Effects of Nonsurgical Periodontal Therapy on Salivary 8-Hydroxy-Deoxyguanosine Levels and Glycemic Control in Diabetes Mellitus Type 2 Patients.

Diabetes and periodontitis are complex chronic diseases that are potentially interrelated, as well as associated with oxidative stress. Thus, the aim of the present study was to evaluate the influence of nonsurgical periodontal treatment on salivary 8-hydroxy-deoxyguanosine (8-OHdG) levels and glycemic control in patients suffering from both diabetes mellitus type 2 (DM2) and periodontitis. The study sample included 53 DM2 patients, while 31 systemically healthy patients served as controls. Participants in both groups suffered from periodontitis of comparable severity. Periodontal clinical parameters, namely plaque index (PI), gingival index (GI), papilla bleeding index (PBI), probing pocket depth (PPD), and clinical attachment level (CAL) were recorded, along with salivary 8-OHdG levels and glycated hemoglobin (HbA1c). Levels of 8-OHdG were analyzed by ELISA. All aforementioned parameters were evaluated prior to commencing the study and at 90-day follow-up upon nonsurgical periodontal therapy completion. At baseline, salivary levels of 8-OHdG in DM2 patients were significantly higher (1.17 ng/mL) than those measured for the control group (0.75 ng/mL) and showed significant positive correlation with GI and PPD (p < 0.05). Three months after nonsurgical periodontal therapy, the salivary 8-OHdG levels were significantly reduced in DM2 patients (p < 0.05). Analysis results also revealed statistically significant changes in all measured clinical parameters between baseline and three-month follow-up in both groups (p < 0.05). Upon treatment completion, a decline in the HbA1c level was noted in DM group, but it did not reach statistical significance (p > 0.05). It can be concluded that DM2 patients benefit from non-surgical periodontal therapy, as indicated by a marked reduction in their salivary 8-OHdG level and a modest improvement in glycemic control. Short-term clinical benefits noted in the DM group were similar to those observed in the non-diabetic periodontal patients.

THE INFLUENCE OF PERIODONTAL DISEASE TREATMENT ON 8-HYDROXY-DEOXYGUANOSINE CONCENTRATIONS IN SALIVA AND PLASMA OF CHRONIC PERIODONTITIS PATIENTS.

The 8-hydroxy-deoxyguanosine (8-OHdG) is one of the customary products of oxidized DNA. The purpose of this study was to compare salivary and plasma 8-OHdG concentrations in a group of chronic periodontitis patients to those measured in a group of patients with healthy periodontium, as well as to determine the impact of periodontal therapy on 8-OHdG concentrations in saliva and plasma in chronic periodontitis patients. The study sample comprised of 24 patients with chronic periodontitis and 16 periodontally healthy individuals. Plaque index, gingival index, papilla bleeding index, probing depth and clinical attachment level were indices used to determine patient periodontal status. Salivary and plasma 8-OHdG concentrations were determined by ELISA method. The salivary 8-OHdG concentration was statistically significantly higher in the group of periodontitis patients compared to periodontally healthy subjects. After initial periodontal therapy, the 8-OHdG concentration in saliva was significantly reduced in the periodontitis group (p=0.021). Differences in plasma 8-OHdG concentrations between the two groups did not reach statistical significance and no significant changes were noted in the periodontitis group following initial periodontal therapy. A higher salivary 8-OHdG concentration reflects increased oxidative stress caused by periodontal disease. Initial periodontal therapy may be helpful in reducing salivary 8-OHdG concentrations in chronic periodontitis patients.

Assessment of risk factors and preventive measures and their relations to work-related musculoskeletal pain among dentists.

BACKGROUND: Dentists have a high prevalence of musculoskeletal (MS) pain, which is the most common symptom associated with work-related musculoskeletal disorders (WMSDs). To overcome this problem, identification of the risk factors and preventive measures for MS pain are of paramount importance to dentists in order to improve their quality of life and work. OBJECTIVES: The aims of this study were to recognize the risk factors for MS pain and their impact on dental work, as well as to identify preventive measures of MS pain among dentists. METHODS: Self-reporting questionnaire consisting of 78 questions was exclusively developed for the study and sent to 500 working active dentists in Serbia. RESULTS: Response rate was 71.2% (356 dentists). The prevalence of MS pain was 82.6% among dentists. The main risk factors for MS pain were advanced age, female dentists, presence of chronic diseases, long working hours, and high frequency of treated patients. The most effective preventive measures in preventing MS pain were massage treatments and physical activities. Followed by use of ergonomically designed equipment, correct and dynamic working positions, and an adequate workflow organization. CONCLUSION: The risk factors for MS pain and their impact on dental work should widely be disseminated among dentists. Importantly, proper implementation in everyday life of adequate preventive measures is essential for preventing MS pain and development of WMSDs.

Different methods for subgingival application of chlorhexidine in the treatment of patients with chronic periodontitis.

OBJECTIVE: The aim of this study was to evaluate clinical efficacy of different chlorhexidine gluconate (CHX) preparations applied subgingivally as an adjunct to scaling and root planing (SRP). MATERIAL AND METHODS: A total of 120 periodontal pockets was included in this randomized, controlled, split mouth designed study. According to protocols used in treatment, periodontal pockets were assigned to experimental and control groups as follows: CHX solution as an addition to SRP versus control SRP group; CHX gel as an addition to SRP versus control SRP; CHX chip as an addition to SRP versus control SRP group. Following clinical parameters were recorded at baseline, one and three months after the baseline: plaque index (PI), probing pocket depth (PPD), bleeding index (BI) and clinical attachment level (CAL). RESULTS: The most significant improvements were found concerning PI in CHX solution with SRP and CHX gel with SRP groups over controls at one month recall, as well as concerning BI and PPD in CHX chip with SRP group over SRP alone at three-month recall. CONCLUSION: Results of this study favour combination therapy using CHX chip as an adjunct to SRP due to greater improvements in BI and PPD compared to those obtained by SRP alone in the treatment of chronic periodontitis.

The Association Between Periodontal Inflammation and Labor Triggers (Elevated Cytokine Levels) in Preterm Birth: A Cross-Sectional Study.

BACKGROUND: Periodontitis is considered to be a risk factor for preterm birth. Mechanisms have been proposed for this pathologic relation, but the exact pathologic pattern remains unclear. Therefore, the objective of the present study is to evaluate levels of four major labor triggers, prostaglandin E2 (PGE2), interleukin (IL)-1ß, IL-6, and tumor necrosis factor (TNF)-α, in gingival crevicular fluid (GCF) and serum samples between women with preterm birth (PTB) and full-term birth (FTB) and correlate them with periodontal parameters. METHODS: PGE2, IL-1ß, IL-6, and TNF-α levels were estimated using enzyme-linked immunosorbent assays in GCF and serum samples collected 24 to 48 hours after labor from 120 women (60 FTB, 60 PTB). RESULTS: Women with PTB exhibited significantly more periodontitis, worse periodontal parameters, and increased GCF levels of IL-6 and PGE2 compared with the FTB group; there were no significant differences in serum levels of measured markers. GCF levels of IL-1ß, IL-6, and PGE2 and serum levels of TNF-α and PGE2 were significantly higher in women with periodontitis compared with periodontally healthy women. Serum levels of PGE2 were positively correlated with probing depth (PD) and clinical attachment level (CAL) as well as with GCF levels of TNF-α in women with PTB. CONCLUSIONS: Women with PTB demonstrated worse periodontal parameters and significantly increased GCF levels of IL-6 and PGE2 compared with those with FTB. Based on significant correlations among serum PGE2 and PD, CAL, and GCF TNF-α in PTB, periodontitis may cause an overall increase of labor triggers and hence contribute to preterm labor onset.

MMP-9 -1562 C>T (rs3918242) promoter polymorphism as a susceptibility factor for multiple gingival recessions.

The objective of this pilot study was to investigate the potential role of -1562 C>T single nucleotide polymorphism (SNP) in the promoter region of the matrix metalloproteinase-9 (MMP-9) gene as a risk modulator in the development of multiple gingival recessions (MGRs) in young adults in the Serbian population. The study sample comprised 161 systemically healthy people: 60 with MGRs and 101 controls with healthy periodontal tissues. Genotyping was done using polymerase chain reaction/restriction fragment length polymorphism approach on DNA obtained from buccal swabs. Clinical measurements included vertical recession depth (VRD), clinical attachment level (CAL), keratinized gingival width (KGW), visible plaque index (PI), and bleeding on probing (BOP). Heterozygotes (CT) were significantly more frequent in the MGRs group than in the control group (P = .005) and carriers of the T allele had an approximately threefold increase of MGRs risk. Patients with the CT genotype exhibited significantly higher values of VRD and CAL and significantly lower values of KGW than patients with the wildtype genotype. Associations among different genotypes and periodontal biotypes in the MGRs group remained insignificant because all participants exhibited thin biotype. The -1562 C>T SNP in the promoter region of MMP-9 appears to be a risk factor for MGR development and a potential predictor of more severe clinical phenotype.

[Utilization of two different surgical techniques in gingival recession treatment: a comparative study].

INTRODUCTION: Gingival recession is a displacement of gingival margin apically to cement-enamel junction. OBJECTIVE: The aim of this study was to compare the results achieved with two different surgical procedures used in gingival recession treatment. METHODS: Ten patients with bilateral buccal recession on maxillary canines or premolars were included in the study. Professional teeth cleaning was performed before surgery. Recession on the experimental side was treated with connective tissue graft in combination with coronally advanced, split thickness flap (tunnel technique). Control side recession was treated with connective tissue graft in combination with trapezoidal coronally advanced, full thickness flap. Coin toss was used for side decision. The following parameters were evaluated before surgery and 6 months post-op: Vertical Recession Dimension, Clinical Attachment Level, Apico-coronal width of the keratinized tissue, Healing index (Laundry), RES index, and Patient evaluation of esthetic results. Student's t-test was used for statistical analysis. RESULTS: Six months after surgery, mean root coverage was 91.5 +/- 14.1% and 90.1 +/- 14.6% on the experimental and on the control side, respectively. RES index, Healing index (Laundry) and Patient Subjective evaluation of esthetic results showed significantly better results (p < 0.05). CONCLUSION: Both surgical procedures produce highly successful clinical results based on evaluated parameters, but this tunnel technique provides significantly better esthetic results.

The influence of different therapeutic modalities and platelet rich plasma on apexogenesis: a preliminary study in monkeys.

BACKGROUND: Traumatic injuries of permanent teeth with incomplete root formation are frequent during childhood. Adequate therapy is important for the further destiny of teeth with damaged pulp. OBJECTIVES: To evaluate the effect of pulpotomy and high pulpotomy on the pulp and on root development, and the effect of platelet rich plasma (PRP) with hydroxyapatite (HAP) as a carrier and hydroxyapatite alone on apexogenesis. MATERIAL AND METHODS: The study included eight monkeys (Cercopithecus aethiops) in which high pulpotomies were performed on the mandibular lateral incisors and canines, and pulpotomies were performed on the mandibular central incisors and premolars. The materials used in the study were commercial HAP (Apatec®, Stomygen) and PRP (prepared at the Torlak Institute of Immunology and Virology, Belgrade, Serbia.). Histological and radiological evaluations were done six months after the treatment. RESULTS: Considering the differences between HAP+PRP treated teeth in the pulpotomy group and teeth in the high pulpotomy group, two times more root growth retardation was observed in the high pulpotomy group. In the high pulpotomy group, root growth retardation was less common in HAP+PRP treated teeth (42.9%) than in HAP treated teeth (50%). In the pulpotomy group, retardation of root development was also less common in HAP+PRP treated teeth (25%) compared to HAP treated teeth (50%). There were differences between the pulpotomy and high pulpotomy groups, but without statistical significance. CONCLUSIONS: The application of endogenous growth factors in conjunction with the preservation of dental pulp vitality can result in a good outcome for pulp therapy of injured teeth, which means successfully completed apexogenesis.

Antioxidative status of saliva before and after non-surgical periodontal treatment.

INTRODUCTION: Oxidative stress and antioxidants play an important role in the pathogenesis of inflammatory disease, including chronic periodontitis (CP). Saliva contains enzymatic (glutathione peroxidase - GPx, superoxide dismutase - SOD, etc.) and non-enzymatic (albumin - ALB, uric acid - UA, glutathione, etc.) antioxidants. OBJECTIVE: The aims of this study were to investigate: a) level of SOD, GPx, UA, ALB and total antioxidative status (TAS) of saliva in CP patients before and after non-surgical treatment, and b) correlations between clinical periodontal parameters and levels of salivary antioxidants. METHODS: Saliva was collected from 21 CP patients before and after non-surgical treatment. The condition of periodontium was assessed by plaque index, gingival index, bleeding on probing, probing depth and clinical attachment loss. Level of investigated antioxidants (except GPx) and TAS was determined using colorimetric method and commercial kits. GPx activity was determined using UV method and commercial kits. RESULTS: After the treatment significant increase of UA, ALB, Gpx, TAS was detected (p<0.01) and decrease of SOD activity (p>0.05). A significant correlation was observed between GPx and PI (r=0.575, p=0.008), SOD and GI (r=0.525, p=0.017) before therapy, and SOD and bleeding on probing (BP) (r=0.59, p=0.006), TAS and BP (r=0.453, p=0.045) after therapy. CONCLUSION: These data suggest that levels of salivary antioxidants generally increase after non-surgical periodontal treatment. Correlation between some clinical periodontal parameters and level of salivary antioxidants was found.

The role of specific cow's milk proteins in the etiology of recurrent aphthous ulcers.

BACKGROUND: Recurrent aphthous ulcerations (RAU), or recurrent aphthous stomatitis, is recognized as one of the most common oral mucosal diseases worldwide. It was noted some connection between immunity to cow's milk proteins (CMP) and oral diseases. The goal of this study was to determine the prevalence of the increased levels of serum antibodies to specific cow's milk proteins (SCMP), constituents of cheese or of whey, by enzyme-linked immunosorbent assay (ELISA) test, in subjects who have RAU. METHODS: Fifty subjects with RAU and 50 healthy people, as controls (C), were included in this research. Levels of serum IgA, IgG, and IgE antibodies to SCMP were determined by ELISA. The statistical analysis of data was performed by Wilcoxon rank sum test with continuity correction. RESULTS: The levels of serum anti-SCMP IgA, IgG, and IgE antibodies were significantly higher in subjects with RAU in comparison with controls (P < 0.005). CONCLUSIONS: These results indicate the strong association between high levels of serum anti-SCMP IgA, IgG, and IgE antibodies, especially to caseins: α-, ß-, and κ-casein from cow's milk and clinical manifestations of RAU. Serum immunity to the whey proteins in subjects with RAU was not in so high percentage expressed.

[Gingival crevicular fluid in the diagnosis of periodontal and systemic diseases].

Gingival crevicular fluid (GCF) can be found in the physiologic space (gingival sulcus), as well as in the pathological space (gingival pocket or periodontal pocket) between the gums and teeth. In the first case it is a transudate, in the second an exudate. The constituents of GCF originate from serum, gingival tissues, and from both bacterial and host response cells present in the aforementioned spaces and the surrounding tissues. The collection and analysis of GCF are the noninvasive methods for the evaluation of host response in periodontal disease. These analyses mainly focus on inflammatory markers, such as prostaglandin E2, neutrophil elastase and beta-glucuronidase, and on the marker of cellular necrosis-aspartat aminotransferase. Further, the analysis of inflammatory markers in the GCF may assist in defining how certain systemic diseases (e.g., diabetes mellitus) can modify periodontal disease, and how peridontal disease can influence certain systemic disorders (atherosclerosis, preterm delivery, diabetes mellitus and some chronic respiratory diseases). Major factors which influence the results obtained from the analyses of GCF are not only the methods of these analyses, but the method of GCF collection as well. As saliva collection is less technique-sensitive than GCF collection, some constituents of saliva which originate from the GCF can be analysed as more amenable to chairside utilization.

[Circulating immune complexes, immunoglobulin G, salivary proteins and salivary immunoglobulin A in patients with Sjögren's syndrome].

INTRODUCTION: Sjögren's syndrome (SS) is a chronic autoimmune disorder, with its major clinical manifestations resulting from changes in exocrine glands. OBJECTIVE: The aim of this study was to evaluate serum concentrations of circulating immune complexes (CIC) and immunoglobulin G (IgG), and salivary proteins (SP) and salivary immunoglobulin A (slgA) in 40 patients with SS, and to correlate these values among themselves, as well as with the unstimulated salivary flow rate (USFR) and the duration of disease. METHODS: The total of 40 patients were included in this research. CIC was determined using the solution of polyethylene glycol and IgG with the standard procedure of radial immunodiffusion. SP was investigated by the method of Lowry and slgA was separated from the whole saliva using the method of immune chromatography. RESULTS: The values of most of the studied parameters exceeded the normal range in a high degree: CIC 72.5%, IgG 70%, SP 80%. The concentrations of CIC were significantly higher in the patients with the duration of disease less than 10 years. With the decrease of USFR, the concentration of slgA and IgG were increased with statistical significance. CONCLUSION: The increased prevalence of abnormal values of CIC, IgG and SP indicate that the patients with SS have developed a higher level of immune reactivity. These results could be useful in diagnosis and disease activity monitoring.

[The effect of two different oral antiseptics on dental plaque formation (de novo biofilm) and on gingival inflammation].

INTRODUCTION: Since the discovery that periodontal diseases are caused by microbial plaque the interest of many scientists has been focused on oral antiseptics. There are very few mouthrinses with oral antiseptic effect originally designed in our country. One of these is Ozosept solution. OBJECTIVE: This study evaluated the effect of Ozosept solution (phenol compound) on the oral hygiene and gingival inflammation, in comparison with Hibidex DAP solution (chlorhexidine digluconate). METHODS: Two groups, each of 21 persons, which did not significantly differ concerning Silness-Löe plaque index (PI) and Löe-Sillnes gingival index (GI), used one of the studied oral antiseptic for a 15-day period. Oral hygiene was maintained by subjects' habitual home methods, and no technique of professionally advised brushing was performed during the experimental period. RESULTS: At the end of the study, PI and GI scores were lowered to a statistically high significance in both groups of participants in comparison to the indexes at the beginning of the study. At the end of the study, PI and GI scores did not significantly differ between the two analyzed groups. No side effects, which were recorded in the Hibidex DAP group (tooth and filling staining 9.5% and 4.74% respectively, transitory tongue numbness 28.6% and reduced taste sensation 14.3%), were registered in the group of subjects using Ozosept solution. CONCLUSION: It is concluded that Ozosept solution is effective in the control of dental plaque--biofilm accumulation and gingival inflammation, and produces no side effects related to chlorhexidine digluconate usage.

[The use of beta-tricalcium phosphate and bovine bone matrix in the guided tissue regeneration treatment of deep infra-bony defects].

INTRODUCTION: The primary goal of bone regeneration procedures with application of various regenerative biologic agents and biomaterials is to facilitate the formation of periodontal tissues lost as a result of periodontitis. OBJECTIVE: The aim of the study was to compare clinical outcome of the guided tissue regeneration (GTR) treatment with the use of beta-tricalcium phosphate and with bovine bone matrix in human deep intra-osseous defects. METHODS: Twenty-one systemically healthy subjects with moderate to advanced periodontitis, between 30 and 56 years of age, 11 females and 10 males, were selected. Patients having two similar inter-proximal defects with pocket probing depths following initial therapy greater than 5 mm were recruited for the study. Experimental sites were grafted with pure beta-tricalcium phosphate biomaterial (Cerasorb) and a biomembrane, while control sites were treated with bovine-bone hydroxiapatite xenograft (Bio-oss) and a biomembrane. Immediately before surgery and 12 months after surgery, pocket probing depth (PPD), epithelial attachment level (EAL) and gingival recession (GR) were evaluated. RESULTS: In the experimental group PPD amounted to 6.76 +/- 0.83 mm before surgery, and decreased significantly to 2.67 +/- 0.48 mm 12 months following surgery, while in the control group PPD significantly decreased from 7.14 +/- 0.65 mm presurgically to 2.85 +/- 0.57 mm postsurgically. After one year, EAL gain was 2.76 +/- 0.99 mm in the experimental group, and 3.24 +/- 0.16 mm in the control group. After twelve months postoperatively GR amounted to 1.33 +/- 0.79 mm in the experimental group and to 1.05 +/- 0.80 mm in the control group. No statistically significant differences for PPD reduction, EAL gain and GR increase were detected between the groups. CONCLUSION: Results from the present study indicate that GTR treatment of deep intra-osseous defects with Bio-oss and Cerasorb resulted in clinically and statistically significant improvement of EAL gain and PPD reduction. A GR was slightly increased, with no statistical significance.