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At least 1,135 records · Page 63Linked to original sources
PubMed2006

Effect of a controlled-release chlorhexidine chip on clinical and microbiological parameters and prostaglandin E2 levels in gingival crevicular fluid.

BACKGROUND: The aim of the present study was to determine the effect of a chlorhexidine chip on crevicular prostaglandin E2 (PGE2) levels and on the clinical and microbiological parameters of periodontitis when used as adjunctive therapy to scaling and root planing (SRP) in patients with chronic periodontitis. METHODS: This randomized single-blind study was carried out in parallel design. The test group received SRP plus chlorhexidine chip, whereas the control group received SRP alone. Thirty-four subjects, aged 20 to 55 years, with chronic periodontitis were recruited. Clinical indices, microbiological samples, and gingival crevicular fluid (GCF) samples were evaluated at baseline and after 1, 3, and 6 months. Microbiological samples were evaluated under a light microscope. GCF PGE2 levels were determined using radioimmunoassay. RESULTS: Significant improvements could be found for all clinical variables in both groups over the study period. The mean changes in probing depth obtained by SRP plus chlorhexidine chip were greater than those obtained by the SRP alone group at 3 and 6 months. In the test group, there was also significant gain in clinical attachment level at 6 months. When data were combined from all groups, significant reductions in GCF PGE2 levels and number of microorganisms were noted at all time points. However, in the test group, reduction was greater at 6 months for crevicular PGE2 level and at 3 and 6 months for proportions of spirochetes. CONCLUSION: Based on the findings of this study, the chlorhexidine chip reduced GCF PGE2 levels and had positive effects on clinical parameters and subgingival flora when used as adjunctive therapy to SRP in patients with chronic periodontitis.

Adult↗
PubMed2006

Local drug delivery in the treatment of periodontal diseases: assessing the clinical significance of the results.

BACKGROUND: Local drug delivery can be used in the management of periodontal patients. However, statistically significant responses to therapy recorded in clinical trials may not be clinically significant. METHODS: Controlled clinical trials were selected that assessed the capability of local drug delivery to improve periodontal health. RESULTS: Several local drug delivery systems employed as monotherapies improved periodontal health and provided results that were not statistically significantly different than attained with scaling and root planing (SRP) alone. In contrast, many local drug delivery devices when used as adjuncts to SRP provided a statistically significant enhancement of parameters commonly used to monitor periodontal status. However, mean improvements with respect to probing depth reduction or gain of clinical attachment were often limited to tenths of millimeters. Several devices also achieved specific criteria that can be used to identify clinically significant findings (e.g., number of sites with probing depth reduction >or=2 mm). However, there are conflicting data with respect to the ability of local drug delivery to enhance results of SRP at deep probing sites, and there is limited information relative to its capability to inhibit disease progression or enhance osseous repair in infrabony defects. CONCLUSION: The decision to use local drug delivery during active treatment or maintenance should be based upon clinical findings, responses to therapy recorded in the literature, desired clinical outcomes, and the patient's dental and medical history.

Alveolar Bone Loss↗
PubMed2006

Periodontal debridement with povidone-iodine in periodontal treatment: short-term clinical and biochemical observations.

BACKGROUND: The aim of the present study was to evaluate the clinical effects of one-stage periodontal debridement with an ultrasonic instrument, associated with 0.5% povidone (pvp)-iodine irrigation in patients with chronic periodontitis. METHODS: Forty-five patients were randomly assigned into three groups: the control group (CG) received quadrant root planing at 1-week intervals over four consecutive sessions; the periodontal debridement plus pvp-iodine group (PD-PIG) received a 45-minute full-mouth debridement with an ultrasonic instrument, associated with 0.5% pvp-iodine irrigation; and the periodontal debridement group (PDG) received a 45-minute full-mouth periodontal debridement with an ultrasonic instrument, associated with NaCl irrigation. RESULTS: At the 3-month evaluation, the mean probing depth (PD) reduction in CG was 2.51+/-0.52 mm, 2.53+/-0.50 mm in PD-PIG, and 2.58+/-0.60 mm in PDG (P<0.05). The clinical attachment level (CAL) analysis showed a statistically significant gain in all groups compared to baseline (1.87+/-0.56 mm [CG], 1.94+/-0.70 mm [PD-PIG], and 1.99+/-0.92 mm [PDG]). Intergroup analysis of PD and CAL at 1 and 3 months showed no differences (P>0.05). The N-benzoyl-L-arginine-p-nitroanilide (BAPNA) test showed a significant reduction in trypsin activity only during the first month (P<0.05); at 3 months there were no differences compared to baseline (P=0.80). CONCLUSION: This study provides no evidence that pvp-iodine is effective as an adjunct for one-stage periodontal debridement.

Adult↗
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↗
PubMed2006

The use of celecoxib and dexamethasone for the prevention and control of postoperative pain after periodontal surgery.

BACKGROUND: Conventional non-steroidal anti-inflammatory drugs have been widely used in the control of postoperative pain, but sparse information is available on the efficacy of celecoxib, a selective cyclooxygenase-2 inhibitor, or dexamethasone, a steroidal anti-inflammatory drug, after periodontal surgeries. The purpose of the present study was to compare the use of celecoxib and dexamethasone in the management of pain after mucoperiosteal flap surgery. METHODS: A randomized double-masked cross-over clinical trial was conducted on 20 patients from 27 to 52 years old with generalized moderate to advanced chronic periodontitis. Mucoperiosteal flap surgeries for scaling and root planing were performed under local anesthesia on at least three quadrants, with a 4-week interval between. Each quadrant was randomly assigned to one of the following medication protocols: placebo, 4 mg dexamethasone 1 hour before surgery and 8 hours after the first dose, and 200 mg celecoxib 1 hour before surgery and 12 hours after the first dose. Postoperative pain was accessed during the first 8 hours and on the following 3 days using the visual analog scale (VAS), the 101-point numerical rate scale (NRS-101), and the four-point verbal rating scale (VRS-4). RESULTS: Pain perception was statistically significantly lower in the celecoxib group than in the placebo group during the first 4 hours using VAS (P = 0.01) and at 1, 2, 3, 4, 6, and 7 hours using NRS-101 (P = 0.03). The level of pain was lower in the dexamethasone group than in the placebo only at the 3-hour period (P = 0.001). Statistically significant differences could be found among the groups at 1 hour (P = 0.015), 3 hours (P = 0.004), 4 hours (P = 0.02), and 7 hours (P = 0.05) using VRS-4. There was no statistically significant difference between the celecoxib and dexamethasone groups. CONCLUSION: The findings of this study suggest that the preemptive and postoperative use of celecoxib or dexamethasone were effective in the management of postoperative pain following open-flap debridement.

Adult↗
PubMed2007

Gingival crevicular fluid prostaglandin E(2) and thiobarbituric acid reactive substance levels in smokers and non-smokers with chronic periodontitis following phase I periodontal therapy and adjunctive use of flurbiprofen.

BACKGROUND: It has been established that smoking is an important risk factor for the initiation and progression of chronic periodontitis (CP). This study investigates the effects of phase I periodontal therapy and adjunctive flurbiprofen administration on prostaglandin E(2) (PGE(2)) and thiobarbituric acid reactive substance (TBARS) levels in gingival crevicular fluid (GCF) samples from smoker and non-smoker patients with CP. METHODS: Twenty-one non-smoker and 21 smoker patients with CP were divided into four groups according to treatment modalities. Group 1 (non-smokers with CP) and group 3 (smokers with CP) patients received daily 100-mg flurbiprofen tablets in a 2 x 1 regimen for 10 days together with scaling and root planing (SRP). Patients in group 2 (non-smokers with CP) and group 4 (smokers with CP) received placebo tablets in a 2 x 1 regimen for 10 days together with SRP. Plaque index (PI), gingival index (GI), probing depth (PD), and clinical attachment level (CAL) measurements were recorded and GCF samples were collected at baseline and on day 10 of drug intake from each sampling area by a single examiner who was unaware of the treatment modality. Assays for GCF PGE(2) and TBARS were carried out by an enzyme-linked immunosorbent assay and fluorometric method, respectively. RESULTS: All groups showed statistically significant reductions in PI and GI scores following the phase I periodontal treatment on day 10 (P <0.05), but no statistical differences were observed in PD and CAL scores after the therapy. In groups 1 and 2, the reduction of GCF PGE(2) and TBARS levels were not significant after the therapy compared to baseline levels. In group 3, GCF PGE(2) and TBARS levels exhibited a statistically significant decrease (P <0.05) after the therapy. Group 4 showed significant reductions (P <0.05) in GCF PGE(2) levels after the therapy. No statistically significant reductions were observed in group 4 with regard to GCF TBARS levels. When groups 1 and 3 were compared according to GCF TBARS levels after the therapy, a more statistically significant reduction was observed in group 3 (P = 0.001). CONCLUSION: These results suggest that additional flurbiprofen administration may have more inhibitory effects on GCF levels of PGE(2) and TBARS in the groups of smokers compared to non-smokers with CP.

Adult↗
PubMed2002

Emerging concepts in periodontal therapy.

Conventional periodontal therapy consists of mechanical scaling and root planing, and surgical treatment. This is still the mainstay of periodontal treatment. Adjunctive antimicrobial treatments, both systemic and local delivery, are becoming more sophisticated and useful in the treatment of recurrent periodontitis. Also very promising are adjunctive treatments that modulate the host response and decrease levels of destructive pro-inflammatory cytokines or matrix metalloproteinases. Smoking is a major risk factor for periodontitis and has a profound impact on the progression of periodontal bone and attachment loss. In the interest of improved periodontal health patients should be encouraged to stop smoking. Finally bacterial endotoxins that stimulate the release of pro-inflammatory cytokines can have systemic effects and may lead to pre-term, low birthweight babies, and cardiovascular diseases such as atherosclerosis, myocardial infarction and stroke. Health professionals need to be cognisant of the effect dental health can have on systemic diseases and refer for treatment when appropriate to ensure that optimum oral and systemic health is achieved for their patients.

Anti-Infective Agents↗
PubMed2002

Putting your money where your mouth is: willingness to pay for dental gel.

OBJECTIVES: To measure preferences and willingness to pay (WTP) for a novel anaesthetic (dental gel) versus existing anaesthetic options for periodontal maintenance visits. DESIGN: The study was conducted by developing and administering a survey, composed of a modified decision aid and a WTP instrument. The decision aid provided clinical information in layman's terms. Patients stated their anaesthetic preference; WTP elicited the hypothetical amount of money a subject would pay to have dental gel available for maintenance cleaning, should they require anaesthetic. PATIENTS: Periodontal recall patients (n = 97; 'recall') and participants from the general population (n = 196; 'general') from southwestern Ontario, Canada. RESULTS: The overwhelming majority of participants chose dental gel over injectable local anaesthetic or no anaesthetic as their first anaesthetic preference (general: 81.0%; recall: 82.5%). The median WTP for dental gel was 20.00 Canadian dollars (dollars Can) per visit for the general population and dollars Can10.00 for the recall population (1999 values). The majority of participants were willing to pay an insurance premium for dental gel, even if they did not personally prefer dental gel (general: 72.4%; recall: 73.2%). The median monthly premium to have dental gel available for any plan beneficiary requiring scaling and root planing (SRP) during maintenance was dollars Can2.00 per month for both groups. CONCLUSIONS: In this population, an alternative to traditional injectable local anaesthetic (i.e. dental gel) was overwhelmingly preferred by both general population participants and recall patients for maintenance cleaning procedures. Most participants were willing to pay to have dental gel available, either for themselves or for others.

Administration, Topical↗
PubMed1989

[Microbiological evaluation of initial preparation for adult periodontitis patients].

The microbial flora from 46 adult periodontitis lesions of 23 patients and 18 sites in 9 healthy persons were examined and levels of serum IgG antibody to gram negative periodontal disease-associated bacteria were measured by enzyme-linked immunosorbent assay. Plaque samples and serum samples were taken 40-50 days after initial preparation consisting of scaling and root planing. To evaluate the effects of the therapy on 10 patients with adult periodontitis, changes in clinical parameters were compared with alterations of the microbial flora and serum IgG antibody levels. Black-pigmented Bacteroides species, mainly Bacteroides gingivalis, were found to be predominant in periodontitis lesions. A significant relationship was found between the prevalence of B. gingivalis and elevated titers of serum IgG antibody against the microorganism. No relationships between Bacteroides intermedius, Actinobacillus actinomycetemcomitans and elevated titers of serum IgG antibody to them were detected. The fact that there was no marked reduction of serum IgG antibody to B. gingivalis after initial preparation suggests that a more extended, longitudinal study is required. Although brushing resulted in a significant reduction of the number of total cultivable organisms in samples from periodontal pockets, no significant proportional changes in gram-negative bacteria in the lesional flora were found. Initial preparation was not effective in eliminating gram-negative bacteria from deep periodontal pockets. However, the microbiological shifts, especially the reduction in the proportion and frequency of detection of B. gingivalis in periodontal pockets, was paralleled by significant improvement in the clinical parameters.

Actinobacillus↗
PubMed1989

[Microbiological and serological investigation of periodontal disease activity].

If disease activity in periodontal disease can be determined, the therapeutic measures of periodontitis may become diverse and different from patient to patient. The purpose of the present study was to evaluate the usefulness of microbiological and serological examination of periodontopathic bacteria in detecting destructive periodontal disease activity. One hundred and forty-eight sites in 52 subjects with moderate to severe periodontitis were studied clinically. Clinical parameters included plaque index, gingival index, probing depth, bleeding on probing and percent bone loss as measured radiographically. Subgingival plaque of whole sites was investigated microbiologically by means of indirect fluorescent-antibody technique with rabbit antibodies against Actinomyces viscosus, Actinobacillus actinomycetemcomitans (2 serotypes), Eikenella corrodens, Fusobacterium nucleatum, Bacteroides gingivalis and Bacteroides intermedius. The levels of serum IgG antibody to these organisms were determined by enzyme-linked immunosorbent assay with whole cell preparations. Thirty-two of 52 subjects were instructed in oral hygiene and received several sessions of scaling and root planing. The clinical, bacteriological and serological assessments were also performed after periodontal therapy. Active disease site was defined as the site of which clinical status did not be improved even after periodontal treatment. B. gingivalis, B. intermedius and A. viscosus were detected in 80% of periodontal lesions, and the proportion of B. gingivalis was the highest among six bacterial species tested. A. actinomycetemcomitans, E. corrodens and F. nucleatum were found only occasionally and in low numbers. The proportion of B. gingivalis was higher in severely inflamed sites than in clinically healthy sites. B. gingivalis and B. intermedius are rarely found in treated periodontitis sites, while the proportion of A. viscosus was slightly increased after treatment. Sera of the pre-treatment patients demonstrated significantly higher antibody levels to B. gingivalis and significantly lower levels to A. viscosus than those of healthy persons. Antibody levels reactive with other four species in the patients did not significantly differ from the levels in healthy persons. After periodontal therapy, antibody levels to B. gingivalis, B. intermedius and A. actinomycetemcomitans (serotype a) significantly decreased and the levels to A. viscosus increased to a slight degree. B. gingivalis was found more frequently in disease-active sites than in disease-inactive sites. The proportions of other bacterial species in disease-active sites did not differ from those in disease-inactive sites. The results of the present investigation suggest that monitoring B. gingivalis in subgingival plaque and serum IgG antibody titer against this organism may aid in the description and adequate treatment of the periodontal disease.

Bacteroides↗
PubMed1994

Subgingival plaque formation on single and polycrystal aluminum ceramics.

A study was conducted to investigate subgingival plaque formation on two types of dental implant material in the human oral cavity. Fifteen teeth affected by severe periodontitis and scheduled for extraction in five patients were selected. After thorough root planing, inlay cavities were prepared from the gingival margin to 5 mm subgingivally. Then, rectangular test specimens (polycrystal aluminum ceramic (P), single-crystal aluminum ceramic (S)) or a control dentin specimen (D) were installed in gold inlays, which were placed in the inlay cavities and left for 3, 7 or 21 d. As a consequence, 4 mm of the surface of each specimen was exposed to the environment of the periodontal pocket. After each test period, the specimens were removed from the inlays and examined by scanning electron microscopy (SEM). The results suggested that S is a more suitable dental implant material than P from the viewpoint of clinical application because of its lower degree of plaque accumulation.

Adult↗
PubMed2000

Measurement of peptidase activity and evaluation of effectiveness of administration of minocycline for treatment of dogs with periodontitis.

OBJECTIVE: To determine clinical, enzymatic, and microbiologic effects of controlled-release localized administration of minocycline on dogs with periodontitis. ANIMALS: Five adult Beagles with periodontitis. PROCEDURE: After tooth scaling and root planing, 2 treatment, 1 placebo, and 1 control site were selected for each dog. Treatment sites (n = 10) received a periodontal formulation of minocycline hydrochloride, placebo sites (5) received ointment without minocycline, and control sites (5) did not receive ointment. Treatments were administered 4 times at weekly intervals. Peptidase activity and clinical and microbiologic effects were evaluated and compared among sites for 17 weeks. RESULTS: Bleeding of the gums on probing (BOP) and pocket depth (PD) improved at the treatment site and were maintained for 13 weeks after treatment. However, BOP and PD in placebo and control sites increased from weeks 9 to 17 Peptidase activity in the periodontal pocket decreased noticeably from week 1 to 17, compared with baseline values for the treatment site. However, peptidase activity for placebo and control sites increased and were above baseline values on week 9 and week 13, respectively. Total bacterial counts decreased by 90% for treatment sites and remained at that value for 13 weeks. However, for placebo and control sites, bacterial counts increased and reached the baseline value on week 17. CONCLUSIONS AND CLINICAL RELEVANCE: Increased peptidase activity is correlated with the progression of periodontitis in dogs. Treatment with minocycline, using a localized delivery system, was effective in dogs for at least 13 weeks after cessation of drug administration.

Animals↗
PubMed1985

Chemical and morphological studies of the acquired pellicle formed subgingivally on dentin in vivo.

The morphological appearance and chemical composition of the subgingival pellicle were studied, using Auger analysis and scanning and transmission electron microscopy. A pellicle was formed on pieces of dentin (2 X 2 X 1 mm), prepared from freshly extracted teeth after root planing. The dentin slabs were inserted for 2 h into healthy gingival sulci. Control slabs cemented supragingivally were used for comparison. The results confirmed the presence of an organic film on the surface of all slabs. Auger analysis of the organic film showed the presence of Ca in the supragingival integument but not in the subgingival integument. The subgingival pellicle was in all cases thicker than the supragingival pellicle. The transmission and scanning electron microscopy observations confirmed the presence of a film essentially free of bacteria on the subgingival specimens and also indicated a possible morphological difference between the supra- and sub-gingival pellicle.

Dental Deposits↗
PubMed1997

[The effect of periodontal initial therapy on detection frequency of Bacteroides forsythus, Porphyromonas gingivalis, and Actinobacillus actinomycetemcomitans--detection by DNA probe and PCR methods].

The purpose of this study was to examine microbiological changes after periodontal initial therapy by DNA probe and polymerase chain reaction (PCR) assays in addition to clinical evaluation. Twenty-six periodontitis patients, 10 males and 16 females, were selected. All subjects were treated by scaling and root planing following oral hygiene instruction. Bacterial samples were collected with paper points from a total of 104 sites, 4 sites in each patient, at baseline and after initial therapy. DNA probe analysis was used to monitor Bacteroides forsythus and Porphyromonas gingivalis. PCR analysis was performed to identify the presence of Actinobacillus actinomycetemcomitans. The initial therapy resulted in significant clinical improvements as assessed by clinical parameters including pocket depth, attachment level and bleeding on probing. After the therapy, the detection frequency of B. forsythus and P. gingivalis was significantly reduced, but the detection frequency of A. actinomycetemcomitans did not significantly decreased. These results indicated that initial therapy can bring about elimination of B. forsythus and P. gingivalis by means of conventional techniques, but not of A. actinomycetemcomitans. When complete elimination of these microorganisms was obtained, significant clinical improvement was found. Monitoring the changes of three bacteria may provide a more effective modality.

Adolescent↗
PubMed1999

[Halitosis: a multidisciplinary problem].

Bad breath, or halitosis, affects between 50 and 65% of the population. Despite its frequency, this problem is often unaccepted and declared taboo. In about 8% of the cases, bad breath is related to an ENT pathology (sinusitis, tonsillitis, ...). More rarely it is caused by a metabolic (diabetes, trimethylaminuremia, ...) or gastric dysfunction. Ninety percent of the cases however, are associated to an oral disease: either gingivitis due to an inadequate removal of dental plaque, especially from interdental spaces, or periodontitis (alveolar bone destruction), or bacterial accumulation on the dorsum of the tongue. In most cases, an intensive disinfection of the mouth by scaling and root planing and/or instruction of a perfect oral hygiene will be sufficient to solve the problem. Perfumed mouthwashes or toothpastes will only give a short-term masking effect. An effective collaboration between a dentist or a periodontist and an ENT specialist is of great importance to dealt with bad breath.

Circadian Rhythm↗
PubMed1998

Local delivery of antimicrobial agents for the treatment of periodontitis.

Periodontitis is a result of an infection with specific pathogenic microorganisms. Thus, the local delivery of antimicrobials has been investigated as a possible method for controlling this infection and treating periodontal disease. A number of antimicrobial agents have been studied both as adjunctive therapies with scaling and root planing and as stand-alone chemotherapies. These agents have been administered in irrigation solutions and as single-dose formulations, but with little long-term efficacy in the treatment of periodontitis. Recent investigations have focused on the delivery of antimicrobials in sustained-release formulations designed to maintain effective concentrations of drug within the periodontal pocket. This article provides an overview of the development of the use of locally delivered antimicrobials in periodontal therapy and the current state-of-the-art of the technique.

Anti-Bacterial Agents↗
PubMed1999

Local delivery of doxycycline for the treatment of periodontitis.

The use of local drug delivery to treat periodontitis is effective in various clinical circumstances. This article describes clinical results after using locally delivered doxycycline to treat periodontitis and compares those results to scaling and root planing. Commonly asked questions concerning the use of local doxycycline treatment are also discussed.

Anti-Bacterial Agents↗
PubMed1999

Evaluation of Periostat for patient management.

The cause of adult periodontitis involves complex bacteria-host interactions, with modifying influences exerted by genetic and environmental factors. Current thinking indicates that successful, long-term management of adult periodontitis requires a treatment approach that takes into account the various etiologic components of the disease. Recently, a formulation containing a subantimicrobial dose of doxycycline (Periostat) was approved for use as an adjunct to scaling and root planing (SRP) in the treatment of adult periodontitis. As an inhibitor of matrix metalloproteinases that have been implicated in the pathologic degradation of connective tissue collagen in periodontal support structures, Periostat in conjunction with SRP was shown to significantly improve clinical attachment and reduce probing depth compared with placebo in conjunction with SRP. This article reviews the clinical trial results leading to US Food and Drug Administration approved of Periostat and discusses the potential use of this host-modulatory agent as a complementary systemic pharmacotherapy in periodontal management programs.

Adult↗