aspects, posterior mandibles may be more demanding to handle than corresponding areas of maxillae.

Adult↗

PubMed2002

Aging successfully: oral health for the prime of life.

Aging is a worldwide phenomena. More adults, particularly those in developed countries, are living longer and healthier lives. The average US life expectancy was 47 years in 1900; by 2000, it had increased to 74 years. As the population ages, the number of adults with acute and chronic illnesses increases. The use of medications also increases with age. People over 65 years of age make up about 12% of the US population, but they consume 30% of all prescription medications, many of which can have a negative impact on oral health. Although tooth loss is declining in US adults, the need for various types of dental services in the adult population continues to increase. Data on the use of dental services has shown that dental visits by older adults correlate with the presence of teeth, not age. Research on the epidemiology of periodontal disease in older adults suggests that the disease in older adults is probably not due to greater susceptibility but, instead, the result of cumulative disease progression over time. Data on root caries has shown that exposed root surfaces, in combination with compromised health status and the use of multiple medications, can increase an older adult's risk for root caries. Oral candidiasis commonly occurs in immunocompromised individuals of any age, but in older adults, nursing home residents are particularly susceptible. Oral cancer is a disease of older adults, with a median age of 64 at diagnosis. Tobacco and alcohol use are the most common risk factors. Mental or physical impairments, such as dementing illnesses, or impaired dexterity as a result of arthritis or stroke, can impair an adult's ability to perform adequate oral self-care. Preventing oral diseases in older adults requires an understanding of the risk factors for oral diseases and how these risk factors change over time. Of particular concern are nursing home residents, who remain the most vulnerable of elders. Incorporating preventive oral health strategies into dental treatment and nursing home care will play a critical role in maintaining oral health for a lifetime. Oral health education of family, caregivers, and nursing home staff is essential if oral diseases are to be avoided later in life.

Adult↗

PubMed2005

The global burden of oral diseases and risks to oral health.

This paper outlines the burden of oral diseases worldwide and describes the influence of major sociobehavioural risk factors in oral health. Despite great improvements in the oral health of populations in several countries, global problems still persist. The burden of oral disease is particularly high for the disadvantaged and poor population groups in both developing and developed countries. Oral diseases such as dental caries, periodontal disease, tooth loss, oral mucosal lesions and oropharyngeal cancers, human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS)-related oral disease and orodental trauma are major public health problems worldwide and poor oral health has a profound effect on general health and quality of life. The diversity in oral disease patterns and development trends across countries and regions reflects distinct risk profiles and the establishment of preventive oral health care programmes. The important role of sociobehavioural and environmental factors in oral health and disease has been shown in a large number of socioepidemiological surveys. In addition to poor living conditions, the major risk factors relate to unhealthy lifestyles (i.e. poor diet, nutrition and oral hygiene and use of tobacco and alcohol), and limited availability and accessibility of oral health services. Several oral diseases are linked to noncommunicable chronic diseases primarily because of common risk factors. Moreover, general diseases often have oral manifestations (e.g. diabetes or HIV/AIDS). Worldwide strengthening of public health programmes through the implementation of effective measures for the prevention of oral disease and promotion of oral health is urgently needed. The challenges of improving oral health are particularly great in developing countries.

Aged↗

PubMed1999

Discontinuity of life conditions at the transition from the Roman imperial age to the early middle ages: Example from central Italy evaluated by pathological dento-alveolar lesions.

Teeth are highly informative in the study of past human populations. In particular, the occurrence of lesions in the masticatory apparatus relates diseases, diet, and living conditions. The dental pathology of three skeletal samples from the north-central part of Latium (central Italy) is reported. Two of them belong to the Roman Imperial Age (1st-3rd century AD): the first (including 942 permanent teeth and 1,085 tooth sockets) represents the rural town of Lucus Feroniae and is mainly composed of slaves and/or war veterans, whereas the second (872 permanent teeth and 1,325 tooth sockets) comes from the Isola Sacra necropolis at Portus Romae and represents the "middle class" segment of an urban population. The medieval sample (912 teeth and 1,097 tooth sockets), dated to the 7th century AD, belongs to the Lombard necropolis of La Selvicciola. All of the samples were examined for caries, abscesses, antemortem tooth loss, calculus, alveolar resorption, attrition, and enamel hypoplasia; standard methods were used to identify, classify, and quantify these conditions. The results reveal different patterns of dental and alveolar lesions for the three populations, indicating a different combination of dietary factors and hygienic conditions in the Roman samples compared to the Lombard series. As evidenced by multivariate correspondece analysis, the Romans show afffinites between each other, whereas the Medieval sample appears associated with the incidence of caries and the pathological conditions related to them, thus indicating increase of these lesions and deterioration of the quality of life in the transition to the early Middle Ages. These data agree with the respective archeological characterizations of the necropolises and the hypothetical social composition of each population. Am. J. Hum. Biol. 11:327-341. Copyright 1999 Wiley-Liss, Inc.

Journal Article↗

PubMed2006

Guided tissue regeneration for periodontal infra-bony defects.

BACKGROUND: Conventional treatment of destructive periodontal (gum) disease arrests the disease but does not usually regain the bone support or connective tissue lost in the disease process. Guided tissue regeneration (GTR) is a surgical procedure that specifically aims to regenerate the periodontal tissues when the disease is advanced and could overcome some of the limitations of conventional therapy. OBJECTIVES: To assess the efficacy of GTR in the treatment of periodontal infra-bony defects measured against conventional surgery (open flap debridement (OFD)) and factors affecting outcomes. SEARCH STRATEGY: We conducted an electronic search of the Cochrane Oral Health Group Trials Register, MEDLINE and EMBASE up to April 2004. Handsearching included Journal of Periodontology, Journal of Clinical Periodontology, Journal of Periodontal Research and bibliographies of all relevant papers and review articles up to April 2004. In addition, we contacted experts/groups/companies involved in surgical research to find other trials or unpublished material or to clarify ambiguous or missing data and posted requests for data on two periodontal electronic discussion groups. SELECTION CRITERIA: Randomised, controlled trials (RCTs) of at least 12 months duration comparing guided tissue regeneration (with or without graft materials) with open flap debridement for the treatment of periodontal infra-bony defects. Furcation involvements and studies specifically treating aggressive periodontitis were excluded. DATA COLLECTION AND ANALYSIS: Screening of possible studies and data extraction was conducted independently. The methodological quality of studies was assessed in duplicate using individual components and agreement determined by Kappa scores. Methodological quality was used in sensitivity analyses to test the robustness of the conclusions. The Cochrane Oral Health Group statistical guidelines were followed and the results expressed as mean differences (MD and 95% CI) for continuous outcomes and risk ratios (RR and 95% CI) for dichotomous outcomes calculated using random-effects models. Any heterogeneity was investigated. The primary outcome measure was change in clinical attachment. MAIN RESULTS: The search produced 626 titles, of these 596 were clearly not relevant to the review. The full text of 32 studies of possible relevance was obtained and 15 studies were excluded. Therefore 17 RCTs were included in this review, 16 studies testing GTR alone and two testing GTR+bone substitutes (one study had both test treatment arms).No tooth loss was reported in any study although these data are incomplete where patient follow up was not complete. For attachment level change, the mean difference between GTR and OFD was 1.22 mm (95% CI Random Effects: 0.80 to 1.64, chi squared for heterogeneity 69.1 (df = 15), P < 0.001, I(2) = 78%) and for GTR + bone substitutes was 1.25 mm (95% CI 0.89 to 1.61, chi squared for heterogeneity 0.01 (df = 1), P = 0.91). GTR showed a significant benefit when comparing the numbers of sites failing to gain 2 mm attachment with risk ratio 0.54 (95% CI Random Effects: 0.31 to 0.96, chi squared for heterogeneity 8.9 (df = 5), P = 0.11). The number needed to treat (NNT) for GTR to achieve one extra site gaining 2 mm or more attachment over open flap debridement was therefore 8 (95% CI 5 to 33), based on an incidence of 28% of sites in the control group failing to gain 2 mm or more of attachment. For baseline incidences in the range of the control groups of 3% and 55% the NNTs are 71 and 4. Probing depth reduction was greater for GTR than OFD: 1.21 mm (95% CI 0.53 to 1.88, chi squared for heterogeneity 62.9 (df = 10), P < 0.001, I(2) = 84%) or GTR + bone substitutes, weighted mean difference 1.24 mm (95% CI 0.89 to 1.59, chi squared for heterogeneity 0.03 (df = 1), P = 0.85). For gingival recession, a statistically significant difference between GTR and open flap debridement controls was evident (mean difference 0.26 mm (95% CI Random Effects: 0.08, 0.43, chi squared for heterogeneity 2.7 (df = 8), P = 0.95), with a greater change in recession from baseline for the control group. Regarding hard tissue probing at surgical re-entry, a statistically significant greater gain was found for GTR compared with open flap debridement. This amounted to a weighted mean difference of 1.39 mm (95% CI 1.08 to 1.71, chi squared for heterogeneity 0.85 (df = 2), P = 0.65). For GTR + bone substitutes the difference was greater, with mean difference 3.37 mm (95% CI 3.14 to 3.61). Adverse effects were generally minor although with an increased treatment time for GTR. Exposure of the barrier membrane was frequently reported with a lack of evidence of an effect on healing. AUTHORS' CONCLUSIONS: GTR has a greater effect on probing measures of periodontal treatment than open flap debridement, including improved attachment gain, reduced pocket depth, less increase in gingival recession and more gain in hard tissue probing at re-entry surgery. However there is marked variability between studies and the clinical relevance of these changes is unknown. As a result, it is difficult to draw general conclusions about the clinical benefit of GTR. Whilst there is evidence that GTR can demonstrate a significant improvement over conventional open flap surgery, the factors affecting outcomes are unclear from the literature and these might include study conduct issues such as bias. Therefore, patients and health professionals need to consider the predictability of the technique compared with other methods of treatment before making final decisions on use. Since trial reports were often incomplete, we recommend that future trials should follow the CONSORT statement both in their conduct and reporting. There is therefore little value in future research repeating simple, small efficacy studies. The priority should be to identify factors associated with improved outcomes as well as investigating outcomes relevant to patients. Types of research might include large observational studies to generate hypotheses for testing in clinical trials, qualitative studies on patient-centred outcomes and trials exploring innovative analytic methods such as multilevel modelling. Open flap surgery should remain the control comparison in these studies.

Alveolar Bone Loss↗

PubMed2004

Ozone therapy for the treatment of dental caries.

BACKGROUND: Dental caries is a bacterially mediated disease characterised by demineralisation of the tooth surface, which may lead to cavitation, discomfort, pain and eventual tooth loss. Ozone is toxic to certain bacteria in vitro and it has been suggested that delivering ozone into a carious lesion might reduce the number of cariogenic bacteria. This possibly could arrest the progress of the lesion and may, in the presence of fluoride, perhaps allow remineralisation to occur. This may in turn delay or prevent the need for traditional dental conservation by 'drilling and filling'. OBJECTIVES: To assess whether ozone is effective in arresting or reversing the progression of dental caries. SEARCH STRATEGY: We searched the Cochrane Oral Health Group's Trials Register (to 7 November 2003); Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library Issue 3, 2003); MEDLINE and PREMEDLINE (OVID, 1966 to November 2003); EMBASE (OVID, 1980 to November 2003); CINAHL (OVID, 1982 to November 2003); AMED (OVID, 1985 to November 2003). Quintessence was handsearched through 2002 and KaVo were contacted as manufacturers of the HealOzone apparatus for any additional published or unpublished trials. SELECTION CRITERIA: Inclusion was assessed independently by at least two reviewers. Trials were only included if they met the following criteria: randomisation in a controlled trial; single surface in vivo carious lesion accessible to ozone application; clear allocation concealment; ozone application to the lesions in the intervention group; no such application of ozone in the control group; outcomes measured after at least 6 months. DATA COLLECTION AND ANALYSIS: Reviewers independently extracted information in duplicate. A paucity of comparable data did not allow meta-analytic pooling of the included studies. MAIN RESULTS: Three trials were included, with a combined total of 432 randomised lesions (137 participants). Forty-two conference papers, abstracts and posters were excluded (from an unknown number of studies). The risk of bias in all studies appeared high. The analyses of all three studies were conducted at the level of the lesion, which is not independent of the person, for this reason pooling of data was not appropriate or attempted. Individual studies showed inconsistent effects of ozone on caries, across different measures of caries progression or regression. Few secondary outcomes were reported, but one trial reported an absence of adverse events. REVIEWERS' CONCLUSIONS: Given the high risk of bias in the available studies and lack of consistency between different outcome measures, there is no reliable evidence that application of ozone gas to the surface of decayed teeth stops or reverses the decay process. There is a fundamental need for more evidence of appropriate rigour and quality before the use of ozone can be accepted into mainstream primary dental care or can be considered a viable alternative to current methods for the management and treatment of dental caries.

Cariostatic Agents↗

PubMed2005

Routine scale and polish for periodontal health in adults.

BACKGROUND: Many dentists or hygienists provide scaling and polishing for patients at regular intervals, even if those patients are considered to be at low risk of developing periodontal disease. There is debate over the clinical effectiveness and cost effectiveness of 'routine scaling and polishing' and the 'optimal' frequency at which it should be provided. OBJECTIVES: The main objectives were: to determine the beneficial and harmful effects of routine scaling and polishing for periodontal health; to determine the beneficial and harmful effects of providing routine scaling and polishing at different time intervals on periodontal health; to compare the effects of routine scaling and polishing provided by a dentist or professionals complementary to dentistry (PCD) (dental therapist or dental hygienist) on periodontal health. SEARCH STRATEGY: We searched the Cochrane Oral Health Group Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE and EMBASE. Reference lists from relevant articles were scanned and the authors of eligible studies were contacted where possible to identify trials and obtain additional information. Date of most recent searches: 9th April 2003. SELECTION CRITERIA: Trials were selected if they met the following criteria: design - random allocation of participants; participants - anyone with an erupted permanent dentition who were judged to have received a 'routine scale and polish' (as defined in this review); interventions - 'routine scale and polish' (as defined in this review) and routine scale and polish provided at different time intervals ; outcomes- tooth loss, plaque, calculus, gingivitis, bleeding and periodontal indices, changes in probing depth, attachment change, patient-centred outcomes and economic outcomes. DATA COLLECTION AND ANALYSIS: Information regarding methods, participants, interventions, outcome measures and results were independently extracted, in duplicate, by two reviewers. Authors were contacted where possible and where deemed necessary for further details regarding study design and for data clarification. A quality assessment of all included trials was carried out. The Cochrane Collaboration's statistical guidelines were followed and both standardised mean differences and weighted mean differences were calculated as appropriate using random-effects models. MAIN RESULTS: Eight studies were included in this review and all studies were assessed as having a high risk of bias. Two split-mouth studies provided data for the comparison between scale and polish versus no scale and polish. One study, involving patients attending a recall programme following periodontal treatment, found no statistically significant differences for plaque, gingivitis and attachment loss between experimental and control units at each time point during the 1 year trial. The other study, involving adolescents in a developing country with high existing levels of calculus who had not received any dental treatment for at least 5 years, reported statistically significant differences in calculus and gingivitis (bleeding) scores between treatment and control units at 6, 12 and 22 months (in favour of 'scale and polish units') following a single scale and polish provided at baseline to treatment units. For comparisons between routine scale and polish provided at different time intervals, there were some statistically significant differences in favour of scaling and polishing provided at more frequent intervals: 2 weeks versus 6 months, 2 weeks versus 12 months (for the outcomes plaque, gingivitis, pocket depth and attachment change); 3 months versus 12 months (for the outcomes plaque, calculus and gingivitis). There were no studies comparing the effects of scaling and polishing provided by dentists or Professionals Complementary to Dentistry. AUTHORS' CONCLUSIONS: The research evidence is of insufficient quality to reach any conclusions regarding the beneficial and adverse effects of routine scaling and polishing for periodontal health and regarding the effects of providing this intervention at different time intervals. High quality clinical trials are required to address the basic questions posed in this review.

Adult↗

PubMed2002

Proteolysis of interleukin-6 receptor (IL-6R) by Porphyromonas gingivalis cysteine proteinases (gingipains) inhibits interleukin-6-mediated cell activation.

Current consensus is that periodontitis is an infectious disease in which a deregulated chronic inflammatory reaction not only may lead to periodontal tissue damage but also eventually may cause tooth loss. In controlling the inflammatory state the interplay between a network of cytokines and their receptors plays an important role. Here we show that the interleukin-6 receptor (IL-6R) is rapidly and efficiently inactivated by gingipains, the arginine- (HRgpA and RgpB) and lysine- (Kgp) specific cysteine proteinases from Porphyromonas gingivalis. Preincubation of HepG2 cells with active gingipains results in the loss of gp80 (CD126) from the cell surface. This also correlates with a decreased responsiveness to stimulation by interleukin-6 (IL-6), as determined by measurement of the status of IL-6R-mediated STAT 3 (Signal Transducer and Activator of Transcription 3) activation by this cytokine. Significantly, incubation of cells with gingipains was not accompanied by release of the soluble receptor, indicating its degradation, and this was confirmed by susceptibility of the recombinant, soluble receptor to proteolytic digestion by these enzymes. With the exception of the degradation of soluble IL-6R (sIL-6R) by Kgp, all of these reactions were also observed in the presence of serum suggesting that receptor inactivation may occur in vivo. Interestingly, Kgp, although less effective in cleaving sIL-6R, was able to decrease cell responsiveness to IL-6, possibly through degradation/inactivation of the signal transducing component (gp130) associated with IL-6R. These data, together with previous observation that IL-6 itself is inactivated by gingipains, suggest that at periodontitis sites infected by P. gingivalis the inflammatory reactions dependent on IL-6 could be severely hindered contributing to both tissue damage and periodontopathogen survival.

Adhesins, Bacterial↗

PubMed1997

[Oral manifestations in patients with systemic lupus erythematosus].

Forty-six patients with systemic lupus erythematosus underwent thorough dental examination to determine the frequency and severity of oral lesions and periodontal diseases. According to clinical criteria, disease was classified as severe (n = 26) or less severe (n = 20). The overall rate of mucosal involvement in the studied patients was 48%-from 54% in patients with severe disease, 40% in those with less severe disease. Patients with severe disease were found to have a higher rate of tooth loss and an increased rate of gingival inflammation. The severity of periodontal lesions correlated with alterations in the immunoglobulin pattern, particularly with an increase in gamma-immunoglobulins. Thus it is suspected that complex immunodysregulation in combination with immunosuppressive therapy is responsible for the high rate of oral and periodontal lesions in patients with systemic lupus erythematosus.

Adult↗

PubMed2000

Polymorphism of the N-acetyltransferase (NAT2), smoking and the potential risk of periodontal disease.

Periodontal disease is a common multifactorial process that leads to bone destruction and tooth loss. Interactions of environmental and genetic factors determine the extent and severity of periodontal disease. Smoking is one of the risk factors for periodontal disease, and the risk may be influenced by the polymorphism of N-acetyltransferase (NAT2) via metabolism of smoke-derived xenobiotics. We therefore hypothesized that a NAT2 genotype would be a risk factor for periodontal disease. A total of 154 Caucasian subjects were assigned to one of two groups (1) no or mild and (2) severe periodontal disease based on radiographic (bone destruction) and clinical criteria (probing depth, attachment loss) and the number of teeth. In all subjects genotyping for mutations on NAT2 was performed by means of PCR and RFLP analysis. In the less-affected group genotyping showed a fraction of predicted slow and rapid acetylators (53.6% and 46.4%, respectively) corresponding to the normal distribution in Caucasians. Severely affected patients were predominantly slow acetylators, the odds ratios being between 2.38 and 5.02 for the NAT2-related risk depending on the outcome parameters chosen. Adjustment for age had no influence on these findings. Our data indicate that the slow acetylator phenotype is associated with a higher risk of periodontitis, especially with respect to the severity of the disease. Possible implications with respect to the risk associated with smoking are discussed.

Acetylation↗