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PubMed2005

Commentary: clinical implications of periodontal disease assessments using probing depth and bleeding on probing to measure the status of the periodontal-biofilm interface.

Periodontal disease has traditionally been classified based upon history and clinical presentation, but considerable heterogeneity persists within each diagnostic category. Clinical signs have relatively weak sensitivity and specificity for predicting disease outcomes in treated and untreated individuals, suggesting the need for improved periodontal classifications, prognosis, and treatment strategies. Data from an epidemiologic study that included full-mouth clinical periodontal measurements from more than 6700 community-dwelling subjects were analyzed to identify heterogeneity in disease presentation. These analyses were used to create periodontal disease classifications based upon probing depths (PD) and bleeding on probing (BOP) scores. Two distinct disease classifications emerged: i.e. moderate periodontitis (MP) and severe periodontitis (SP). MP was defined as 1 or more sites with a PD of 4 mm or greater and BOP extent scores less than 50%, and SP was defined as 1 or more sites with a PD of 4 mm or greater and BOP extent scores of 50% or higher. These definitions were used to retrospectively analyze data from a pilot study designed to determine the clinical effects of scaling and root planing (SRP) treatment. Examiners evaluated 58 subjects for potential differences in treatment response comparing MP with SP subjects at baseline and 6 weeks after SRP treatment. Plaque scores were associated with greater extent of pocketing (extent PD > or =4 mm) in the MP group, but not in the SP group. Significant clinical improvement in PD and BOP was detected at 6 weeks in the SP group but not in the MP group when using the presented classification to retrospectively compare patient response to SRP treatment using a separate clinical data set. Periodontal disease is a heterogeneous condition, and classifications based upon BOP and PD may be useful considerations in predicting patient clinical response to therapy.

Biofilms↗
PubMed2005

The clinical significance of new therapies for the management of periodontal disease.

With the approval of interventions or treatments for periodontal disease based on results of large clinical trials, it is often difficult for the clinician to determine whether the statistical results obtained from these studies are clinically significant and whether these interventions or treatments will thus be effective in their individual patients. In this article, a series of measures of clinical significance are derived from the literature, and a 2-step approach is suggested for determining clinical significance. First, the reliability of the data as a function of the reliability of the measurement tool(s) is calculated, and then clinical significance is put into the context of effect size. By using these estimators, clinicians can determine, for example, whether administration of an experimental local medication plus scaling and root planing provides a clinically significant outcome, which can assist them in deciding which interventions are most effective for their patients.

Clinical Trials as Topic↗
PubMed2005

Subgingival topical doxycycline versus mechanical debridement for supportive periodontal therapy: a single blind randomized controlled two-center study.

PURPOSE: To evaluate the clinical effects of topical subgingival application of a doxycycline gel compared to conventional mechanical debridement in supportive periodontal therapy. METHODS: 37 patients with residual or recurring periodontitis after systematic periodontal treatment at two centers (Heidelberg, Frankfurt) participated in this study. They had to exhibit at least one single-rooted tooth with either a probing depth (PPD) = 5 mm and bleeding-on-probing (BOP) or with PPD > or = 6 mm. The patients were randomly assigned to one of the two different treatment regimes: DOXY (exclusively subgingival application of a 14% doxycycline gel) or SRP (scaling and root planing with a sonic scaler). Clinical examinations (plaque index [P1I], PPD, vertical relative attachment level [RAL-V], gingival index [GI]) were performed before, 3, and 6 months after therapy. RESULTS: In 37 patients (19 female), aged 30-76 years with a total of 168 teeth were treated (DOXY: 79; SRP: 89). Six months after therapy, both groups exhibited statistically significant (P< 0.001) reductions of PPD (DOXY: -1.43 +/- 0.22 mm; SRP: -1.14 +/- 0.18 mm) and gains of RAL-V (DOXY: 0.79 +/- 0.22 mm; SRP: 0.72 +/- 0.19 mm). Multilevel regression analyses, considering the therapy of different numbers of teeth in different patients, failed to show statistically significant differences concerning PPD reduction and RAL-V gain between both therapies (DOXY/SRP). For both therapies, PPD reduction was significantly better in deeper pockets (PPD > or = 7 mm) than in shallow pockets (PPD: 5-6 mm).

Adult↗
PubMedDate not supplied

The use of doxycycline in periodontology. Histologic in vivo study on mice affected by diabetes mellitus.

Delay in wound healing process and periodontal disease are 2 possible complications of diabetes mellitus; in case of periodontitis, surgical therapy is necessary if, due to the anatomical and topographical characteristics of periodontal lesions, it is not technically possible to eliminate all the etiological factors by scaling and root-planing therapy only. This work aimed at analysing the effectiveness of doxycycline hyclate as an accelerator of the healing process in laboratory animals (mice with diabetes mellitus). The results obtained after surgical incision of the oral epithelium in diabetic mice show that the topical application of doxycycline hyclate improves, in terms of reparative response time, the regenerative capacity of tissues analysed. Further studies are suggested to test the topical use of doxycycline hyclate in diabetic patients undergoing a periodontal operation in order to accelerate the wound healing process of the tissues concerned.

Administration, Topical↗
PubMed2006

[Links between periodontal disease and general health. 2. Preterm birth, diabetes and autoimmune diseases].

The condition of the periodontium may effect people's general health. There is evidence of a correlation between periodontal disease and preterm birth or low birth weight. In pregnant women with periodontal disease, scaling and root planing seems to reduce the risk of preterm birth or low birth weight. Furthermore, periodontal disease appears to have an adverse effect on glycemic control in diabetics. However, periodontal treatment as a means to glycemic control is restricted unless it includes the use of systemic antibiotics. Slowly, a possible correlation between periodontal disease and autoimmune diseases is emerging. Further research into the correlations between periodontal disease and systemic health is desirable and might well result in new therapeutic options.

Autoimmune Diseases↗
PubMed2006

Treatment of cyclosporine-induced gingival overgrowth with azithromycin-containing toothpaste.

OBJECTIVES: Gingival overgrowth is a complication of cyclosporine therapy following organ transplantation. Oral azithromycin is frequently used to treat this complication. This study examined the efficacy of local azithromycin, in the form of toothpaste, against cyclosporine-induced gingival overgrowth. MATERIALS AND METHODS: Twenty stable renal transplanted patients (10 men and 10 women) with gingival hyperplasia were randomly assigned to a test group and a control group. Azithromycincontaining toothpaste had 85 mg azithromycin per gram of toothpaste. Both toothpastes were prescribed b.i.d., each time using 1.5 cm, for 1 month. All participants received scaling, root planing, polishing, and oral hygiene instructions, at least 4 weeks prior to initiation of the study. Gingival overgrowth index, bleeding on probing, blood urea nitrogen, creatinine, and serum cyclosporine levels were measured at baseline, and then again in the second and fourth weeks after tooth brushing. Patient satisfaction with the toothpastes was evaluated by a visual analogue scale. The stability of clinical responses was followed for 3 months after cessation of the toothpastes. RESULTS: Gingival overgrowth index decreased significantly in the azithromycin-containing toothpaste group (from 1.1+/-0.56 to 0.51+/-0.47, P<.001); however, in the control group, this decrease was not significant (P=.22). Bleeding on probing also decreased significantly in patients in the azithromycin-containing toothpaste group compared with controls (P=.001). When compared with baseline levels, trough levels of cyclosporine, blood urea nitrogen, and creatinine did not change in either of the groups. Patients in the control group were more satisfied with the toothpaste than were patients in the test group (53 vs 38). CONCLUSIONS: Azithromycin-containing toothpaste is an effective, simple, and noninvasive treatment for cyclosporine-induced gingival overgrowth.

Adult↗
PubMed2006

Oral malodor: a review of the literature.

Oral malodor or halitosis is any unpleasant odor emerging from the mouth that is detected by others. Many patients experience extreme discomfort and embarrassment and therefore seek help for this problem. Oral causes, such as poor oral hygiene, periodontal disease, tongue coating, food impaction, unclean dentures, faulty restorations, and dry mouth, are far more common than nonoral causes of malodor. Management may include simple measures such as scaling and root planing, instructions in oral hygiene, tongue cleaning, and mouth rinsing. This paper reviews the current knowledge, etiology, diagnosis, and possible treatment strategies for oral malodor. Emphasis is placed on the recognition of the dental hygienist as a specialist in aspects of patient care and instruction, which relate to the prevention and control of oral malodor.

Breath Tests↗
PubMed2006

Clinical and microbiological effects of subgingival irrigation with Streblus asper leaf extract in chronic periodontitis.

OBJECTIVE: To determine the clinical and microbiological effects of subgingival irrigation of Streblus asper leaf extract (SAE) solution as an adjunct to scaling and root planing (SRP) in chronic periodontitis patients. METHODOLOGY: Forty-two subjects were included and treated with SRP at baseline (week 0), followed by subgingival irrigation with saline (control group, n=21) or SAE (test group, n=21) solution (80 mg/ml) at weeks zero, one, two, three, and four. Clinical parameters, including gingival index (GI), plaque index (PI), probing depth (PD), and relative attachment level (RAL) were measured at weeks zero, six, and 12. Microbiological parameters were measured at weeks zero, one, two, three, four, six, and 12. RESULTS: The SAE solution significantly reduced the GI compared with saline solution (p < 0.01). However, a reduction in PI, PD, and RAL was noted for both groups, with no statistically significant intergroup differences. The reduction in the number ofA. actinomycetemcomitans and/or P. gingivalis was maintained throughout the study period after subgingival irrigation with SAE solution, while an initial reduction and subsequent rebound were observed after saline irrigation. However, the mean number and mean percentages of sites with 10 times the reduction in number of these bacteria were not significantly different between the two groups. CONCLUSION: Subgingival irrigation with SAE solution as an adjunct to SRP is effective at reducing gingival inflammation, but not PD, RAL, and the number of A. actinomycetemcomitans and/or P. gingivalis.

Actinomyces↗
PubMedDate not supplied

Local delivery of antimicrobial drugs in the treatment of chronic adult periodontitis.

AIM: The aim of this study was to evaluate the clinical and microbiologic results of local delivery of adjunctive antimicrobials in the treatment and management of patients with periodontitis. METHODS: The study population included 33 patients (age range, 37-49 years), with chronic adult periodontitis. Eleven of 33 received local treatment with 10% doxycycline injected directly into the periodontal pocket; 11 received local treatment with a chlorhexidine-based gel (1.5%) in situ; 11 received mechanical treatment with scaling and root planing. The crevicular fluid of the doxycycline-treated group was analyzed using high performance liquid chromatography over a period of 1 month. RESULTS: In the 11 patients treated with an antibiotic we observed a reduction in attachment loss and a reduction in probing depth of 1.4 mm; in the 11 chlorhexidine-treated patients we observed a reduction in attachment loss and a reduction in probing depth of 0.9 mm; in the remaining 11 patients the reduction in attachment loss and probing depth was less than those measured in the other two treatment groups. CONCLUSIONS: Our results suggest that direct delivery of antimicrobial agents to the infection site may be a useful adjunctive to conventional periodontal treatment.

Administration, Topical↗
PubMedDate not supplied

Effect of vitamin E gel, placebo gel and chlorhexidine on periodontal disease.

The purpose of this study was to compare the effects of a topical 5% vitamin E gel, a placebo gel and chlorhexidine on established and developing plaque and periodontal disease in 48 adult subjects. Baseline data included Plaque Index, Gingival Index and periodontal probing depth. All data were collected by a single calibrated examiner using a double-blind methodology. One group of subjects applied 12 mL of a vitamin E-containing gel delivering 800 mg of alpha-tocopherol, another applied 12 mL of a placebo gel, and the final group rinsed with 0.5 oz of 0.12% chlorhexidine gluconate. After two weeks, the clinical data were again recorded, and two quadrants were randomly selected and treated by root planing and scaling, with data collection repeated after both 4 and 6 weeks. Our results indicated that no significant effects upon plaque or gingivitis were obtainable in either the placebo or the vitamin E groups. However, use of 0.12% chlorhexidine significantly reduced plaque. These results do not support the use of vitamin E as a topical chemotherapeutic agent for the control of gingivitis or periodontal disease.

Adult↗
PubMed1991

Current concepts in irrigation therapy.

The delivery of chemical agents by subgingival irrigation has become increasingly important as an adjunct to mechanical procedures such as scaling and root planing in the treatment of gingivitis and early stages of periodontal diseases. This article presents the rationale for subgingival irrigation therapy in the dental office, and outlines proper irrigation technique as well as treatment planning guidelines.

Dental Prophylaxis↗
PubMed1991

[Microbiology of periodontitis. 2. Microbiological diagnosis of periodontitis].

By common methods like scaling and root planing, flap procedures or surgical furcation treatment, a successful therapy of periodontal disease is possible in about 90% of the cases. The remaining 10%, mainly patients with juvenile or rapidly progressive periodontitis, are causing great problems, due to poor treatment response and frequent, local or general recidives. In the future, microbiological tests for a precise diagnosis of the pocket flora will be used in the dental office. They can provide better indications for additional antibiotic therapy. The present article reviews several microbiological investigation methods and their future use in the office during periodontal treatment.

Aggressive Periodontitis↗
PubMed1991

[Methods aimed at lengthening the clinical crown: a review].

This review deals with the different methods of lengthening the clinical crown and discusses the advantages and/or disadvantages of each method. Different flap procedures, including ostectomy and osteoplasty, reduce the height of the alveolar crest aiming at a distance of about 3 mm to a future reconstruction margin. Root planing may avoid reattachment of surgically separated fibers. Other methods like gingivectomy, electrosurgery, intra-alveolar transplantation, and forced eruption might contain considerable biological disadvantages. However, if the extrusion is combined with regular fiberotomy, this method becomes the most conservative with respect to the periodontal tissues of neighboring teeth. On the other hand, not all situations which require lengthening of the clinical crown can be solved by orthodontic extrusion and fiberotomy. Therefore, depending on the clinical problem, either the surgical lengthening of the clinical crown or the orthodontic extrusion with separation of the fibers are the recommended procedures.

Alveolectomy↗
PubMed1991

[Subgingival irrigation in periodontal therapy].

Subgingival plaque control is a decisive factor in periodontal therapy. Up to the present, removal of plaque and calculus by repeated scaling procedures has been regarded as the only viable method to achieve this goal. Recent investigations, however, suggest that the topical application of antibacterial substances or subgingival irrigation procedures are capable of yielding comparable improvements of periodontal health. This review paper is dedicated to subgingival irrigation. Besides an overview of techniques and results, we discuss our own experiences, including two case presentations. The results so far are encouraging. Nevertheless, due to the general lack of scientific data with extended time intervals, this method is not suitable yet as an alternative to conventional procedures in periodontal routine care. Until further long-term evidence has been gathered, subgingival irrigation should be regarded only as a valuable adjunct to scaling and root planing.

Dental Plaque↗
PubMed1991

[Tartar and periodontal disease--a cofactor in etiopathogenesis].

Calculus may be considered as an aggregate of calcified deposits or deposits that are going to calcify in the oral cavity. From a topographical point of view calculus is classified in supragingival and subgingival calculus. Calculus is composed by inorganic (70-80%) and organic (20-30%) components. Calculus results from calcification of plaque and epithelial cells exfoliated from oral mucosae. Calcification phenomena (carbonic acid theory) are caused by a rapid fall down of salivary acidity when saliva springs out gland ducts. In fact in the mouth there is a lower pressure of carbon dioxide than in the gland ducts. From this fact results that calcium bicarbonate (dissolvable) becomes calcium carbonate (undissolvable) that forms, starting from nucleating particles, calcium carbonate crystals. Then calculus is one of the most important cofactors in the etiology and pathogenesis of periodontal disease: a) it favors plaque growth and stabilizes it to dental and periodontal tissues; b) it favors retention of food debris and hinders dental cleaning; c) it has endotoxins and lets them free slowly; d) it hinders periodontal recovery. From this study it results that scaling and root planing are one of the first steps in periodontal therapy.

Dental Calculus↗
PubMed1991

Clinical and morphologic response to interdental brushing therapy.

The interdental papilla is the anatomic site most susceptible to periodontal disease. The gingival epithelium plays an important role as a barrier to protect the underlying connective tissue from exogenous noxious agents. A study was undertaken to evaluate the papillary epithelial response to reconstructive stresses conducted by gingival brushing (oral therapy) and scaling and root planing, intended to induce a keratinization associated with reduction or resolution of connective tissue inflammation. Results showed that patients who prolonged the interproximal hygiene practices for more than 30 minutes a day achieved a satisfactory keratinization of the papillary gingival epithelium.

Dental Plaque↗
PubMed1991

Bone-fill in guided tissue regeneration of periodontal defects.

The feasibility of regeneration and attachment of periodontal ligament and alveolar bone after surgical treatment of periodontal defects is documented in the literature. This article presents four cases of clinical and radiographic evidence showing apparent new attachment after root isolation with expanded polytetrafluoroethylene (PTFE) periodontal material, following the principle of guided tissue regeneration. Combination one-, two-, and three-wall angular bony defects of molars and incisors were exposed and root planed. A skirt of PTFE periodontal material was sutured into place and removed after 6 weeks in situ. Reductions in probed pocket depths and gain in bone-fill, as revealed by radiography, were achieved in every case. Maximum regeneration of alveolar bone was 6 mm in the two-wall angular defect of a first molar; minimum gain in bone height was 3 mm.

Aged↗
PubMed1991

[Clinical and histological evaluation of implantation of a microporous resin in periodontitis. Report of a case after 13 months].

A patient with adult periodontitis was treated for a 2 and 3-walled intrabony lesion on tooth n degrees 27. After scaling and root planing, the defect was surgically exposed and filled with a micro-porous resin. Following healing, there was a reduction in pocket depth as a result of gingival recession and a gain in probing attachment levels. This was confirmed 13 months post-operatively by clinical observation on re-entry. A biopsy of the treated site was taken at that time and undecalcified sections were studied by light microscopy and microradiography. New bone formation was noted inside and on the surface of the resin granules and at a distance from the particles. From a clinical and histologic point of view, the material seemed to be well tolerated by the host.

Adult↗