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[Research into actual conditions and preventive care in periodontal disease. Relationship between questionnaire results and periodontal disease in youth].

The purpose of this study was to determine the prevalence of periodontal disease and the relationship between the results of questionnaire concerning periodontal disease and the actual periodontal condition in youth. The examination was carried out in three parts. In the first part, a questionnaire was conducted on 3,886 junior and senior high school students (12 to 18 years of age) living in Kawagoe, Japan. The questionnaire was composed by of items concerning habits of oral hygiene, periodontal symptoms, understanding of periodontal disease and history of diagnosis by dentist of periodontal disease. Secondary, mass intraoral examination was carried out on all objects. The examination covered gingival inflammation, periodontal probing depth, calculus, dental plaque, dental caries and malalignment. Lastly, we examined the relationship between the results of periodontal examination and questionnaire with the original periodontal classification. The following results were obtained: 1. As an example of items in questionnaire, 83.1% brushed their teeth more than two times daily. The understanding of oral hygiene concerning dental caries was improved, but concerning periodontal disease was still poor. 2. The symptom most frequently reported was gingival bleeding during tooth brushing (18.4%). 3. The percentage of persons with periodontal disease (moderate gingival inflammation and periodontal pocket 4 mm or deeper) was of the highest frequency at 13 years old. The proportion of males increased with the advanced state of periodontal disease. 4. A significant correlation was found (chi 2-test: alpha less than 0.001) between advanced state of periodontal disease and a decrease in tooth brushing time per day. 5. A significant correlation was found between the advance of periodontal disease and gingival bleeding on tooth brushing (chi 2-test: alpha less than 0.001). Similarly, a correlation was found between the advance of periodontal disease and gingival swelling (chi 2-test: alpha less than 0.001). 6. A significant correlation was found (chi 2-test: alpha less than 0.001) between the advance of periodontal disease and aggravation of condition of dental plaque, calculus, dental caries and malalignment.

Adolescent

DNA probe detection of periodontal pathogens in HIV-associated periodontal lesions.

Recent studies have shown that an atypical gingivitis and a rapidly progressive periodontal disease may be early-occurring opportunistic infections associated with human immunodeficiency virus (HIV) infection. This study examined the prevalence of selected periodontal pathogens associated with these HIV-related periodontal lesions. Subgingival plaque samples were obtained from both HIV-seronegative and HIV-seropositive homosexual men and from presumably uninfected heterosexual men. DNA probes were used to detect Actinobacillus actinomycetemcomitans, Bacteroides intermedius, Bacteroides gingivalis, Eikenella corrodens and Wolinella recta in the plaque. The healthy sites in both the seronegative and seropositive homosexual groups showed a greater prevalence of all test bacteria, except for E. corrodens, than did the heterosexual group. HIV-associated periodontitis sites showed a microbial profile qualitatively similar to that of conventional periodontitis, except that B. gingivalis was more prevalent in conventional periodontitis. In contrast, HIV-associated gingivitis sites exhibited a greater prevalence of all bacteria tested than conventional gingivitis sites. In fact, HIV gingivitis generally showed a bacterial profile similar to that of the HIV periodontitis lesions, except that W. recta was significantly more prevalent in HIV periodontitis. These data suggest that the HIV gingivitis lesion is a precursor to HIV periodontitis. Thus, early identification and prophylactic treatment of high-risk individuals may prevent the destruction of periodontal tissues.

Adult

The microbial flora from root canals and periodontal pockets of non-vital teeth associated with advanced periodontitis.

Microflora from root canals and periodontal pockets of periodontally affected teeth were compared in order to elucidate the as yet unknown relationship between pulpal and periodontal disease. Caries-free teeth affected with advanced periodontitis and diagnosed as clinically dead by electric pulp testing were selected. The root canals and periodontal pockets were sampled, and the bacterial flora examined by both culture and interference microscopy. The results indicated that the aerobe/anaerobe ratio in the periodontal pocket was 0.23, while it was 0.0022 in the root canal, the large predominance of obligate anaerobes reflecting the anaerobic environment found in the root canal. Morphological classification obtained from interference microscopy showed similar proportions of morphotypes in the two sites. Results of anaerobic culture demonstrated a significantly higher rate of detection of facultative Streptococcus bacteria in the periodontal pocket than in the root canal. The predominant bacterial species common to both regions were Streptococcus, Peptostreptococcus, Eubacterium, Bacteroides, and Fusobacterium for obligate anaerobes. As for facultative anaerobes, Actinomyces and Streptococcus were detected predominantly in the periodontal pocket. The occurrence of micro-organisms common to both sites in this study suggests that the periodontal pocket may be a possible source of root canal infections.

Actinomyces

Periodontal therapy in humans. I. Microbiological and clinical effects of a single course of periodontal scaling and root planing, and of adjunctive tetracycline therapy.

The present results showed that maarked and long-lasting changes in the subgingival microflora associated with periodontal disease could be achieved by a single course of periodontal treatment. Immediately following therapy, the total number of subgingival organisms decreased 10- to 100-fold and the proportions of cultivable Gram negative organisms and anaerobic organisms generally decreased 3- to 4-fold or more. After treatment, most periodontal pockets were populated by a scant microflora predominated by facultative Actinomyces and Streptococcus species. The kinetics of the subgingival bacterial recolonization revealed that the total cell counts and the proportions of spirochetes and Capnocytophaga species did not reach their pretreatment levels even after 6 months. Other Gram negative anaerobic species returned to pretreatment proportions after 3 to 6 months. Several Gram positive species exhibited higher posttreatment than pretreatment proportions throughout the 6 months study. The microbiological shifts paralleled significant changes in the clinical status of the periodontal tissues. Following therapy, the periodontal pocket depths decreased generally 1 to 4 mm, the gingival inflammatory index, the gingival fluid flow, and the suppurative index were generally lower, and nine of 33 test pockets examined showed apposition of alveolar bone. The microbiological and clinical changes described were exhibited by two patients treated with periodontal scaling and root planing alone and by two patients treated with the adjunctive use of systemic tetracycline therapy. In two other patients, mechanical periodontal therapy only slightly reduced the total number of subgingival organisms and the proportions of spirochetes and other Gram negative anaerobic rods. A shift in the subgingival microbial composition was achieved in these two patients after tetracycline therapy. The following model for treatment of periodontal disease is proposed: (1) Conventional therapy including thorough periodontal scaling and root planing; (2) Monitoring the subgingival flora and the clinical course; and (3) Use of antimicrobial therapy in refractory cases. Further studies are needed to develop means for rapid identification of refractory patients, and to determine the optimal antimicrobial agent, the optimal route of administration, and the optimal dosage regime.

Actinomyces

Study of Chinese periodontal patients at National Taiwan University Hospital. Part I: Basic periodontal information and oral hygiene status.

A cross-sectional study of 288 subjects with complete periodontal documentation was evaluated to determine the clinical status of periodontal disease. The patients were divided into age group intervals of ten years. The conditions of oral hygiene and their association with the clinical status of periodontal disease were compared and analyzed. Chronological features of the disease and its background development among Chinese patients is also explored. Our results indicated that in the mind of Chinese patients the loss of teeth was considered to be a natural fate of aging, and dental and periodontal problems were viewed merely as a symptom of pain, but not as disease entity. Most patients were completely ignorant of both the importance of oral hygiene care and prevention of periodontal diseases. A high incidence of ill-fitted restorations, lack of motivations, and insufficient knowledge on prevention were common in our subjects. In this study, the oral hygiene index (OHI) in females was found to be lower than that of males. The OHI dropped abruptly after 20 years of age in females and after 30 years of age in males. The lowest gingival index (GI) was found in the 31-40 age group in both sexes. During the later periods of life, the OHI again rose, and this increase appeared earlier in females than in males. The GI corresponded to chronological changes in OHI. There was no statistical difference in GI between the corresponding age groups of males and females. The periodontal disease index (PDI) increased progressively with age in both sexes. However, no significant difference was noted between males and females. The progression of the PDI appeared stationary in the 31-40 age group, which corresponded to the period of lowest GI. In conclusion, our Chinese subjects exhibited poor oral hygiene and had an associated high incidence of periodontal disease. Irrespective of sex, OHI showed a positive correlation with GI. However, there was no obvious correlation between OHI and PDI. In contrast, GI was highly correlated to PDI in the 21-30 and 31-40 age groups in the present study. In addition, the paroxysmal nature of clinical periodontal parameters supports the recently held concept that the onset and progression of periodontal disease is intermittent.

Adolescent

Effect of experimentally induced marginal periodontitis and periodontal scaling on the dental pulp.

Experimental breakdown of the periodontal attachment apparatus was produced in six young adult monkeys to study the effect on the tissue of the dental pulp by (1) periodontitis, (2) scaling and plaque accumulation on exposed root dentin. Periodontal tissue breakdown was induced by the placement of ligatures around the neck of 92 permanent teeth. Subsequent plaque formation caused marked loss of periodontal tissue support, which after a period of 5--7 months amounted to 30--40% of the root length. One group of teeth received no further treatment. Other teeth were subjected to scaling and root planing. Following treatment, plaque was allowed to accumulate for 2, 10, and 30 days on the freshly planed root dentin surfaces. Histologic examination revealed that in comparison to teeth with normal periodontal conditions, 57% of the teeth exposed to periodontitis exhibited pathologic pulp tissue alterations. Secondary dentin formation and/or inflammatory cell infiltrates were observed within localized areas of the pulp subjacent to root surfaces exposed to periodontal tissue destruction. The changes within the pulp were of "mild" nature and only one tooth displayed signs of total pulp necrosis. Lateral canals communicating with both the pulp cavity and the exposed root surface were never detected. Teeth subjected to scaling and subsequent plaque accumulation in comparison with teeth with periodontitis alone exhibited no obvious aggravation or increased incidence of pathologic pulp reactions. The findings show that in the monkey (1) periodontal destruction limited to the cervical half of the root and (2) plaque accumulation on exposed root dentin does not cause severe alteration in the pulp of the roots involved.

Animals

Clinical studies on juvenile, rapidly progressive and adult periodontitis before and after periodontal therapy (I).

The sample in the present study comprised 36 patients who were referred for treatment of periodontal disease. Twenty-four of them were early onset periodontitis (EOP) patients and 12 were adult periodontitis (AP) patients. Based upon the age, number of involved teeth and the location of diseased sites, the EOP patients were divided into two groups as juvenile periodontitis (JP) and rapidly progressive periodontitis (RPP). All the patients were individually examined both clinically and radiographically. At a baseline examination and 3 months after active therapy, the patients were evaluated for plaque, gingivitis, probing depths and probing attachment levels. Following instruction in proper oral hygiene measures, all of the patients were subjected to periodontal treatment. Treatment comprised scaling and root-planing, occlusal adjustment, tetracycline administration and periodontal surgery with osteoplasty. Results showed that age limits between JP and RPP cannot be drawn with certainty. The mean age for the JP group was 21.83 years and was 30.58 years for the RPP group. The number of involved teeth was found to increase with age. The first molars were the most frequently affected teeth followed by the incisors. Three months after active treatment, the response of periodontal tissues to therapy both in EOP and AP groups was almost identical.

Adolescent

Identification of polymorphonuclear leukocyte collagenase and gelatinase activities in mouthrinse samples: correlation with periodontal disease activity in adult and juvenile periodontitis.

In previous studies, elevations in the levels of active and latent collagenase in gingival crevicular fluid (GCF) have been correlated positively with periodontal disease activity. To provide a simple diagnostic approach for testing collagenolytic activity, the feasibility of using a 3.0 ml water mouthrinse to collect GCF simultaneously from all sites in the mouth was assessed. Patients with adult periodontitis (AP, n = 23) and local juvenile periodontitis (LJP, n = 7) were sampled before periodontal therapy and some (12 AP, 4 LJP) were also assessed longitudinally after scaling and root planing, administration of antibiotics, and following periodontal surgery. Healthy patients (n = 19) were used as controls. The levels of active collagenase, procollagenase, and collagenase inhibitor activity were determined by functional assays and quantitated after SDS-PAGE and fluorography. Gelatinase and progelatinase were assayed by enzymography on gelatin-substrate gels. Active collagenase levels were found to be significantly higher (14- to 20-fold) in AP and LJP patients compared to controls, whereas matrix metalloproteinase activity was not detected in mouthrinses from edentulous patients. Collagenase inhibitor levels were generally low in all groups of subjects tested. Following clinical treatment the levels of active collagenase and gelatinase were reduced; the reduction was significant for active collagenase after tetracycline treatment and scaling in LJP patients. Of the clinical indices recorded (gingival index, plaque index, and pocket depth) there were no significant correlations with enzyme activity but similar trends were observed between the changes in active collagenase and gingival index. In patients with untreated periodontal disease, collagenase occurred predominantly in the active form. N-ethylmaleimide (NEM) and p-aminophenylmercuric acetate (AMPA) were equally effective as activators of the latent collagenase, indicating that the collagenase was derived from PMNs, which were also the source of gelatinase. The results of these studies indicate that measurement of active collagenase and gelatinase in mouthrinse samples is potentially useful in the diagnosis and assessment of periodontal disease activity.

Adolescent

Effects of destructive periodontitis, induced by diet, on the mechanical properties of the periodontal ligament of the mandibular first molar in golden hamsters.

To examine progressive changes in the mechanical properties of the periodontal ligament in the hamster mandibular first molar with experimental periodontitis--induced by feeding a high-carbohydrate diet--load-deformation curves obtained by extracting the tooth from its socket in the dissected jaw were analyzed. The maximum shear load, elastic stiffness and failure energy in shear in the experimental groups decreased significantly during the experimental period. On the other hand, significant differences in the maximum deformation were not found between the experimental and the relevant control groups. Radiographic and histological observations showed that the alveolar bone loss and destruction of the periodontal tissues occurred at the cervical region of the tooth in the experimental animals at 8 and 12 weeks after the start of the experiment. It is suggested that the reduction of the mechanical strength of the periodontal ligament in the experimental animals may be due to the alveolar bone loss, destruction of the periodontal tissues at the cervical region--particularly on the lingual aspect--followed by a decrease in the surface area of the ligament. It is also suggested that degenerative changes in the remaining periodontal ligament occurred in hamsters with periodontal disease, causing a reduction in the mechanical strength of the ligament.

Alveolar Bone Loss

Relationship of occlusion and periodontal disease: part IX-incisor inclination and periodontal status.

In this study population the following observations have been made: Periodontal destruction, gingival inflammation and mobility were not significantly related to axial inclination of the incisor teeth. Labial gingival recession of the mandibular incisor was related to linguoversion (less than 85 degrees to GoGn). No other associations between incisor inclination and labial or lingual recession were found. Age was not related to either maxillary or mandibular incisor inclination. The periodontal-incisor inclination relationships reported above for periodontal destruction and gingival inflammation were not altered by the factor of age. Study of the secondary influence of incisor inclination on the relationships of selected occlusal factors and periodontal pathosis showed: A. Severe overjet (more than 6mm) had been found to be associated with more periodontal destruction. With severe overjet maxillary incisors in linguoversion (less than 100 degrees to SN) were somewhat healthier than all others. Among the same cases of severe overjet mandibular incisors in labioversion had slightly more disease than all others. B. The absence of a significant correlation between anterior overbite or crowding reported previously was not influenced by incisor inclination. C. Facial alveolar bone thickness, observed clinically, was studied for its relation to periodontal destruction and gingival inflammation. Thick facial alveolar bone was found to be associated with increased pathosis. This finding was not consistent for the maxillary and mandibular incisor and the influence of other factors might be suspected: Incisor inclination had no effect on the bone thickness-periodontal disease findings.

Adolescent

[The effect of periodontal cytomedin on lipid peroxidation and hemostasis in spontaneous periodontitis in rats].

Rats with spontaneous periodontitis develop lipid peroxidation in the blood and periodontal tissues, that is associated with hypercoagulation and fibrinolysis inhibition, reduced antiaggregation activity of the periodontal tissues. Administration of periodontal cytomedin results in normalization of lipid peroxidation, blood coagulation, and euglobulin lysis, as well as in increase in the activities of periodontal antioxidant enzymes and antiaggregation properties. Cytomedin effect on lipid peroxidation and antioxidant enzymes was more manifest in periodontal tissues than in the blood. Visual examination has shown an improvement of the periodontal tissue status, thus indicating good prospects for such therapy.

Animals

[Changes of the periodontal vascular network, periodontal fiber and alveolar bone incident to tooth extrusion].

During the application of orthodontic force to a tooth, the surrounding tissues undergo changes of bone resorption and apposition, thereby resulting in tooth movement. The purpose of this study was to investigate the interrelationship between alveolar bone changes and the periodontal vascular network caused by extrusive orthodontic force using a scanning electron microscopy. Extrusive orthodontic force was applied to the mandibular 2nd and 3rd premolars of adult dogs. At the completion of the loading process, the inferior alveolar arteries were injected with a low viscosity MMA resin (Mercox). The following results were obtained. 1) At 3 days post-extrusion, various types of vascular network showing a loop pattern were seen along the direction of the tooth movement. 2) At 7 days post-extrusion, various types of vascular network with a hairpin loop pattern along the direction of the tooth movement were observed. Histologically, the fibers of periodontal ligament were stretched in the direction of the extrusion, Vascular hairpin loop formations were observed within the fibers of periodontal ligament. Bone apposition was not observed on the surface of alveolar bone. 3) At 14 days post-extrusion, a much more extensive and developed hairpin loop pattern occurred. Furthermore, new bone apposition was seen on the alveolar bone beneath under the hairpin loops. The periodontal ligament space was retained in the same width, even after bony apposition. 4) At 21 days post-extrusion, the tooth side microvascular network showed abundant low hairpin loops which anastomosed each other, and new spinous bony apposition was observed right below the periodontal vascular network. 5) At 30 days post-extrusion, the periodontal vascular network showed a almost normal appearance, with the rearrangement of vascular network. The surface of the spinous bony apposition became flat. The appositional bone had a lower degree of calcification than the alveolar bone in control group. 6) At 60 days post-extrusion, the periodontal vascular network completed the rearrangement of vasculature.

Alveolar Bone Loss

Comparison of clinical periodontal parameters with the Community Periodontal Index for Treatment Needs (CPITN) data.

The purpose of this analysis was to assess the ability of the CPITN system to rate severity and prevalence of periodontal diseases in a population, in comparison with full mouth scorings using conventional clinical parameters (Plaque Index, Gingival Index, Retention Index, Pocket Probing Depth and Loss of Attachment). These parameters were collected in a randomly selected sample in Switzerland. The data were then transformed to fit the definitions of the CPITN. Furthermore, a comparison of the data set from Switzerland with data obtained from the Oral Global Data Bank of the WHO was made. By conversion of the Swiss data into the CPITN format, many details were lost, which were considered to be relevant to assess severity, prevalence and localization of periodontal diseases within a population. In addition, the transformed data generally overestimated the prevalence of periodontal destruction when compared with data from surveys in other industrialized countries in which the CPITN was used to evaluate the periodontal status. The comparison of the data before transformation into the CPITN, however, corroborated results from epidemiological studies in which conventional periodontal index systems were used. This indicates that data obtained to determine defined treatment needs (CPITN) may be of questionable value for the assessment of the true prevalence and severity of periodontal disease in a population.

Dental Health Services

Putative periodontal pathogens on titanium implants and teeth in experimental gingivitis and periodontitis in beagle dogs.

The microflora around titanium implants and teeth in 4 beagle dogs was analyzed in order to follow the longitudinal development from healthy conditions to experimental gingivitis and periodontitis. A 2-month plaque control program was performed to establish healthy conditions on titanium implants and control teeth (baseline, day 0). Subgingival bacterial samples and radiographs were obtained. The plaque control was ceased and all measurements were repeated on day 21 (gingivitis). A new period of plaque control was initiated to re-establish healthy conditions (day 49). A cotton ligature was placed subgingivally around the implants and the control teeth to induce tissue breakdown. The ligatures were removed on day 91. The study was completed with registrations on day 121 (periodontitis). No significant microbiological difference was found between titanium implants and teeth in healthy conditions and in gingivitis and periodontitis. The mean total viable count increased 10 times on implants as well as on teeth. Streptococci were dominating at baseline: 40.2% on implants and 60.6% on teeth and decreased in gingivitis to 11.7% and 5.4%. When periodontitis had developed, the proportion of streptococci was < 1%. At baseline few Porphyromonas gingivalis and Prevotella intermedia were detected. They increased at gingivitis to 37.4% and 21.0%; when periodontitis developed, they comprised about 25.0%. Microbial colonization and establishment on titanium implants with healthy gingiva, experimental gingivitis and periodontitis follow the same pattern as on teeth.

Animals

The natural history of periodontal disease in man. The rate of periodontal destruction before 40 years of age.

This longitudinal study of randomly selected Norwegian students and academicians has shown that 50% of the 17-year olds have lost no periodontal support, and the other 50% exhibited slight localized loss of attachment primarily on buccal surfaces of first molars and first bicuspids of both jaws. At 21 all students show one or more of these lesions as well as loss of attachment on interproximal surfaces. At 30 years of age the mean cumulative loss is still less than 1 mm. As they approach 40 years of age the mean individual loss of attachment is slightly above 1.5 mm or 10% of the total periodontal support, and the mean annual rate of attachment loss is 0.08 for interproximal surfaces and 0.1 mm for buccal surfaces. No case of juvenile periodontitis (periodontosis) or adult aggressive periodontitis were seen in this population. Seventy percent of the 15-year-old Sri Lankans have no or very little loss of periodontal support. However, approximately 30% exhibit localized lesions measuring between 2 and 9 mm and more than 1% have one or more root surfaces with 10 mm loss of attachment or more. In this age group the lesions occur at the interproximal and buccal aspects of lower central incisors and in first molars of both jaws. At 30 years of age the mean loss of attachment is 3.11 mm and approximately 25% of the tea laborers have lesions extending 10 mm or more below the cemento-enamel junction. As the Sri Lankan approaches 40 years of age the mean loss of attachment is 4.50 mm and the mean rate of progress of the lesion is 0.20 mm per year for buccal surfaces and 0.30 mm for interproximal surfaces. This study suggests that without interference the periodontal lesion progresses at a relatively even pace and that the progress is continuous.

Adolescent

[A rapid diagnosis for periodontitis based on enzymatic activity of periodontopathic bacteria. Correlation between enzymatic activity, clinical periodontal parameters, and subgingival level of microorganisms].

There have been various laboratory methods for the microbiological diagnosis of periodontal disease. However, there have been some disadvantages in these methods. In this study of the application of a chair-side test for microbiological diagnosis, the activity of peptidases in periodontal pockets of patients was examined by using the assay system SK-013. SK-013 consists of synthetic substrates and is capable of rapidly (in 15 min) evaluating the activity of specific peptidase from Treponema denticola and Bacteroides species. Using SK-013, we evaluate the correlation between the enzymatic activity, clinical periodontal parameters and subgingival level of microorganisms, including phase contrast microscopy. We calculated the sensitivity and efficacy of SK-013 as a diagnostic indicator in the presence of Spirochetes and in periodontitis. A positive correlation were demonstrated between enzymatic activity, clinical periodontal parameters, the numbers of total cell count, Spirochetes, and M & S ratio. SK-013 was highly sensitive and efficacious (sensitivity: 92%, efficacy: 96%). We concluded that the assay system SK-013 is a useful chair-side method for diagnosing periodontal disease.

Bacteroides

[Importance of periodic follow up of periodontal diseases for the maintenance of periodontal health and the longevity of dental restoration].

The major objective of the author's investigation was to determine if the progression of attachment loss, the recurrence of active phase of periodontitis and development of new carious lesions can be controlled and prevented in individuals with prior history of aggressive periodontitis provided full mouth reconstruction and maintained at a proper level of oral hygiene. The results of a group on regular periodontal recall program were compared with the five years dental and periodontal findings on a matched group of patients having not been on regular maintenance program. The well maintained group of patients' annual recall data did not vary markedly. In five years basically the same amount of attachment apparatus was maintained. The reexamination of the non recall group at the end of the fifth year shoved a total deterioration of dentition due to the progression of periodontal disease and attachment loss. Especially those of rapidly progressing periodontitis cases shoved 70 to 100% attachment loss. This comparative study attempted to outline the insufficiency of our former dental philosophy of patient management and follow up. Authors emphasize the importance of the follow up, and maintenance of a very high level.

Adult

[Is it possible for periodontal patients to recognize periodontal disease].

The purpose of this study was the evaluation of clinical symptoms of periodontal disease in a sample of adult periodontal patients, that were presented for periodontal treatment in the private clinics of the authors during a period of ten years. A questionnaire was designed for this reason which included questions related to gingival bleeding, gingival enlargement, tooth migration and tooth mobility. 330 questionnaires were evaluated from a total of 1175 consisting a representative sample. The results have showed that the clinical symptoms that directed patients to look for periodontal treatment were (a) gingival bleeding when brushing or spontaneously (74.78%), (b) tooth mobility (65.65%), (c) presence of gingival enlargement (60%) and (d) tooth migration (36.96%). Comparison between positive answers, in all questions in relation with the presence of the clinical symptoms of periodontal disease showed significant differences between men and women. Furthermore, women were presented for appropriate periodontal treatment with the presence of two symptoms while men with the presence of three. In conclusion gingival bleeding when brushing or spontaneously is a symptom that is easily evaluated by the patient--as the results of this study indicated--provided he knows its significance. Therefore, emphasis must be given in informing the patients regarding its significance.

Adult