Obesity Phenotypes and Dental Calculus in Young Adults: CHIEF Oral Health Study.

AIM: The study aimed to examine the association of obesity phenotypes with dental calculus. BACKGROUND: Obesity has been recognized as a risk factor for kidney and gallbladder stones formation and periodontitis. OBJECTIVE: We have investigated the association between obesity, metabolic risk factors, and dental calculus, which is a sequela following periodontitis. METHODS: This study included 5,281 military members, aged 19-45 years, without antihypertensive medications in Taiwan. Obesity was defined as body mass index ≥27.5 kg/m2, and metabolic syndrome (MetS) was defined according to the modified ATP III criteria. Supragingival calculus in any teeth, except for impacted teeth and the third molar, was the outcome of interest. Multiple linear regression analysis with adjustments for age, sex, toxic substance use, brushing teeth frequency, and blood leukocyte counts, was used to determine the association of obesity with dental calculus numbers. Multiple logistic regression analysis was used to assess the association between obesity with or without MetS and the presence of any dental calculus. RESULTS: BMI was positively correlated to dental calculus numbers [ß and confidence intervals (CI) = 0.023 (0.014, 0.032)]. Compared to the obesity(-)/MetS(-) group, there were dosedependent associations for the obesity(-)/MetS(+), obesity(+)/MetS(-), and obesity(+)/MetS(+) groups with the presence of any dental calculus [odds ratios (ORs): 1.08 (0.76, 1.53), 1.31 (1.08, 1.58), and 1.51 (1.20, 1.90), respectively]. Of the metabolic risk factors, abdominal obesity and hypertension were independently associated with dental calculus [ORs: 1.33 (1.13, 1.55) and 1.30 (1.11, 1.52), respectively]. CONCLUSION: This study suggests general obesity as an independent risk factor for dental calculus formation, and MetS, particularly the components of abdominal obesity, and hypertension may also increase the prevalence of dental calculus. Diet control and regular exercise might be preventive measures for the development of both obesity and dental calculus.

Salivary Levels of IL-6 and IL-17 Could Be an Indicator of Disease Severity in Patients with Calculus Associated Chronic Periodontitis.

Background/Purpose. Chronic periodontitis is an inflammatory disease of gums that causes loss of supporting structures of teeth, that is, gingiva, periodontal ligament, cementum, and alveolar bone. Levels of various cytokines in the serum, gingival tissues, and gingival crevicular fluid in patients with chronic periodontitis have been studied, but limited data are available on the level of cytokines in saliva. Therefore, a study was designed to determine levels of salivary IL-6 and IL-17 in patients with calculus associated chronic periodontitis. Materials and Methods. It was a comparative, cross-sectional study that is comprised of 41 healthy controls and 41 calculus associated chronic periodontitis patients (CP patients). According to the degree of attachment loss, CP patients were subcategorized as mild (CAL 1-2 mm), moderate (CAL 3-4 mm), and severe (CAL > 5 mm) forms of periodontitis. Salivary levels of IL-6 and IL-17 were determined using enzyme-linked immunosorbent assay (ELISA) technique. Data was analyzed using SPSS 20.0. Results. Between healthy controls and CP patients (moderate and severe disease), a statistically significant difference was observed in the concentrations of IL-6 and IL-17. In CP patients, the highest mean ± SD of salivary IL-6 and IL-17 was observed in severe CP, followed by moderate and mild CP. Regarding level of IL-6, a statistically significant difference was observed between mild and severe disease and between moderate and severe subcategories of CP patients. Similarly, statistically significant difference was observed in the level of IL-17 between mild and moderate, mild and severe disease, and moderate and severe disease. Conclusion. The levels of salivary IL-6 and IL-17 were increased significantly in calculus associated CP patients as compared to healthy controls and these levels increased with the progression of CP. Clinical Significance. Salivary levels of IL-6 and IL-17 may help in the subcategorization of CP.

The periodontal pocket.

Periodontal disease is synonymous with the presence of periodontal pockets, and very often the clinical success of periodontal therapy is based on periodontal pocket depth reduction. Therefore, in the fields of periodontology and implant dentistry, significant research effort has been placed on the etiopathogenesis, diagnosis and treatment of periodontal/peri-implant disease and as a consequence on pocket pathology. In this volume of Periodontology 2000, the in-depth reviews include topics ranging from preclinical models, anatomy and structure of tissues, and molecular and bacterial components, to treatments of pockets around teeth and implants. These reviews aim to provide the readers with current and future perspectives on the different areas of research into the periodontal pocket.

Natural history of periodontitis: Disease progression and tooth loss over 40 years.

OBJECTIVES: To assess long-term attachment and periodontitis-related tooth loss (PTL) in untreated periodontal disease over 40 years. MATERIAL AND METHODS: Data originated from the natural history of periodontitis study in Sri Lankan tea labourers first examined in 1970. In 2010, 75 subjects (15.6%) of the original cohort were re-examined. RESULTS: PTL over 40 years varied between 0 and 28 teeth (mean 13.1). Four subjects presented with no PTL, while 12 were edentulous. Logistic regression revealed attachment loss as a statistically significant covariate for PTL (p < .004). Markov chain analysis showed that smoking and calculus were associated with disease initiation and that calculus, plaque, and gingivitis were associated with loss of attachment and progression to advanced disease. Mean attachment loss <1.81 mm at the age of 30 yielded highest sensitivity and specificity (0.71) to allocate subjects into a cohort with a dentition of at least 20 teeth at 60 years of age. CONCLUSIONS: These results highlight the importance of treating early periodontitis along with smoking cessation, in those under 30 years of age. They further show that calculus removal, plaque control, and the control of gingivitis are essential in preventing disease progression, further loss of attachment and ultimately tooth loss.

Effect of occlusal calculus utilized as a potential "biological sealant" in special needs patients with gastric feeding tubes: a qualitative in vitro contrast to pit and fissure sealant restorations.

The aim of this case report and in vitro investigation was to evaluate the marginal microleakage of intact occlusal calculus of primary molars extracted from a special needs patient who received nutrition via a gastric feeding tube. An adolescent with a history of developmental disturbance presented for routine dental care in a hospital facility. Prophylaxis was performed, and 2 mandibular permanent molars were restored. Five primary molars were extracted due to mobility and delayed retention. Heavy deposits of intact calculus were present on the occlusal surfaces of the primary teeth. The extracted teeth were immersed in methylene blue dye solution, invested in acrylic resin, sectioned into blocks, and photographed at 20× and 40× magnification. Previously photographed calculus-free molars with pit and fissure sealants were reviewed and served as contrasting "restorations." The occlusal calculus on the primary teeth extracted from the patient absorbed the dye, while the comparison teeth containing pit and fissure sealants exhibited varying degrees of marginal dye penetration (microleakage). No marginal microleakage was noted in the calculus specimens, indicating that this substrate may serve as a "natural" occlusal surface sealant and that its removal from occlusal surfaces during routine oral prophylaxis may be unnecessary.

Periodontal status and its association with self-reported hypertension in non-medical staff in a university teaching hospital in Nigeria.

BACKGROUND: A growing body of evidence suggests a relationship between periodontal disease and non-communicable systemic diseases with rising prevalence in developing countries, Nigeria inclusive. OBJECTIVES: To determine the periodontal status and its association with self-reported hypertension among non-medical staff in a university teaching hospital in Nigeria. METHODS: A cross-sectional study was conducted among non-medical staff using self-administered questionnaires and periodontal clinical examination between July and August 2013. Multivariate analysis was explored to determine the independent variables associated with self-reported hypertension. P values < 0.05 were considered statistically significant. RESULTS: A total of 276 subjects were enrolled into the study. Shallow pockets (CPI code 3) constituted the predominant periodontal disease (46.7%), calculus (CPI code 2) 46%, bleeding gingiva (CPI code 1) in 3.3% and deep pockets ≥ 6mm (CPI code 4) in 2.2%. Self-reported hypertension was the most prevalent self-reported medical condition (18.1%) and found to be associated with periodontitis, increasing age, lower education, and a positive family history of hypertension. CONCLUSION: Periodontal disease was highly prevalent in this study. Self-reported hypertension was associated with periodontitis, older age, lower education and a positive family history. Periodic periodontal examination and regular blood pressure assessment for non-medical staff is recommended.

Dental Calculus Links Statistically to Angina Pectoris: 26-Year Observational Study.

OBJECTIVES: Dental infections, such as periodontitis, associate with atherosclerosis and its complications. We studied a cohort followed-up since 1985 for incidence of angina pectoris with the hypothesis that calculus accumulation, proxy for poor oral hygiene, links to this symptom. METHODS: In our Swedish prospective cohort study of 1676 randomly selected subjects followed-up for 26 years. In 1985 all subjects underwent clinical oral examination and answered a questionnaire assessing background variables such as socio-economic status and pack-years of smoking. By using data from the Center of Epidemiology, Swedish National Board of Health and Welfare, Sweden we analyzed the association of oral health parameters with the prevalence of in-hospital verified angina pectoris classified according to the WHO International Classification of Diseases, using descriptive statistics and logistic regression analysis. RESULTS: Of the 1676 subjects, 51 (28 women/23 men) had been diagnosed with angina pectoris at a mean age of 59.8 ± 2.9 years. No difference was observed in age and gender between patients with angina pectoris and subjects without. Neither was there any difference in education level and smoking habits (in pack years), Gingival index and Plaque index between the groups. Angina pectoris patients had significantly more often their first maxillary molar tooth extracted (d. 16) than the other subjects (p = 0.02). Patients also showed significantly higher dental calculus index values than the subjects without angina pectoris (p = 0.01). Multiple regression analysis showed odds ratio 2.21 (95% confidence interval 1.17-4.17) in the association between high calculus index and angina pectoris (p = 0.015). CONCLUSION: Our study hypothesis was confirmed by showing for the first time that high dental calculus score indeed associated with the incidence of angina pectoris in this cohort study.

Halitosis as a product of hepatic disease.

OBJECTIVES: This study evaluated halitosis in patients suffering from hepatic disease. MATERIAL AND METHODS: Twenty-five patients (12 males and 13 females) aged between 16 and 73 years who had undergone treatment for liver disease were included in this study. Three halimeter recordings were performed to measure methyl mercarptan and hydrogen sulphite. Mean values were calculated and compared with normal values (75-120 ppb). The level of significance was set at P < .05. Results: Thirteen of the 25 subjects (52%) had normal Volatile Sulphur Compound (VSC) values (75-120 ppb). Twelve subjects (48%) recorded values ranging from 132 to 1112 ppb. There was no correlation between hepatic pathology and halitosis. Fifty-two percent of all subjects had poor oral hygiene, strongly correlated with high VSC values (P<0.05) whereas the remaining 48% with good hygiene had normal levels of VSC. CONCLUSIONS: Within the limitations of this study, high values of VSC were not associated with the presence of hepatic disease.

Calculus detection technologies: where do we stand now?

Epidemiological studies have implicated dental calculus as an ideal substrate for subgingival microbial colonization. Therefore, the main objective of periodontal therapy is to eliminate the microbial biofilm along with the calculus deposits from the root surface by root surface debridement. Over the past years, a large number of clinical and laboratory studies have been conducted to evaluate the efficacy of calculus removal by various methods. None of these conventional methods or devices was effective in completely eliminating all the calculus from the diseased root surfaces. In this context, a number of newer technologies have been developed to identify and selectively remove the dental calculus. Regarding this fact, the present article highlights a critical review of these devices based on published clinical and experimental data.

Prevalence and associated factors of gingival recession in Greek adults.

AIM: The aim of the present cross-sectional study was to estimate gingival recession (GR) prevalence and associated risk factors in young Greek adults. METHODS: The study population consisted of 420 young adults (200 males and 220 females). All individuals were clinically examined and answered questions regarding their smoking status, educational level, and oral hygiene practices. In addition, the association between GR and the following aspects was assessed: sex, smoking status, educational level, plaque index, gingival index, calculus presence, and plaque control methods. Statistical analysis of data was accomplished using the multivariate linear regression analysis model. RESULTS: The average number of GR overall was 1.38 mm (standard deviation: 0.18 mm). Gingival index (P = 0.000) and smoking (P = 0.01) were the most important associated risk factors of GR, while sex, oral hygiene practices, presence of supragingival calculus, educational level, and plaque index were not significantly associated with it. CONCLUSION: Gingival inflammation, as determined by the gingival index, and smoking were the most important associated risk factors of GR.

Oral health of the elderly with Alzheimer's disease.

OBJECTIVE: The objective of this study was to describe the oral health of elderly people diagnosed with Alzheimer's disease (AD). STUDY DESIGN: Thirty elderly subjects with AD (mild, moderate, and severe) and 30 without AD (controls) were included in the study. Volunteer-reported oral health data were collected using the General Oral Health Assessment Index (GOHAI). Demographic and oral characteristics were assessed, including the number of natural teeth; number of decayed, missing, and filled teeth (DMTF); oral health index (OHI); removable prosthesis conditions; and oral pathologies. RESULTS: GOHAI values were similar for both groups. Compared with the controls, the subjects with AD had a higher age, DMTF, OHI, and number of oral pathologies and a lower educational level and number of natural teeth. CONCLUSIONS: Elderly subjects with AD had poorer oral health than those without the disease. Despite the positive self-perception of their oral health, the oral health of subjects with AD tended to decline as their disease progressed.

Drug-induced gingival overgrowth: a case report.

A variety of systemic drugs can lead to adverse effects in the oral environment. This article reports the case of a 61-year-old man who had a severe drug-induced gingival overgrowth (DIGO) caused by nifedipine. DIGO is relevant due to severe gingival enlargement, which causes disfigurement and blocks physiological and social functions such as mastication and speaking. Management of DIGO is always a challenge due to the patient's systemic condition. This article shows, step-by-step, how the treatment was executed and how the DIGO was reversed.

Association between obesity and periodontal disease in young adults: a population-based birth cohort.

AIM: To evaluate the association between obesity and periodontal disease and the mediating effect of oral hygiene, systemic inflammation and carbohydrate intake. MATERIAL AND METHODS: Subjects born in 1982 in Pelotas, Brazil (n = 5,914), have been followed for several times. Oral health was assessed in a representative sample of 720 individuals at 24 years. Obesity, waist circumference and number of episodes with obesity between 15 and 23 years of age were the main exposures. Mediating effect of oral hygiene, C-reactive protein level and carbohydrate consumption was also assessed. RESULTS: Obese individuals were more likely to have ≥ 2 teeth with gingival bleeding. However, after adjusting for confounders, the association was not statistically significant [OR (obese × 2 or more teeth) 1.72 (95% CI: 0.95, 3.11)] and adjustment for potential mediators decreased the OR (OR = 1.38). The risk of presenting calculus in obese subjects was 10% higher [PR 1.10 (95% CI: 1.02, 1.18)]. The number of episodes of obesity between 15 and 23 years was associated with dental calculus. Periodontal pockets were not associated with obesity. CONCLUSION: Systemic inflammation and oral hygiene may be mediating the association between obesity and gingivitis. Obesity was not associated with periodontal pockets in young adults in this cohort.

Exotic encounters with dental implants: managing complications with unidentified systems.

As the application of dental implants increases worldwide, so is the number of technical and biological complications that general dental practitioners will be called to manage, while maintaining implant patients. In addition, the greater patient mobility encountered today combined with a growing trend of 'dental implant tourism' will very often result in situations where the dentist is requested to deal with complications in implants placed elsewhere and which sometimes might be of an 'exotic' system one cannot directly recognize. Such a situation can pose significant challenges to even experienced clinicians. The challenges are not only in the scientific field, but often include professional and ethical implications. This case report will discuss strategies for the management of implant complications in cases of unidentified implant systems. Critical factors in such situations would be the clinician's experience and special training, the correct radiographic technique, as well as access to the appropriate tools and devices.

Periodontal conditions in patients with oral lichen planus: a pilot study.

OBJECTIVE: To evaluate the periodontal status of patients with oral lichen planus and compare it with that of healthy controls. The association between periodontal condition and the extent of disease in oral lichen planus patients was also examined. METHOD AND MATERIALS: A descriptive clinical study was made of the periodontal condition of 80 consecutive patients with clinically and histologically diagnosed oral lichen planus and 40 healthy controls. Measurements were made of the Gingival Index, Plaque Index, and Community Periodontal Index of Treatment Needs (CPITN). RESULTS: Mean CPITN scores were significantly higher in oral lichen planus patients (2.8 ± 0.7) than in the healthy controls (1.1 ± 0.8) (P < .001).The patients with oral lichen planus showed no statistically significant difference in CPITN scores according to the extent of the lesions or their clinical form of presentation. CONCLUSION: The periodontal condition of the oral lichen planus patients was significantly worse than in the control group.

Periodontal health and treatment needs among hospitalized chronic psychiatric patients in Istanbul, Turkey.

OBJECTIVE: The aim of the study was to evaluate the periodontal health and treatment needs of chronically hospitalized psychiatric patients in Istanbul, Turkey. METHOD: The subjects' periodontal health was recorded by the CPI (Community Periodontal Index) method. RESULTS: Of the 330 patients examined, 179 (52.5%) were males and 151 (47.5%) females. The mean age of the patients was 49.2 +/- 11.7 years. The majority (61.8%) was diagnosed with schizophrenia and 30.6% diagnosed with mental retardation. The mean length of hospitalization was 16.0 +/- 10.9 years. Healthy periodontal tissues (CPI 0) were found in 8.8% of the subjects. Bleeding on probing (CPI 1) was recorded in 6.3%, and dental calculus (CPI 2) in 51.8% of the subjects. These were determined as the worst findings. Altogether, 33% of the subjects had deep periodontal pockets, 14.2% with at least one 4- to 5-mm pocket (CPI 3), and 18.8% with at least one 6-mm pocket (CPI 4). The stepwise logistic regression analysis, between the final CPI score and seven variables including age, gender, psychiatric diagnosis, length of hospitalization, degree of helplessness, tooth brushing habits and smoking, showed that irregular tooth brushing habits and male gender were significant contributors to having a final CPI score of 2 or more. The regression analysis also showed that tooth brushing habits remained as an explanatory variable in CPI 0 coded subjects; helplessness and psychiatric diagnosis (mental retardation) in CPI 2; tooth brushing habits and psychiatric diagnosis (schizophrenia) in CPI 3; and only helplessness in CPI 4. CONCLUSION: The present study underlines a considerable need for prevention and treatment of periodontal disease among chronic psychiatric patients in Istanbul. Efforts need to be focused above all on raising this population's awareness of the importance of oral hygiene and on early diagnosis of periodontal problems.

Interrelation between obesity, oral health and life-style factors among Turkish school children.

Obesity, dental caries and periodontal diseases are among major public health concerns which may affect children's growth and development. This study seeks any clustering between obesity, oral health and life-style factors among school children in Istanbul, Turkey. A cross-sectional study of children, 10- to 12-year-olds, from a public and a private school was undertaken with questionnaires for children and their mothers and child oral health data, in Istanbul (n = 611). DMFS (number of decayed, missing and filled surfaces of permanent teeth), CPI (Community Periodontal Index), body mass index (BMI) and life-style factors (tooth-brushing frequency, milk consumption at breakfast and bedtimes on school nights) of children were examined. Data analysis included factor analysis, Student's t test and Chi-square tests by cross-tabulation. Public school children were more dentally diseased but less obese than were those in private school (P < 0.001). They more frequently had calculus (62%) and reported non-recommended tooth-brushing (68%) than did those in private school (37%, 56%; P < 0.05). Principal component analysis revealed that DMFS, CPI and BMI shared the same cluster among all children. A need exists for addressing obesity, oral health and nutrition jointly in health promotion strategies to improve children's well-being and empower good life-style factors.