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Carbohydrates act as receptors for the periodontitis-associated bacterium Porphyromonas gingivalis: a study of bacterial binding to glycolipids.

In this study we show for the first time the use of carbohydrate chains on glycolipids as receptors for the periodontitis-associated bacterium Porphyromonas gingivalis. Previous studies have shown that this bacterium has the ability to adhere to and invade the epithelial lining of the dental pocket. Which receptor(s) the adhesin of P. gingivalis exploit in the adhesion to epithelial cells has not been shown. Therefore, the binding preferences of this specific bacterium to structures of carbohydrate origin from more than 120 different acid and nonacid glycolipid fractions were studied. The bacteria were labeled externally with (35)S and used in a chromatogram binding assay. To enable detection of carbohydrate receptor structures for P. gingivalis, the bacterium was exposed to a large number of purified total glycolipid fractions from a variety of organs from different species and different histo-blood groups. P. gingivalis showed a preference for fractions of human and pig origin for adhesion. Both nonacid and acid glycolipids were used by the bacterium, and a preference for shorter sugar chains was noticed. Bacterial binding to human acid glycolipid fractions was mainly obtained in the region of the chromatograms where sulfated carbohydrate chains usually are found. However, the binding pattern to nonacid glycolipid fractions suggests a core chain of lactose bound to the ceramide part as a tentative receptor structure. The carbohydrate binding of the bacterium might act as a first step in the bacterial invasion process of the dental pocket epithelium, subsequently leading to damage to periodontal tissue and tooth loss.

Carbohydrate Metabolism↗

A cross-sectional study of human serum sphingolipids, diet and physiologic parameters.

Sphinganine and sphingosine, the two sphingoid base backbones of sphingolipids, are highly bioactive compounds that are of increasing interest to nutritionists because they occur in food and their metabolism can be altered by fungal toxins that contaminate some foods. Nonetheless, no studies of diet and sphinganine or sphingosine concentrations in serum have yet been reported. Here we describe a cross-sectional study of 265 residents of Linxian, People's Republic of China, which examines potential demographic, physiologic and dietary correlates of serum sphinganine and sphingosine in this population. Median concentrations of serum sphinganine and sphingosine were compared among strata for 29 different variables. For sphinganine, no significant differences were found. For sphingosine, significant differences were seen among strata of age, menstruation status, serum cholesterol, carotenoids, retinol, tocopherols, fresh and dried vegetable and fresh fruit consumption. Using multivariate linear regression with stepwise selection, we found that the significant predictors for serum sphingosine included total tocopherols, age, serum selenium and retinol, with a final R(2) = 0.22; for sphinganine, tooth loss was the sole correlate, with R(2) = 0.015. Analyses using ranked sphingolipid data or principal components analysis, to simplify the food variables, did not materially alter these results. This study represents the largest report of human serum sphingolipid concentrations to date and provides insight into potential explanatory variables that can be incorporated into future studies.

Adult↗

Maxillary myxoma treated with wide resection and immediate reconstruction: a case report.

Myxoma of the jaw is a rare, benign bone tumor of odontogenic origin. Given the locally aggressive nature of the myxoma and the high rate of recurrence, there is a tendency to choose radical resection of the jaw segment containing the tumor mass as the treatment modality. As they appear to attain a considerable size prior to diagnosis because of their insidious growth characteristics, particularly in the maxilla, treatment requiring a hemimaxillectomy often results in a significant functional and aesthetic disability. This is particularly distressing as this condition usually affects the young. We present the case of a 16-year-old female who suffered a large maxillary myxoma with swelling of the left cheek for 2 years. Wide resection of the tumor tissue including the maxillary medial and lateral buttresses and part of the hard palate with preservation of maxillary alveolar bone and teeth was undertaken, and the maxillary buttresses were reconstructed with autogenous rib grafts. At the 3.5-year follow-up there was no local recurrence and no tooth loss. Both the functional result and aesthetic contour proved satisfactory. Wide resection with preservation of vital structures and simultaneous autogenous bone graft reconstruction is our preferred method. A long-term follow-up is needed.

Adolescent↗

Mastication influences the survival of newly generated cells in mouse dentate gyrus.

We examined the effects of soft food and tooth loss on neurogenesis in the adult dentate gyrus. Four-week-old mice were subjected to a powder diet for 10 weeks with or without removal of molars. They received a daily injection of bromodeoxyuridine (BrdU) at 14 weeks of age for 12 consecutive days. The number of BrdU-positive cells in the dentate gyrus of these mice did not differ from that of control at 1 day after the last BrdU injection. However, the BrdU-positive cells in these mice showed a larger reduction in number than in control at 5 weeks after the BrdU injection and the ratio of neurons to BrdU-positive cells decreased in the molarless mice. These results suggest that mastication influences the survival of newly generated cells in the adult dentate gyrus.

Age Factors↗

Endodontic treatment of a Patient with Huntington's disease.

Huntington's disease is a lethal autosomal dominant disorder that affects men and women equally. The prevalence of Huntington's disease in North America is 5 to 10 per 100000 people. It is characterized by regular personality changes, dementia, and choreiform (dance-like) movements. Literature concerning dental treatment of patients who have been diagnosed with this type of disease is scarce. Continuous ingestion of medications to control the symptoms of this disease leads to xerostomia, which, maximized by unrestrained movements, often leads to progressive tooth decay, irreversible pulpitis, and tooth loss. Maintenance of teeth in patients with this type of disease is desirable and challenging. Like any patient, a comprehensive treatment plan needs to be developed with equal emphasis on restoration and home care. This case report illustrates how a morphologically difficult endodontic procedure can be successfully administered in a patient diagnosed with HD. Overall case success was attributed to a dental team approach and short-duration appointments to limit patient stress.

Adult↗

The use of high-density polytetrafluoroethylene membrane to treat osseous defects: clinical reports.

Alveolar bone resorption can result from tooth loss, periodontal disease, or trauma. Guided tissue regeneration is used in an attempt to exclude tissues devoid of osteogenic potential from a bone defect or cavity and promote new bone growth to replace missing osseous structure. Many types of barrier membranes have been used, but none have been found to be ideal for every clinical situation. Macroporous membranes, such as expanded polytetrafluoroethylene, require primary closure and a second surgical procedure for their removal. Macroporous membranes can incorporate bacteria and may become infected if exposed in the oral cavity. Membranes manufactured of resorbable polymers require primary closure of the augmentation site and exhibit variable patterns of resorption, introducing a degree of unpredictability into the procedure. The use of high-density polytetrafluoroethylene membrane to promote deposition of bone for ridge augmentation in the oral cavity is described. Two clinical reports are presented.

Alveolar Ridge Augmentation↗

Langerhans cell histiocytosis.

The term histiocytosis identifies a group of disorders characterized by localized or generalized reactive or neoplastic proliferation of cells similar, if not identical, to cells of the mononuclear phagocyte and dendritic cell systems. In Langerhans cell histiocytosis (LCH), the proliferating cell is the Langerhans cell, and the morphologic and immunohistochemical criteria for the definitive diagnosis of LCH have been established. The clinically evident pathology of LCH is broadly divided into two categories: direct involvement with the disease (e.g., lytic lesions of the bone or organ involvement) and secondary consequences resulting from permanent damage by the primary disease, LCH (eg, diabetes insipidus, fractures, and tooth loss). Current knowledge suggests tailoring the therapy to the extent of disease. Single-system disease can be treated by excisional biopsy, low-dose radiotherapy, or mild chemotherapy. Multisystem disease should be treated with combination chemotherapy, and current experimental therapeutic approaches include randomized treatment protocols for multisystem disease. A pressing current controversy regarding LCH is that its etiology is unknown. Whether LCH is reactive or neoplastic is even debated, and several features provide seemingly contradictory evidence on this point (spontaneous resolution of disease on one hand and clonality of lesional LCH cells on the other), underscoring the need for further studies to elucidate the etiology and pathogenesis of LCH.

Antigen-Presenting Cells↗

The effect of cigarette smoking on dental implants and related surgery.

Cigarette smoking is still considered a common habit. Of smokers, increased plaque accumulation, higher incidence of gingivitis and periodontitis, higher rate of tooth loss, and increased resorption of the alveolar ridge have been found in the oral cavity. Cigarette smoking may adversely affect wound healing, and, thus, jeopardize the success of bone grafting and dental implantation. Bone grafts and sinus lift operations are both common and well-documented procedures before dental implant placement. Heat as well as toxic by-products of cigarette smoking, such as nicotine, carbon monoxide, and hydrogen cyanide, have been implicated as risk factors for impaired healing, and, thus, may affect the success and complications of those surgical procedures. An association among dental implants, grafting procedures (i.e., bone grafts, maxillary sinuses augmentation), and history of smoking has been reported. A higher degree of complication, or implant failure rates, were found in smokers with and without bone grafts. The relationship between cigarette smoking and implant-related surgical procedures, including the incidence of complications associated with these procedures, will be described and discussed based on relevant literature and results of our recent studies.

Alveolar Bone Loss↗

Surgical technique for the correction of postpalatoplasty fistulae of the hard palate.

Postpalatoplasty fistulas of the hard palate remain challenging. The reported recurrence rate after surgical correction ranges between 33 and 37 percent. The authors describe a surgical technique for the correction of postpalatoplasty fistulas by total elevation of the palatal gingivoperiosteum starting at the dental sulcus, excision of the fistula, and watertight separate closure of the nasal and palatal mucosa by means of the transoral approach. This technique has the advantages of providing adequate exposure for closure of the nasal mucosal gap and allowing closure of the palatal defect under minimal tension. Placement of interdental sutures leaves no raw bone surfaces exposed. The authors have used this technique on 60 consecutive patients with fistulas of the primary and secondary hard palate between 1998 and 2003. Their overall success rate of fistula closure was 90 percent. The success rate for previously unoperated postpalatoplasty fistulas was 96.9 percent. All of the failures occurred in patients who had bilateral cleft lip and palate. No complications of tooth loss or gingival recession were observed. A detailed description of the technique with illustrations is provided.

Adolescent↗

Clinical and pathological features of pachyonychia congenita.

Pachyonychia congenita (PC) is a rare genodermatosis affecting the nails, skin, oral mucosae, larynx, hair, and teeth. Pathogenic mutations in keratins K6a or K16 are associated with the PC-1 phenotype whereas K6b and K17 mutations are associated with the PC-2 phenotype. Analysis of clinical, pathological, and genetic data from the literature and two research registries reveal that >97% of PC cases exhibit fingernail and toenail thickening, and painful plantar keratoderma. Prospective evaluation of 57 PC patients from 41 families revealed variable clinical findings: hyperhidrosis (79%), oral leukokeratosis (75%), follicular keratosis (65%), palmar keratoderma (60%), cutaneous cysts (35%), hoarseness or laryngeal involvement (16%), coarse or twisted hair (26%), early primary tooth loss (14%), and presence of natal or prenatal teeth (2%). Stratification of these data by keratin mutation confirmed the increased incidence of cyst formation and natal teeth among PC-2 patients, although cysts were more commonly seen in PC-1 than previously reported (25%-33%). Previously unreported clinical features of PC include development of painful oral and nipple lesions during breastfeeding, copious production of waxy material in ears, and inability to walk without an ambulatory aid (50%). Possible pathogenic mechanisms are discussed with respect to the clinicopathologic and genetic correlations observed.

Darier Disease↗

A study of the proximity of the Broadrick ideal occlusal curve to the existing occlusal curve in dentate patients.

Increasingly, clinicians are called upon to restore dentitions, which have become mutilated because of tooth loss, wear, trauma and disease. In many cases, restoration of the occlusal plane may be required. A simple tool, which provides the laboratory technician with an approximation of the patient's original occlusal curve may be useful. The purpose of this study is to determine the accuracy of the occlusal curve designed using the Broadrick flag. A total of 100 patients with intact dental arches were examined, and deviations from the Broadrick curve were measured on scanned study models using a software package. Simple descriptive statistics were used to investigate the data, and intra-examiner reliability was examined using a Bland Altman plot. The results demonstrated little deviation from the Broadrick curve in natural adult dentitions, mean deviation 0.1262 mm, 95% confidence interval -0.32 to 0.2844. Good intra-examiner reliability was achieved. It can be concluded that the Broadrick flag method may be of use in determining an appropriate occlusal curve for dentate individuals with deranged occlusal planes.

Adult↗

Anangu oral health: the status of the Indigenous population of the Anangu Pitjantjatjara lands.

OBJECTIVE: To describe oral health in the Anangu Pitjantjatjaraku lands in South Australia and to compare with earlier surveys and national data. DESIGN: Descriptive. SETTING: Data were collected at the time of dental care service provision, according to World Health Organization protocols, at the request of the Nganampa Health Council on optical mark reader forms. PARTICIPANTS: There were 356 Anangu adults and 317 children surveyed. RESULTS: The mean number of teeth affected by dental caries in the deciduous dentition in young children, aged 5-6 years, was double (mean 3.20) that of the overall Australian child population aged 5-6 years (mean 1.44). In contrast to the decline in deciduous caries in Australian children generally, Anangu children aged 5-9 years had a 42% increase in the mean number of teeth affected since 1987. Adults experienced low levels of dental caries, but severe periodontal disease was more prevalent among diabetics (79%) compared with-non-diabetics (13.8%). Tooth loss was found more frequently among adults with diabetes (mean 5.51) than non-diabetics (mean 1.53). CONCLUSIONS: Oral health promotion strategies, in association with general health strategies, need to be developed to improve oral health in this remote Aboriginal population.

Adolescent↗

Aging and mastication: changes in performance and in the swallowing threshold with natural dentition.

Few comprehensive studies of oral function have been conducted on adult populations. A "Longitudinal and Cross-Sectional Study of Oral Health in Healthy Veterans" was activated at the VA Outpatient Clinic in Boston in 1969; it included general oral and dental examinations as well as tests of masticatory performance and the swallowing threshold. The current investigation involved 863 subjects from the "Dental Study" who had either their natural teeth or a fixed replacement for missing teeth. Masticatory performance as measured by the subject's ability to reduce a test portion of cut carrot by a mandatory number of chewing stroked remained constant for persons with complete or partially compromised natural dentition. Swallowing threshold performance as measured by the particle size acceptable for swallowing remained constant for persons with complete dentition. Tooth loss significantly decreased the swallowing threshold performance and increased the particle size which the subject was willing to swallow. Older subjects increased the number of chewing strokes and the time required for this test, an observation not related to performance as measured by final particle size. Only with compromised dentition, however, did this increased effort result in increased performance.

Adult↗

Oral disease and physical disability in community-dwelling older persons.

OBJECTIVE: The aim of this epidemiologic investigation was to determine whether poor oral health in older persons was associated with physical disability. DESIGN: The study was a cross-sectional survey involving in-home interviews and dental examinations of older persons. SETTING: A random sample of 68 cities and towns was selected from the six New England states, with stratification according to population size. PARTICIPANTS: The study sample consisted of 1,156 community-dwelling (non-institutionalized) individuals aged 70 and over, randomly selected from the Medicare beneficiary lists for each city and town. MEASUREMENTS: Oral health was assessed by three dichotomous indices: edentulism (no teeth); current caries, including either coronal or root decay; and periodontal disease, as measured by gingival pocket depth. Physical disability was indicated by the subject's self-report of difficulty in the areas of personal care (eating, bathing, dressing, and using the toilet) and mobility (walking, bed transfer, getting outside). Additional independent variables included age, sex, number of teeth, education, living alone, oral hygiene practices, and time since last dental visit. RESULTS: We found a direct association between specific areas of physical disability and current caries and edentulism. The risk of poor oral health did not increase with advancing age once the related risk factors were controlled for. Those subjects with mobility disabilities were at increased risk of tooth loss; those with personal care limitations were at increased risk of current caries. CONCLUSIONS: Physical disability should be added to the list of known risk factors for oral disease among the older population. Our findings call attention to the need for health care providers to screen for oral health problems among disabled older persons. Further gerontologic research is needed to identify the mechanisms linking physical disability with oral disease in older persons.

Activities of Daily Living↗

The importance of oral health in the older patient.

Oral health is important to general health because stomatologic disease affects more than the mouth. Increasing preservation of teeth among present and future cohorts of older people has increased their risk for serious disease from oral pathogens. The intent of this paper is twofold: first, to alert non-dental health personnel to the significance of oral health and oral disease in the older adult; and second, to recruit the assistance of non-dental professionals in helping patients to achieve and maintain an optimal oral condition. Normative aging processes alone have little effect on the oral cavity, but common disease processes affecting oral health include tooth loss, dental caries, periodontal diseases, and oral mucosal diseases (including candidiasis and squamous cell carcinoma). Systemic diseases and their treatments frequently affect salivary, oral motor, and oral sensory functions. As a result of bacteremia or aspiration of oral contents, organisms of oral origin can be responsible for serious nonstomatological infections. Clinicians caring for older people need to recognize the importance of stomatological health, include an oral component in the multidisciplinary geriatric assessment, support the education of patients on aspects of dental health, and advocate the expansion of personal and public oral health benefits for older adults.

Adult↗

Biomechanics of cantilever fixed partial dentures in shortened dental arch therapy.

PURPOSE: The purpose of the present study was to investigate, by means of 3-dimensional finite element analysis, aspects of the biomechanics of cantilever fixed partial dentures replacing the maxillary canine in shortened dental arch therapy. The null hypothesis was that no differences would be identified by finite element analysis in the mechanical behavior of the 2 designs of cantilever fixed partial denture under different scenarios of occlusal loading. MATERIALS AND METHODS: Single- and double-abutted cantilever fixed partial dentures were modeled and analyzed using the finite element packages PATRAN and ABAQUS. Displacement and maximum principal stresses (magnitude and location) within the fixed partial dentures, supporting structures, and the periodontal ligament/bone and abutment/retainer interfaces were examined under 20 different scenarios of axial and lateral occlusal loading. RESULTS: The results indicate that more displacement occurred in the 2 rather than the 3-unit cantilever fixed partial denture, with the greatest displacement having occurred under lateral loading. The maximum principal stresses observed in the periodontal ligament/bone interfaces were greatest buccocervically, with the highest value being observed in the 2-unit fixed partial denture under lateral loading. The highest maximum principal stresses observed in the retainer/abutment interfaces were located cervically in relation to the distal margin of the retainer of the 2-unit fixed partial denture under axial loading. CONCLUSIONS: It was concluded that in adopting a cantilever fixed partial denture approach for the replacement of a missing maxillary canine in shortened dental arch therapy, there may be merits, in terms of mechanical behavior, in selecting a double-rather than a single-abutment design. Furthermore, prostheses' displacement and functional stresses may be minimized by reducing lateral loading and avoiding pontic only loading.

Biomechanical Phenomena↗