The effect of intrasulcular toothbrushing on the amount of sulcular fluid.

Nineteen young adult Caucasian males had an average Gingival Score of 0.47. Each was asked to demonstrate his present method of toothbrushing. Thirteen used a scrub method, and six combined the scrub and roll methods. Sulcular fluid measurements were taken from the facial aspect of the mandibular left second bicuspid using filter paper strips stained with ninhydrin. An average value of 0.94 mm was obtained. Intrasulcular brushing was performed in the mandibular left posterior segment, for 30 seconds daily for 40 days. The brushing was done by the investigator on 28 days and by the subjects on 12 days. The average Gingival Index score following intrasulcular brushing was 0.26. Sulcular fluid measurements were again taken from the mandibular left second bicuspid. A decreased amount of sulcular fluid was found in six subjects, while nine exhibited an increase and four showed no change. An average sulcular fluid measurement of 0.87 mm resulted following the experimental brushing period. From these data, it can be concluded that, within the limitations of this study, intrasulcular brushing had no significant effect on the amount of gingival fluid.

Histologic evaluation of the effects of intrasulcular toothbrushing on human sulcular epithelium.

Nineteen young adult Caucasian males had an average Gingival Index Score of 0.47. Each was asked to demonstrate his present method of toothbrushing: thirteen used the scrub method, and six combined the scrub and roll methods. Control gingival tissue specimens were taken from the mandibular left first bicuspid or first molar regions, and the area was allowed to heal for 40 days. Following complete healing, intrasulcular brushing was used in the mandibular left posterior segment, for 30 seconds daily for a period of 40 days. The brushing was done by the investigator on 28 days and by the subjects on 12 days. The average Gingival Index Score following intrasulcular brushing was 0.25. A gingival specimen was taken from the experimental area of the mandibular left second bicuspid region. Histological findings in control specimens from 13 subjects showed parakeratinization for varying distances in the sulcus epithelium apical to the gingival crest. In six specimens a complete absence of sulcus keratinization was observed. The average Inflammatory Index Score was 1.21. Following intrasculcular brushing, 18 specimens showed a parakeratin layer apical to the gingival crest; in 14, it extended the entire length of the coronal sulcular epithelium or apparent clinical sulcus, whereas in four more it extended well beyond the gingival crest into the sulcus. In the six subjects whose control specimens showed an absence of keratin apical to the gingival crest, parakeratinization of part or all of the clinical sulcus was found following intrasulcular brushing. The average Inflammatory Index Score was 1.015. A moderately intense acute inflammatory reaction was observed within the attachment epithelium in three subjects. Possible therapeutic benefits and hazards of intrasulcular brushing are discussed.

Treatment of localized juvenile periodontitis (periodontosis). A review.

Localized juvenile periodontitis is a disease of the adolescent periodontium characterized by rapid alveolar destruction around molar and incisor teeth of the permanent dentition. Early treatment methods were variable and often empirical due to lack of knowledge concerning etiology. Elucidation of factors associated with the disease has led to different therapeutic approaches. A comprehensive review of these modalities is presented.

Severe gingival overgrowth associated with cyclosporine therapy.

A case of severe gingival overgrowth secondary to cyclosporine therapy in a 19-year-old black male who received a liver allograft transplant is reported. Clinical examination revealed a severely overgrown and inflamed gingiva. Surgical excision of the excess tissue was accomplished under general anesthesia. Healing occurred uneventfully, with acceptable contours; however, some regrowth was evident as early as 2 months. Spontaneous repositioning of the teeth was also seen postoperatively. Examination of the excised tissues revealed alternating areas of dense collagen and myxomatous change. An inflammatory infiltrate primarily of plasma cells was present. There was no evidence of an increased number of fibroblasts in the specimens examined.

Severe localized destruction of the periodontium secondary to subgingival displacement of an elastic band. Report of a case.

A seven-year-old male with localized severe periodontal destruction at the maxillary central incisior region presented for treatment. There was a history of acute trauma, but local factors were inconsistent with the clinical picture. Initial treatment consisting of palliative nonsurgical debridement coupled with systemic tetracycline resulted in a more chronic lesion with progressive bone loss. Surgical entry revealed an elastic band close to the apices of the central incisors. Removal of the etiologic agent has resulted in increased radiographic bone density and decreased probing depths. Periodontal lesions induced by elastic bands are difficult to diagnose but have several features in common that may aid in rapid diagnosis and treatment.

Periodontal surgery as an adjunct to endodontics, orthodontics, and restorative dentistry.

Periodontal surgery and biologic principles can be used to treat a variety of restorative and endodontic complications. Four cases illustrated the application of orthodontic therapy and periodontal surgery in the treatment of these difficulties.

Burnished versus nonburnished application of citric acid to human diseased root surfaces: the effect of time and method of application.

Citric acid (pH = 1) was applied passively or by vigorous burnishing for 3 or 5 minutes to diseased human root surfaces following root planning in vitro. Control surfaces were similarly treated with saline only. Teeth were fixed in glutaraldehyde, dehydrated, freeze-dried, and sputter coated with gold for scanning electron microscopic viewing. Results suggested that optimal exposure of collagen and demineralization occurred with the burnishing application of citric acid for 3 minutes. Although somewhat similar results were found with passive application for 5 minutes, the result of the burnishing application for 5 minutes was that the root was overdemineralized or that the exposed collagen was completely obscured by an amorphous layer that was suggestive of protein denaturization.

Cervical enamel projection with gingival fenestration in a maxillary central incisor: report of a case.

Bacterial plaque has been implicated as the primary etiologic factor in the initiation and progression of periodontal disease. Anatomic factors, such as cervical enamel projections, enamel pearls, and radicular grooves, are often associated with advanced localized periodontal destruction. Enamel projections and pearls are most often associated with molars, while radicular grooves are usually located on the palatal aspect of maxillary incisors. Gingival fenestrations are of uncertain etiology and have rarely been reported in the dental literature. An unusual case is presented of a cervical enamel projection located on the facial aspect of a maxillary central incisor in association with gingival fenestration. Rationale for therapy and likely healing results are discussed.

Nifedipine-associated gingival overgrowth: a survey of the literature and report of four cases.

A survey of the literature indicates that calcium channel-blocking medications are used for an ever-increasing number of medical problems. Their use may result in gingival overgrowth that can be of concern to the patient and dentist. Four cases are presented that illustrate several relevant points: (1) histologic examination may reveal factors overlooked in the medical history; (2) the condition exists in a variety of clinical manifestations; (3) the level of plaque control maintained by the patient is important to the management of the condition; and (4) responses vary to different approaches to treatment, including changes in medication, as well as nonsurgical and surgical therapies.

Altered collagen metabolism in nifedipine-induced gingival overgrowth.

Fibroblasts from nifedipine-induced fibrotic gingiva (NFG) have been characterized with respect to several cellular functions which could contribute to the characteristic clinical overgrowth of the gingiva: collagen synthesis and breakdown, glycosaminoglycan production, fibronectin synthesis, and proliferation. Histologic examination of NFG tissue revealed a hyperplastic epithelium with elongated, branched rete pegs. The connective tissue consisted of densely-packed collagen fibers and numerous enlarged fibroblasts, as well as regions of thinner, disorganized collagen fibers in the vicinity of scattered inflammatory and mast cells. Results of in vitro experiments showed that the fibroblast strains from the fibrotic gingiva (NFG) produced significantly greater amounts of collagen and lower levels of collagenase activity when compared to age- and sex-matched normal human gingival fibroblast strains. The NFG fibroblasts did not produce significantly greater amounts of fibronectin, and their level of glycosaminoglycan production was less than that of the normal fibroblasts. The NFG fibroblasts did not proliferate significantly more rapidly than the normal fibroblast strains. These findings therefore show that there are defects in the regulation of collagen production by NFG fibroblasts in vitro, and suggest that these alterations in collagen metabolism contribute to the over-deposition of collagen in this tissue, rather than hyperproliferation of the fibroblasts or through the production of increased amounts of fibronectin and glycosaminoglycans.