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PubMed1999

Aesthetic enhancement of anterior dental implants with the use of tapered osteotomes and soft tissue manipulation.

An adequate bone base is usually a prerequisite for functionally and aesthetically optimal reconstruction of the soft tissue architecture around a dental implant. In patients with sufficient bone height but insufficient bone width as a result of tooth loss, a jaw enlargement technique with osteotomes combined with soft tissue manipulation may be utilized to facilitate proper implant placement while concomitantly optimizing the aesthetics of the final implant prosthesis. The learning objective of this article is to familiarize the reader with the principles of ridge expansion with tapered osteotomes combined with periodontal plastic soft tissue surgery to aid in proper implant placement and enhance the aesthetic result of the final prosthesis.

Alveolar Ridge Augmentation↗
PubMed2004

[Psycometrics properties of subjetive indicator in children].

OBJECTIVE: To evaluate the psychometric properties of the Oral Heath Impact Profile (OHIP-14) to measure oral health in children. METHODS: The OHIP-14 questionnaire was applied to 312 schoolchildren aged 12 years residing in Sabará, Brazil, in 2001. OHIP-14's reliability was evaluated using Cronbach's alpha and correlation intraclass coefficient. For examining content validity, Pearson's correlation and logistic regression analysis were applied. For construct validity, Student's t-test and Tukey-Kramer test were used. RESULTS: Tooth loss among the subjects was low in this study (between 85% and 100%). Caries prevalence was very low and not detectable in 59.0% of the sample. The logistic regression model showed high predictive values for reporting treatment need and intermediate values for dental caries perception. The comparison between different OHIP average scores, according to the DMF-S index's three categories of decayed, missing, filled surfaces, indicated significant difference only for the categories social disability and deficit. CONCLUSIONS: The study results indicated that the adolescents did not report high prevalence of oral conditions. The OHIP was associated with perceived treatment need, reporting of dental caries and increased DMF-S index. These results suggest that the OHIP has good psychometric properties when applied to children and could be a promising instrument for screening priority care groups.

Brazil↗
PubMedDate not supplied

Periodontal aspects of the juvenile form of paracoccidioidomycosis.

Three cases of the juvenile form of paracoccidioidomycosis are reported. Emphasis has been given to the oral manifestations, particularly the periodontal involvement. The main periodontal findings were: generalized and progressive alveolar bone destruction leading to gingival recession with exposure of the tooth roots, and spontaneous tooth losses. The gingival mucosa was predominantly smooth, erythematous and slightly swollen. These aspects, although rare, may be the earliest signs of the disease and sometimes its only manifestations.

Adolescent↗
PubMed2006

[Oral health of institutionalized elderly in the eastern zone of São Paulo, Brazil, 1999].

The objective was to verify oral health conditions in institutionalized elderly people in the city of São Paulo, Brazil, through epidemiological analysis. The sample consisted of 293 subjects and was stratified according to age (65-74 years and over 75) and gender. Epidemiological analysis was conducted according to WHO criteria to determine prevalence of oral disease. Chi-square and Mann-Whitney tests were used to check differences between strata. Of the subjects evaluated, 64.8% were women and 65.2% were over 75 years old. DMFT was 30.8 with tooth loss of 96.3%, and this percentage was statistically greater for women (97.0%); 94.7% showed calculus as a major degree of periodontal condition, and only 1.8% presented healthy periodontal conditions and 33.3% presented loss of attachment ranging from 6 to 8 mm. Some 48.1% used total upper and 22.5% total lower prostheses. Edentulism was 68.3%. The data indicate unsatisfactory clinical conditions, as shown by the high CPO-D index and high percentage of edentulism.

Age Distribution↗
PubMed2001

The oral health of children with clefts of the lip, palate, or both.

OBJECTIVE: The purpose of this study was to assess the prevalence of dental caries, developmental defects of enamel, and related factors in children with clefts. DESIGN: This cross-sectional prevalence study used standard dental indices for assessment. SETTING: Children underwent a dental examination under standard conditions of seating and lighting in the outpatient department of a dental hospital as part of an ongoing audit to monitor clinical outcomes. PARTICIPANTS: Ninety-one children aged 4, 8, and 12 years were included in the study. OUTCOME MEASUREMENTS: Dental caries were assessed by use of the decayed, missing, and filled index for primary teeth (dmft); Decayed, Missing, and Filled index for permanent teeth (DMFT) according to the criteria as used in the national survey of children's dental health in the United Kingdom. Developmental defects were assessed using the modified Developmental Defects of Enamel Index (Clarkson and O'Mullane, 1989). Dental erosion was assessed using the criteria derived for the national survey of children's dental health. RESULTS: Caries prevalence increased with age; 63% of patients at 4 years and 34% at 12 years were caries free. The mean dmft for the 4-year-olds was 1.3 with a mean DMFT for the 12-year-olds of 1.8. All the 4-year-olds had evidence of erosion of enamel in the primary teeth (incisors and first molars) and 56% of the 12-year-olds had erosion of permanent teeth (incisors and first permanent molars). Developmental defects of enamel became more prevalent with age, with at least one opacity in 56% of 4-year-olds and 100% of 12-year-olds. Hypoplasia was not found in the primary dentition but affected permanent teeth in 38% of 8-year-olds and 23% of the 12-year-olds. CONCLUSION: This study has shown that dental disease is prevalent in these patients. These assessments not only provide a baseline on oral health parameters in young people with clefts but underline the need for a more aggressive approach to prevention of oral disease to optimize clinical outcome.

Age Factors↗
PubMed2001

Oral health status in Greek children and teenagers, with disabilities.

Nowadays there is a sharp increase of population with disabilities. The aim of this investigation was a) to survey the dental health status, estimate the treatment requirements of children and adolescents with cerebral palsy, mental retardation and visual disorders and b) to compare the oral health status of these groups of individuals. The investigation entailed the clinical examination of 170 individuals, between 6 and 15 years old, who were attending four special schools in Athens, Greece. In conclusion, our investigation documented the following: The treatment needs regarding both dentitions are extremely high in all groups of individuals. The oral hygiene status is in general, moderate to low-grade, especially in the individuals with mental retardation. The highest rate of malocclusion is observed in the group of individuals with cerebral palsy.

Adolescent↗
PubMed2002

Perceptions of pediatric patients and guardians about prosthetic appliances.

Forty patients that received prosthetic appliances as part of dental treatment were interviewed about satisfaction with the apparatus. The opinions of the guardians were also considered. The majority of children had complained about missing teeth, but even a greater percentage expressed satisfaction during wear of the prosthetic appliance. Among the guardians, only one of them expressed dissatisfaction with the appliance design. Rehabilitation plan should be discussed with children and guardians considering their perceptions and adequate indications for each case.

Caregivers↗
PubMed1998

Cigarette smoking and periodontal diseases: etiology and management of disease.

Cigarette smoking has long been suspected to be associated with a variety of oral conditions including periodontal diseases. Experimental evidence accumulated over the last 2 decades has indicated that cigarette smoking is probably a true risk factor for periodontitis. This environmental exposure has been associated with 2- to 3-fold increases in the odds of developing clinically detectable periodontitis. Smokers have both increased prevalence and more severe extent of periodontal disease, as well as higher prevalence of tooth loss and edentulism, compared to non-smokers. The greater severity of periodontal destruction may be partly accounted for by the reported increases in the rate of periodontal disease progression. The noxious effect of smoking has been shown to be dose dependent and to be particularly marked in younger individuals; in these subjects, up to 51% of the observed risk of periodontitis was associated with smoking. Much of the literature has also indicated that smokers affected with periodontitis respond less favorably to both non-surgical, surgical, and regenerative periodontal treatments. The success rate of dental implants has also been shown to be compromised in smokers. Furthermore, longterm studies have pointed out that smoking was associated with recurrence of periodontitis during periodontal maintenance; the effect appeared to be dose dependent, with heavy smokers (> 10 cigarettes/day) presenting with higher levels of disease progression. The indication that previous smokers have lower levels of risk for periodontitis compared to current smokers is considered to be the strongest available evidence that smoking cessation will result in improved periodontal health and that smoking cessation counseling should be an integral part of periodontal therapy and prevention. So far, however, no randomized controlled clinical trial establishing the effect of smoking cessation and/or reduction on the periodontal outcomes has been reported. Given the present state of uncertainty about the periodontal benefits, but in light of the established general health gains for the patient that could be derived from a smoking cessation program, practitioners are incorporating smoking cessation counseling as an integral part of periodontal therapy. Furthermore, smoking status represents a key parameter to assess the periodontal risk of an individual subject and therefore to make evidence-based clinical decisions.

Health Education, Dental↗
PubMed2002

Porphyromonas gingivalis lipopolysaccharide displays functionally diverse interactions with the innate host defense system.

Periodontitis is a bacterially induced chronic inflammatory disease and a major cause of tooth loss in the world. The tissue damage and alveolar bone resorption characteristic of the disease are believed to be due to a destructive innate host response to a pathogenic subgingival biofilm. Porphyromonas gingivalis, a Gram-negative bacterium, is a member of this mixed microbial community that has been designated an etiologic agent of periodontitis. The innate host response to lipopolysaccharide (LPS) obtained from P. gingivalis is unusual in that different studies have reported that it can be an agonist for Toll-like receptor (TLR) 2 as well as an antagonist or agonist for TLR4. In addition, human monocytes respond to this LPS by secreting a variety of different inflammatory mediators, while endothelial cells do not. We have examined highly purified preparations of P. gingivalis LPS and found that they activate both TLR2 combined with TLR1 and TLR4 in transiently transfected human embryonic kidney (HEK) 293 cells. We have further demonstrated that highly purified P. gingivalis LPS preparations contain at least 3 major different lipid A species. We speculate that P. gingivalis lipid A structural heterogeneity contributes to the unusual innate host response to this LPS and its ability to interact with different TLR molecules.

Cell Line↗
PubMed1983

The effect of a televised periodontal campaign on public periodontal awareness.

The purpose of this investigation was to evaluate the impact of the Minnesota Dental Association's 1979 to 1980 periodontal awareness television campaign in terms of (1) reaching the target population, (2) improving public knowledge regarding the major reason for tooth loss in adults and (3) increasing intended future preventive dental visits. Based on the Health Belief Model, a 30-second television message was developed presenting periodontal disease as an often overlooked but compelling reason to seek preventive dental care. The message was aimed at adults 18 years of age and older who did not visit the dentist regularly. It was broadcast 1280 times over two separate 6-week periods on 17 statewide television stations. A postcampaign personal interview of a representative cross section of 1,000 Minnesota adults indicated that the campaign reached 79% of the population surveyed, or 786 individuals. Eighty-two percent (534) of the 654 individuals who made regular dental visits and 73% (252) of the 346 individuals who did not, indicated exposure to the message. Of the 786 persons who viewed the message, 90% (707) correctly recalled the message content. Seventy-five percent (488) of the 654 individuals who made regular dental visits and 63% (219) of the 346 individuals who did not, correctly recalled the message content. As a result of exposure to the television campaign, 10% (76) of the 786 viewers indicated their intention to make more preventive dental visits in the future. Among individuals stating such an intention were 10% (71) of the 707 viewers who correctly recalled the message and six percent (5) of the 79 viewers who were not able to correctly recall the message content.

Adolescent↗
PubMed1991

Prognosis versus actual outcome: a long-term survey of 100 treated periodontal patients under maintenance care.

One hundred treated periodontal patients under maintenance care were evaluated for 5 years, and 39 of these patients were followed for 8 years to determine the accuracy of assigned prognoses based on commonly taught clinical criteria. The results suggested that this population reflected many of the same characteristics seen in well-maintained patients. The ultimate fate of teeth initially labeled as hopeless varied substantially, and even though the average prognosis of the teeth studied at each interval remained relatively stable over time, individual prognosis categories and individual tooth prognoses changed frequently. Possible reasons for these shifts are discussed. In conclusion, it was found that projections were ineffective in predicting any prognosis other than good, and that prognoses tended to be more accurate for single rooted teeth than for multi-rooted teeth. Further evaluation of the data is needed to determine how each of the prognostic indicators relate to the success or failure of our projection.

Adult↗
PubMed1992

Incorporating new technologies in periodontal diagnosis into training programs and patient care: a critical assessment and a plan for the future.

New diagnostic technologies may be capable of providing the dental practitioner with powerful tools that can assist in the early identification of periodontal disease that can result in expediated treatment. In this paper, clinical, host, and microbiological parameters will be evaluated for their ability to assess disease activity and to assist in the treatment decision-making process. The discussion will focus on: 1) the perceived need for markers of disease activity; 2) the most commonly proposed markers of disease activity currently under consideration for clinical application; and 3) a plan for future use of disease activity markers. The review concludes that: 1) tooth loss and most forms of rapid disease progression is limited to a small subset of patients within the periodontally diseased population; 2) no single parameter will stand alone as a measure of disease activity; 3) different aspects of treatment may require different combinations of tests to successfully intercept disease in this vulnerable patient group; and 4) early diagnosis can affect long-term periodontal status. Best estimates are presented for: 1) pre-disease identification of high-risk population groups; 2) early diagnosis of disease activity on a site and patient basis; and 3) assistance in the therapeutic decision-making process. It is further concluded that the complexity of the problem may require a re-examination of priorities such that more time and money is allocated to early diagnosis as opposed to treatment in this highly vulnerable patient population.

Disease Susceptibility↗
PubMed1996

Detection of local and systemic cytokines in adult periodontitis.

Periodontitis is a chronic inflammatory disease of the soft and hard supporting tissues of the teeth and is a major cause of tooth loss in adults. The local host response to periodontopathic bacteria results in the release of inflammatory mediators and cytokines. Since cytokines are indicative of effector functions, we compared the pattern of cytokine production in periodontal patients and healthy controls. Specifically, we investigated the simultaneous presence of cytokines produced by T helper (Th)1, Th 2, and inflammatory cells which could be involved in periodontitis. We also compared the expression of these cytokine mRNAs in healthy and diseased tissues. No significant differences were detected at the protein or mRNA levels of the cytokines in the systemic circulation of patients and controls. The surface markers CD16 and CD56 were expressed on significantly fewer peripheral mononuclear cells of patients when compared to controls. gamma delta + T cells were found in half of the diseased tissues, but in none of the healthy tissues of either patients or controls. Finally, significant differences were observed between healthy and inflamed gingival tissues in the cytokine mRNA profile. Expression of IL-6 and IFN-alpha mRNA was significantly higher in diseased tissues compared to healthy tissues in patients.

Adult↗
PubMed1998

Increased presence of interleukin-6 (IL-6) and IL-8 secreting fibroblast subpopulations in adult periodontitis.

Periodontitis is a chronic inflammation of the supporting structures of the dentition which constitutes one of the most common causes of adult tooth loss. While certain microorganisms have been associated with the onset of the disease process, the exact pathogenetic mechanisms underlying periodontal destruction are still poorly understood. We have tested the hypothesis that gingival fibroblasts from diseased sites contribute to pathogenesis by possessing a secretory phenotype characterized by an exuberant secretion of inflammatory mediators and cytokines. Of the cytokines and mediators tested, fibroblast IL-1beta and prostaglandin E2 (PGE2) secretion was not different between health and disease. However, we have shown that fibroblasts from periodontal lesions produce in vitro greater amounts of IL-6 and IL-8 constitutively than healthy controls. When fibroblasts were stimulated with a panel of endogenous or exogenous response modifiers, the magnitude of cytokine and mediator stimulation above constitutive levels did not differ between health and disease. A strong positive correlation was identified between IL-6 or IL-8 constitutive secretion levels in vitro and the in situ expression of these cytokines within the connective tissues from where these cells originated, indicating that the in vitro phenotype mirrors their in vivo function. Furthermore, we present evidence which indicates that increased cytokine secretion by fibroblasts in disease is due to an elevated proportion of subpopulations with higher cytokine secretory capacity. Finally, we demonstrated that cultures from diseased sites are composed of cells with higher levels of constitutive CD40 expression, which may contribute to the increased IL-6 and IL-8 secretory phenotype.

Adult↗
PubMed2000

Interleukin-1 gene polymorphisms and long-term stability following guided tissue regeneration therapy.

BACKGROUND: Specific interleukin (IL)-1 gene polymorphisms are associated with an increased susceptibility to severe periodontitis, increased inflammation, and increased likelihood of tooth loss during the maintenance phase after conventional periodontal therapy. The aim of the present study was to evaluate the impact of genotype on the maintenance of gained clinical attachment obtained after guided tissue regeneration (GTR) surgical therapy in deep intrabony defects. METHODS: Forty deep (> or =4 mm) interproximal angular bony defects with presurgical clinical attachment loss of >8 mm were treated by GTR using a non-absorbable expanded polytetrafluoroethylene (ePTFE) membrane. Membranes were surgically removed 4 to 6 weeks after surgery. Afterwards patients were placed on monthly recall for the first year and every 3 months for the following 3 years. At the 4-year re-evaluation, a IL-1 genetic susceptibility test was performed on all patients. RESULTS: Fourteen (35% of the 40 patients) were genotype-positive (+). At baseline no statistically significant differences were found between patients with different genotypes in full mouth plaque score (FMPS), full mouth bleeding score (FMBS), clinical attachment level (CAL), probing depth (PD), or gingival recession. At year 1 follow up visit, no statistically significant differences were noted between genotype + and genotype - patients in FMPS, FMBS, amount of CAL gain, decrease in PD, or increase in gingival recession. Sixteen patients had membrane exposure after the GTR procedures. In these patients, the amount of CAL gain (P <0.001) and PD reduction (P <0.01) 1 year after surgery was significantly lower than those observed in patients without membrane exposure. At the year 4 follow-up visit, no significant differences were found between genotype negative and positive patients in FMPS or FMBS and both groups showed a significant loss in CAL (P<0.001) and increase in PD (P<0.001) when compared to year 1 visit. No change in gingival recession was noted. Genotype + patients showed significantly more CAL loss (P<0.002) and increase in PD (P<0.001) between the years 1 and 4 when compared to genotype - patients. A significant association between genotype and stability of the regenerated attachment was also demonstrated. CONCLUSIONS: The results of this study demonstrate that genotype expression did not effect GTR treatment response at 1 year, but had a great impact on long-term stability (year 4). In a 3-year period, patients with positive IL-1 genotype lost about 50% of the first year gained CAL and were about 10 times more likely of experiencing > or = 2 mm CAL loss when compared to oral hygiene matched genotype-negative patients.

Adult↗
PubMed2000

Parameter on "refractory" periodontitis. American Academy of Periodontology.

The American Academy of Periodontology has developed the following parameter on the treatment of "refractory " periodontitis. Patients should be informed of the disease process, therapeutic alternatives, potential complications, expected results, and their responsibility in treatment. Consequences of no treatment should be explained. No treatment is very likely to result in further progression of the disease and eventual tooth loss. Given this information, patients should then be able to make informed decisions regarding their periodontal therapy.

Chronic Disease↗
PubMed2004

Analysis of the interleukin-6 gene promoter polymorphisms in Czech patients with chronic periodontitis.

BACKGROUND: Chronic periodontitis is an inflammatory disease, which is a major cause of tooth loss. The proinflammatory cytokines interleukin-1 (IL-1) and interleukin-6 (IL-6) are key regulators of the host response to microbial infection and major modulators of extracellular matrix catabolism and bone resorption. The purpose of this study was to investigate the associations of chronic periodontitis with IL-6 gene polymorphisms (at positions -597 [G/A], -572 [G/C], and -174 [G/C]). METHODS: We analyzed allele, genotype, and haplotype distributions of the IL-6 promoter variants in a case-control study involving 148 patients with chronic periodontitis and 107 unrelated controls. RESULTS: Our results showed significant differences in the distributions of alleles and genotypes of the IL-6 (-572 G/C) polymorphism between patients and the control population (chi2 = 10.393, P= 0.001, P(corr) < 0.01). The difference was due to the underrepresentation of the -572 G/C heterozygotes in patients (6.1%) compared to controls (19.6%). Although no variant "CC" homozygotes were detected in our cases and controls, heterozygosity protected against chronic periodontitis, representing a 73% reduction of risk (odds ratio [OR] = 0.27, 95% confidence interval: 0.12-0.61) compared to wild-type homozygotes. However, there were no significant differences in genotype or allele frequencies between both groups for IL-6 -597 G/A and -174 G/C polymorphisms. CONCLUSION: This study is the first, to our knowledge, suggesting that the -572 G/C polymorphism of the IL-6 gene may be one of the protective factors associated with lower susceptibility to chronic periodontitis.

Adult↗
PubMed2004

Levels of cytokine receptor activator of nuclear factor kappaB ligand in gingival crevicular fluid in untreated chronic periodontitis patients.

BACKGROUND: Receptor activator of nuclear factor kappaB ligand (RANK-L) is a cytokine involved in the regulation of osteoclastogenesis in bone remodeling and inflammatory osteolysis. One of the major causes of tooth loss in humans is bone destruction. The aim of our study was to determine the presence of RANK-L in gingival crevicular fluid (GCF) samples from adult patients with untreated chronic periodontitis and in healthy controls. We also identified the RANK-L present in lesions undergoing episodic attachment loss from GCF. METHODS: GCF samples were collected from two periodontally affected sites (probing depth > or = 5 mm, attachment loss > or = 3 mm) in 20 patients (N = 40). After monitoring for 4 months, seven patients showed active periodontal disease, and GCF samples were collected from one active and one inactive site (N = 14 samples). The comparison with healthy controls was carried out by collecting GCF samples from 12 healthy volunteers (N = 24 samples). GCF was collected using a paper strip, and enzyme-linked immunosorbent assay (ELISA) was performed to determine the total amount of RANK-L. RESULTS: RANK-L was found in a higher proportion (85%) of samples from patients than from controls (46%). The total amount of RANK-L was significantly higher in patients (115.53 +/- 78.18 picograms [pg]) than in healthy subjects (63.08 +/- 55.08 pg) (P = 0.003). Active sites, presumably associated with tissue destruction, had significantly higher levels of RANK-L than their inactive counterparts (125.95 pg versus 91.80 pg, P = 0.007). CONCLUSION: GCF total amount of RANK-L is significantly increased in periodontal disease, supporting its role in the alveolar bone loss developed in this disease.

Adult↗