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PubMed2005

Chronic periodontal disease is associated with single-nucleotide polymorphisms of the human TLR-4 gene.

Periodontitis is an inflammatory disease affecting the connective tissue surrounding the teeth leading to tooth loss. Pathogens associated with periodontitis interact with Toll-like receptors (TLRs) to induce cytokines causing and aggravating disease. We screened 197 individuals suffering from generalized periodontitis for the presence of Asp299Gly and Thr399Ile of TLR-4 as well as Arg753Gln of TLR-2 in comparison to matched controls. Single-nucleotide polymorphisms (SNPs) of TLR-4 were elevated among patients (odd's ratio 3.650, 95% CI 1.573-8.467, P < or = 0.0001), while no difference was observed for TLR-2. TLR-4 SNPs were correlated with chronic periodontitis (odd's ratio 5.562, 95% CI 2.199-14.04, P < or = 0.0001), but not with aggressive periodontitis. This observation was confirmed employing a group of periodontally healthy probands over 60 years of age. These data demonstrate that genetic variants of TLR-4 may act as risk factors for the development of generalized chronic periodontitis in humans.

Adult↗
PubMed1998

Identification of a new endogenous platelet-activating factor-like molecule in gingival crevicular fluid.

Periodontal disease is an inflammatory disease and the major cause of tooth loss in adults. Bacteria and their products are the causative agents of this disease. Endogenous molecules mediate the inflammatory process and play a major role in its amplification and perpetuation as well as in the ensuing tissue destruction. The relationship between platelet-activating factor (PAF) and periodontal disease has not so far been examined thoroughly. We have isolated a phospholipid molecule with PAF-like activity from gingival crevicular fluid. This molecule, purified on HPLC, causes washed platelet aggregation with EC50 value 0.1 microM, based on phosphorus determination. It acts through PAF-receptors and is inactivated by PAF-acetylhydrolase. In addition, this phospholipid presents biological activity towards human platelets. The combination of the results obtained from the chemical and enzymic treatments, the biological assays as well as results from the electrospray analysis, leads to the conclusion that this phospholipid is a hydroxyl-PAF analogue with relative molecular mass 703. This PAF-like molecule may be implicated in periodontal disease.

1-Alkyl-2-acetylglycerophosphocholine Esterase↗
PubMed2002

Effects of periodontopathic bacteria on the expression of endothelin-1 in gingival epithelial cells in adult periodontitis.

Adult periodontitis, which is the major cause of adult tooth loss, is commonly characterized by chronic inflammatory disease caused by infection with periodontopathic bacteria such as Porphyromonas gingivalis. Our aims in the present study were to examine the expression of endothelin-1 (ET-1) in cultured HEp-2 epithelial cells after infection with P. gingivalis, and in gingival tissue from adult periodontitis patients. The cell lines were infected with the strains P. gingivalis 33277 and 381 for assessment of bacterial invasion using an antibiotic protection assay, and the expression of ET-1, inflammatory cytokines and cell adhesion molecules was examined by ELISA and reverse transcription-PCR. The expression of ET-1, as well as that of interleukin-1 beta, interleukin-8 and ICAM-1 (intercellular cell adhesion molecule 1), was induced significantly in a time-dependent manner, whereas the expression of MCP-1 (monocyte chemotactic protein-1), RANTES (regulated upon activation, normal T-cell expressed and secreted) and VCAM-1 (vascular cell adhesion molecule 1) was not. Furthermore, in gingival tissues from adult periodontitis patients, we also observed increased expression of ET-1 mRNA compared with tissue from normal healthy donors. These results suggest that infection by periodontopathic bacteria up-regulates the expression of ET-1, together with that of inflammatory cytokines and ICAM-1, in gingival epithelial cells, and that ET-1 expression may be closely involved in the regulation of cytokine responses and cell-cell adhesion in adult periodontitis lesions.

Adult↗
PubMed2003

Effect of triclosan on healing following non-surgical periodontal therapy in smokers.

BACKGROUND: Tobacco smoking is an established risk factor for periodontitis, and is associated with periodontal attachment and tooth loss. Clinical studies have indicated that smoking may adversely affect and impede healing following periodontal therapy. Adjunctive antimicrobials, on the other hand, have been shown to enhance the effect of non-surgical periodontal therapy. The objective of this study was to evaluate the effect of a triclosan/copolymer/fluoride dentifrice on healing following non-surgical periodontal therapy in smokers. METHODS: Sixty smokers (aged 35-59 years; 23 females) with chronic periodontal disease volunteered to participate in a double-blind, randomized, controlled, clinical trial. The subjects were randomly assigned to use a triclosan/copolymer/fluoride (30 subjects) or a standard fluoride (30 subjects) dentifrice and received detailed information on proper techniques for self-performed plaque control. The participants then received non-surgical periodontal therapy followed by periodontal maintenance care every 6 months over 24 months. Clinical recordings included evaluation of oral hygiene standards, gingival health, and periodontal status. RESULTS: Subjects using the triclosan/copolymer/fluoride dentifrice exhibited significantly improved oral hygiene conditions, gingival health, and periodontal status compared with those using the standard fluoride dentifrice over the 24-month maintenance interval. CONCLUSIONS: The results suggest that an oral hygiene regimen including a triclosan/copolymer/fluoride dentifrice may sustain the short-term effect of non-surgical periodontal therapy in smokers.

Adult↗
PubMed2004

Oro-facial manifestations in paediatric HIV: a comparative study of institutionalized and hospital outpatients.

The aim of the study was to compare dental caries status and the number and type of oral mucosal lesions in HIV positive children from a hospital outpatient department and an institutionalized setting. Oral examinations were performed using presumptive diagnostic criteria. The Fisher's Exact and the Mann-Whitney tests were used for statistical comparison of the two study groups. A total of 169 children were examined of whom 42% were institutionalized and 58% hospital outpatients. One institutionalized child presented with Noma. Twenty-one percent of the institutionalized population presented with molluscum contagiosum, while none of the hospital outpatients presented with this condition. Significantly more intraoral mucosal lesions were observed in the hospital compared with the institutionalized group. The most frequently encountered oral lesion was candidiasis. Pseudomembranous candidiasis was the most common type. Twice as many intraoral ulcers were recorded in the institutionalized group. Thirty-nine percent of the hospitalized patients had multiple lesions compared with 28% in the institutionalized group. Almost three quarters of both populations were caries-free. The mean DMFT was considerably higher in the hospital population. For both the permanent and primary teeth, the decayed component (D/d) made up the major part of the DMFT/dmft, followed by the missing (M/m) component. No fillings were recorded in either the primary or permanent teeth for both groups. Oral lesions are common in HIV populations and were seen in both the hospital and institutionalized groups, at high prevalence levels (63 and 45%). HIV infected children should be considered high risk for caries because of the use of chronic medications, and to receive appropriate care in terms of both treatment and services.

Candidiasis, Oral↗
PubMed2002

Relationship between number of proximal contacts and survival of root canal treated teeth.

AIM: The present study tested the hypothesis that having two proximal contacts (PCs) at access is associated with improved survival of root canal treated (RCT) teeth, controlling for important presenting conditions, endodontic variables and restorative factors. METHODOLOGY: A treatment database at the University of Iowa College of Dentistry was used to identify permanent teeth undergoing obturation between 1 July 1985 and 31 December 1987. The list was restricted to teeth of patients with at least one dental visit in each two-year interval from 1985 to 1996, and a simple random sample of 280 patients (n = 400 teeth) was selected. Dental charts, radiographs, and computerized databases were examined to ascertain variables of interest and to verify study inclusion criteria. Kaplan-Meier survival estimates were generated for the 221 teeth satisfying study inclusion criteria. Multivariate Cox models were developed, with standard errors adjusted to account for clustering of teeth within patients. RESULTS: The final Cox model showed that teeth with < or =1 PC at access were lost at a rate three times that of teeth with 2 PCs (hazard ratio = 3.1; 95% confidence interval = 1.9-5.1), controlling for tooth type, presence of radiographic caries at access, and presence of a crown before or after obturation. CONCLUSIONS: Because RCT teeth with two PCs at access experienced substantially better survival than teeth with fewer than two PCs, the influence of PCs on prognosis should be recognized during treatment planning. Future research should employ prospective study designs, capture additional variables, and provide data to support endodontic treatment decisions.

Humans↗
PubMed2002

Evidence for reversal of the caries decline among Norwegian children.

OBJECTIVE: The purpose of the present study was to report on caries status and to explore possible reasons for changes in caries experience among 5- and 12-year-old Norwegian children. DESIGN: National cross-sectional and time trend study. METHODS: Aggregated data from the Public Dental Services and from official statistics were used. Information was available on the total number of children, the proportion receiving treatment, sale of fluoride tablets, socio-economic background, caries prevalence and dmft/DMFT scores. RESULTS: The prevalence of caries among 5-year-olds reached a low of 30.4% in 1997 and increased to 38.9% in 2000. The mean dmft scores increased from 1.1 to 1.5. Conversely, the prevalence of caries among 12-year-olds decreased from 55.4% in 1997 to 52.2% in 2000 and the mean DMFT score from 1.7 to 1.5. Bivariate analyses at county level revealed significant associations, which for the most part disappeared in multivariate analyses. The sale of fluoride tablets had a significant effect on caries prevalence among 5-year-olds in 1998, in 1999 and in 2000. Infant mortality was associated with the dmft score in 1999. The only consistently significant predictor of caries experience at 12 years of age was caries prevalence at age 5. CONCLUSIONS: There has been a highly significant increase in caries experience among 5-year-olds (P < 0.001) and a levelling off among 12-year-olds over the past 3 years. Considering the association between caries prevalence at age 5 and caries experience at 12 years of age, there is a need for reassessment of the caries preventive programmes for children in Norway.

Age Factors↗
PubMed2003

Dental health of dentists' children in Mongolia.

OBJECTIVES: To describe the dental health of dentists' children, to evaluate its association with their dentist-parents' background and work-related characteristics and to compare it with that of children in the general population in Mongolia. DESIGN: Cross-sectional survey, questionnaire-based data. SUBJECTS: Dentists' children, aged 3-13 years. SAMPLE: All dentists (n = 250) actively practising in the capital city of Mongolia. RESULTS: The dentists' children's dmft ranged from 0 to 12, and DMFT from 0 to 8; 50% were caries-free. The younger the children, the higher was their total caries experience expressed as the sum of DMFT + dmft scores (r = -0.22; P = 0.001). Dentist-parents' background and work-related factors were not associated with their children's caries status (P > 0.05). When dentists' children were compared with their counterparts at the population level, mean dmft for 6-year-olds was 2.6 for (urban) dentists' children, 6.5 for children in the urban population and 0.9 for those in rural population of equivalent age. Mean DMFT for 12-year-olds were 1.0, 1.8 and 1.2, respectively, in the same three groups. In general, (urban) dentists' children in all age groups had better dental health than did their urban counterparts at the population level. Among 5-7-year-olds, dentists' children had worse dental health than did their counterparts in the rural population. CONCLUSIONS: Despite the dentists' knowledge and awareness, their children demonstrated higher rates of dental caries than expected. This suggests that Mongolian dentists may have insufficient preventive orientation. In particular, the primary dentition of younger children seems to be poorly valued. In Mongolia, dentists should have better training and education in modern methods of caries prevention and their advantages. Appreciation and care of the primary dentition need to be improved at all levels of oral health promotion in Mongolia.

Adolescent↗
PubMed2000

[Smoking and periodontal health].

The causal agents of destructive periodontal disease are several gram-negative bacteria. The mere presence, however, in the dental biofilm does not guarantee onset of the disease. The immunological and inflammatory host response as well as connective tissue and bone metabolism are strongly influenced by genetic, acquired and behavioural risk factors. Among the last, tobacco consumption holds a primary position. Prevalence, extent and severity of periodontitis as well as tooth loss and edentulism are influenced by tobacco consumption in a dose-dependent manner. About 50% of periodontal disease in young adults is attributable to cigarette smoking. Postoperative results in periodontally diseased smokers are considerably poorer than those achieved in non-smokers. As a consequence smoking cessation has to be in corporated in traditional treatment concepts for inflammatory periodontal disease.

Adult↗
PubMed2002

A clinical trial of the anticaries efficacy of casein derivatives complexed with calcium phosphate in patients with salivary gland dysfunction.

OBJECTIVE: The purpose of this study was to compare the caries preventive efficacy of a mouthrinse solution containing casein derivatives coupled with calcium phosphate (CD-CP) with that of a 0.05% sodium fluoride mouthrinse among individuals with dry mouth. STUDY DESIGN: A randomized control trial design was used. Participants included individuals who had had radiotherapy for head and neck cancer (n = 82) and others with Sjögren's syndrome (n = 56). Baseline data collection was followed by reexamination 12 months later. Posterior bite-wing radiographs were taken on both occasions. RESULTS: A total of 124 participants, 61 (49.2%) in the sodium fluoride group and 63 (50.8%) in the CD-CP group, completed the 12-month examination. The baseline characteristics of the 2 groups did not differ. Coronal caries incidence was higher in the sodium fluoride group than in the CD-CP group (34.4% and 27%, respectively), but the difference was not statistically significant. Similarly, the small difference in coronal caries increment between the 2 groups was not statistically significant (0.4 and 0.3 surfaces, respectively). There was insufficient root surface caries experience between the 2 groups observed for differences to be examined. Proportionately more of the CD-CP group lost 1 or more teeth, and the mean number of tooth loss was higher. The participants with the highest incidence and increment were those with Sjögren's syndrome in the CD-CP group. Some of that difference was accounted for by differences in baseline caries status. CONCLUSION: It appears that CD-CP preparations hold promise as caries preventive agents for individuals with dry mouth, although confirmation of this study's findings in other settings is warranted before a definitive conclusion can be reached.

Adult↗
PubMed2001

Prosthetic considerations in the restoration of orthodontically treated maxillary lateral incisors to replace missing central incisors: a clinical report.

The treatment of young patients with missing maxillary incisors poses a challenge to prosthodontists and orthodontists. The 2 principal treatment options are (1) the reopening or maintenance of space for future autotransplantation and/or prosthodontic restoration of the missing teeth, or (2) total orthodontic space closure, followed by prosthodontic modification of the lateral incisors to simulate the central incisors. This article discusses only the second option and describes 2 alternative methods for the modification of crown anatomy. These procedures facilitate the orthodontic closure of missing central incisor spaces to ensure satisfactory, esthetic results.

Adolescent↗
PubMed2004

Dental caries among the elderly in Norway.

OBJECTIVES: [corrected] To describe the occurrence of decayed teeth (DT), missing teeth (MT), filled teeth (FT), and the total sum score DMFT in elderly Norwegian pensioners, 67 years or more. BASIC PROCEDURES: A representative sample of 582 elderly Norwegians (12.5% receiving social care) participated in a nationwide study (46% men and 54% women). In all, 394 (68%) still had some of their own teeth. A standardized clinical examination was performed by one of the authors (BMH) using well-defined criteria. MAIN FINDINGS: Mean DT was 0.46, FT was 8.4, and DMFT was 25.4. Mean number of root remnants was 0.11. Mean DT, FT, DMFT, and root remnants for the dentate participants were 0.67, 12.4, 24.1, and 0.17, respectively. Men had significantly higher DT than women. DT decreased with increasing age. Only small differences were found in the prevalence of dentate individuals with caries between gender, age groups, geographical regions, and residence in areas of varying population density. CONCLUSION: It seems that caries is a minor problem in the Norwegian elderly population. Age and the number of remaining teeth do not have a decisive role in the development of caries. Further, there are no differences in these respects between geographical areas in Norway.

Age Factors↗
PubMed2004

Self-reporting of periodontal diseases and clinical assessment outcome in a Swedish urban population of smokers and non-smokers.

The aim of this study was to determine whether there is an association between self-reporting of periodontal diseases and outcome in a clinical examination, and whether any difference is present in awareness of periodontal status between smokers and non-smokers. Participants comprised 1676 adults (838 M and 838 F aged between 31 and 40 years), 564 of whom reported being smokers. Subjects were asked via questionnaire whether they thought they had periodontal disease and why. A total of 1655 subjects answered the questionnaire and were subsequently divided into those who suspected having periodontal disease (Yes-group) and those who did not (No-group). A full-mouth clinical examination was carried out in all subjects. Female smokers in the Yes-group had a significantly higher number of teeth with pockets > or = 5 mm (P < 0.001) and a higher calculus index (CI-S, P < 0.01) than female smokers in the No-group. Male smokers in the Yes-group had significantly less remaining teeth (P < 0.01), more teeth with pockets > or = 5 mm (P < 0.001), and a higher CI-S (P < 0.05) than their counterparts in the No-group. For smokers, multivariate logistic regression analysis yielded an odds ratio (OR 3.21 [95% CI 1.73 5.74]) of self-reported periodontal disease to periodontitis outcome which was significant (P < 0.001). This association remained significant (P < 0.01) after adjustment for confounding factors. Subjects who reported having periodontal disease, especially those who also reported having movable teeth, were confirmed to have the disease. Smokers were more aware of their periodontal status than non-smokers.

Adult↗
PubMed2003

Development of Web-based intervention system for periodontal health: a pilot study in the workplace.

BACKGROUND: It has recently been accepted that periodontal disease is a risk factor for not only tooth loss but also systemic diseases. An effective system of public intervention for periodontal health to enable continuous intervention of dental professionals has been sought. We developed a Web-based intervention system regarding periodontal health and evaluated the effects of the system in the workplace. METHODS: The system was capable of storage and display of personalized oral health records including video images pertaining to toothbrush manipulation within their own oral cavities based on instructions by dental professionals. The system enabled clients to view movement of their own skill, and repeatedly. Thirteen workers of a company were randomized to either an experimental or control group. The control group received face-to-face toothbrushing instruction at the company and follow-up via telephone. The experimental group received follow-up through our system in addition to those components employed in the control group. MAIN RESULTS: The workers in the experimental group benefited in terms of improvements of not only plaque removal but also periodontal health over 3 months. CONCLUSIONS: These results indicate that implementation of an Web-based approach for periodontal health affords the possibility of remote instruction and produces additional public benefit.

Health Promotion↗
PubMed2003

Platelet-derived growth factor gene delivery stimulates ex vivo gingival repair.

Destruction of tooth support due to the chronic inflammatory disease periodontitis is a major cause of tooth loss. There are limitations with available treatment options to tissue engineer soft tissue periodontal defects. The exogenous application of growth factors (GFs) such as platelet-derived growth factor (PDGF) has shown promise to enhance oral and periodontal tissue regeneration. However, the topical administration of GFs has not led to clinically significant improvements in tissue regeneration because of problems in maintaining therapeutic protein levels at the defect site. The utilization of PDGF gene transfer may circumvent many of the limitations with protein delivery to soft tissue wounds. The objective of this study was to test the effect of PDGF-A and PDGF-B gene transfer to human gingival fibroblasts (HGFs) on ex vivo repair in three-dimensional collagen lattices. HGFs were transduced with adenovirus encoding PDGF-A and PDGF-B genes. Defect fill of bilayer collagen gels was measured by image analysis of cell repopulation into the gingival defects. The modulation of gene expression at the defect site and periphery was measured by RT-PCR during a 10-day time course after gene delivery. The results demonstrated that PDGF-B gene transfer stimulated potent (>4-fold) increases in cell repopulation and defect fill above that of PDGF-A and corresponding controls. PDGF-A and PDGF-B gene expression was maintained for at least 10 days. PDGF gene transfer upregulated the expression of phosphatidylinosital 3-kinase and integrin alpha5 subunit at 5 days after adenovirus transduction. These results suggest that PDGF gene transfer has potential for periodontal soft tissue-engineering applications.

Adenoviridae↗
PubMed2004

Association between serum concentrations of 25-hydroxyvitamin D3 and periodontal disease in the US population.

BACKGROUND: Periodontal disease (PD) is a common chronic inflammatory disease and an important risk factor for tooth loss. Vitamin D might affect periodontal disease risk via an effect on bone mineral density (BMD) or via immunomodulatory effects. OBJECTIVE: The objective was to evaluate whether serum 25-hydroxyvitamin D(3) [25(OH)D(3)] concentrations are associated with PD in the third National Health and Nutrition Examination Survey. DESIGN: We analyzed data on periodontal attachment loss (AL) and serum 25(OH)D(3) concentrations from 11 202 subjects aged > or =20 y. Mean AL was modeled in a multiple linear regression with quintile of serum 25(OH)D(3) concentration as an independent variable. The model was stratified by age and sex and was adjusted for age within age groups, race or ethnicity, smoking, diabetes, poverty income ratio, body mass index, estrogen use, and gingival bleeding. RESULTS: 25(OH)D(3) concentrations were significantly and inversely associated with AL in men and women aged > or =50 y. Compared with men in the highest 25(OH)D(3) quintile, those in the lowest quintile had a mean AL that was 0.39 mm (95% CI: 0.17, 0.60 mm) higher; in women, the difference in AL between the lowest and highest quintiles was 0.26 mm (0.09, 0.43 mm). In men and women younger than 50 y, there was no significant association between 25(OH)D(3) and AL. The BMD of the total femoral region was not associated with AL and did not mediate the association between 25(OH)D(3) and AL. CONCLUSIONS: Low serum 25(OH)D(3) concentrations may be associated with PD independently of BMD. Given the high prevalence of PD and vitamin D deficiency, these findings may have important public health implications.

Adult↗