Association between bleeding periodontal pockets and eczemas: Results of the Northern Finland Birth Cohort 1966.

AIM: To investigate whether the periodontal condition as measured by bleeding periodontal pockets is associated with atopic dermatitis, seborrheic dermatitis, and eczema nummulare. MATERIALS AND METHODS: The study population (n = 1871) was obtained from the 46-year follow-up study of the Northern Finland Birth Cohort 1966 study (NFBC1966). The periodontal condition was measured by the number of sites with bleeding periodontal pockets that were ≥4 mm deep. The whole skin of the participants was clinically examined, and diagnoses of skin diseases were made according to the International Classification of Diseases. Prevalence rate ratios (PRR) and 95% confidence intervals (95% CIs) were estimated using Poisson regression models with robust error variance. RESULTS: In this cohort, comprising 46-year-old participants of NFBC1966, the presence of 1-3 and ≥4 bleeding-deepened periodontal pockets (≥4 mm deep) were associated with seborrheic dermatitis (PRR 1.9, 95% CI: 1.3-2.8 and PRR 2.2, 95% CI: 1.4-3.3, respectively) and with eczema nummulare (PRR 1.7, 95% CI: 0.9-3.1 and PRR 1.7, 95% CI: 0.9-3.3, respectively). For non-smokers, the corresponding estimates were 1.7 for seborrheic dermatitis (95% CI: 1.1-2.6) and 1.8 (95% CI: 1.1-3.1) and 1.4 for eczema nummulare (95% CI: 0.7-2.9) and 1.2 (95% CI: 0.5-2.9), respectively. No association was found between bleeding-deepened periodontal pockets and atopic dermatitis. Further adjustments for C-reactive protein, diabetes, and inflammatory diseases did not essentially change the risk estimates among either the total population or the non-smokers. CONCLUSION: Bleeding periodontal pockets appeared to be associated with the presence of seborrheic dermatitis and eczema nummulare.

Effects of oral healthcare motivation in patients with gingival oral lichen planus: A randomized controlled trial.

OBJECTIVES: The role of dental plaque in gingival lesions caused by oral lichen planus has not been fully defined. The aim of this clinical trial was to evaluate the effects of oral healthcare motivation on clinical variables in patients with gingival oral lichen planus. MATERIAL AND METHODS: Oral lichen planus patients with symptomatic gingival lesions were randomized in control and intervention groups. The intervention group was instructed to effectively remove bacterial biofilm from dental surfaces, while controls did not receive any advice. The outcome variables were as follows: quality of life (OHIP-14), pain, plaque index and clinical severity of the disease (Escudier index). Outcome variables were assessed at 0, 4 and 20 weeks and analysed using an ANOVA model for factorial design. RESULTS: Data from 60 patients were collected. Regression analysis showed a significant positive trend of OHIP-14, plaque index and Escudier index in the intervention group compared to controls (p < 0.05). Pain did not prove significantly different (p = 0.408). CONCLUSIONS: Plaque control improved both OHIP-14 and gingival lesion clinical severity. Oral hygienists should be involved in the multidisciplinary management of patients affected by oral lichen planus with gingival lesions.

Reported gum disease as a cardiovascular risk factor in adults with intellectual disabilities.

BACKGROUND: Several risk factors for cardiovascular disease (CVD) have been identified among adults with intellectual disabilities (ID). Periodontitis has been reported to increase the risk of developing a CVD in the general population. Given that individuals with ID have been reported to have a higher prevalence of poor oral health than the general population, the purpose of this study was to determine whether adults with ID with informant reported gum disease present greater reported CVD than those who do not have reported gum disease and whether gum disease can be considered a risk factor for CVD. METHODS: Using baseline data from the Longitudinal Health and Intellectual Disability Study from which informant survey data were collected, 128 participants with reported gum disease and 1252 subjects without reported gum disease were identified. A series of univariate logistic regressions was conducted to identify potential confounding factors for a multiple logistic regression. RESULTS: The series of univariate logistic regressions identified age, Down syndrome, hypercholesterolemia, hypertension, reported gum disease, daily consumption of fruits and vegetables and the addition of table salt as significant risk factors for reported CVD. When the significant factors from the univariate logistic regression were included in the multiple logistic analysis, reported gum disease remained as an independent risk factor for reported CVD after adjusting for the remaining risk factors. Compared with the adults with ID without reported gum disease, adults in the gum disease group demonstrated a significantly higher prevalence of reported CVD (19.5% vs. 9.7%; P = .001). CONCLUSION: After controlling for other risk factors, reported gum disease among adults with ID may be associated with a higher risk of CVD. However, further research that also includes clinical indices of periodontal disease and CVD for this population is needed to determine if there is a causal relationship between gum disease and CVD.

Oral Infections and Pregnancy: Knowledge of Gynecologists/Obstetricians, Midwives and Dentists.

PURPOSE: To establish an inventory of knowledge, attitudes and daily pratice of dental and medical practitioners in France regarding oral health care and its relationship to pregnancy, particularly to preterm delivery and low birth-weight infants. MATERIALS AND METHODS: A questionnaire was distributed to health-care professionals (n= 460), consisting of 100 prenatal care practitioners (obstetricians, midwives) and 360 dentists, about their knowledge of oral alterations during pregnancy, the possible association between periodontal disorders and preterm/low birth weight, and their conduct toward their patients. RESULTS: Bleeding gums and pregnancy gingivitis were the oral manifestations most often cited by all the practitioners. In contrast, prenatal care practitioners were unaware of epulis and a greater percentage of them than dentists believed caries risk to increase during pregnancy. The most adverse pregnancy outcomes cited were risk of premature delivery and chorioamniotis. Only dentists had received initial training on pregnancy complications. Finally, all health professionals point out the lack of continuing education on this topic. CONCLUSION: The present results underline the need for a better initial professional education and continuing education regarding pregnancy and oral health conditions and emphasise the need to update the guidelines in health care practices for pregnant women for a more effective prevention of risk-related adverse pregnancy outcomes, such as pre-term birth or pre-eclampsia.

The impact of structured plaque control for patients with gingival manifestations of oral lichen planus: a randomized controlled study.

AIM: To evaluate the impact of a structured plaque control intervention on clinical and patient-centred outcomes for patients with gingival manifestations of oral lichen planus. MATERIALS AND METHODS: Eighty-two patients were recruited into a 20-week randomized controlled trial. The intervention was structured plaque control comprising powered tooth brushing and inter-dental cleaning advice. Control subjects continued with their normal dental plaque control regimen. The primary outcome measure was the oral health impact profile (OHIP) with secondary outcomes of pain, plaque index, mucosal disease score and cost-effectiveness. RESULTS: Overall, the intervention patients showed statistically significant improvements in OHIP sum ordinal and OHIP dichotomous scores compared with control. There were improvements in the functional limitation, psychological discomfort and physical disability domains at 4- and 20-weeks and in the psychological disability domain at 20-weeks. The intervention was successful in reducing plaque compared to control (p < 0.001) and improvements were observed using the mucosal disease indices at the 4- and 20-week follow-ups (p < 0.001). CONCLUSION: A structured plaque control intervention was effective in improving the oral health-related quality of life and clinically observed gingival lesions. This study provides evidence to include intensive plaque control within patients' initial and on-going management.

Enamel defect and gingival enlargement in pediatric patients with kidney disease at Srinagarind Hospital, Khon Kaen University, Thailand.

BACKGROUND: Although many complications from kidney disease therapy can be prevented or effectively treated, oral health problems are nevertheless a consequence. OBJECTIVE: The objective of this study was to explore the prevalence of enamel defect and gingival enlargement in pediatric patients with kidney disease at Srinagarind Hospital, Khon Kaen University, Thailand. MATERIAL AND METHOD: This cross-sectional study was conducted between January and August 2013, at SrinagarindHospital, Khon Kaen University. Ninety-seven pediatric patients with kidney disease were allowed by their parents to participate in this study. Data were collected from medical records, questionnaires and oral examination records. The enamel defect was recorded using the Developmental Defects of Enamel Index. Gingival enlargement was recorded using the GingivalEnlargement Index. An oral examination was conducted using a mouth mirror, explorer and periodontal probe. RESULTS: The average age of the pediatric patients with kidney disease was 11.53+3.7years (range, 4-17). The majority of subjects were able to (a) come for an appointment (97.9%), (b) take medication according to the medical directions (93.8%) and (c) avoid inappropriatefoodsfor those suffering kidney disease (84.5%). The prevalence of enamel defect was 27.8%. The most common enamel defects were demarcated opacities (13.4%) or diffuse opacities (9.3%). The prevalence ofgingival enlargement was 16.5%. CONCLUSION: This study revealed that the prevalence ofenamel defect was 27.8% and the prevalence ofgingival enlargement was 16.5%.

Treatment of invasive cervical resorption with sandwich technique using mineral trioxide aggregate: a case report.

This article presents two cases of large invasive cervical resorption (ICR) with maintenance of pulp vitality after treatment with mineral trioxide aggregate (MTA) in a sandwich technique.Invasive cervical resorption is a relatively uncommon but aggressive form of external resorption, primarily caused by dental trauma or injury of the cervical periodontal attachment. The resorptive process does not penetrate into the root canal, and the pulp is not involved in the first phase of the resorption. This feature differentiates external resorption from internal resorption. In most cases, invasive cervical resorption is found during routine radiographic or clinical examination. Different materials have been proposed for the treatment of external cervical resorption. Therapy can be effective when it 1) removes the etiological factors and 2) interrupts the progressive resorption mechanism.The key learning points of this article are the following: treatment strategy to arrest the cervical resorption process and to prevent further resorption without changing pulpal vitality and successful seal of invasive cervical resorption defect using MTA with a sandwich technique.

Professional oral hygiene treatment and detailed oral hygiene instructions in patients affected by mucous membrane pemphigoid with specific gingival localization: a pilot study in 12 patients.

OBJECTIVES: The aim of this prospective case series was to assess the clinical efficiency of an oral hygiene protocol in patients affected by mucous membrane pemphigoid (MMP) with specific gingival localization, before starting any medical treatment. METHODS: Patients received oral hygiene instruction followed by non-surgical periodontal therapy including oral hygiene instructions in a 3-week cohort study. Clinical outcome variables were recorded at baseline and 5 weeks after intervention and included, as periodontal parameters, full mouth plaque (FMPS) and bleeding (FMBS) scores and patient-related outcomes (visual analogue score of pain). RESULTS: A total of 12 patients were recruited. The mean age at presentation was 59.5 ± 14.52 years. Five weeks after finishing the oral hygiene and periodontal therapy protocol, a statistical significant reduction was observed for FMPS (P = 0.001), FMBS (P = 0.022) and reported pain (P = 0.0028). CONCLUSIONS: Professional oral hygiene procedures and non-surgical periodontal therapy are connected with improvement of gingival status and decrease in gingival-related pain, in female patients affected by MMP with specific gingival localization.

Periodontal status in oral mucous membrane pemphigoid: initial results of a case-control study.

OBJECTIVE: To evaluate the periodontal status of mucous membrane pemphigoid (MMP) patients and compare it with that of healthy controls. METHODS: A prospective study was undertaken to examine the impact of gingival MMP lesions on the human periodontium of 29 patients. Parameters evaluated included full mouth plaque score (FMPS), full mouth bleeding upon probing scores, probing depths (PD), gingival recession, clinical attachment level (CAL), mobility score, furcation involvement, number of missing teeth and Machtei criteria. RESULTS: All periodontal parameters recorded were increased in cases when compared to controls in univariate statistics. The mean differences between groups in PD (0.8±0.2mm, 95% CI 0.3-1.3), CAL (1.3±0.4mm, 95% CI 0.4-2.2), FMPS (41.0±6.2%, 95% CI 28.7-53.4), FMBS (16.2±6.6%, 95% CI 3.0-29.4) and tooth loss (2±1 teeth, 95% CI 1-3) were all statistically significant (P<0.01 for all). Substantial differences in domiciliary oral hygiene routines were observed (P<0.0001). In multivariate models when FMPS was included as covariate the difference between groups in all clinical periodontal parameters was no longer statistically significant. CONCLUSIONS: Our results showed that periodontal status is worse in MMP patients if compared with healthy controls due to a substantial difference in oral hygiene. Oral health should be promoted in MMP.

Influence of oral health and lifestyle on oral malodour.

OBJECTIVE: To assess the influence of oral health and lifestyle on the prevalence of oral malodour among university students. MATERIALS AND METHODS: Self-administered questionnaires. Chi-square test was used to detect any significant association between malodour and various variables. RESULTS: 9% of males and 6% of females complained of malodour, while 36% of males and 31% of females did not complain of malodour. Nevertheless, 12% of the males and 6% of females were unable to decide. The highest percentage of respondents not complaining of malodour were non-smokers (55%). A significant number of respondents were free from caries (48%), gingival disease (55%) and also were not complaining of malodour. Statistically, a significant association was found between malodour and gingival disease (p < 0.05) and between malodour and the use of a toothbrush on a daily basis (p < 0.001). CONCLUSIONS: The results highlight the influence of oral self-care and lifestyle on malodour. Public awareness, diagnosis and treatment of malodour are primarily the responsibility of dentists. Malodour can have a distressing effect and the affected person may avoid socialising.

Evaluation of oral hygiene status, salivary characteristics and dental caries experience in acute lymphoblastic leukemic (ALL) children.

Leukemia constitutes approximately 30% of all childhood cancers and Acute Lymphoblastic Leukemia (ALL) is the most common type of malignancy. Oral dryness, ulceration, increased dental decay seen is due to altered salivary flow rate and buffering capacity in these children. Oxidative stress may play an important role in the malignancies resulting in onset of inflammatory oral pathologies. Saliva constitutes first line of defense against free radical-mediated oxidative stress. The present study attempted to relate the oral health status, salivary flow rate, salivary pH, gingival health status, dental caries experience and total salivary antioxidant levels in ALL children. A total of 120 children aged 4-10 years (90 leukemic children, study group and 30 normal healthy siblings, control group) were divided into 4 groups of 30 each. Oral health status, gingival status and dental caries experience was recorded followed by un-stimulated saliva collection. Total antioxidant capacity of un-stimulated saliva was evaluated. The results depicted deterioration in oral health status, gingival status and increased dental caries experience in leukemic children. Salivary flow rate, salivary pH and total salivary antioxidant levels were lowered in leukemic children when compared with control group.

Oral lichen planus and dental hygiene: a case report.

BACKGROUND: The presence of atrophic-erosive lesions among gingival tissues makes oral hygiene procedures difficult for several reasons. Plaque control and rigorous oral hygiene are a fundamental requisite for the treatment of any oromucosal disease. CASE REPORT: A patient suffering from a mixed atrophic-erosive form of oral lichen planus (OLP), with serious gingival involvement, was also treated with the topical application of clobetasol propionate 0.05% using gingival trays. The highest hygiene standards of both patient and trays were of fundamental importance. DISCUSSION: The management of the patient suffering from gingival atrophic-erosive OLP requires the synergic treatment of both dentist and dental hygienist, whose contribution supports the corticosteroid and/or immunosuppressive treatment.

Peripheral giant cell granuloma.

Peripheral giant cell granuloma is a benign reactive lesion of gingiva. It manifests as a firm, soft, bright nodule or as a sessile or pedunculate mass. This article reports the management of peripheral giant cell granuloma in a 12-year-old boy by surgical excision.

Langerhans cell histiocytosis: oral/periodontal involvement in adult patients.

OBJECTIVE: Langerhans cell histiocytosis (LCH) is a clonal proliferative multisystem disease. Although bone and mucosae have been classified as non-risk organs, their involvement may increase the risk of disease progression. Oral and periodontal lesions are burdened with a significant impairment of quality of life for associated signs, symptoms and loss of function. Most of information regards paediatric disease; the disease in adults has received limited attention. SUBJECTS AND METHODS: A total of 31 adult patients affected by immuno-histopathology confirmed LCH have been prospectively examined; attention was paid to the occurrence and characterization of oral lesions. RESULTS: Twelve patients developed oral lesions. Posterior regions of jawbones were always affected; the involvement of anterior regions was not constant. Unifocal oral involvement was significantly associated with multisystemic disease while multifocal lesions were associated with unisystemic disease. Oral disease presented with soft tissue ulcers (50% of cases), gingival bleeding (66.7%), pain (83.4%), periodontal damage (50%), tooth mobility (16.7%), non-healing extraction socket (8.3%); 41.6% of patients complained of negative outcomes on quality of life. Oral lesions were easily handled with local measures. CONCLUSIONS: Posterior regions require attention; single oral lesions may be part of multisystemic disease; oral and periodontal lesions may be early signs of disease reactivation.