Prevotella nigrescens and Porphyromonas gingivalis are associated with signs of carotid atherosclerosis in subjects with and without periodontitis.

BACKGROUND AND OBJECTIVE: Oral microorganisms may be involved in the development of cardiovascular diseases, and Porphyromonas gingivalis is one of the periodontal microorganisms that has been found in carotid atheroma. The aim of this work was to study subgingival microorganisms and early carotid lesions in subjects with and without periodontitis. MATERIAL AND METHODS: Eighty-eight subjects with periodontitis and 40 subjects without periodontitis underwent dental examinations in 2003. The presence of the periodontal microorganisms Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis, Prevotella intermedia, Prevotella nigrescens and Tannerella forsythia was analyzed from subgingival plaque using PCR amplification. The common carotid artery was scanned using ultrasound and the calculated intima-media area (cIMA) was measured. The association between periodontitis, the cIMA value and the presence of periodontal microorganisms, together with several confounders, was studied in a multiple logistic regression model. RESULTS: Smoking [odds ratio (OR) = 5.64; p = 0.001), level of education (OR = 5.02; p < 0.05) and the presence of P. gingivalis (OR = 6.50; p < 0.05) were associated with periodontitis. Explanatory factors for the increased cIMA were periodontitis (OR = 4.22; p < 0.05), hypertension (OR = 4.81; p < 0.05), high body mass index (OR = 5.78; p < 0.01), male gender (OR = 3.30; p < 0.05) and poor socioeconomic status (OR = 4.34; p < 0.05). P. nigrescens (OR 4.08; p < 0.05) and P. gingivalis (OR 7.63; p < 0.01) also appeared as explanatory variables associated with increased cIMA values. CONCLUSION: This cross-sectional study showed that P. nigrescens and P. gingivalis were significantly associated with increased cIMA values.

Matrix metalloproteinase-9 and tissue inhibitor of matrix metalloproteinase-1 in blood as markers for early atherosclerosis in subjects with chronic periodontitis.

BACKGROUND AND OBJECTIVE: An association has been found between periodontal disease and the development of atherosclerosis. We investigated the hypothesis that periodontal disease triggers the expression of matrix metalloproteinase-9 (MMP-9) and tissue inhibitor of matrix metalloproteinase-1 (TIMP-1) in blood. Increased levels of these parameters might then indicate early atherosclerosis. MATERIAL AND METHODS: In this cross-sectional study, the material comprised 80 subjects with chronic periodontitis and 31 subjects with no periodontal disease. Sixteen years after diagnosis of periodontal disease ultrasonography revealed a statistically significant difference (p < 0.001) of carotid intima-media thickness between the subjects with chronic periodontitis and the periodontally healthy subjects. Matrix metalloproteinase-9 and TIMP-1 were analyzed from blood as periodontal and systemic inflammatory markers. The relationship between MMP-9, TIMP-1 and MMP-9/TIMP-1 as dependent variables and several independent variables (age, sex, smoking, education, body mass index, hypertension, periodontal disease and cholesterol) were analyzed in multiple logistic regression models to assess the value of the inflammatory markers in predicting carotid atherosclerosis. RESULTS: Matrix metalloproteinase-9 and TIMP-1 were significantly higher in plasma from subjects with periodontal disease and atherosclerosis. Periodontal disease was identified as the principal independent predictor both for atherosclerosis (odds ratio 3.89 for increase in bilateral carotid intima-media thickness) and for increased MMP-9, TIMP-1 and MMP-9/TIMP-1 (odds ratio 2.58, 5.53 and 3.41, respectively). Classical atherosclerosis risk factors, such as increased total cholesterol, age and sex (women), were significant predictors in the model. CONCLUSION: Matrix metalloproteinase-9, TIMP-1 and MMP-9/TIMP-1 in blood from subjects with periodontal disease could be useful laboratory markers for increased carotid artery intima-media thickness.

An enzyme-linked immunosorbent assay for the determination of the IgA subclass distribution of antigen-specific antibodies.

An ELISA for the determination of the IgA subclass distribution of antigen-specific antibodies was developed using commercially available monoclonal anti-IgA1 anti-IgA2 subclass antibodies. Furthermore an anti-A2m allotype-specific antibody was included in the study. The specificity and sensitivity of the monoclonal anti-immunoglobulin antibodies used was analyzed using sera from normal and IgA class- or subclass-deficient individuals (with or without homozygous C alpha 1 subclass gene deletions). Human IgA1 and IgA2 hybridoma antibodies were also used. In this particular assay, only two out of four tested anti-IgA1 and two out of three tested anti-IgA2 antibodies proved to be specific for their corresponding IgA subclass. The anti-A2m(2) monoclonal antibody was shown to be specific for the corresponding allotype. These ELISA methods may facilitate further work on the regulation of IgA subclass production in man.

Ontogeny of immunoglobulins in bone marrow-transplanted individuals. An analysis of serum and salivary levels.

Unstimulated whole saliva and serum samples were collected from ten allogeneic bone marrow transplant recipients before and after bone marrow transplantation, seven donors, and from twenty healthy individuals. Two patterns with regard to salivary IgA were found after transplantation. In five patients, a short-lasting peak of excessive IgA production was noted shortly after BMT. Two of these patients had an increase of both secretory and the nonsecretory form of IgA, whereas the other three only demonstrated elevated nonsecretory IgA levels. After the IgA peak the IgA level decreased below the level before BMT. In five patients a different pattern was seen, with a marked decrease in salivary IgA, IgG, and IgM as well as albumin after grafting. A highly variable pattern of reconstitution was seen after one year, when three out of seven patients were still deficient in secretory IgA.

Measurement of gingival swelling from dental casts by generation of a moiré pattern with laser light.

The aim of the study was to develop a sensitive measuring method enabling direct evaluation of gingival swelling to be made as registered on dental casts. On two separate occasions, when different degrees of severity of gingival inflammation were present in the same subject, reversible hydrocolloid impressions were taken of the mandible. The casts obtained were located successively in identical three-dimensional relationships in a field of interference fringes generated by two intersecting beams of collimated helium-neon laser light, and were photographed. The evaluation of the moiré pattern obtained directly by superimposition of the two images of the surface studied indicated that a decrease in gingival height of 0.38 mm in the direction of the camera had occurred between the two occasions. The use of a computer-based image-processing system considerably improved the visibility of the pattern. The reproducibility of the impression technique, as well as the relocation and superimposing techniques, proved satisfactory at the moiré resolution used (0.19 mm). The method has potential application in clinical experimental research, and therefore warrants further evaluation.

Movements of healthy and periodontally involved teeth measured with laser reflection technique.

The laser reflection method of remote measurement was used to register small tooth movements of upper central incisors from a group of subjects with healthy teeth and another group with periodontally involved teeth. The mobility of the healthy maxillary incisors over a period of 24 hours was well within normal limits. Among orthodontically treated and periodontally involved maxillary incisors relapse was larger sagittally than laterally and largest buccally. This tendency was greatest during the first 5 hours and almost reached its maximum after 1 day. These movements were within the limits of mobility but were not always correlated with mobility or the loss of marginal bone. Furthermore, the relapse was not correlated with the magnitude of orthodontic correction. In this respect, the mean buccal relapse was low, however, individual variations were large. The extent of relapse may be related to the varying intensity of parafunctional habits.

Fiber glass splints.

Temporary splints to immobilize periodontally diseased teeth were made by fiber glass bonded and attached to the teeth with acid-etch technique with BIS-GMA resin. Twenty-one splints were made. Observation time ranged from 4 to 14 months. During the observation only one splint fractured and was repaired while the others functioned without failure.

The use of laser beams for measuring tooth mobility and tooth movements.

The laser reflexion method, a direct contactless measuring technique with a high accuracy, has been applied for clinical purposes. A prototype has been tested using a laser beam to illuminate a patient's tooth fixed to the equipment by an impression plate. The reflected patterns were thrown onto a screen with a coordinate system and photographically recorded, and the movement of the tooth has been geometrically calculated. The relapse tendency after orthodontic treatment of a patient with periodontal disease and parafunctions was studied by repeated measurements of the left medial upper incisor. By use of the method, it was possible to observe that the velocity of the studied tooth was highest during the 1st day and, besides the horizontal movement, a rotation of the tooth began at the end of the measuring period.

The effect of systemic metronidazole after non-surgical treatment in moderate and advanced periodontitis in young adults.

The effect of adjunctive systemic metronidazole was studied in patients with moderate and advanced periodontitis recalcitrant to comprehensive non-surgical treatment. The material originated from a randomly selected part of the population aged 31 to 40 years. After non-surgical treatment of 149 patients, 98 with persisting pathological pockets greater than or equal to 5 mm (52 men and 46 women) became the subjects for the study. Clinical parameters were registered and pocket contents subjected to laboratory analysis. The subjects were randomized into two groups according to a code list known only by the manufacturer and the statistician. The test group took three 400 mg metronidazole tablets daily for 1 week and the control group took placebo tablets. Reassessment 6 months later showed statistically significant clinical improvement, with a reduction in the number of sites greater than or equal to 5 mm in both test and control groups. Complete healing, with no pockets greater than or equal to 5 mm, was noted in 30% of the test group and 9% of the control group. The difference is statistically significant and shows the supplementary effect of adjunctive metronidazole in non-surgical treatment of moderate and advanced periodontitis.

A 15-month evaluation of the effects of repeated subgingival minocycline in chronic adult periodontitis.

BACKGROUND: A double-blind, randomized, parallel, comparative study was designed to evaluate the long-term safety and efficacy of subgingivally administered minocycline ointment versus a vehicle control. METHODS: One hundred four patients (104) with moderate to severe adult periodontitis (34 to 64 years of age; mean 46 years) were enrolled in the study. Following scaling and root planing, patients were randomized to receive either 2% minocycline ointment or a matched vehicle control. Study medication was administered directly into the periodontal pocket with a specially designed, graduated, disposable applicator at baseline; week 2; and at months 1, 3, 6, 9, and 12. Scaling and root planing was repeated at months 6 and 12. Standard clinical variables (including probing depth and attachment level) were evaluated at baseline and at months 1, 3, 6, 9, 12, and 15. Microbiological sampling using DNA probes was done at baseline; at week 2; and at months 1, 3, 6, 9, 12, and 15. RESULTS: Both treatment groups showed significant and clinically relevant reductions in the numbers of each of the 7 microorganisms measured during the entire 15-month study period. When differences were detected, sites treated with minocycline ointment always produced statistically significantly greater reductions than sites which received the vehicle control. For initial pockets > or =5 mm, a mean reduction in probing depth of 1.9 mm was seen in the test sites, versus 1.2 mm in the control sites. Sites with a baseline probing depth > or =7 mm and bleeding index >2 showed an average of 2.5 mm reduction with minocycline versus 1.5 mm with the vehicle. Gains in attachment (0.9 mm and 1.1 mm) were observed in minocycline-treated sites, with baseline probing depth > or =5 mm and > or =7 mm, respectively, compared with 0.5 mm and 0.7 mm gain at control sites. Subgingival administration of minocycline ointment was well tolerated. CONCLUSIONS: Overall, the results demonstrate that repeated subgingival administration of minocycline ointment in the treatment of adult periodontitis is safe and leads to significant adjunctive improvement after subgingival instrumentation in both clinical and microbiologic variables over a 15-month period.

Spirochaetes and granulocytes at sites involved in periodontal disease.

Eighty-six men and 63 women with periodontitis participated in this investigation, at the start of which clinical indices were recorded and the pocket contents from one periodontally involved site for each patient were analysed. The numbers of spirochaetes, other motile microorganisms, non-motile filaments, rods or cocci and of granulocytes, monocytes and epithelial cells were determined. After non-surgical treatment 98 patients (P-group) were unsuccessfully and 51 (C-group) were successfully treated. At baseline the P-group had significantly higher numbers of spirochaetes (p = 0.0001) and polymorphonuclear leucocytes (p = 0.0256) than the C-group. The number of rods was statistically higher in the C-group (p = 0.0254). There was no significant difference between the groups with respect to the number of remaining teeth, plaque or calculus scores. Significantly higher values were found in the P-group for bleeding on probing (p = 0.0434), number of pockets greater than or equal to 5 mm (p = 0.0001), mean pocket depths (p = 0.0001), percentage bone loss per site (p = 0.0001) and the number of sites with greater than or equal to 20% bone loss on radiographs (p = 0.0001).

The approximal bone height and intrabony defects in young adults, related to the salivary buffering capacity and counts of Streptococcus mutans and Lactobacilli.

Using a computerized technique the bone height and prevalence of approximal periodontal intrabony defects were assessed on posterior bite-wing radiographs from 151 young adults. The results were related to the buffering capacity and counts of Streptococcus mutans and lactobacilli in whole stimulated saliva. The mean distance from the cement-enamel junction to the alveolar bone crest was greater in the high buffering group than in the low buffering group (p less than 0.05), and particularly in non-smokers (p less than 0.01). Intrabony defects were more common in the low buffering group (p less than 0.05) and in women (p less than 0.001).

The relation between tooth eruption and alveolar crest height in a human skeletal sample.

It is commonly assumed that alveolar crest height increases with continuing tooth eruption unless affected by marginal inflammation. To test this hypothesis, the relation between eruption and alveolar crest height was examined in skulls from a sample consisting of the remains of 244 individuals from the late medieval period. The mandibular first and second molars and second premolars were analysed. The age of the skulls was determined on the basis of dental development and molar attrition. Radiographs were taken and points representing the levels of the inferior dental canal (IDC), root apices (AP), alveolar crest (AC), cementum-enamel junction (CEJ) and occlusal surface were determined on the radiographs. The level of the IDC was used as a reference not changing with age. The distances between the points were measured with a help of a computer-digitizer system. Variable IDC-AP increased with age, indicating continuous eruption of the teeth. The distance between AC and CEJ also increased while the distance between IDC and AC remained constant, showing that the alveolar crest height did not increase accordingly. The lack of inflammatory changes on the alveolar bone surface suggests that occlusal attrition may be compensated for by continuous eruption without bone growth in the alveolar margin.

Patient involvement in oral hygiene cooperation: a factor analytic study.

In a previous study the concept "patient involvement" was found to be strongly predictive of therapy outcome. On the basis of a questionnaire concerning patients' background and motivation, 82 patients were interviewed before treatment. To cover the concept "patient involvement" 16 variables were considered as relevant measures. In a factor analysis four factors accounted for 90% of the common variance. The factors were interpreted in terms of: initial attitudes, attendance, self-confidence and teeth-mindedness.

Periodontal status in an urban adult population in Sweden.

The purpose was to describe the current periodontal status in a Swedish urban population aged 31-40 yr. 1681 individuals, 840 men and 841 women, participated in the study. 68.5% of the subjects had low amount of plaque, 82.8% low level of calculus and 28.9% healthy gingiva or mild gingivitis. 82.8% of the subjects had no pockets with probing depth (PD) > or = 5 mm. 4.9% of the subjects had one tooth with PD > or = 5 mm, 6.7% 2-5 teeth, 2.4% 6-9 teeth and 3.2% > or = 10 teeth with pockets. 55.8% of the subjects had no missing teeth, third molars excluded. 16.5% had one tooth missing, 23.8% 2-5 teeth, 2.7% 6-9 teeth and 1.2% > or = 10 teeth. 8.6% of the subjects had at least one front tooth missing, 28.7% one premolar and 24.1% one molar missing. Men had significantly higher scores than women for plaque (DI-S), calculus (CI-S), gingivitis (GI-M), and number and percent of remaining teeth with PD > or = 5 mm. Smokers had significantly higher scores than non-smokers for DI-S, CI-S, GI-M, number and percent of remaining teeth with PD > or = 5 mm, and number of missing teeth. The individuals who visited the dentist every year had better oral hygiene and gingival status than those who attended for > 3 yr. The multiple regression analysis showed that calculus (P = 0.0001) smoking (P = 0.001), and dental visits (P = 0.0284) were significantly correlated to the number of teeth with PD > or = 5 mm.

Re- and allotransplantation of teeth--an experimental study in monkeys.

In each of six monkeys one of the permanent lateral incisors with uncompleted root development was replanted. At the same time the contralateral incisors in four of the monkeys were allotransplanted by pairs. The remaining two contralateral incisors served as controls. After 4 weeks and 4 months, respectively, three monkeys were decapitated and the upper lateral incisors with adjacent periodontal tissue were examined histologically. The replanted teeth in five cases had a vital pulp. In the sixth case, however, the replanted incisor exhibited pulpitis and partial necrosis of the pulp. The periodontal membrane had a normal histologic appearance. In two cases a small area of arrested root resorption was observed. With the allotransplanted teeth the histologic appearance was altered. After 4 weeks a pronounced inflammatory reaction was observed in both the pulpal tissue and the periodontal membrane. The pulp was in most cases necrotic, and marked root resorption was observed. Most of the allotransplanted teeth were resorbed and replaced by an irregular hard tissue that resembled osteoid, which in many cases was connected with the tooth remnants by ankylosis. These results indicate that allotransplanted teeth, in contrast to replanted teeth, exhibit the characteristic features of an allograft rejection, including an inflammatory reaction and resorption.

The relation between foetor ex ore, oral hygiene and periodontal disease.

Bad breath usually originates in the mouth. It is described with different names as oral malodor, halitosis or foetor ex ore. Dental plaque, bacterial products from deep periodontal pockets and bacterial products from the tongue probably cause bad breath but also bacterial products from tonsils and pharynx probably are involved. In this study we clinically examined subjects with very strong bad breath, foetor ex ore. Foetor ex ore was defined as strong evil-smelling odor from the mouth of the patient which had an affect on the examiner and made the oral examination excruciating. Subjects with foetor ex ore are not aware of it. It is usually noticed by others. There are also persons who complain of bad breath that cannot be detected by others, halitophobia. Our aim was to study the relation between foetor ex ore, halitophobia and oral hygiene, periodontal disease. A total of 840 men, mean age 35.7(+/- 2.8 SD) and 841 women, mean age 35.7+/- 2.9 SD), participated. Clinical findings were noted, including the presence or absence of foetor ex ore. The subjects also filled in a self-reported questionnaire concerning problems in the oral cavity and teeth. Foetor ex ore was present in 2.4 percent of the subjects. Multiple regression analysis showed that calculus (P < 0.001), plaque (P < 0.01), and dental visits once every 3 yr. (P < 0.01) were significantly correlated to foetor ex ore. Periodontitis patients with foetor ex ore had more severe disease (P < 0.001) than those without. Foetor ex ore was not related to suspected halitosis. One percent of the subjects had suspected halitosis. Using multiple regression analysis, we found a significant correlation between calculus (P < 0.001) and suspected halitosis. In conclusion this study shows that foetor ex ore was correlated to oral hygiene and dental visits. Periodontitis patients with foetor ex ore had more severe disease than those without.

Clinical characteristics of destructive periodontitis in a risk group of Swedish urban adults.

An initial screening investigation of 1681 Swedish urban adults aged 31-40 years with untreated periodontitis showed that 17.2% (289) had at least one site with probing depth > or = 5 mm. The 289 subjects were offered a complete clinical examination and treatment. 144 subjects, 85 men and 59 women, agreed to participate and 145 were non-responding subjects and used as a drop out sample. The results from the screening data showed that the attendants had poorer oral hygiene status and more severe periodontitis than the drop out subjects. The present report describes clinical data of this representative sample with adult periodontitis. Clinical indices were recorded and bone height (BH%) for all teeth was measured with a computer digitizing system. In the 144 attendants, Plaque Index was > 1 in 56.2%, Calculus Index was > 1 in 57.0%, Gingival Index was > 1 in 97.2% and bleeding on probing was found in 89.1% of the sites. 11.1% of the subjects had 1-3 teeth with probing depth > or = 5 mm, 59.0% 4-10 teeth, 25.7% 11-20 teeth and 4.2% > 20 teeth. 47.9% of the subjects had mean BH% less than 80. 45.1% of the subjects had at least one site with an intrabony defect, of which 20% had 3-4 sites and 27.7% > or = 5 sites. It is concluded that advanced generalized periodontitis exists in a limited number of 31-40 year-olds in Sweden. Specific risk factors may be involved in the pathogenesis of the disease.

Lustre changes on teeth. The use of laser beams for comparative studies in vivo.

An instrument for studies of lustre changes on teeth in vivo was constructed and evaluated. The equipment was based on a helium-neon gas laser, a coordinate screen and a photocell. The intensity of light reflected from incisors of ten test subjects was measured before and after brushing with different dentifrices. The investigation showed that the instrument was useful for measuring intensity differences of laser light reflected from teeth. The intensity was found to vary within wide limits from teeth of different persons. During a test period of 70 days only few lustre changes caused by dentifrices were registered.

Increased numbers of black-pigmented Bacteroides in induced periodontitis in monkeys.

In four young adult monkeys, periodontitis was experimentally induced by inserting elastic rubber bands around the necks of two teeth on each side of the mandible. On one side the teeth were not cleaned during the experimental period. On the control side, the teeth were cleaned by scaling and polishing weekly. After 8 weeks there were 6 mm deep pockets and great bone loss on the experimental side. Subgingival plaque was collected from experimental and control sides under anaerobic conditions and transported in a reduced transport fluid. The microorganisms were incubated anaerobically for 7 days on four different media: 1) Horse blood agar, 2) Rabbit blood agar, 3) Kanamycin-vancomycin blood agar, 4) Rabbit blood agar with Kanamycin and supernatant of filtrated Propionibacterium acnes culture (BPBSM). All media contained 0.5 microgram/ml menadione and 5.0 micrograms/ml hemin. Colony forming units of black-pigmented Bacteroides were found on all four media from all animals and were increased in numbers in the experimental side. One hundred and fifteen isolates of black-pigmented colonies were identified biochemically. Recovery of black-pigmented Bacteroides on BPBSM was significantly higher than on the other three media.