Dental plaque-induced gingival conditions.

OBJECTIVE: This review proposes revisions to the current classification system for gingival diseases and provides a rationale for how it differs from the 1999 classification system. IMPORTANCE: Gingival inflammation in response to bacterial plaque accumulation (microbial biofilms) is considered the key risk factor for the onset of periodontitis. Thus, control of gingival inflammation is essential for the primary prevention of periodontitis. FINDINGS: The clinical characteristics common to dental plaque-induced inflammatory gingival conditions include: a) clinical signs and symptoms of inflammation that are confined to the gingiva: b) reversibility of the inflammation by removing or disrupting the biofilm; c) the presence of a high bacterial plaque burden to initiate the inflammation; d) systemic modifying factors (e.g., hormones, systemic disorders, drugs) which can alter the severity of the plaque-induced inflammation and; e) stable (i.e., non-changing) attachment levels on a periodontium which may or may not have experienced a loss of attachment or alveolar bone. The simplified taxonomy of gingival conditions includes: 1) introduction of the term "incipient gingivitis;" 2) a description of the extent and severity of gingival inflammation; 3) a description of the extent and severity of gingival enlargement and; 4) a reduction of categories in the dental plaque-induced gingival disease taxonomy. CONCLUSIONS: Dental plaque-induced gingival inflammation is modified by various systemic and oral factors. The appropriate intervention is crucial for the prevention of periodontitis.

Site-level risk predictors of peri-implantitis: A retrospective analysis.

AIM: The goal of the present investigation was to identify site-level factors that might allow prognostication of individual implants in partially dentate patients with multiple non-splinted restorations. METHODS: We analysed clinical and radiographic characteristics of 222 non-splinted single implants in function for at least 5 years in 86 partially dentate individuals at the time of functional loading and at follow-up, with the outcome variable being peri-implantitis. Principal component analysis identified factors contributing to greatest variability and linear discriminant analysis coupled with Random Forest Classifier used to identify risk predictors. RESULTS: After controlling for patient-level factors, the following characteristics were associated with significantly increased risk for peri-implantitis: Periodontal disease on adjoining teeth at the time of restoration (Odds Ratio (OR): 8.0), implant placement at a depth of 6 mm or more in relation to the CEJ of adjacent tooth (OR: 8.5), asymmetric prosthesis (OR: 4.3), history of tooth loss due to periodontitis (OR: 2.4) and a mean baseline plaque index of 1.6 or more (OR: 7.9). CONCLUSIONS: Our findings suggest that a system that incorporates both subject level and implant-level factors is required to effectively prognosticate the success of individual implants.

Defining periodontal health.

Assessment of the periodontium has relied exclusively on a variety of physical measurements (e.g., attachment level, probing depth, bone loss, mobility, recession, degree of inflammation, etc.) in relation to various case definitions of periodontal disease. Periodontal health was often an afterthought and was simply defined as the absence of the signs and symptoms of a periodontal disease. Accordingly, these strict and sometimes disparate definitions of periodontal disease have resulted in an idealistic requirement of a pristine periodontium for periodontal health, which makes us all diseased in one way or another. Furthermore, the consequence of not having a realistic definition of health has resulted in potentially questionable recommendations. The aim of this manuscript was to assess the biological, environmental, sociological, economic, educational and psychological relationships that are germane to constructing a paradigm that defines periodontal health using a modified wellness model. The paradigm includes four cardinal characteristics, i.e., 1) a functional dentition, 2) the painless function of a dentition, 3) the stability of the periodontal attachment apparatus, and 4) the psychological and social well-being of the individual. Finally, strategies and policies that advocate periodontal health were appraised.

Prevention in practice--a summary.

BACKGROUND: This paper is a summary document of the Prevention in Practice Conference and Special Supplement of BMC Oral Health. It represents the consensus view of the presenters and captures the questions, comments and suggestions of the assembled audience. METHODS: Using the prepared manuscripts for the conference, collected materials from scribes during the conference and additional resources collated in advance of the meeting, authors agreed on the summary document. RESULTS: The Prevention in Practice conference aimed to collate information about which diseases could be prevented in practice, how diseases could be identified early enough to facilitate prevention, what evidence based therapies and treatments were available and how, given the collective evidence, could these be introduced in general dental practice within different reimbursement models. CONCLUSIONS: While examples of best practice were provided from both social care and insurance models it was clear that further work was required on both provider and payer side to ensure that evidence based prevention was both implemented properly but also reimbursed sufficiently. It is clear that savings can be made but these must not be overstated and that the use of effective skill mix would be key to realizing efficiencies. The evidence base for prevention of caries and periodontal disease has been available for many years, as have the tools and techniques to detect, diagnose and stage the diseases appropriately. Dentistry finds itself in a enviable position with respect to its ability to prevent, arrest and reverse much of the burden of disease, however, it is clear that the infrastructure within primary care must be changed, and practitioners and their teams appropriately supported to deliver this paradigm shift from a surgical to a medical model.

The ambit of periodontal reproductive endocrinology.

A preface on the historical background, scope and clinical importance of the effects of reproductive endocrinology on the periodontium is presented. Furthermore, deductive explanations of intuitive observations evaluating the influence of reproductive endocrinology on the periodontium are discussed.

Endocrinology of sex steroid hormones and cell dynamics in the periodontium.

Numerous scientific studies assert the existence of hormone-sensitive periodontal tissues. Tissue specificity of hormone localization, identification of hormone receptors and the metabolism of hormones are evidence that periodontal tissues are targets for sex steroid hormones. Although the etiologies of periodontal endocrinopathies are diverse, periodontal pathologies are primarily the consequence of the actions and interactions of sex steroid hormones on specific cells found in the periodontium. This review provides a broad overview of steroid hormone physiology, evidence for the periodontium being a target tissue for sex steroid hormones and theories regarding the roles of sex steroid hormones in periodontal pathogenesis. Using this information, a teleological argument for the actions of steroid hormones in the periodontium is assessed.

Physiology, pathology and pharmacology of the male reproductive system.

The male reproductive system consists of the testes, a ductal system and sex accessory organs. Production of sperm by the testes combined with fluids formed by the sex accessory organs (e.g. seminal vesicles, prostate and bulbourethral glands) produce a secretion that supports the survival of spermatozoa and provides a medium through which they can move through the reproductive ducts (e.g. epididymis, vas deferens, ejaculatory duct and urethra) for ejaculation of viable sperm into the female reproductive tract. Summarized herein are the essentials of normal male reproductive physiology, disorders of male sexual differentiation, pharmacological therapy of common diseases of the male genitourinary tract and the impact of drugs of abuse on the male reproductive system.

Principles of endocrinology.

The endocrine system plays a major role in human survival. Endocrine glands secrete chemical messengers or hormones that affect every tissue of the body, including the periodontium, during the life of the individual. As the endocrine system influences a broad assortment of biological activities necessary for life, a general understanding of the principal components and functions of this system is essential. A fundamental assessment of hormone structure, mechanism of action and hormone transport, as well as influence on homeostasis is reviewed. A concise evaluation of the functions of the central endocrine glands, the functions of the major peripheral endocrine glands (other than gonadal tissues) and the known relationships of these hormones to the periodontium is examined.

Periodontal disease in men.

In relation to periodontal diseases associated with sex-steroid hormones, men have been the forgotten sex. It is not surprising that there has been less scrutiny of the effects of sex-steroid hormones in men considering the more striking changes that occur in women during different periods of their life. Despite the gingival inflammatory changes reported in women, men have been reported to have a higher prevalence of destructive periodontal diseases. The information presented in this review will provide a contemporary evaluation of male susceptibility to periodontal diseases.

Molecular characteristics of periodontal health: Collagens: Defining the healthy human gingival collagen transcriptome: Defining the healthy human gingival collagen transcriptome.

BACKGROUND: Defining periodontal health has been an ambitious and complex goal. The numerous and varied definitions of what constitutes periodontal health have resulted in a collection of subjective and unreliable clinical findings to diagnose and classify periodontal health and disease. The aim of this study was to fundamentally delineate the molecular characteristics of healthy periodontal tissues in men and women as they age, using the most abundant connective tissue component: Collagens. METHODS: Healthy gingival biopsies were separated into "young" (aged 18-35 years, five men/five women) and "old" (≥60 years, five men/four women) age groups depending on biological sex. RNA was extracted and next-generation RNA sequencing was performed using Unique Molecular Identifiers. Collagen gene expression was determined and quantified for young and old, male and female individuals. RESULTS: Twenty-six human collagens were identified in healthy gingival tissues. In general, age and biological sex affected expression of collagen α-chain transcripts. Ten of the 26 human gingival collagen genes formed a unique pattern for gingival health. More specifically, the expression of fibrillary (types I and III), fibril-associated collagens with interrupted triple-helices (FACIT) and FACIT-like (types XII, XIV, and XX), network-forming (types IV and VI), transmembrane (type XVII), and multiplexin (types XV and XVIII) collagens, taken together, exhibited a distinct pattern of characteristics for gingival health that was independent of age or biological sex. CONCLUSIONS: Although specific α-chains of the collagen transcriptome were affected by age and biological sex, the compilation of various collagen transcripts can be used to define gingival health that is independent of age and biological sex.

Periodontists' Trends in the Management of Peri-implant Diseases.

PURPOSE: The scarce standard therapeutic protocols for the management of peri-implant diseases results in the empirical application of therapeutic modalities. The objective of this study was to carry out a survey to analyze the therapeutic trends of professionals with different academic backgrounds and levels of expertise. MATERIALS AND METHODS: An exploratory cross-sectional internet-based study survey of board-certified members of the American Academy of Periodontology (AAP) and the European Federation of Periodontology (EFP) was conducted. To assess the therapeutic trends, four clinical vignettes representing different scenarios of peri-implant biologic complications were provided to the participants. Differences in practice patterns were determined using chi-square test and Student t test or analysis of variance (ANOVA) test for qualitative variables. RESULTS: A total of 268 members of the AAP and EFP completed the survey. A significant difference in preferred treatment plan was found between EFP and AAP periodontists, resective therapy being the treatment of choice by the majority of the former (41.2%) and regenerative therapy by the latter (48.9%; P < .001). Overall, 48.1% of experts did not consider any intervention for the management of mucositis. Antibiotic prescriptions differed among groups, with statistical significance in each clinical case, and the explantation criteria were inconsistent and differed significantly among groups. CONCLUSION: Substantial variations exist concerning the decision-making to manage peri-implant diseases and conditions.

Biome-microbiome interactions in peri-implantitis: A pilot investigation.

BACKGROUND: Dental implants replace missing teeth in at least 100 million people, yet over one million implants fail every year due to peri-implantitis, a bacterially induced inflammatory disease. Our ability to treat peri-implantitis is hampered by a paucity of information on host-microbiome interactions that underlie the disease. Here, we present the first open-ended characterization of transcriptional events at the mucosal-microbial interface in the peri-implant crevice. METHODS: We simultaneously sequenced microbial and human mRNA from five pairs of healthy and diseased implants from the same patient and used graph theoretics to examine correlations between microbial and host gene expression in the peri-implant crevice. RESULTS: We identified a transcriptionally active peri-implant microbiome surrounding healthy implants. Microbial genes encoding phenylalanine, tyrosine, and tryptophan biosynthesis, cysteine, methionine, arginine, proline, and histidine metabolism correlated to human genes encoding cell development, metabolism, morphogenesis, adhesion, gap junctions, cell-cell signaling, and immunoinflammatory pathways, suggesting a role for commensals in protecting epithelial integrity. In disease, we found 4- to 200-fold upregulation in microbial genes encoding biofilm thickness, heme transport and utilization, and Gram-negative cell membrane synthesis. These genes correlated with mucosal zinc finger proteins, apoptosis, membrane transport, inflammation, and cell-cell communication. CONCLUSIONS: Within the limitations of a small sample size, our data suggest that microbial dysbiosis in the peri-implant sulcus might promote abandonment of host-bacterial transactions that dictate health and instead drive a move towards chronic programming of a non-healing wound.

Experimental gingivitis in patients with and without altered passive eruption.

BACKGROUND: Individuals with altered passive eruption (APE) are assumed to be more susceptible to periodontal diseases. To date, this hypothesis has not been sufficiently supported by scientific evidence. The aim of this study, using an experimental gingivitis model, was to examine the development and resolution of gingival inflammation in patients with APE when compared to patients with normal gingival anatomy. METHODS: A localized experimental gingivitis was induced in 9 patients with APE (test group) and 9 patients without APE (control group) in the maxillary right quadrant. After 21 days, patients were instructed to resume proper home oral hygiene procedures. At baseline (day 0) and at days 7, 14, 21, 28, 35, and 42, plaque index (PlI), gingival index (GI), and gingival crevicular fluid volume (GCF) were evaluated for teeth 6 (canine), 7 (lateral incisor) and 8 (central incisor) of test and control groups. RESULTS: During the experimental gingivitis phase (days 0 to 21), the rate of change in gingival inflammation (GI) was dramatically different between the APE test group and the control group. On day 21, at the time of maximum plaque accumulation, the GI of the APE test group was a 109% greater than the GI of the test group (P ≤ 0.001) despite similar plaque levels (P = 0.436). During the resolution of inflammation phase (days 22 to 42), the APE test group continued to exhibit statistically higher GI scores than the control group (P = 0.029). CONCLUSION: In the presence of similar amounts of plaque deposits and plaque accumulation rates, APE patients exhibited differences in the development and resolution of plaque-induced gingival inflammation when compared to controls.

Updated recommendations for managing the care of patients receiving oral bisphosphonate therapy: an advisory statement from the American Dental Association Council on Scientific Affairs.

BACKGROUND: and Overview. In 2005, the American Dental Association (ADA) Council on Scientific Affairs convened an expert panel to develop clinical recommendations for dentists treating patients who are receiving oral bisphosphonate therapy. The Journal of the American Dental Association published the resulting report in 2006. This 2008 advisory statement is the first of projected periodic updates of the 2006 clinical recommendations. CONCLUSION: This 2008 advisory statement concludes, on the basis of a review of the current literature, that for patients receiving bisphosphonate therapy, the risk of developing bisphosphonate-associated osteonecrosis (BON) of the jaw apparently remains low. It also newly concludes that current screening and diagnostic tests are unreliable for predicting a patient's risk of developing the condition. This statement updates the 2006 recommendations regarding general dentistry, management of periodontal diseases, implant placement and maintenance, oral and maxillofacial surgery, endodontics, restorative dentistry and prosthodontics, and orthodontics.

Bisphosphonates and osteonecrosis of the jaws.

Bisphosphonates are important drugs that are increasingly prescribed to reduce the morbidity associated with osteoclast-mediated bone diseases. Shortly after the turn of the century, a variety of case reports described a necrosis of the jaw bone in patients using bisphosphonates. Currently, an exposed area of necrotic jaw bone present for at least eight weeks in patients using bisphosphonates has been defined as a bisphosphonate-associated osteonecrosis (BON) by the American Dental Association. BON may occur spontaneously but is more frequently associated with local trauma to the jaw. At this time, a causal relationship between BON and bisphosphonates has not been demonstrated. This review will evaluate current data related to the occurrence, risk, prevention, treatment, and management of BON.

Dental plaque-induced gingival conditions.

OBJECTIVE: This review proposes revisions to the current classification system for gingival diseases and provides a rationale for how it differs from the 1999 classification system. IMPORTANCE: Gingival inflammation in response to bacterial plaque accumulation (microbial biofilms) is considered the key risk factor for the onset of periodontitis. Thus, control of gingival inflammation is essential for the primary prevention of periodontitis. FINDINGS: The clinical characteristics common to dental plaque-induced inflammatory gingival conditions include: a) clinical signs and symptoms of inflammation that are confined to the gingiva: b) reversibility of the inflammation by removing or disrupting the biofilm; c) the presence of a high bacterial plaque burden to initiate the inflammation; d) systemic modifying factors (e.g., hormones, systemic disorders, drugs) which can alter the severity of the plaque-induced inflammation and; e) stable (i.e., non-changing) attachment levels on a periodontium which may or may not have experienced a loss of attachment or alveolar bone. The simplified taxonomy of gingival conditions includes: 1) introduction of the term "incipient gingivitis;" 2) a description of the extent and severity of gingival inflammation; 3) a description of the extent and severity of gingival enlargement and; 4) a reduction of categories in the dental plaque-induced gingival disease taxonomy. CONCLUSIONS: Dental plaque-induced gingival inflammation is modified by various systemic and oral factors. The appropriate intervention is crucial for the prevention of periodontitis.

Benefits and harms associated with analgesic medications used in the management of acute dental pain: An overview of systematic reviews.

BACKGROUND: Effective pain management is a priority in dental practice. Government and private agencies highlight the need to provide optimal pain relief, balancing potential benefits and harms of both opioid and nonopioid analgesic agents. The purpose of this study is to summarize the available evidence on the benefits and harms of analgesic agents, focusing on preexisting systematic reviews. TYPES OF STUDIES REVIEWED: An overview of systematic reviews was conducted to evaluate the efficacy or reported adverse events associated with orally administered medication or medication combinations for relief of acute pain. Reviews were inclusive of all age populations but were limited to those that evaluated medication and medication combinations marketed in the United States and had moderate or high methodological quality according to the A MeaSurement Tool to Assess systematic Reviews (AMSTAR) 2 tool. RESULTS: Five reviews were found eligible for inclusion. The data identified combinations of ibuprofen and acetaminophen as having the highest association with treatment benefit in adult patients and the highest proportion of adult patients who experienced maximum pain relief. Diflunisal, acetaminophen, and oxycodone were found to have the longest duration of action in adult patients. Medication and medication combinations that included opioids were among those associated most frequently with acute adverse events in both child and adult-aged patient populations. PRACTICAL IMPLICATIONS: The best available data suggested that the use of nonsteroidal medications, with or without acetaminophen, offered the most favorable balance between benefits and harms, optimizing efficacy while minimizing acute adverse events.

A review of the functional and esthetic requirements for dental implants.

BACKGROUND: The esthetic replacement of teeth has become an important standard for implant dentistry. While defining this goal has not been difficult, the ability to restore implants esthetically has been fraught with obstacles and sometimes has not been attainable. The purpose of this review is to summarize essential anatomical and surgical considerations for cosmetic implant dentistry. METHODS: This article provides a summary of the predominant findings from clinical studies and case reports that help develop implant surgical guidelines for better esthetic outcomes. RESULTS: Soft- and hard-tissue requirements for placing an implant in an ideal position are defined. The authors discuss the best treatment approaches as well as the limitations associated with esthetic implant placement. They evaluate the available data specifically for the maxillary anterior sextant, since this anatomical region has higher esthetic demands. CONCLUSIONS: Several parameters and various surgical techniques have been developed to manipulate soft- and hard-tissue contours and to control the esthetic outcome for implant-supported restorations. CLINICAL IMPLICATIONS: It is essential for practitioners to understand the anatomical basis for and limitations of implant dentistry in the esthetic zone.

The Future of Periodontal-Systemic Associations: Raising the Standards.

PURPOSE OF REVIEW: Periodontal medicine recognizes a "bidirectional" interaction between periodontitis and systemic conditions. Unfortunately, the facile ability to publish a periodontal-systemic association, regardless of biologic plausibility or rigorous scientific scrutiny, continues without abate. RECENT FINDINGS: The increasing number of periodontal-systemic associations corrupts the ability of dentists to distinguish which of the associations are spurious and which are valid. SUMMARY: The use of a Disease Association Checklist creates a register for rational assessment of current disease associations. However, to diminish the publication of spurious periodontal-systemic observational associations, editors must demand that authors follow Bradford-Hill criteria and the STROBE Statement to ensure a stringent pathway to publication.