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PubMed2006

Innate immune signaling and Porphyromonas gingivalis-accelerated atherosclerosis.

Periodontal diseases are a group of diseases that lead to erosion of the hard and soft tissues of the periodontium, which, in severe cases, can result in tooth loss. Anecdotal clinical observations have suggested that poor oral health may be associated with poor systemic health; however, only recently have appropriate epidemiological studies been initiated, with defined clinical endpoints of periodontal disease, to address the association of periodontal disease with increased risk for cardiovascular and cerebrovascular disease. Although conflicting reports exist, these epidemiological studies support this connection. Paralleling these epidemiological studies, emerging basic scientific studies also support that infection may represent a risk factor for atherosclerosis. With P. gingivalis as a model pathogen, in vitro studies support that this organism can activate host innate immune responses associated with atherosclerosis, and in vivo studies demonstrate that this organism can accelerate atheroma deposition in animal models. In this review, we focus primarily on the basic scientific studies performed to date which support that infection with bacteria, most notably P. gingivalis, accelerates atherosclerosis. Furthermore, we attempt to bring together these studies to provide an up-to-date framework of emerging theories into the mechanisms underlying periodontal disease and increased risk for atherosclerosis, as well as identify intervention strategies to reduce the incidence of periodontal disease in humans, in an attempt to decrease risk for systemic complications of periodontal disease such as atherosclerotic cardiovascular disease.

Animals↗
PubMed2002

Porphyromonas gingivalis lipopolysaccharide signaling in gingival fibroblasts-CD14 and Toll-like receptors.

Periodontal disease is the major cause of adult tooth loss and is commonly characterized by a chronic inflammation caused by infection of oral bacteria. Porphyromonas gingivalis (P. gingivalis) is one of the suspected periodontopathic bacteria and is frequently isolated from the periodontal pockets of patients with chronic periodontal disease. The lipopolysaccharide (LPS) of P. gingivalis is a key factor in the development of periodontitis. Gingival fibroblasts, which are the major constituents of gingival connective tissue, may directly interact with bacteria and bacterial products, including LPS, in periodontitis lesions. It is suggested that gingival fibroblasts play an important role in the host responses to LPS in periodontal disease. P. gingivalis LPS enhances the production of inflammatory cytokines such as interleukin (IL)-1, IL-6, IL-8, and tumor necrosis factor alpha (TNF-alpha) in gingival fibroblasts. However, the receptor that binds with P. gingivalis LPS on gingival fibroblasts remained unknown for many years. Recently, it was demonstrated that P. gingivalis LPS binds to gingival fibroblasts. It was also found that gingival fibroblasts express CD14, Toll-like receptor 4 (TLR4), and myeloid differentiation primary response gene 88 (MyD88). P. gingivalis LPS treatment of gingival fibroblasts activates several intracellular proteins, including protein tyrosine kinases, and up-regulates the expression of monocyte chemoattractant protein-1 (MCP-1), extracellular signal-regulated kinase 1 (ERK1), and signal-regulated kinase 2 (ERK2), IL-1 receptor-associated kinase (IRAK), nuclear factor-kappaB (NF-kappaB), and activating protein-1 (AP-1). These results suggest that the binding of P. gingivalis LPS to CD14 and TLR4 on gingival fibroblasts activates various second-messenger systems. In this article, we review recent findings on the signaling pathways induced by the binding of P. gingivalis LPS to CD14 and Toll-like receptors (TLRs) in gingival fibroblasts.

Animals↗
PubMed2003

Assessment of oral health related quality of life.

In Dentistry, as in other branches of Medicine, it has been recognised that objective measures of disease provide little insight into the impact of oral disorders on daily living and quality of life. A significant body of development work has been undertaken to provide health status measures for use as outcome measures in dentistry. In descriptive population studies, poor oral health related quality of life is associated with tooth loss. There is a less extensive literature of longitudinal clinical trials, and measurement of change and interpretation of change scores continues to pose a challenge. This paper reviews the literature regarding the development and use of these oral health related QoL measures and includes an appraisal of future research needs in this area.

Health Services Research↗
PubMed2004

The quicksilver prize: Mercury vapor poisoning aboard HMS Triumph and HMS Phipps.

In 1810, two British ships, HMS Triumph and HMS Phipps, salvaged a large load of elemental mercury from a wrecked Spanish vessel near Cadiz, Spain. The bladders containing the mercury soon ruptured. The element spread about the ships in liquid and vapor forms. The sailors presented with neurologic compromises: tremor, paralysis, and excessive salivation as well as tooth loss, skin problems, and pulmonary complaints. The events are reviewed in the context of what was known about mercury vapor inhalation.

History, 19th Century↗
PubMed2000

Near-patient test for nicotine and its metabolites in saliva to assess smoking habit.

Smoking is a major risk factor for periodontal disease, causing bone and tooth loss. Effective management of many oral conditions requires accurate information about smoking. We describe a disposable, 10-min, near-patient saliva test to monitor cigarette smoking. A plastic device contains the dried reagents to measure nicotine and its metabolites by a colorimetric assay. The device can be used to give a semi-quantitative assessment of tobacco consumption by observing a colour change and comparing it to a reference chart. Alternatively, the test can be quantified by measuring the light absorbance with a colorimeter and determining the concentration of nicotine metabolites by reference to a cotinine standard. This method correlates with reported daily cigarette consumption (r=0.62, P<0.0001) and nicotine yield of cigarettes smoked (r=0.35, P<0.01) and compares favourably with cotinine, as measured independently by radioimmunoassay (r=0.57, P<0.005). The method provides a simple-to-use, inexpensive way of monitoring tobacco consumption in dental surgeries.

Adult↗
PubMed1999

Gamma-ray scattering for mandibular bone density measurement.

There has been considerable interest in the measurement of bone density in the mandible, either to study bone resorption following tooth loss or to determine the relationship between mandibular and skeletal bone mineral density. Measurements mostly have been made on dental radiographs but more significant correlations between mandibular and skeletal bone density have been obtained when more sophisticated techniques have been used, such as quantitative CT and dual energy X-ray absorptiometry. The present work investigates the feasibility of using gamma-ray scattering measurements to estimate mandibular bone density. Using a phantom to simulate the jaw, an 241Am source and a hyperpure germanium detector it is shown that bone density may be measured with a precision of about 1%.

Absorptiometry, Photon↗
PubMed1989

Dentinal dysplasia type I: a report of four cases.

Dentinal dysplasia type I is a relatively uncommon condition and four cases are described. The radiographic features in these patients are somewhat different to those reported in other cases in that anterior teeth appeared to be less affected than posterior, and tooth loss was less prevalent. These findings support the proposal that the characteristics of dentinal dysplasia type I can be divided into two subgroups.

Adult↗
PubMed2005

A precise receptor-positioning device for subtraction radiography, based on cross-arch stabilization.

OBJECTIVES: To devise and test for reproducibility a new patient-beam alignment device for subtraction radiography. METHODS: A rigid, cross-arch bar was used with bite-registration material. A modified Rinn XCP rod and ring were firmly attached to the bar and were placed in contact with the X-ray cone. The receptor was held by a slot in the bar. Duplicate sets (n=8 pairs) of digital radiographs were made with a modified, calibrated DenOptix photostimulable phosphor system. Image pairs were registered and compared for geometrical and intensity errors by means of quantitative subtraction radiography. The reproducibility of patient-beam alignment for each pair was determined by measuring spatial errors at alveolar crest edges and by comparing magnifications. Intensity errors measured at two predetermined regions of alveolar bone were used to estimate corresponding bone-mass errors. RESULTS: Misalignment at the alveolar crest was generally <1 pixel (0.085 mm), and everywhere < or =0.25 mm. The magnification was constant within a relative standard deviation of 0.13% (n=8). Trabecular features were generally invisible or barely visible in subtraction images. The standard deviation of intensity errors was 1.07% (n=16). This corresponds to a change in bone mass of approximately 2% or less. CONCLUSION: The device has potential for clinical population studies in which the goal is to detect small changes in bone mass and alveolar-crest height. It is convenient to use and comfortable for patients. Because of the cross-arch design, patient-beam alignment is expected to be relatively insensitive to bite-registration errors, tooth movement, and tooth loss.

Alveolar Process↗
PubMed2001

A modified technique for minimal-preparation, resin-retained bridges: four case reports.

The minimal-preparation, resin-retained adhesive bridge may be considered to be an ideal choice of fixed prosthesis to replace a single missing tooth, especially in the anterior maxillary region. The technique is well documented, enjoys a high success rate, and with suitable case selection generally employs a conservative preparation. Other advantages include reduced cost compared with conventional bridges and simplified laboratory and clinical procedures. Its limitations are principally due to occlusal factors, or the presence of unsuitable abutment teeth--for example, those that are extensively restored. Another traditional contraindication is the presence of diastemas, which may limit the potential aesthetic gains. This paper presents a series of case reports which describe an altered technique in order to maintain anterior spacing.

Adult↗
PubMed2006

Treatment and maintenance of a dentate patient with 'radiation caries'.

UNLABELLED: Patients with xerostomia are presenting dental practitioners with challenges in caries control, long-term restoration and prosthodontic difficulties. In many cases, extraction may be the best option, but for younger, dentate patients, this may be inappropriate. This paper describes the management of a young partially dentate patient with severe xerostomia following irradiation of the salivary glands. Preventive and restorative management are discussed, together with treatment and healing of peri-radicular pathology. The case report demonstrates that long-term stabilization and management of caries and peri-radicular lesions are possible over a seven-year period for a patient with severe radiation caries. CLINICAL RELEVANCE: Many dental patients present with some degree of xerostomia due to age, side-effects of anti-hypertensive and psychotropic drugs and also as a side-effect of radiotherapy. General dental practitioners are ideally placed to monitor and provide early intervention for this highly caries-susceptible group of patients. With good patient motivation and professional support, tooth loss is not inevitable and this case report suggests strategies and demonstrates the clinical stages in the management of severe caries due to xerostomia.

Adult↗
PubMed2003

Phenotypic characterization of early onset Paget's disease of bone caused by a 27-bp duplication in the TNFRSF11A gene.

Three different insertion mutations in the TNFRSF11A gene affecting the signal peptide of RANK have been described. An 18-bp duplication at position 84 (84dup18) is associated with the clinical syndrome of familial expansile osteolysis (FEO), whereas a 15-bp duplication at the same site (84dup15) causes the syndrome of expansile skeletal hyperphosphatasia (ESH). Here we report the phenotype of patients harboring a 27-bp duplication at position 75 (75dup27) in RANK. Affected individuals had hearing impairment and tooth loss beginning in the second or third decade. Radiographs of affected bones showed lytic and sclerotic lesions with bony enlargement and deformity. Serum alkaline phosphatase levels were elevated between 2 and 17 times above the normal range. Most patients had pelvic and skull involvement, and all had involvement of the mandible and maxilla. Most patients also had bony enlargement of the small joints of the hands, and one developed hypercalcemia during a period of immobilization. We conclude that the 75dup27 mutation of RANK causes a Paget's disease of bone-like phenotype that is distinct from, but which overlaps with, FEO and ESH. A particularly striking feature was involvement of the mandible and maxilla, but it remains to be seen if this is a specific feature of the 75dup27 mutation until further kindreds with this mutation are reported.

Age of Onset↗
PubMed1996

The impact of edentulousness on food and nutrient intake.

The authors collected dietary intake data about the food and nutrient intake of 49,501 male health professionals. Edentulous participants consumed fewer vegetables, less fiber and carotene, and more cholesterol, saturated fat and calories than participants with 25 or more teeth. These factors could increase the risks of cancer and cardiovascular disease. Mean differences in intake ranged from 2 to 13 percent, independent of age, smoking, exercise and profession. Longitudinal analyses suggest that tooth loss may lead to detrimental changes in diet.

Adult↗
PubMed1997

Clinical features of early-onset periodontitis.

The authors estimate the prevalence of early-onset periodontitis, or EOP, in U.S. adolescents and describe the clinical features that occur at an early stage in those who have EOP. In 1986 and 1987, about 10.0 percent of African-American, 5.0 percent of Hispanic and 1.3 percent of white U.S. adolescents had EOP. Clinical features that may be useful in the early detection of EOP include overt gingival inflammation, dental calculus and a high rate of caries, restorations and tooth loss.

Adolescent↗
PubMed1997

Tooth avulsions resulting from basketball net entanglement.

The authors conducted a survey of dentists reporting tooth avulsions from basketball net accidents. Although the number of people injured was small, the dental injuries were serious. In many cases, multiple teeth were avulsed as a result of the maxillary anterior teeth becoming entangled in the basketball net while the patients were attempting to slamdunk a basketball either on a lowered backboard or from a raised take-off area. The authors present recommendations for preventing tooth avulsions resulting from basketball net entanglement.

Accidents, Home↗
PubMed1999

Chief complaints of patients seeking treatment for periodontitis.

BACKGROUND: Hardly any data are available concerning the chief complaints, or CCs, of patients with periodontitis. The authors conducted a study to determine the most common CCs among a group of subjects with periodontitis. METHODS: The authors examined the dental records of 191 patients with periodontitis to determine what CCs they orally reported having at an initial examination. Patients were referred mainly by other members of the dental health team. Eighty percent of the patients were diagnosed with moderate or moderate-to-severe periodontitis. The authors recorded the frequency of different CCs to determine the most common complaints. RESULTS: The authors recorded 336 CCs from the records of 191 subjects with periodontitis. There were 21 different CCs. The most common CC reported was, "I was told I have gum disease." The second most common CC reported was, "I would like to save my teeth." Neither of these CCs are true periodontitis symptoms. Bleeding gums--a true periodontitis symptom--was the third most common CC. Only 6.2 percent of the subjects reported having painful gingiva, and only 29.3 percent of the subjects reported having dental-emergency-related CCs. CONCLUSIONS: The authors found that the motivation to seek periodontal treatment was most commonly based on information given to the subjects by a member of the dental health team, rather than a periodontitis symptom. CLINICAL IMPLICATIONS: Renewed efforts and increased responsibility of the dental health team members to inform patients about the presence of periodontitis are needed, as well as emphasizing to the public the risk of losing teeth as a result of periodontitis.

Adolescent↗
PubMed2000

Trends in total caries experience: permanent and primary teeth.

BACKGROUND: This article is the last in a series of three that focuses on recent changes in the caries status of children aged 18 years or younger in the United States. METHODS: This study is based on analyses of data regarding total carious (treated and untreated) permanent and primary teeth among children 6 to 18 years old and children 2 to 10 years old from the first and third National Health and Nutrition Examination Surveys, or NHANES I and NHANES III. The NHANES is periodically conducted by the National Center for Health Statistics of the Centers for Disease Control and Prevention. RESULTS: The cumulative number of carious permanent teeth, both treated and untreated, among 6- to 18-year-olds decreased 57.2 percent, from 4.44, as measured in NHANES I, to 1.90, as measured in NHANES III. The cumulative number of carious primary teeth, both treated and untreated, among 2- to 10-year-olds decreased 39.7 percent, from 2.29, as measured in NHANES I, to 1.38, as measured in NHANES III. CONCLUSIONS: Since the 1970s, the cumulative number of carious permanent and primary teeth, both treated and untreated, has declined substantially among children in the United States. PRACTICE IMPLICATIONS: Effective prevention has reduced caries in children. As a result, dental practice will be more focused on maintaining intact dentitions than on repairing teeth damaged by disease.

Adolescent↗
PubMed2000

Recent approaches to periodontal therapy.

Periodontal diseases encompass a variety of disease classifications, all involving inflammation of the supporting tissues of the teeth. When progressive, these diseases ultimately lead to the destruction of attachment apparatus including bone and periodontal ligament, culminating in eventual tooth loss. Inflammation extends from superficial gingival structures, effecting adjacent submerged bone and periodontal ligament. Progression modifies an initially highly favourable, reversible diagnosis of gingivitis to a less favourable, somewhat irreversible situation: periodontitis. Periodontal diseases manifest variable and sometimes unpredictable prognoses, are generally somewhat complicated and costly to treat and often require long-term follow-up for maintenance and monitoring. Treatment aims at restoration of health and control of future disease within a functional, albeit reduced, periodontium. In the strictest sense, periodontal diseases are not 'cured'. The conventional, usually successful, approach to the treatment of patients with gingivitis or chronic periodontitis has involved non-surgical mechanical periodontal therapy [1,2]. Some patients manifest localised or generalised continuous attachment loss and periodontal destruction. These sites are prime candidates for alternative therapeutic regimens. This review highlights some of the recent advances in periodontal therapy and evokes some questions that should be addressed during future studies.

Animals↗