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PubMed2002

Biological effects of hyperbaric oxygen on human severe periodontitis.

This paper reports the effects of Hyperbaric Oxygen (HBO2) in a controlled study of periodontitis in 24 patients. The patients received either HBO2 or no HBO2, and study teeth were divided into 4 groups based on treatment: 1-HBO2 therapy, 2-HBO2 + scaling, 3-scaling, 4-control. We measured indices of periodontal disease and gingival blood flow (GBF). The microorganisms in a periodontal pocket were stained and the percentage of straight rods (Rods), curved rods (Cur), fusiforms (Fusi) and spirochetes (Spiro) were observed. The numbers of anaerobic organisms were measured by routine anaerobic culture. Highly significant differences in Gingival Indices (GI), Sulcus Bleeding Indices (SBI), Probing Depth (PD), Attachment Loss (AL), Plaque Index (PLI), and GBF were seen in the HBO2, the HBO2 + Scaling and the Scaling Groups compared to the Control Group (P < 0.01). The number of subgingival anaerobes as well as the number of Rods, Cur, Fusi, and Spiro were reduced markedly in these three treatment groups. Statistically greater differences in clinical indices, GBF, subgingival anaerobe number and number of Rods, Cur, Fusi and Spiro were found by comparison of HBO2 + Scaling and HBO2 Groups, as well as between the HBO2 + Scaling and Scaling Groups, but no significant differences were observed in GI, SBI, PD, or AL between the HBO2 and Scaling Groups. In conclusion, HBO2 had beneficial therapeutic effects on severe periodontitis. HBO2 therapy combined with scaling and root planing was the most beneficial in the treatment of periodontitis. Clinical follow-up suggests that this treatment effect could last more than 1 year.

Adolescent↗
PubMed2003

Clinical and histologic evaluation of bone-replacement grafts in the treatment of localized alveolar ridge defects. Part 2: bioactive glass particulate.

The purpose of this study was to evaluate the feasibility of using a bioactive alloplast and a physical barrier to augment localized alveolar ridge defects for the subsequent placement of dental implants. Twelve systemically healthy patients (aged 29 to 55 years) with inadequate dental alveolar ridge widths were selected for study. All patients completed initial therapy, which included scaling, root planing, and oral hygiene instruction. All ridge defects were augmented with a bioactive glass alloplast and a titanium-reinforced e-PTFE barrier. Vertical (height) and horizontal (width) hard tissue measurements were taken the day of ridge augmentation surgery (baseline) and at the 6-month reentry surgery. The change in ridge width varied from a loss of 1 mm to a gain of 4.5 mm, with a mean gain of 1.1 mm (P < .03). Eight of the 12 sites gained 1 mm or less. The difference in mean ridge width gain between maxillary and mandibular sites was not statistically significant (P > .08). Mean ridge width gain was 1.1 mm for both maxillary and mandibular sites. There was a loss in bone height of 0.3 mm from baseline. Four implants in four patients could not be placed because of inadequate ridge width augmentation. Histologic examination of the grafted sites revealed connective tissue encapsulation of most residual graft particles. In this study, bioactive glass particulate and an e-PTFE barrier did not consistently augment localized ridge defects for dental implant placement.

Adult↗
PubMed2003

Adherence to periodontal maintenance in Tehran, Iran. A 7-year retrospective study.

Periodontal disease is chronic but not life threatening. Therefore, adherence to periodontal maintenance (PM) is often not ideal. However, this service is frequently needed for the remainder of one's life in order to prevent disease progression and recurrence. This study evaluates the degree of compliance with PM in a private periodontal practice in Tehran, Iran. Data were collected and analyzed for degree of compliance from 519 patients who had completed active periodontal treatment up to 7 years earlier and who had begun PM. The patients were classified according to age, sex, diagnosis, prognosis, procedures performed, and compliance with prescribed maintenance intervals. In total, the overall rate of complete compliance was 3.3%, while 57.6% were erratic compliers, and 39.1% never returned for therapy. Female patients complied better than males. Patients who had received surgery complied better with PM than patients who had received scaling and root planing. These results confirmed that the degree of compliance following periodontal therapy is far from ideal. Although universal findings of poor compliance have been found, there may not be a universal solution to resolve the problem.

Adult↗
PubMed2003

The relationship between periodontal status and peripheral levels of neutrophils in two consanguineous siblings with severe congenital neutropenia: case reports.

Congenital neutropenia is characterized by a severe reduction in absolute neutrophil counts, resulting in an almost total absence of neutrophils. It is well known that severe neutropenia affects periodontal status. Oral manifestations include ulcerations, gingival desquamation, gingival inflammation, attachment loss, and alveolar bone loss which may result in tooth loss. Treatment with granulocyte-colony stimulating factor (G-CSF) may improve this periodontal condition. This article reports the relationship between periodontal disease status and peripheral neutrophil levels in two consanguineous siblings with severe congenital neutropenia who did not receive routine G-CSF for 2 years prior to examination. Both siblings were given scaling, root planing, and periodontal prophylaxis in regular follow-up visits. This report demonstrates that periodontal therapy supported by adequate oral hygiene may result in restoration of neutrophil counts in siblings with congenital neutropenia.

Adolescent↗
PubMed2003

Periodontal disease and diabetes mellitus. Bidirectional relationship.

Periodontitis is a common problem in patients with diabetes. The relationship between these 2 maladies appears bidirectional--insofar that the presence of one condition tends to promote the other, and that the meticulous management of either may assist treatment of the other. Both diabetes and periodontitis can stimulate the chronic release of proinflammatory cytokines that have a deleterious effect on periodontal tissues. The chronic systemic elevation of proinflammatory cytokines caused by periodontitis may even predispose individuals to the development of type 2 diabetes. Mechanical treatment of periodontitis (scaling and root planing), when combined with short-term administration of therapeutic levels of tetracycline-type antimicrobials, can temporarily improve glycemic control in diabetic patients, especially in those with advanced forms of periodontitis and poor glycemic control before treatment. The biochemical mechanisms suggested by these studies imply that other periodontal procedures designed to rid patients of periodontal pathogens may also improve the management of diabetes. Therefore, the authors suggest that periodontal patients with diabetes be treated in consultation with a periodontist (Figures 3a through 4b).

Aged↗
PubMed1992

[Gingival crevicular aspartate aminotransferase levels in periodontitis patients before and after periodontal treatment].

Gingival crevicular fluid samples were collected from 296 teeth from 40 subjects, including 19 rapidly progressive periodontitis (RPP), 8 chronic adult periodontitis (CAP), 7 marginal gingivitis (MG) and 6 healthy subjects (H). The activities of aspartate aminotransferase (AST) in each sample were tested. The results were as follows: (1) The two groups with destructive periodontal disease (RPP and CAP) had greater GCF-AST levels than that from the two non-destructive groups (MG and H). (2) The GCF-AST activities showed significant positive correlations with clinical periodontal parameters, such as probing depth, attachment loss, bleeding index and suppuration. (3) Four weeks after thorough full-mouth root planing, both clinical parameters and GCF-AST levels decreased significantly. The present study suggests that GCF-AST activity might be a sensitive and objective marker for detection of periodontal tissue destruction and inflammation.

Adult↗
PubMed1992

Clinical studies on juvenile, rapidly progressive and adult periodontitis before and after periodontal therapy (I).

The sample in the present study comprised 36 patients who were referred for treatment of periodontal disease. Twenty-four of them were early onset periodontitis (EOP) patients and 12 were adult periodontitis (AP) patients. Based upon the age, number of involved teeth and the location of diseased sites, the EOP patients were divided into two groups as juvenile periodontitis (JP) and rapidly progressive periodontitis (RPP). All the patients were individually examined both clinically and radiographically. At a baseline examination and 3 months after active therapy, the patients were evaluated for plaque, gingivitis, probing depths and probing attachment levels. Following instruction in proper oral hygiene measures, all of the patients were subjected to periodontal treatment. Treatment comprised scaling and root-planing, occlusal adjustment, tetracycline administration and periodontal surgery with osteoplasty. Results showed that age limits between JP and RPP cannot be drawn with certainty. The mean age for the JP group was 21.83 years and was 30.58 years for the RPP group. The number of involved teeth was found to increase with age. The first molars were the most frequently affected teeth followed by the incisors. Three months after active treatment, the response of periodontal tissues to therapy both in EOP and AP groups was almost identical.

Adolescent↗
PubMed1992

Juvenile periodontitis: a review of pathogenesis, diagnosis and treatment.

Juvenile periodontitis (JP) and its treatment has become a critical concern to the practicing dentist. Actinobacillus actinomycetemcomitans has been diagnosed as the prime etiological agent associated with this disease. Decreased chemotaxis and phagocytosis of polymorphonuclear leukocytes have also been described in these patients. The precise treatment regimen must be individualized for each patient. In addition to aggressive antibiotic therapy, root planing, curettage or a surgical approach, with mandatory follow-up care, should be considered. This review discusses the etiology and pathogenesis of JP and recommends treatment regimens, according to patient diagnosis.

Adolescent↗
PubMed2004

[Observations of the non-surgical treatment response on diabetic patients with chronic periodontitis].

PURPOSE: To observe the non-surgical treatment response on diabetic patients with chronic periodontitis. METHODS: Moderate to advanced chronic periodontitis was studied in 36 Diabetes Mellitus (DM) patients classified as 20 cases with high and fluctuating blood glucose level (DM-H) and 16 cases with relatively low and stable blood glucose level (DM-L). 28 non-DM patients with chronic periodontitis served as control (Non-DM). Plaque Index (PlI), Gingival Index (GI), Bleeding on Probing (BOP), Probing Depth (PD) and Clinical Attachment Loss (AL) of all patients were recorded at 6 sites on each tooth at the baseline and in the first, the third, the sixth month after oral hygiene instrument (OHI), scaling and root planing. RESULTS: It was found that the short-term effect of non-surgical periodontal procedure had resulted in significant resolution of gingival inflammation and pronounced reduction in pocket depth and gain of attachment loss in all patients. The treatment response was similar in both DM and Non-DM patients with chronic periodontitis. CONCLUSIONS: Non-surgical periodontal treatment allowed for favorable treatment responses in a group of diabetic patients with chronic periodontitis and that their various profiles of blood glucose did not influence the short-term healing response to the treatment.

Adult↗
PubMed2004

[Antibacterial effect of Nd:YAG laser in periodontal pockets decontamination: a in vivo study].

AIM: Tha aim of this paper is to assess the effects in vivo of the Nd: Yag laser on gingival microflora in patients periodontally at risk. METHODS: An investigation has been carried out on 5 patients suffering from serious periodontal disease, with a sub-gingival check-up a week after the treatment. The selected patients presented either a relapse after the raising of a traditional flap, or showed acute phenomena and were, therefore, treated with a laser with the propedeutic intention of surgery; or they refused traditional surgical therapy or presented systematic pathologies that could not be included in the appropriate protocol. Pockets were chosen that had a probe depth of between 5-8 mm, an optic fibre probe was pushed as far as possible into the probe depth, for about 1 minute per site, 5 times, at 30 second intervals. The samples, taken in order to calculate bacteria colonies, were carried out before using the laser, immediately after and, again, 1 week later. RESULTS: All the sites showed a slight reduction in the quantity of colonies forming immediately after the Nd:Yag laser application, while a week later, only if clinical inflammation appeared to be resolved, the bacteria forming colonies seemed to be reduced. CONCLUSION: From this study it can be concluded that the use of the Nd:Yad laser represents, in mild and average periodontitis, a therapeutic aid to scaling and root planing and, in the same way, in serious periodontitis for traditional surgical therapy.

Humans↗
PubMed2004

The microbial outcome observed with polymerase chain reaction in subjects with recurrent periodontal disease following local treatment with 25% metronidazole gel.

The aim of this study was to evaluate the microbial outcome in patients with recurrent periodontal disease following treatment with 25% metronidazole gel using the polymerase chain reaction (PCR). Twenty subjects in a maintenance care program but with recurrent periodontal disease participated. Three months after scaling and root planing a total of 40 sites, 2 in each patient, with pocket probing depth of > or = 5 mm were selected. One site randomly selected was treated with 25% metronidazole gel (test) and the other site with a placebo gel (control). A bacterial sample was collected on paperpoint from each test and control site at baseline and 12 weeks after treatment. The following pathogens were analysed and detected with PCR:Actinobacillus actinomycetemcomitans (A.a.), Porphyromonas gingivalis (P.g.) and Prevotella nigrescens (P.n.). At baseline, A.a., P.g. and P.n. were detected in 30, 60 and 70% of all test sites and in 32, 58 and 21% of all control sites. There was a statistically significant difference between the test and control sites for P.n. at baseline. The major difference after treatment with 25% metronidazole gel was the increase of positive control sites for P.g. and P.n. However, there were no statistically significant differences in the occurrence rate of A.a., P.g. and P.n. at test and control sites after treatment. This study has shown that 25% metronidazole gel treatment did not seem to influence the microbial outcome, when PCR was used to analyse the presence/absence of A.a., P.g. and P.n. in this group of subjects with recurrent periodontal disease.

Adult↗
PubMed2004

[Periodontal abscess: etiology, diagnosis and treatment].

The periodontal abscess is an acute destructive process in the periodontium resulting in localized collections of pus communicating with the oral cavity through the gingival sulcus or other periodontal sites and not arising from the tooth pulp. The prevalence of periodontal abscess is relatively high and it affects the prognosis of the tooth. Periodontal abscesses can develop on the base of persisting periodontitis but can also occur in the absence of periodontitis. The cause of the development of periodontal abscess originating from chronic periodontitis is the marginal closure of a periodontal pocket, or the pocket lumen might be too tight to drain the increased suppuration due to changes in the composition of subgingival microflora, alteration of bacterial virulence or host defenses. Diagnosis of a periodontal abscess is based on medical and dental history as well as oral examination (pocket depth, swelling, suppuration, mobility, sensibility of the tooth). The most prevalent group of bacteria: P. gingivalis, P. intermedia, B. forsythus, F. nucleatum and P. micros. Previous studies have suggested that the complete therapy of the periodontitis patients with acute periodontal abscess has to do in two stages: the first stage is the management of acute lesions, then the second stage is the appropriate comprehensive treatment of the original and/or residual lesions. The management of acute lesions includes establishing drainage via pocket lumen, subgingival scaling and root planing, curettage of the lining pocket epithelia and seriously inflamed connective tissue, compressing pocket wall to underlying tooth and periodontal support, and maintaining tissue contact. Some authors recommend the incision or to establish drainage and irrigation, or a flap surgery, or even extraction of hopeless teeth. We recommend the use of systemic antibiotics as a preventive measure of systemic disease or in case of systemic symptoms.

Acute Disease↗
PubMed2004

A post-marketing study of 2805 patients treated for periodontal disease with Arestin.

Recent studies have demonstrated the effectiveness of locally delivered antibiotics adjunctive with scaling and root planing (SRP) in patients with chronic periodontitis. Specifically, several studies have demonstrated the efficacy of minocycline microspheres (Arestin). The objective of the current study was to evaluate the use of Arestin in a study using private practices all over the United States and adopting a predefined protocol. Eight hundred ninety-five dentists and 2805 patients participated in the largest reported trial in chronic periodontal disease in private practice. The protocol outlined that patients were to have SRP at baseline with one application of Arestin in all pockets > or = 5 mm, a recall visit three months later that included a second application of Arestin, and a final assessment after 6 months. One thousand ninety five patients were treated in accordance with the protocol, and 1710 patients returned for a second assessment but only received one therapeutic intervention. Mean pocket depth reduction from baseline in the 1710 patients was 1.82 mm (p < 0.0001) and for the 1095 patients at 6 months it was 1.94 mm (p < 0.0001). Similar results were obtained in smokers, diabetes patients and patients with a history of cardiovascular disease. After 1 treatment 62% of sites had decreased to less than 5 mm and after two treatments the corresponding number was 67%. There were no serious adverse events in the study. This study demonstrated that a large study could be conducted in a private practice setting, that Arestin and SRP were effective in reducing pocket depth, and that adherence to the protocol yielded additional benefits.

Anti-Infective Agents, Local↗
PubMed2004

The aetiology and treatment of oral halitosis: an update.

Halitosis refers to the condition of offensive mouth odour. More than 90% of cases of halitosis originate from the oral cavity. The implicated bacteria (Fusobacterium nucleatum, Prevotella intermedia, and Tannerella forsythensis) are located in stagnant areas in the oral cavity, such as the dorsal surface of tongue, periodontal pockets, and interproximal areas. These bacteria proteolyse the amino acids releasing volatile sulphur compounds. The management of halitosis involves determining and eliminating the causes, which includes identifying any contributory factors, because certain medical conditions are also associated with characteristic smells. Professional advice should be given on oral hygiene and diet, and treatments should include dental scaling, and root planing of the associated periodontal pockets to reduce the bacterial loading. In addition to the normal oral hygiene practice, tongue cleaning and use of mouthwash are advocated. This paper discusses the common aetiological factors, classification of oral halitosis, and its treatment.

Bacteroidaceae Infections↗
PubMed2004

Recent developments in local anesthesia and oral sedation.

This article reviews 3 recent developments in anxiety and pain control with significant potential for altering dental practice. First is the introduction of articaine hydrochloride as an injectable local anesthetic. Although articaine is an amide, its unique structure allows the drug to be quickly metabolized, reducing toxicity associated with repeated injections over time. The second development is the formulation of a lidocaine and prilocaine dental gel for topical anesthesia of the periodontal pocket. This product may significantly reduce the need for anesthetic injections during scaling and root planing. Finally, the use of triazolam as an oral sedative/anxiolytic is reviewed. The recent administration of triazolam in multiple doses has extended the availability of anxiety control to many dental patients, but unknowns about the safety of the technique as practiced by some dentists remains a concern.

Adjuvants, Anesthesia↗
PubMed2005

Adjunctive periodontal treatment with Centella asiatica and Punica granatum extracts in supportive periodontal therapy.

BACKGROUND: Centella asiatica and Punica granatum are medicinal plants that have been reported to promote tissue healing and modulate host responses. Preliminary study revealed positive clinical effects of an innovative preparation from the two herbal extracts in the form of biodegradable chips as a subgingival adjunct to scaling and root planing. The purpose of this research was to evaluate further augmenting efficacy the combined herbal preparation may have among maintenance patients in comparison to standard supportive periodontal therapy (SPT), with additional monitoring of certain inflammatory markers. METHODS: Fifteen patients in the recall programme who had completed conventional periodontal therapy with remaining probing pocket depths of 5-8 mm were enrolled. After baseline examination and collection of gingival crevicular fluid (GCF) samples, SPT was provided and the target teeth in the test group received subgingival delivery of the medicated chips. The clinical parameters, which included probing pocket depth (PD), attachment level (AL), bleeding index (BI), gingival index (GI) and plaque index (PI) were recorded and GCF samples were collected at baseline, 3 and 6 months. RESULTS: The results showed significant improvement of PD, AL, and GI at 3 and 6 months and of BI at 6 months in the test group as compared to control. No significant differences in PI were found between the two treatment modalities at all subsequent visits. The test group also showed statistically greater reduction of IL-1beta at both 3 and 6 months and lower IL-6 concentration, which almost reached the level of significance at 6 months. CONCLUSION: The results indicate that adjunctive local delivery of extracts from C. asiatica in combination with P. granatum significantly improved clinical signs of chronic periodontitis and IL-1beta level in maintenance patients.

Adult↗
PubMed2005

Adjunctive periodontal therapies.

In general, systemic and local chemotherapeutic treatments offer a variety of options as adjuncts to traditional mechanical therapy, but they should not be used routinely for every patient. In fact, initial debridement to disrupt the biofilm and remove calculus prior to drug treatment may enhance results. Dentists will need to use their clinical judgment based on disease nature and severity to make treatment decisions, with the knowledge that these therapies may be best utilized in the few localized persistent lesions present following thorough scaling and root planing.

Anti-Bacterial Agents↗
PubMed1992

CPITN application in regular dental practice.

The periodontal status of 8862 dentulous and partially dentulous inhabitants of the Federal Republic of Germany was investigated in various dental practices, using the CPITN, developed by the World Health Organization. The results show that a total of only 4.3% of those examined have a healthy periodontal apparatus and thus require no periodontal treatment. At least detailed oral hygiene instruction needs to be given to 95.7% of all subjects. Furthermore, 80% patients with periodontal disease require scaling or root planing, and 10% of them require periodontal surgery. The treatment of shallow gingival pocketing (CPITN 3) is predominant in every age group, and every fifth patient aged 35 years or more is need of periodontal surgery. This high frequency rate of periodontal disease illustrates the urgent necessity in regular dental practice for each and every patient to undergo periodontal screening. Such screening, based on the time saving CPITN, is to be recommended as it ensures fast, reliable determination of the periodontal status of each individual patient and the treatment needs involved.

Age Factors↗