Factors influencing tooth loss in European populations.

AIM: This study aimed to identify the factors influencing the changes in the number of teeth present and the number of healthy or filled surfaces between two time points. MATERIALS AND METHODS: Repeated cross-sectional data from population-based studies, namely the German Oral Health Studies (DMS-III vs. DMS-V), the Studies of Health in Pomerania (SHIP-START-0 vs. SHIP-TREND-0), and the Jönköping study (2003 vs. 2013), were analysed. Oaxaca decomposition models were constructed for the outcomes (number of teeth, number of healthy surfaces, and number of filled surfaces). RESULTS: The number of teeth increased between examinations (DMS: +2.26 [adults], +4.92 [seniors], SHIP: +1.67, Jönköping: +0.96). Improvements in education and dental awareness brought a positive change in all outcomes. An increase in powered toothbrushing and inter-dental cleaning had a great impact in DMS (adults: +0.25 tooth, +0.78 healthy surface, +0.38 filled surface; seniors: +1.19 teeth, 5.79 healthy surfaces, +0.48 filled surface). Inter-dental cleaning decreased by 4% between SHIP-START-0 and SHIP-TREND-0, which negatively affected the outcomes. CONCLUSIONS: From this study, it can be concluded that education may be the most important factor having a direct and indirect effect on the outcomes. However, for better oral health, powered toothbrushing and inter-dental cleaning should not be neglected.

[Trends in dental and oral health status in Germany between 1997 and 2014]. / Entwicklung der Zahn- und Mundgesundheit in Deutschland von 1997 bis 2014.

BACKGROUND: Currently, there is no comprehensive presentation of trends in oral diseases in the German general population over the last 20 years. OBJECTIVES: How did prevalences of caries, periodontitis, and tooth loss and their determinants change in Germany between 1997 and 2014? MATERIALS AND METHODS: We analysed data from 35- to 44-year-olds and 65- to 74-year-olds from the German Oral Health Studies ("Deutsche Mundgesundheitsstudien" [DMS]) III to V and of 25- to 74-year-olds from the Studies of Health in Pomerania (SHIP­0 and SHIP-Trend-0). The decayed, missing, filled teeth index (DMFT), the number of sound teeth, the community periodontal index (CPI), and data on tooth count and edentulism were analysed. RESULTS: Regarding determinants, an increase in subjects with high school education, a slight decrease in smokers, and an increase in better oral hygiene patterns was observed in both studies. In 35- to 44-year-olds, the number of sound teeth increased from 11.9 in DMS III to 16.8 in DMS V, while in 65- to 74-year-olds the number of sound teeth increased by 5.9. A similar trend was observed in SHIP. In DMS, the prevalence of the highest CPI score of 4 decreased from 9.3% to 3.5% in 35- to 44-year-olds; in 65- to 74-year-olds, the 2014 prevalence was at the same level as in 1997 (10.5% and 9.8%). In parallel, the percentage of edentulous 65- to 74-year-olds halved in both studies. The number of teeth increased across all age strata. CONCLUSIONS: DMS and SHIP consistently showed an increase in the number of healthy teeth free of fillings, a slight reduction of subjects with a CPI score of 4, more tooth retention, and less edentulism. Because of more tooth retention and current demographic changes, higher periodontal treatment needs might be expected for the future.

Epidemiological trends, predictive factors, and projection of tooth loss in Germany 1997-2030: part II. Edentulism in seniors.

OBJECTIVE: This is the second part of a report on tooth loss in Germany 1997-2030. Here, we describe trends in the prevalence of edentulism in seniors 1997-2014, assess predictive factors for edentulism, and projected it into 2030. MATERIAL AND METHODS: We used data from three waves of the cross-sectional, multi-center, nationwide representative German Oral Health Studies. Overall, 3449 seniors (65-74 years) were included (1997: 1367; 2005: 1040; 2016: 1042). Age, sex, educational level, smoking status, and the cohort were entered into age-cohort binary-logistic regression models to assess the association of predictors with edentulism and to project edentulism in 2030 via Monte Carlo simulations. RESULTS: Between 1997 and 2014, the prevalence of edentulism decreased from 24.8 to 12.4%. With each year of age, the risk of being edentate increased (by 11%, p < 0.001); it was also significantly increased in female versus male (by 40%, p = 0.001), low versus medium and high educational level (up to 257%, p < 0.001), and in former and current smokers (up to 258%, p < 0.001). We predict the prevalence of edentulism to be reduced to 4.2% in 2030. The reduction will be higher in males, never and former smokers, and those with low socio-educational level. On an absolute level and despite a growing elderly population (aged 60-80 years), the number of edentate individuals will have decreased by 3.6 million in 2030 compared with 1997. CONCLUSIONS: Edentulism in seniors has declined equitably in Germany. The decline is expected to continue until 2030. Further efforts are needed to tackle the underlying risk factors. CLINICAL RELEVANCE: This study presents trends of edentulism in Germany for a period of three decades. It provides clinically relevant data for health care planning by 2030.

When to intervene in the caries process? An expert Delphi consensus statement.

OBJECTIVES: To define an expert Delphi consensus on when to intervene in the caries process and on existing carious lesions using non- or micro-invasive, invasive/restorative or mixed interventions. METHODS: Non-systematic literature synthesis, expert Delphi consensus process and expert panel conference. RESULTS: Carious lesion activity, cavitation and cleansability determine intervention thresholds. Inactive lesions do not require treatment (in some cases, restorations will be placed for reasons of form, function and aesthetics); active lesions do. Non-cavitated carious lesions should be managed non- or micro-invasively, as should most cavitated carious lesions which are cleansable. Cavitated lesions which are not cleansable usually require invasive/restorative management, to restore form, function and aesthetics. In specific circumstances, mixed interventions may be applicable. On occlusal surfaces, cavitated lesions confined to enamel and non-cavitated lesions radiographically extending deep into dentine (middle or inner dentine third, D2/3) may be exceptions to that rule. On proximal surfaces, cavitation is hard to assess visually or by using tactile methods. Hence, radiographic lesion depth is used to determine the likelihood of cavitation. Most lesions radiographically extending into the middle or inner third of the dentine (D2/3) can be assumed to be cavitated, while those restricted to the enamel (E1/2) are not cavitated. For lesions radiographically extending into the outer third of the dentine (D1), cavitation is unlikely, and these lesions should be managed as if they were non-cavitated unless otherwise indicated. Individual decisions should consider factors modifying these thresholds. CONCLUSIONS: Comprehensive diagnostics are the basis for systematic decision-making on when to intervene in the caries process and on existing carious lesions. CLINICAL RELEVANCE: Carious lesion activity, cavitation and cleansability determine intervention thresholds. Invasive treatments should be applied restrictively and with these factors in mind.

More teeth in more elderly: Periodontal treatment needs in Germany 1997-2030.

OBJECTIVE: With more teeth retained for longer in an ageing population, population-wide periodontal treatment needs may increase. We assessed and projected periodontal treatment needs from 1997 to 2030 in Germany. METHODS: Partial-mouth probing-pocket depths (PPDs) from repeated waves (1997, 2005, 2014) of the nationally representative German Oral Health Studies were transformed into full-mouth PPDs via decision-tree-based ensemble-modelling. In line with German healthcare-regulations, teeth with PPD ≥ 4 mm were regarded as needing periodontal treatment. Weighted means were interpolated cross-sectionally by fitting spline-curves and then regressed longitudinally 1997-2030. RESULTS: In 1997, younger adults (35-44 years old) had a mean of 7.4 teeth needing treatment (overall 93.8 million teeth); this decreased to 4.8 teeth (47.3 million teeth) in 2014. For 2030, we project 3.2 teeth (33.7 million teeth). In seniors, an increase was recorded (1997: 4.5 teeth, 33.5 million teeth; 2014: 7.5 teeth, 63.4 million teeth); this is expected to continue until 2030 (to 12.2 teeth, 140.8 million teeth). The cumulative number of teeth needing treatment increased from 2000 (355 million) to 2015 (365 million), and will increase further to 2030 (464 million). CONCLUSIONS: Population-wide periodontal treatment needs may increase until 2030, mainly in the elderly. Concepts for addressing, these growing needs are required.

Caries-Preventive Effect of Salt Fluoridation in Preschool Children in The Gambia: A Prospective, Controlled, Interventional Study.

The aim of this study was to investigate the anticaries effect of fluoridated salt in a communal feeding program for preschool children. In the Gambian city of Brikama, drinking water had a low fluoride content (0.1 mg F-/L) and young children did not use toothpaste for oral hygiene. Its 2 preschools served as clusters for the trial. Random allocation of the kindergartens was performed by one person not involved in the study, and the clinical examinations were carried out using the envelope method. Meals were prepared with fluoridated salt (250 mg F-/kg salt) in the intervention group but not in the control group. According to the inclusion criteria (complete primary dentition and informed consent from legal guardian), 441 children aged 3-5 years were enrolled. The children were examined by calibrated persons according to WHO criteria, allowing the calculation of d3mft scores. The primary end point was the mean difference in the incidence of caries cavities (Δd3/4mft) after 12 months. After 12 months, the mean caries incidence per person was 1.29 d3/4mf teeth (95% CI: 0.96; 1.62) in the test group (n = 304 children) and 3.83 d3/4mf teeth (95% CI: 2.94; 4.72) in the control group (n = 137 children). Thus, the caries-prevented fraction was 66.3%. No signs of harm due to the intervention were observed. The use of fluoridated salt in a communal feeding program and in an environment with negligible availability of fluoride from other sources yields a considerable caries-preventive effect.

The Fifth German Oral Health Study (Fünfte Deutsche Mundgesundheitsstudie, DMS V) - rationale, design, and methods.

BACKGROUND: Oral diseases rank among the most prevalent non-communicable diseases in modern societies. In Germany, oral epidemiological data show that both dental caries and periodontal diseases are highly prevalent, though significant improvements in oral health has been taking in the population within the last decades, particularly in children. It is, therefore, the aim of the Fifth German Oral Health Study (DMS V) to actualize the data on current oral health status and to gather information on oral health behavior and risk factors. In addition to current oral health monitoring, the study will also permit conclusions about trends in the development of oral health in Germany between 1989 and 2014. METHODS/DESIGN: DMS V is a cross-sectional, multi-center, nationwide representative, socio-epidemiological study to investigate the oral health status und behavior of the German resident population in four age cohorts. Study participants are children (12-year-olds), adults (35- to 44-year-olds), young olds (65- to 74-year-olds), and old olds (75- to 100-year-olds) who are drawn from local residents' registration offices. Social-science investigation parameters concern subjective perceptions and attitudes regarding oral health and nutrition, sense of coherence, and socio-demographic data. Clinical oral parameters are tooth loss, caries and periodontitis, prosthodontic status, further developmental and acquired dental hard tissue and mucosal lesions. To ensure reproducibility, the dental investigators are trained and calibrated by experts and multiple reliability checks are performed throughout the field phase. Statistical analyses are calculated according to a detailed statistical analysis plan. DISCUSSION: The DMS studies first performed in 1989, 1992 and repeated in 1997 and 2005 are the only cross-sectional oral health studies conducted in Germany on a population-based national representative level. Updated prevalence and trend analyses of key oral diseases are, therefore, of major epidemiological and health services research interest. TRIAL REGISTRATION: German Health Services Research Data Bank VfD_DMSV_13_002152.

Fluoride bioavailability in saliva and plaque.

BACKGROUND: Different fluoride formulations may have different effects on caries prevention. It was the aim of this clinical study to assess the fluoride content, provided by NaF compared to amine fluoride, in saliva and plaque. METHODS: Eight trained volunteers brushed their teeth in the morning for 3 minutes with either NaF or amine fluoride, and saliva and 3-day-plaque-regrowth was collected at 5 time intervals during 6 hours after tooth brushing. The amount of collected saliva and plaque was measured, and the fluoride content was analysed using a fluoride sensitive electrode. All subjects repeated all study cycles 5 times, and 3 cycles per subject underwent statistical analysis using the Wilcoxon-Mann-Whitney test. RESULTS: Immediately after brushing the fluoride concentration in saliva increased rapidly and dropped to the baseline level after 360 minutes. No difference was found between NaF and amine fluoride. All plaque fluoride levels were elevated after 30 minutes until 120 minutes after tooth brushing, and decreasing after 360 minutes to baseline. According to the highly individual profile of fluoride in saliva and plaque, both levels of bioavailability correlated for the first 30 minutes, and the fluoride content of saliva and plaque was back to baseline after 6 hours. CONCLUSIONS: Fluoride levels in saliva and plaque are interindividually highly variable. However, no significant difference in bioavailability between NaF and amine fluoride, in saliva, or in plaque was found.

Total and free fluoride concentrations of African dentifrices marketed in West Africa.

OBJECTIVE: To determine the fluoride concentrations of commercial dentifrices marketed in West Africa. DESIGN: In vitro measurement of the total fluoride concentration by liquid gas chromatography, and of the free fluoride concentration with a fluoride sensitive electrode. SETTING: Collection of fluoride dentifrices in public markets and supermarkets in and around the capital of The Republic of The Gambia, Banjul, after a systematic search. MATERIALS: All commercially available different brands sold in The Gambia and produced locally or in other African countries (Egypt, Morocco, Nigeria and South Africa). OUTCOME MEASURES: Total and free fluoride concentrations of dentifrices in parts per million. RESULTS: Seven different dentifrices were detected with NaMFP as the predominant fluoride source. Four dentifrices showed a total fluoride concentration above 1,000 ppm F-. The products showed - in general - a lower free fluoride concentration. Only one product with NaF as fluoride supplement showed both total and free fluoride concentrations above 1,000 ppm F-. Four products contained calcium-based abrasive additives. CONCLUSION: The measurement of total and free fluoride concentrations of dentifrices available in The Gambia (West Africa) showed inhomogeneities. This was particularly verified where fluoride compounds were combined with calcium-based abrasives. If so, it is recommended that the total fluoride content should be measured by gas chromatography. Periodic quality control of dentifrices should be introduced in areas with an under-developed consumer-counselling infrastructure.

Performance of atraumatic restorative treatment (ART) depending on operator-experience.

OBJECTIVES: Oral health care is not of major interest in developing countries because of lack of infrastructure and professional manpower. Therefore, atraumatic restorative treatment (ART) was introduced by the World Health Organization to be performed by dental auxiliary personnel. The aim of this study was to evaluate the performance of ART depending on operator-experience in The Republic of The Gambia. METHODS: One hundred twenty-eight newly inserted restorations were followed up for 12 months using the clinical ART index in a prospective and blinded study design. The patients were randomly assigned to operators. The clinical performance was compared among three groups: trainees, experienced Community Oral Health Workers (COHW), and professional dentists. The difference in success rates was calculated at a 95 percent confidence interval. RESULTS: There was a statistically significant difference between trainees and dentists in performing leakage/gap-free one-surface restorations (P < 0.05). No significant differences were found between the two groups of auxiliaries (trainees versus experienced COHWs, P > 0.05). Finally, both groups--experienced COHWs and dentists--performed restorations not showing statistically significant differences (P > 0.05). CONCLUSIONS: For The Republic of The Gambia--especially for areas with underdeveloped medical infrastructure--training and assignment to perform ART can be recommended for auxiliary dental staff of Community Oral Health Workers.

Effects of bleaching agents on human enamel light reflectance.

OBJECTIVES: Tooth whitening has been associated with splitting-up chromogenic molecules by hydrogen peroxides. Though micromorphological alterations are well documented, little is known about optical changes as a function of shifting in wavelengths. Therefore, the aim of the current study was to measure reflectance changes after bleaching in vitro by using a spectrometer. METHODS: Forty-eight enamel slabs (diameter = 5 mm) were prepared from the sound enamel of extracted human teeth that were: 1) fully impacted, 2) from juveniles ages 10 to 16 years, 3) from adults 35 to 45 years of age and 4) from seniors older than age 65. In all specimens, the baseline total reflectance measurement was performed with a computer-assisted spectrometer (Ocean Optics, Dunedin, FL, USA) within wavelengths (wl) from 430 nm to 800 nm. Four enamel samples of each age group were exposed to either 10% or 15% carbamide peroxide (Illuminé Home, Dentsply, Konstanz, Germany) or 35% hydrogen peroxide (Pola Office, SDI Limited, Victoria, Australia). After surface treatment, all slabs underwent total reflectance measurement again. Statistical analysis was calculated at wl 450, 500 and 750 nm using the Student's paired t-test and one-way variance analysis. RESULTS: Total reflectance significantly increased after bleaching at all enamel maturation stages, irrespective of the bleaching agent concentration, for wl 450 nm (blue) and 500 nm (green) with p<0.0001. At 750 nm (red), significant changes only occurred in enamel from adults and seniors (p<0.04). However, the efficacy of bleaching was significantly increased in the blue and green light spectra as compared to the red spectra (p<0.0001). CONCLUSIONS: The results of the current study showed that the exclusive assumption of the "chromophore effect" in dental bleaching could not be sustained, because whitening of the dental enamel works at different maturation stages, even in impacted teeth. This effect is irrespective of the bleaching protocol used and the bleaching agent concentration.

Development of a basic root canal treatment (BRT) for primary oral health care--evaluation after one year.

OBJECTIVES: Atraumatic Restorative Treatment (ART) was a major step forward in community dentistry but treatment options for deep carious lesions or pulp involvement still focus on tooth extraction in under-served areas worldwide. To bridge the gap between ART and extraction this pilot study aimed to develop and follow-up a basic root canal treatment for rural dental health facilities in the Republic of The Gambia (West Africa), faced with an environment lacking technical equipment and developing primary oral health care. METHODS: 25 single rooted teeth with acute irreversible pulpitis were root canal treated with a standardised endodontic instrument kit and a specific procedure. A step-back technique was used with intermittent chlorhexidine 0.2% and saline irrigation. Root canal obturation was performed using a single-cone technique with gutta-percha using Grossman's root canal cement. Coronal filling was carried out by using ART. Clinical examinations were documented before treatment, one day, five days, six months and twelve months postoperatively. RESULTS: None of the root canal fillings had to be revised due to postoperative complications. In 9 out of 25 teeth, transitory apical pain disappeared after a few days. After six months, all ART fillings appeared clinically acceptable, two fillings had to be corrected. Four class II restorations and three class IV restorations needed replacement after 12 months. Patients' assessment of health related quality of life improved significantly, especially concerning dental pain, chewing ability and fitness for work. CONCLUSIONS: Preliminary clinical follow-ups showed encouraging results for the basic root canal treatment approach. Longitudinal clinical studies with greater populations are required to substantiate these results. Modifications in the coronal filling technique are preferable to improve the clinical performance of extended ART cavity restorations.

Trends in caries experience in the permanent dentition in Germany 1997-2014, and projection to 2030: Morbidity shifts in an aging society.

The aims of this study were to assess the trends in dental caries experience in the permanent dentition (i.e., the number of decayed, missing, or filled teeth, DMFT) in Germany from 1997-2014 and to project caries experience to 2030. Components of caries experience (decayed teeth, DT, missing teeth, MT, filled teeth, FT) from repeated waves (1997, 2005, 2014) of the nationally representative German Oral Health Studies were analyzed in 12-, 35-44-, and 65-74-year-olds. Weighted means were interpolated cross-sectionally by fitting piecewise-cubic spline-curves and were then subjected to longitudinal regression and combined with population estimates. In 1997, children (12-year-olds) had a mean caries experience (decayed, missing, filled teeth, DMFT) of 1.7 teeth; this experience decreased to 0.5 teeth in 2014. For 2030, an experience of 0.2 teeth is projected. In adults (35-44-year-olds), a decrease was recorded (1997: 16.1 teeth; 2014: 11.2 teeth). This decrease is expected to continue until 2030 (to 7.7 teeth). Similarly, in seniors (65-74-year-olds), a decrease was recorded (1997: 23.6 teeth; 2014: 17.7 teeth); this decrease is expected to continue until 2030 (to 14.9 teeth). While the number of missing teeth has decreased consistently across age groups, the number of filled and decayed teeth has increased in seniors and is expected to continue to increase. The cumulative caries experience has decreased from 1.1 billion DMFT in 2000 to 867 million in 2015 and is expected to decrease to 740 million in 2030. Caries experience in the permanent dentition has been decreasing substantially, mainly due to a decrease in missing teeth. Younger age groups also show fewer decayed and filled teeth, while in older groups, restorative needs have not decreased, as more teeth are retained. Concepts for addressing the emanating morbidity shifts are required.

Fluoride availability from natural resources in The Gambia--implications for oral health care.

INTRODUCTION: Changing food patterns in combination with ineffective oral hygiene measures and insufficient bioavailability of fluoride from drinking water and other sources seem to impair the dental health status in developing countries, especially in the younger population. Therefore, preventive programmes in controlling dental caries progression should be based on local conditions. METHODS: For mapping the drinking water fluoride content throughout The Gambia, samples of water from rural community wells, public water taps, commercial mineral water, and from the Gambia-River were measured. Additionally, fluoride concentrations of locally extracted table salt and green tea were determined. RESULTS: Showed the need for supplementary fluoride intake, because natural dietary fluoride availability is very low. CONCLUSION: Age-related recommendations for oral health care and for additional fluoride bioavailability are given, taking into account local socio-economic conditions in the Republic of The Gambia and similar developing countries.

Oral Symptoms and Oral Health-Related Quality of Life in People with Rare Diseases in Germany: A Cross-Sectional Study.

Background: The aim of this study was to collect information on oral health-related quality of life (OHRQoL) in people with rare diseases. Methods: A questionnaire comprising free text questions and the German version of the standardized Oral Health Impact Profile-14 (OHIP-14) questionnaire on OHRQoL was developed. All participants who indicated oral symptoms in the questionnaire were included in a cluster analysis. Different cluster analyses were performed (Ward's, k-Means) to find symptom profile groups in the data. Results: A total of 484 questionnaires with 96 rare diseases were included in the study. The most reported symptoms were anomalies of the tooth formation, dysgnathia, changes in number of the teeth, and malocclusions. The OHIP mean values of the five resulting symptom clusters ranged from 15.1 to 19.9, which is very high compared to the general population in Germany, which has a mean value of 4.09. Discussion: All investigated symptoms show a negative association with OHRQoL, but the strongest were for symptoms of the oral mucosa and periodontal diseases. All the symptoms described in this cluster analysis can lead to considerably higher mean values of the OHIP total score among people with rare disease and thus to worse OHRQoL than reported in the general population.

Root caries experience in Germany 1997 to 2014: Analysis of trends and identification of risk factors.

INTRODUCTION: We assessed time trends in root caries experience, i.e. the sum of filled and carious root surfaces (FRS, CRS), and evaluated risk indicators of FRS/CRS in Germany. METHODS: FRS and CRS from repeated waves (1997, 2005, 2014) of the nationally-representative German Oral Health Studies were analyzed in 35-44- and 65-74-year-olds (adults/younger seniors; n = 4388). Weighted means were interpolated cross-sectionally across age groups by fitting piecewise-cubic spline-curves, and population-level FRS and CRS calculated. We also projected population-level FRS and CRS to 2030. To evaluate risk indicators of FRS and CRS, zero-inflated negative-binomial regression was applied. RESULTS: In adults FRS increased from 1997 to 2005 at individual and population level (from a mean of 0.49 to 0.63 surfaces; from a total of 6.2 to 8.7 million surfaces) and then decreased to 2014 (to 0.16 surfaces/1.6 million surfaces). CRS constantly increased (1997: 0.37 surfaces/4.7 million surfaces; 2014: 0.94 surfaces/9.3 million). In younger seniors, FRS increased from 1997 to 2005 (from 0.67 to 1.92 surfaces; 5.0 to 17.5 million surfaces) and then decreased to 2014 (0.89 surfaces/7.5 million surfaces). CRS constantly increased (1997: 0.39 surfaces/2.9 million surfaces; 2014: 1.43 surfaces/12.1 million surfaces). Driven by demographic changes until 2030, population-level FRS and CRS is likely to increase in younger seniors, but not adults. Sex, toothbrushing behavior, age, coronal caries experience and the number of teeth with probing-pocket-depths≥4 mm were associated with FRS and CRS. CONCLUSIONS: While FRS does not show a clear trend, CRS has constantly increased since 1997. Concepts for preventing and managing CRS in Germany are needed. CLINICAL SIGNIFICANCE: Evaluating time trends and assessing risk indicators of root caries experience is helpful to understand morbidity dynamics, plan resource allocation and identify individuals/groups at risk. While FRS shows no clear trend, CRS has increased since 1997 in Germany. Concepts for addressing the emanating treatment needs are needed.

Effectiveness of Systematic Periodontal Treatment in Male HIV-Infected Patients after 9 Years: A Case Series.

OBJECTIVE: To investigate effectiveness of systematic periodontal treatment in the long term in HIV-infected patients undergoing highly active antiretroviral treatment. METHODS: Longitudinal, prospective, open-label case series over a period of nine years. Periodontal treatment was performed by scaling and root planing and supportive periodontal care (SPC) at regular intervals. To measure effectiveness, reductions of pocket probing depths were defined as primary study endpoint. RESULTS: During the study period, there was a proportional increase in periodontal pockets ≥4 mm of +53% and in pockets ≥ 6 mm of +100%. Mean pocket depth reductions on patient's level were, however, 0.4 mm nine years after scaling and root planing and supportive periodontal care (p=0.180). No teeth were lost during the observation period. CONCLUSIONS: In terms of best evidence available, it is concluded that systematic periodontal treatment including SPC is effective in virologically controlled HIV infection and can be performed in dental practice safely.

[Implications of antiretroviral therapy in oral medicine--a review of literature]. / Implikationen der antiretroviralen Therapie in der Oralmedizin. Eine Literaturübersicht.

The success of antiretroviral therapy leads to a chronification of HIV-infection resulting in a decline of lethality. The lifelong intake of antiinfectives, though, may result in drug side effects with clinical dental implications. Despite fundamental cellular alterations, including prolonged hemorrhage following surgical interventions, antiretrovirals of all classes, of protease inhibitors, (non-nucleoside) reverse transcriptase inhibitors and of fusion inhibitors may promote oral manifestions like oral ulcera, dysgeusia, salivary gland disorders, papilloma, (peri)oral paresthesia or aphtous stomatitis. Due to inhibitory effects especially of protease inhibitors of cy tochrome P450-isoenzyme CYP3A4 therapeutical interactions with psychotropics/sedatives, antifungal agents, corticoids and intiinfectives, particularly metronidazole, may raise. The application and prescription of systemically metabolized adjuvant drugs as well as the monitoring of the possible progression of HIV infection is a key task in the oral health care of HIV-seropositive patients calling for a close medical coordination of therapeutical interventions.

Clinical treatment outcomes of periodontal therapy in HIV-seropositive patients undergoing highly active antiretroviral therapy.

INTRODUCTION: Since the worldwide HIV/AIDS epidemic started, various oral manifestations have been described. However, scientific assessment of therapeutic outcomes of chronic periodontitis in HIV-seropositive patients, in particular undergoing highly active antiretroviral therapy (HAART), has not been addressed. MATERIALS AND METHODS: 22 patients divided into a HIV-1-seropositve test group and seronegative control group were studied for 12+ months after receiving periodontal therapy by conservative scaling and root planning and maintenance care. RESULTS AND CONCLUSIONS: Periodontal inflammatory parameters improved significantly under the immune reconstituting influence of HAART without major statistical differences in both examination groups. According to this standardized interventional concept, HIV-1-seropositive patients with chronic periodontal disease can be treated successfully. The treatment outcome in maintaining the periodontal attachment is equally well represented in both clinically controlled groups.