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The gingival tissues adjacent to the crowned and unrestored teeth were probed to determine individual pocket depths. The findings are listed here. (1) The average pocket depth adjacent to nonrestored teeth was 2.7 mm. The average pocket depth adjacent to teeth having crowns with subgingival margins was 3.4 mm. (2) Fifty-four nonrestored teeth had at least one pocket depth greater than 3 mm., while 84 crowned teeth had at least one or more measurements greater than 3 mm. (3) No positive relationship could be found between tooth brushing frequency and the pocket depth adjacent to teeth restored with complete cast crowns. (4) In nonrestored teeth, pocket depth increased with reduced frequency of tooth brushing. (5) Pocket depth increased with increased age of (a) the patient in both restored and nonrestored teeth and (b) the cast crown.
Common methods for microbiologic examination of the gingival pocket contents in periodontitis are rarely used in practical periodontology. The author proposes to quantify epithelial cells contaminated by bacterial flora. Results of cytologic studies of smear impressions from 30 patients with periodontal diseases and from 13 normal subjects are presented, evidencing a significant elevation of bacterial contamination of the epithelium in the patients vs. that in normal subjects (66.51 +/- 3.5 vs. 44.66 +/- 4.75 percent).
Single teeth and resected jaw specimens including periodontal tissue were prepared as saw-cut thin-ground specimens without previous decalcification. The specimens were classified into 4 stages of pathogenesis to allow studies into the mechanisms of gingival pocket formation. Examination of the preparations under the light microscope indicated that the pathologic gingival pockets caused by microbial plaque might be formed by degenerative alterations in the second or third innermost cell layer of the junctional epithelium. The intercellular contacts were dissolved and, thus, cyst-like cavities were formed within the epithelium. The contact between tooth enamel/cementum--basal membrane--epithelial cells, however, was maintained. Artifacts could be ruled out by comparing preparations of single teeth with those of entire jaw segments.
AIM: Gingival overgrowth is a common undesired side-effect in patients taking calcium channel blockers. Different reports have suggested that the drug-induced gingival hyperplasia may aggravate inflammatory periodontal disease. However, representative epidemiological data are lacking. We investigated the association between the intake of calcium antagonists and periodontitis in a population-based analysis including the most important risk factors of periodontitis. METHODS: In a cross-sectional epidemiological investigation involving 4290 subjects aged 20-80 years, we recorded periodontal risk factors and identified participants using calcium antagonists. Periodontal parameters, attachment loss, probing depth and number of teeth were assessed. In a subgroup analysis with matched pairs, 456 subjects using calcium antagonists and 456 without were compared for periodontal status. RESULTS: Subjects treated with calcium antagonistic drugs had significantly deeper gingival pockets than their drug-free counterparts. This was observed in the total population of 4290 and confirmed by logistic regression analyses (P < 0.001) controlled for the known risk factors of periodontitis (age, sex, smoking, education). In the matched-pair analysis only the probing depth was increased: extent probing depth > or = 4 mm median 23.5 vs. 17.0% (P < 0.001); mean probing depth 3.0 +/- 0.8 vs. 2.7 +/- 0.9 mm (P < 0.001). No differences were found in extent and severity of clinical attachment loss and in the number of teeth. The risk of gingival overgrowth was aggravated in smokers. CONCLUSION: In the general population, treatment with calcium antagonists leads to gingival overgrowth without an aggravation of periodontal disease. Interaction with smoking indicates the multifactorial background of the undesired effect of calcium antagonists.
The efficacy of a topical anesthetic on pain and unpleasantness provoked by scaling of gingival pockets was investigated in 20 patients with mild chronic periodontitis. A eutectic mixture of local anesthetics (EMLA) and a placebo cream, both occluded by Orahesive Oral Bandages, were applied in a balanced, randomized, double-blind, split-mouth design, which enabled within-subject comparison of the anesthetic and the placebo in the upper and the lower jaw. Pretreatment interviews showed that approximately two-thirds of the patients considered gingival scaling to be associated with some degree of pain and unpleasantness. Pain intensity and unpleasantness were evaluated on 100-mm visual analog scales (VAS). Application of EMLA reduced both pain intensity and unpleasantness significantly compared to placebo cream. Median reductions in VAS pain intensity in the upper and lower jaw were 58.9% and 61.9%, and corresponding reductions in VAS unpleasantness were 31.9% and 25.6%, respectively. Generally, the patients accepted the anesthetic procedure well. The residual perception of pain and unpleasantness following topical anesthesia may be dependent on activation of nonanesthetized nociceptive fibers in the tooth pulp. However, the present study clearly demonstrates the efficacy of a topical anesthetic in a clinical situation, which may be recommended as a simple pharmacologic strategy to reduce pain and unpleasantness during scaling procedures.
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Periodontitis is a locally limited disease caused by bacteria. The local application presents itself useful for the indicated medicamentous therapy of periodontitis by means of metronidazole. In preliminary tests the metronidazole liberation from hollow fibres, in gel and from polyvinyl alcohol platelets has been tested by ultraviolet absorption measurement. The hollow fibres have been evaluated no more because of too small agent absorption in the clinical test. In polyvinyl alcohol metronidazole acts definitely over 3 days. However, the prolonged action in the gel form is not definitely (45 min to 24 h). A single one or repeated twice metronidazole/polyvinyl alcohol platelet application results in a sufficient long and high metronidazole concentration in the gingival pocket.
Printing preparations from the gingival pockets coloured by means of Shorr's method and secretion of pocket fluid have been estimated in 33 patients before and after balneological treatment. A telemicroscope has been used to estimate the preparations. The preparations have been analyzed in the linear enlargement of 1500 times using a network consisting of 35 fields of the dimensions of 3 cm x 3 cm (20 microns x 20 microns in the preparation) marked on a monitor screen. It has been that the sample representative for the whole preparation is contained in the band lying along its centre long axis and it occupies 6.33% of the preparation surface. Correlation between the number of granulocytes and the number of fields with granulocytes and the height of the granulocytar infiltration and between the number of granulocytes in the printing preparation and the excretion of the pocket fluid has been demonstrated in patients before treatment.
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