Does Full-Mouth Disinfection Influence the Size of the Periodontal Inflammatory Burden and the Level of hsCRP?

PURPOSE: To investigate the effect of full-mouth disinfection on the sizes of the periodontal wound and periodontal inflammatory burden and whether it leads to a decrease in C-reactive protein (CRP) levels. MATERIALS AND METHODS: The study included 20 systemically healthy subjects (11 women and 9 men) 30 to 68 years old with localised or generalised periodontitis (stage III, grade C). The sizes of the periodontal wound and periodontal inflammatory burden were measured with the web application "Periodontalwound", which is based on measurements of average tooth cervices, as well as probing depths and bleeding on probing assessed at six sites around each tooth present in the oral cavity. The levels of hsCRP (high-sensitivity CRP) were measured with an immunochemical method. All three parameters were measured before initial treatment and 3 months after therapy. Full-mouth disinfection included removal of plaque and calculus with ultrasonic and hand instruments in one session. RESULTS: The results showed a statistically significant decrease in the size of the periodontal wound (p < 0.001), a statistically significant decrease in the size of periodontal inflammatory burden (p < 0.001), and a decrease in hsCRP levels 3 months after therapy. CONCLUSION: Full-mouth disinfection leads to a decrease in the periodontal wound and periodontal inflammatory burden size, as well as a decrease in the levels of hsCRP in patients with localised or generalised periodontitis (stage III, grade C).

Antimicrobial photodynamic therapy in treatment of aggressive periodontitis (stage III, grade C periodontitis): A comparison between photodynamic therapy and antibiotic therapy as an adjunct to non-surgical periodontal treatment.

BACKGROUND: Treatment of aggressive periodontitis (stage III, grade C periodontitis) represents a challenge. The aim of the study was to compare the long-term results of antimicrobial photodynamic therapy (aPDT) and antibiotic therapy as an adjunct to conventional non-surgical therapy in patients with aggressive periodontitis. MATERIALS AND METHODS: Twenty subjects with untreated aggressive periodontitis (stage III, grade C periodontitis) were divided into two groups: the test group (TG) received non-surgical therapy and two sessions of aPDT using a laser (HELBO TheraLite laser) with a wavelength of 670 nm associated with HELBO Blue photosensitizer, and the control group (CG) received non-surgical therapy and antibiotics (amoxicillin 500 mg and metronidazole 400 mg, 7 days). Clinical parameters of probing depth, clinical attachment level and bleeding on probing (BOP) were assessed at baseline, 3, 6, 9 and 12 months after treatment. RESULTS: The mean probing pocket depths at baseline were 3.68 mm in TG and 3.51 mm in CG. These values decreased to 2.77 mm (p < 0.05) and 2.54 mm (p < 0.05) 3 months after treatment and stayed decreased after 12 months. Clinical attachment levels at baseline were 3.88 mm in TG and 3.70 mm in CG. These values decreased to 3.06 mm (p < 0.05) and 2.80 mm (p < 0.05) after 3 months and stayed decreased after 12 months. We also found a decrease in BOP after 3, 6, 9 and 12 months in TG and in CG. CONCLUSIONS: aPDT and antibiotics as an adjunct to non-surgical periodontal treatment lead to a comparable improvement in long term periodontal parameters.

Effect of Full-mouth Disinfection Protocol on Glycaemic Control and Subgingival Microbiota in Patients with Type 1 and Type 2 Diabetes.

PURPOSE: To evaluate the effect of a full-mouth disinfection protocol (FMD) on periodontal parameters, glycaemic control and subgingival microbiota of periodontal patients with type 1 and type 2 diabetes, as well as those without diabetes. MATERIALS AND METHODS: This study included 33 patients with periodontitis. Eleven of them were type 1 diabetes patients, 11 were type 2 diabetes patients, and 11 were non-diabetics. At baseline and 3 months after the FMD, the periodontal parameters of each patient were recorded, samples of capillary blood for the chairside assessment of HbA1c were taken, and plaque samples from the two deepest periodontal pockets were collected to test for the presence of Aggregatibacter actinomycetemcomitans (Aa), Porphyromonas gingivalis (Pg), Prevotella intermedia (Pi), Tannerella forsythia (Tf) and Treponema denticola (Td). RESULTS: Bleeding on probing (BOP), probing pocket depth (PPD), clinical attachment level (CAL) and glycated haemoglobin (HbA1c) decreased statistically significantly (p < 0.05) in all three groups 3 months after FMD. Only the proportion of Pg in the control group decreased statistically significantly (p < 0.05), while the proportion of other bacteria decreased or remained the same, whereby the differences were not statistically significant. Moreover, the proportion of Aa in type 1 diabetics increased statistically significantly (p < 0.05). CONCLUSION: The FMD protocol improves periodontal parameters and glycaemic control of type 1 and type 2 diabetes patients with periodontitis.

A Longitudinal Study of DMFT Counts in a Population of Ljubljana Over a Thirty Year Period.

PURPOSE: Few longitudinal studies on changes of decayed, missing, or filled teeth (DMFT) counts in a population have been reported. This study aimed to evaluate the changes in DMFT counts in Ljubljana citizens in a 30-year period. MATERIALS AND METHODS: 238 dentate subjects that attended the third epidemiological study were invited. Ninety 45-95-year-old subjects (37.8%) responded to our invitation. Two (2.2%) edentulous subjects were excluded. Among the dentate subjects there were 28 men and 60 women. They were divided in six age groups with mean age of 45, 55, 65, 75, 85, and 95 years. The number of subjects in each age group was: 29, 12, 21, 18, 7, and 1, respectively. For evaluation of the state of teeth we used the DMFT index. RESULTS: The average DMFT value for 45-95-year-old population was 19.3. Mean DMFT counts in all comparable age groups (45-, 55- and 65-years) decreased in 30 years. In 45 year olds they decreased from 17.5 to 15.7, in 55-year-olds they decreased from 20.4 to 19.2, and in 65 year olds they decreased from 22.5 to 20.7. An increase of the average number of present teeth (for 6.4 teeth in average) from the first to the fourth study in subjects of the same age was seen. CONCLUSION: Dental health in Slovenia has improved in 30 years. Average DMFT counts in subjects of the same age (45-, 55- and 65-years) have decreased. Ljubljana citizens have less decayed, less missing and more filled teeth than 30 years ago.

A Longitudinal Study of Periodontal Treatment Needs in a Ljubljana Population over a 30-year Period.

PURPOSE: Only a few studies have presented long-term trends in the prevalence of periodontitis and periodontal treatment needs. The aim of this study was to report the changes in periodontal treatment needs of an adult population in Ljubljana, Slovenia, over a 30-year period. MATERIALS AND METHODS: This study included 88 45- to 95-year-old subjects who had attended the previous three studies 10, 20 and 30 years ago. We used the CPITN for assessing periodontal treatment needs, as the same index had been used in the previous three studies. RESULTS: None of the examined subjects had healthy periodontal tissues, all needed oral hygiene instruction, 96.6% needed scaling and root planing as well as oral hygiene instruction, 47.7% needed complex periodontal treatment as well as oral hygiene instruction plus scaling and root planing. Periodontal treatment needs in Ljubljana adults increased in thirty years in the total study population as well as among 45- to 65-year-olds. CONCLUSION: Periodontal treatment needs in an adult population of Ljubljana are high and have increased in the last thirty years. More effective primary and secondary preventive measures are needed to decrease the prevalence of periodontal disease and periodontal treatment needs in the adult population of Ljubljana, Slovenia.

Prevalence of periodontal pathogens and metabolic control of type 1 diabetes patients.

OBJECTIVE: The aim of the study was to evaluate the prevalence of periodontal pathogens Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis, Prevotella intermedia, Tannerella forsythia and Treponema denticola in subgingival plaque collected at different probing depths of type 1 diabetes patients with periodontal disease in correlation to metabolic control. METHODS: Twenty-one patients 40 to 50 years old were included in the study. In each patient blood samples were taken for the evaluation of HbA1c level and subgingival plaque samples were taken with paper points from the two deepest pockets. The presence of five periodontal pathogens was detected by multiplex polymerase chain reaction. RESULTS: The results of 38 plaque samples showed that T. forsythia was found in 48% followed by T. denticola in 31%, P. gingivalis in 26%, P. intermedia in 9% and A. actinomycetemcomitans in 7%. T. forsythia and T. denticola were the most frequent combination of periodontal pathogens found in the same sample. The serum level of HbA1c in nine patients where T. forsythia was detected (7.5 +/- 1.4%) was significantly higher (F-test, p = 0.001) than in 12 patients where T. forsythia was not detected (6.8 +/- 0.5%). Similarly, the serum level of HbA1c was significantly higher (F-test, p = 0.001) in eight patients where T. denticola was detected (7.5 +/- 1.8%) compared to the 13 patients where T. denticola was not detected (7.0 +/- 0.5%). No such correlation was found for P. gingivalis, P. intermedia or A. actinomycetemcomitans. CONCLUSIONS: We conclude that T. forsythia and T. denticola are most frequently found in subgingival plaque samples of type 1 diabetic patients and these findings correlate with poorer metabolic control of diabetes.

Periodontal inflammatory burden correlates with C-reactive protein serum level.

OBJECTIVE: The aim of study was to present a new method for evaluation of the periodontal inflammatory burden, to apply the method to the adult population and to correlate it with serum levels of C-reactive protein (CRP). MATERIALS AND METHODS: On 515 extracted teeth was measured the neck circumferences (NC). The average values of the NC were obtained for 16 male and 16 female individual tooth types. In the clinical part of this study 238 dentate subjects were included. The subgingival area, inflamed area and periodontal wound size were calculated from NC, probing depth and BOP. The sum of the inflamed and ulcerated subgingival areas of all teeth represented the total periodontal inflammatory burden of an individual. Serum levels of CRP were measured by immunochemical method. RESULTS: The average subgingival area in 238 subjects was calculated to be 13.11 ± 6.35 cm(2) and inflammatory burden area 9.25 ± 5.57 cm(2). The periodontal bleeding wound (p < 0.05) was significantly larger in men. The increased serum levels of CRP correlated with periodontal inflammatory burden (p < 0.05). CONCLUSIONS: This new method quantifies the inflammatory burden caused by periodontal disease. The size of the inflammatory burden is correlated with increased serum levels of CRP.