Association between the number of existing teeth and maintenance dialysis therapy: A cross-sectional study of adult male dentists.

Dental caries and periodontal disease are typical oral diseases frequently observed in patients with renal diseases. Tooth loss is an outcome of dental caries and periodontal disease, and the number of existing teeth is an indicator of oral health status. However, the association between the number of existing teeth and end-stage kidney disease (ESKD) has not been investigated in detail. This study aimed to investigate the association between oral health status, expressed by the number of existing teeth, and ESKD. We analyzed data from the second survey of the Longitudinal Evaluation of Multi-phasic, Odontological, and Nutritional Associations in Dentists, a cohort study conducted among members of the Japan Dental Association. From August 2016 to July 2017, self-administered questionnaires were mailed to 16,128 male dentists and 8,722 responded. Among them, 7,479 men with complete data on age, number of existing teeth, and ESKD were included in the analysis. Multivariate logistic regression analysis was conducted, with ESKD as the dependent variable and the number of existing teeth (≥23 teeth and <23 teeth) as the independent variable. Subgroup analysis by age (<65 years and ≥65 years) was also conducted. The <23 teeth group had a significantly higher rate of ESKD than did the ≥23 teeth group. After adjusting for age, body mass index, smoking habits, hypertension, and diabetes mellitus, there was no significant association between having <23 teeth and ESKD in all participants. However, the subgroup analysis revealed a significant association after adjustment for covariates in participants aged <65 years but not in those aged ≥65 years. In conclusion, having <23 teeth was associated with the risk of requiring maintenance dialysis therapy among Japanese men aged <65 years. Therefore, tooth loss may be associated with renal function decline.

Evaluation of the Oral Health Education Programme for Nurses using an Oral Lesion Simulator.

PURPOSE: This study aimed to investigate the usefulness of a newly developed oral simulator for nursing students' oral assessment education on oral diseases and symptoms. MATERIALS AND METHODS: The participants were first-year students (n=105) at a nursing school in Japan. Ten identical oral simulators with angular cheilitis, missing teeth, dental caries, calculus, periodontitis, hypoglossal induration, food debris, and crust formation were created by a team of dentists. After a 45-minute lecture programme for oral assessment performance with the Oral Health Assessment Tool (OHAT), the ability test with the simulators and the OHAT as well as test feedback were conducted in a 30-minute practical programme. To evaluate the effectiveness of the programmes, questionnaires and ability tests with slides of oral images were conducted at baseline and after the programme. RESULTS: Ninety-nine students (94.3%) participated in this study. The results of the ability test with the simulators and the OHAT in the practical programme showed that the correct answer rates of assessing tongue, gingiva, present teeth, and oral pain were less than 40%. Their levels of confidence, perception, and oral assessment performance were statistically significantly higher after the programmes than they were at baseline. Their level of confidence in assessing the need for dental referral had the largest increase in scores compared to the lowest scores at baseline in the nine post-programme assessment categories. CONCLUSIONS: This study identified several problems with nursing students' oral assessment skills and improvements of their oral assessment confidence, perceptions and performance.

Effects of oral health-related quality of life on total mortality: a prospective cohort study.

BACKGROUND: The effects of oral health on mortality have been reported; however, the association between mortality and Oral Health-Related Quality of Life (OHQOL) is unknown. We investigated the effect of OHQOL on total mortality in a cohort consisting of dentists. METHODS: In this cohort study, we analyzed data from the Longitudinal Evaluation of Multi-phasic, Odonatological and Nutritional Associations in Dentists study. We conducted a baseline survey of general and oral health factors. We called for 31,178 participants and collected responses from 10,256 participants. We followed up with 10,114 participants (mean age ± standard deviation, 52.4 ± 12.1 years; females, 8.9%) for 7.7 years, until March 2014, to determine the average total mortality. OHQOL was assessed using the General Oral Health Assessment Index (GOHAI). The total score was divided into quartiles (Q1 ≤ 51.6, Q2 = 51.7-56.7, Q3 = 56.8-59.9, and Q4 = 60.0), with higher GOHAI scores indicating better OHQOL (score range, 12-60). The association between OHQOL and total mortality was analyzed using the Cox proportional hazards model. RESULTS: We documented 460 deaths. Males with low GOHAI scores possessed a remarkably high risk of total mortality. The multivariate adjusted-hazard ratios (aHRs), were 1.93 (95% confidence interval [CI], 1.07 - 3.48) for Q1, 1.69 (95% CI, 0.90 - 3.17) for Q2, and 0.65 (95% CI, 0.29 - 1.46) for Q3, relative to Q4 (trend p = 0.001). The aHRs in the multivariate model with all background variables were 1.69 (95% CI, 1.15-2.46) for Q1, 1.53 (95% CI, 1.04-2.27) for Q2, and 1.09 (95% CI, 0.71-1.70) for Q3, relative to Q4 (trend p = 0.001). In females, there was no significant association between the quartiles, in both the multivariate-adjusted model (trend p = 0.52) and multivariate-adjusted model with all background variables (trend p = 0.79). CONCLUSIONS: A lower OHQOL indicated an increased risk of total mortality in dentists. OHQOL may be used as an indicator for selecting treatment plans and personalized care interventions, thus contributing to increased healthy life expectancy. TRIAL REGISTRATION: Aichi Cancer Center, Nagoya University Graduate School of Medicine, and Hiroshima University (Approval numbers: 33, 632-3, 8-21, and E2019-1603).

Association Between Oral Health and Swallowing Function in the Elderly.

Objective: Although the oral environment significantly affects the risk of pneumonia, there have been few studies regarding its relation with swallowing. There is no doubt that there is a significant link between the oral environment and the development of pneumonia; however, there have been few comparative studies of swallowing using video endoscopy (VE) and video fluorography (VF) as indicators to determine the actual availability of oral intake and the choice of food form. This study was performed to examine whether the oral environment or swallowing function contributes more to the development of pneumonia in the elderly. Methods: The study population consisted of 24 patients (7 men and 17 women; age range: 64-97 years; average age: 86 years) assessed using the Oral Health Assessment Tool (OHAT), VE and VF at Fukuoka Dental College Hospital. The most common disease was pneumonia (17 patients), followed by cerebral infarction (5 patients), pyelonephritis (4 patients), bronchitis (2 patients), Parkinson's disease (2 patients), scleroderma (1 patient), diabetes (1 patient), eosophageal cancer (1 patient) and Parkinson's syndrome> (1 patient). Some patients had multiple diseases. Oral intake was possible in 20 patients (80%), whereas tube feeding and gastric banding were required in 4 patients. Results: The OHAT score was not correlated with either the VE or VF score. Furthermore, the OHAT score was not significantly different between the multiple- and no/single-pneumonia episode groups. The group with multiple episodes of pneumonia had lower VE and VF scores than those with no or only a single episode of pneumonia. Conclusion: Oral assessment, VE and VF are necessary to evaluate swallowing in patients with suspected dysphagia. Swallowing function, especially as assessed by VE and VF, is more important than examination of the oral environment for evaluating risk of recurrent aspiration pneumonia in the elderly. In addition, multiple factors contribute to recurrent pneumonia in patients with a good oral environment, including subclinical aspiration, pharyngeal clearance and delayed activation of the gag reflex.

Tooth brushing, tooth loss, and risk of upper aerodigestive tract cancer: a cohort study of Japanese dentisits.

Previous studies have focused on the association between poor oral health and upper aerodigestive tract (UADT) cancer. However, whether toothbrushing and tooth loss are associated with UADT cancer risk is still unclear. Therefore, we investigated the association between toothbrushing or tooth loss and UADT cancer in the Longitudinal Evaluation of Multi-phasic, Odontological, and Nutritional Associations in Dentists (LEMONADE) cohort study. From 2001 to 2006, we recruited 20,445 dentists (mean age ± standard deviation, 51.8 ± 12.0 years; 1,607 women [7.9%]) and followed for incidence or mortality of UADT cancer through March 2014. Information on lifestyle and oral health was collected by the baseline questionnaire. The Cox proportional hazards model was used to estimate hazard ratios (HRs) for UADT cancer and corresponding 95% confidence intervals (CI) for brushing frequency and tooth loss with adjustment for covariates. During the mean follow-up of 9.5 years, we confirmed 62 incident or fatal cases of UADT cancer. Infrequent toothbrushing (< 2 times/day) was significantly associated with increased risk of UADT cancer (multivariate HR = 2.13, 95% CI: 1.04-4.37). On the contrary, tooth loss was not significantly correlated with UADT cancer risk; multivariate HR was 1.03 (95% CI: 0.41-2.61) for loss of 15-27 teeth and 1.37 (0.50-3.75) for that of 28 teeth compared to tooth loss of 0-14 teeth. In conclusion, Infrequent toothbrushing was significantly associated with the risk of UADT cancer.

Comparison of Cerebral Blood Flow Patterns in Patients with Phantom Bite Syndrome with Their Corresponding Clinical Features.

BACKGROUND: Phantom bite syndrome (PBS) is characterized by an uncomfortable sensation during occlusion without any evident abnormality. A recent case-control study with single-photon emission computed tomography (SPECT) using 99mTc-ethyl cysteinate dimer could not find the specific features of regional cerebral blood flow (rCBF), which might be due to the heterogeneity of PBS. We analyzed the brain images of PBS corresponding to the clinical features by studying PBS subgroups. METHODS: This study contributes to elucidating the pathophysiology of PBS by evaluating regional brain perfusion on SPECT and its clinical features. We performed SPECT using 99mTc-ethyl cysteinate dimer in 44 patients with PBS. The SPECT images were analyzed qualitatively and quantitatively. RESULTS: Asymmetrical rCBF patterns were detected, corresponding to symptom laterality. Patients with PBS with right-side symptoms showed right-side-predominant rCBF asymmetry in the parietal region and left-side-predominant rCBF asymmetry in the thalamus, and vice versa. Moreover, the analysis of the association between rCBF and patient behaviors revealed that patients who blamed their dentists for their symptoms tended to have a symmetrical rCBF pattern. CONCLUSION: Patients with PBS showed blood flow imbalance in the thalamus and parietal region corresponding to symptom laterality. There are two types of symmetrical and asymmetrical rCBF patterns in the pathophysiology of PBS despite similar clinical manifestations.

Tooth loss and pneumonia mortality: A cohort study of Japanese dentists.

Although associations between oral health and pneumonia have been reported in previous studies, particularly in the institutionalized elderly, few prospective studies have investigated the association between oral condition and pneumonia among community-dwelling people and whether the findings among inpatients or patients in nursing homes are applicable to the general population is still unclear. The oral bacteria propagated in the periodontal regions may drop into the lung and increase the risk of pneumonia. We, therefore, investigated the association of tooth loss with mortality from pneumonia in a cohort study of Japanese dentists. Members of the Japan Dental Association (JDA) participated in the LEMONADE (Longitudinal Evaluation of Multi-phasic, Odontological and Nutritional Associations in Dentists) Study. From 2001 to 2006, they completed a baseline questionnaire on lifestyle and health factors including the number of teeth lost (excluding third molars). We followed 19,775 participants (mean age ± standard deviation, 51.4 ± 11.7 years; 1,573 women [8.0%] and 18,202 men [92.0%]) for mortality from pneumonia (ICD-10, J12-J18). Mortality data were collected via the fraternal insurance program of the JDA. The hazard ratios (HRs) were estimated with adjustment for sex, age, body mass index, smoking status, physical activity and diabetes history. During the median follow-up period of 9.5 years, we documented 68 deaths from pneumonia. Participants who were edentulous at baseline were at significantly increased risk of mortality from pneumonia. The multivariable-adjusted HRs were 2.07 (95% confidence interval [CI], 1.09-3.95) for the edentulous and 1.60 (95% CI, 0.83-3.10) for loss of 15-27 teeth relative to loss of 0-14 teeth (trend p = 0.026). The HR per one tooth loss was also significant; 1.031 (95% CI, 1.004-1.060). In conclusion, a large number of teeth lost may indicate an increased risk of mortality from pneumonia in community-dwelling populations.

Comparison of Practices, Knowledge, Confidence, and Attitude toward Oral Cancer among Oral Health Professionals between Japan and Australia.

The purpose of this study was to investigate the practices, knowledge, confidence, and attitude toward oral cancer among Japanese oral health professionals (J-OHPs) and to identify Japanese-specific problems in oral cancer practices by comparing them between Japan and Australia. A questionnaire survey regarding oral cancer practices among Australian oral health professionals (Au-OHPs) was conducted in Australia in 2014-2015. The questionnaire was translated into Japanese, and a Web-based questionnaire survey was conducted among 131 Japanese dentists (J-Dentists) and 131 dental hygienists (J-DHs) in 2016. To compare the J-OHPs' findings with the Au-OHPs', the data of Australian dentists (Au-dentists) and Australian dental hygienists (Au-DHs) were extracted from the Australian survey. Those findings were then compared via a statistical analysis. Eighty-two J-Dentists, 55 J-DHs, 214 Au-Dentists, and 45 Au-DHs participated in this study. Only 34.1 % of J-Dentists and 36.4 % of J-DHs performed oral cancer screenings on their patients; J-OHPs were significantly less likely to perform them than Au-OHPs. The level of knowledge and confidence regarding oral cancer among JOHPs were significantly lower than among Au-OHPs. About 90 % of J-OHPs felt that they needed additional training in oral cancer practices. Less than 40 % of J-OHPs performed oral cancer screenings in their patients. The low level of knowledge and confidence regarding oral cancer among JOHPs may contribute to their low performance of oral cancer practices. Therefore, further education and training programs for oral cancer practices should be provided to Japanese OHPs for the prevention and early detection of oral cancer.

Gingival Pigmentation Affected by Smoking among Different Age Groups: A Quantitative Analysis of Gingival Pigmentation Using Clinical Oral Photographs.

The presence of any age-related differences in gingival pigmentation associated with smoking, particularly in a young population, remains to be fully investigated. The purpose of this study was to determine the age-related differences in smoking gingival pigmentation. Gingival pigmentation was analyzed using the gingival melanosis record (GMR) and Hedin's classification with frontal oral photographs taken at 16 dental offices in Japan. Participants were categorized into 10-year age groups, and their baseline photographs were compared. In addition, to evaluate the effect of smoking cessation on gingival pigmentation, subjects were divided into a former smoker group (stopped smoking) and current smoker group. A total of 259 patients 19 to 79 years of age were analyzed. People in their 30s showed the most widespread gingival pigmentation. In addition, subjects in their 20s showed a weak effect of smoking cessation on gingival pigmentation. These findings suggested that the gingival pigmentation induced by smoking was more remarkable in young people than in middle-aged people. This information may be useful for anti-smoking education, especially among young populations with a high affinity for smoking.

Measurement of Reduced Gingival Melanosis after Smoking Cessation: A Novel Analysis of Gingival Pigmentation Using Clinical Oral Photographs.

BACKGROUND: Due to moisture and the anatomical complexity of the oral mucosa, it is difficult to measure the extent of gingival melanosis in an optical manner. Therefore, we developed a new quantitative method using clinical oral photographs and compared the extent of gingival melanosis before and after smoking cessation. METHODS: A new analysis method, which we named the gingival melanosis record (GMR), is a quantitative analysis method using clinical oral photographs. We obtained 659 clinical photographs from 263 patients from 16 general dental offices in Japan. Standardized measuring sites were automatically spotted on the screen, and the presence of gingival melanosis was determined at the measuring sites. We assessed the validity of the GMR with the previously reported Hedin's classification using Spearman's rank correlation and intraclass correlation coefficients. RESULTS: The GMR showed a significant association with Hedin's classification (p < 0.01, correlation coefficient = 0.94). The GMR also showed excellent reproducibility of the substantial repeated agreement intraclass correlation coefficients (ICC) (1,1) and ICC (2,1), p > 0.61). The longitudinal loss of gingival melanosis was confirmed by a change in the GMR among patients who successfully achieved smoking cessation for a mean of 4.5 years. CONCLUSION: The GMR is an effective method to assess gingival melanosis. The loss of gingival melanosis after smoking cessation can be objectively confirmed with the use of the GMR.

Surgical or nonsurgical treatment for teeth with existing root filings?

DATA SOURCES: Data was sought using Medline and the Cochrane Library, and relevant chapters from three major endodontic texts were consulted: Principles and Practice of Endodontics (4th Edn; editors; Torabinejad and Walton; 2008); Pathways of the Pulp (9th edition; editors, Cohen and Hargreaves; 2006), and Endodontics (6th edition; editors, Ingle, Bakland and Baumgartner; 2008). Every issue was also searched of the most recent 2 years of the following major endodontic journals: International Endodontic Journal; Journal of Endodontics; and Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology and Endodontology along with the reference lists of identified articles. STUDY SELECTION: Articles were included from peer-reviewed journals if they were published in English, and reported clinical and/or radiographic outcome data for nonsurgical endodontic retreatment or for endodontic surgery, with followup data for a minimum of 25 teeth and a minimum 2-year mean followup period. Studies reporting outcomes based on individual roots as opposed to whole teeth, or that did not report clinical or radiographic outcomes, which were animal studies, or studies that reported histological data only, were excluded. DATA EXTRACTION AND SYNTHESIS: When necessary, the reviewers recalculated success and failure rates when they were not directly provided in papers' tables or in the text, or when only particular data subsets met the inclusion criteria. To facilitate meta-analysis, the data were standardised according to a commonly applied classification system used to assess outcomes for nonsurgical retreatment and surgical endodontics: (1) Complete healing; (2) Incomplete healing; (3) Uncertain healing; and (4) Unsatisfactory healing (failures). When uncertainty existed regarding which of the above four categories correlated with those reported in a given article, the data were assigned to the lower healing category. For this review, success was defined as teeth categorised as showing complete healing or incomplete healing. Weighted success rates, pooled success rates, and 95% confidence interval (CI) estimates of outcomes were generated in the metaanalysis from compiled data from the included studies by using the DerSimonian-Laird random effects pooling method. RESULTS: Twenty-six endodontic surgery and eight nonsurgical retreatment articles were included. There were only four randomised controlled trials (one in the nonsurgical retreatment, and three in the endodontic surgery group). A significantly higher success rate was found for endodontic surgery at 2-4 years (77.8%) than for nonsurgical retreatment for the same followup period (70.9%; P <0.05). At 4-6 years, however, this relationship was reversed, with nonsurgical retreatment showing a higher success rate of 83.0%, compared with 71.8% for endodontic surgery (P <0.05). Insufficient numbers of articles were available to make comparisons after 6 years of followup. Endodontic surgery studies showed a statistically significant decrease in success with each increasing followup interval (P <0.05). The weighted success for 2-4 years was 77.8%, which declined at 4-6 years to 71.8% and further declined at >6 years to 62.9% (P <0.05). Conversely, the nonsurgical retreatment success rates demonstrated a statistically significant increase in weighted success at 2-4 years (70.9%) versus 4-6 years (83.0%; P <0.05). CONCLUSIONS: On the basis of these results it appears that endodontic surgery offers more favourable initial success, but nonsurgical retreatment offers a more favourable long-term outcome.

Tooth loss and intakes of nutrients and foods: a nationwide survey of Japanese dentists.

OBJECTIVES: To clarify the association of tooth loss with dietary intakes among dentists, for whom sufficient dental care is available. METHODS: We analyzed the data from 20 366 Japanese dentists (mean age +/- SD, 52.2 +/- 12.1 years; women 8.0%) who participated in a nationwide cohort study from 2001 to 2006. The baseline questionnaire included a validated food-frequency questionnaire to estimate intakes of foods and nutrients. We computed the geometric means of daily intakes by the number of teeth, adjusting for age, sex, smoking, physical activity, and history of diabetes. RESULTS: The mean intakes of some key nutrients and food groups, such as carotene, vitamins A and C, milk and dairy products, and vegetables including green-yellow vegetables, decreased with the increasing number of teeth lost (P for trend <0.05). On the contrary, mean intakes of carbohydrate, rice, and confectioneries were increased among those with fewer teeth (P for trend <0.05). The difference in the geometric mean (%) between totally edentulous subjects and those with > or =25 teeth, that is [(Geometric mean for > or =25 teeth) - (Geometric mean for 0 teeth)]/(Geometric mean for > or =25 teeth) x 100, was 14.3%, 8.6%, 6.1%, and -6.1% for carotene, vitamin C, vitamin A, and carbohydrate, respectively. For food groups, it was 26.3%, 11.9%, 5.6%, -9.5%, and -29.6% for milk and dairy products, green-yellow vegetables, total vegetables, rice, and confectioneries, respectively. CONCLUSIONS: Tooth loss was linked with poorer nutrition even among dentists.

Parental smoking and smoking status of Japanese dental hygiene students: a pilot survey at a dental hygiene school in Japan.

This study aimed to determine the frequency of smoking and to explore factors associated with the smoking habits of female students at a dental hygiene school in Japan. Questionnaires regarding cigarette smoking were given to 168 female students. The response rate was 97.6%. The prevalence of smoking, including current and occasional smokers, was 20.3%. Among family members, only the smoking status of their mother significantly influenced the smoking status of the students. The odds ratio for smoking among dental hygiene students whose mothers were smokers in comparison to students whose mothers were not smokers was 5.1 (95% confidence interval 2.1-12.2, p=0.000). Decision tree analysis showed that the smoking habit of dental hygiene students was correlated with their mothers' smoking history, as well as the smoking status of junior high school teachers, the smoking habits of close friends and a history of participating in a smoking prevention program when in elementary school. The increased smoking rate of young females, including dental hygienists, is a growing problem in Japan. The smoking statuses of dental hygiene students might be closely influenced by their mothers' smoking status.

The relationship between alcohol consumption and oral malodour.

OBJECTIVE: To analyse the relationship between alcohol consumption and oral malodour. SUBJECTS: 235 individuals, aged 46.5 +/- 15.3 years (mean +/- SD), who complained of oral malodour. METHODS: An organoleptic test (OLT) was used to estimate the degree of oral malodour, gas chromatography was used to measure volatile sulphur compounds (VSCs), and a questionnaire was used to gather data about the subjects' habits related to alcohol consumption. RESULTS: Of the 55 individuals who consumed alcohol daily, 17 (30.9%) had strong malodour (OLT score, 4), and there were significant differences among the 'daily', 'sometimes', and 'no alcohol' groups (Kruskal-Wallis test, p < 0.01). The daily group also had a higher VSC concentration than the 'sometimes' and 'no alcohol' groups (t-test, p < 0.05), and there was no difference in the VSC concentration among the subjects with strong malodour. Analyses of the relationships between drinking habits and the clinical factors causing oral malodour revealed that daily drinking was positively associated with a probing pocket depth > or = 5 mm (chi2 test, p < 0.01). CONCLUSION: This study found an association between daily alcohol consumption and strong malodour, especially related to periodontal disease.

Longitudinal Evaluation of Multi-phasic, Odontological and Nutritional Associations in Dentists (LEMONADE Study): study design and profile of nationwide cohort participants at baseline.

BACKGROUND: To examine the association between oral health and general well-being, we are currently conducting a nationwide cohort study comprising members of the Japan Dental Association (JDA). Herein, we describe the study design and the profile of the participants at baseline. METHODS: From 2001 through 2006, the participants completed a baseline questionnaire that surveyed factors related to lifestyle, general health, and oral health. Morbidity and mortality have been monitored by using information from fraternal insurance programs operated by prefectural dental associations. All respondents provided written, informed consent for participation and the use of their insurance data. RESULTS: A total of 21,272 JDA members participated in the baseline survey (response rate, 36.2%). Their mean age +/- SD was 52.3 +/- 12.3 years; 8.0% were women. Among the respondents, 30.2% of men and 10.7% of women were current smokers; 73.5% of men and 44.8% of women were current drinkers. The cohort scored higher on oral health indices than did the general Japanese population: dentists were more likely to brush their teeth > or =3 times/day, to have > or =20 teeth, to have fewer lost teeth, to be free from periodontal diseases, and to have higher General Oral Health Assessment Index scores. There was, however, considerable inter-individual variation in scores on the indices. CONCLUSIONS: More than one-third of JDA members participated in the study. Their oral average health status was better than that of the general population. Nevertheless, it will be possible to compare morbidity and mortality between those with better and worse scores on oral health indices.

Detection of Helicobacter pylori DNA in the saliva of patients complaining of halitosis.

Helicobacter pylori infection, which causes peptic ulcers and gastric cancer, is considered a possible cause of halitosis. Recently, the oral cavity was identified as a possible H. pylori reservoir, particularly in the presence of periodontal disease, which is a cause of halitosis. The purpose of this study was to evaluate by PCR the prevalence of oral H. pylori in the saliva of subjects complaining of halitosis. Samples were obtained from 326 non-dyspeptic subjects, comprising 251 subjects with actual malodour and 75 subjects without halitosis. DNA was extracted from the samples, and the presence of H. pylori and periodontopathic bacteria including Porphyromonas gingivalis, Treponema denticola and Prevotella intermedia was examined by PCR. H. pylori was detected in 21 (6.4 %) of 326 samples. The methyl mercaptan concentration and periodontal parameters including tooth mobility, periodontal pocket depth (PPD) and occult blood in the saliva were significantly greater in the H. pylori-positive subjects. Each of the periodontopathic bacteria was also detected at a significantly higher frequency in the H. pylori-positive subjects. Among those patients with a PPD of > or =5 mm and a tongue coating score of < or =2, no difference was observed in oral malodour levels between the H. pylori-positive and -negative subjects. However, the presence of occult blood in the saliva and the prevalence of Prevotella intermedia were significantly greater in the H. pylori-positive subjects. H. pylori was detected in 16 (15.7 %) of 102 subjects with periodontitis, suggesting that progression of periodontal pocket and inflammation may favour colonization by this species and that H. pylori infection may be indirectly associated with oral pathological halitosis following periodontitis.

Relationship between halitosis and psychologic status.

OBJECTIVE: To examine the psychosomatic aspects of patients complaining of halitosis. STUDY DESIGN: Breath malodor in 165 patients was measured using an organoleptic test (OLT), sulfide monitoring, and gas chromatography. Clinical evaluation included oral examination, OLT, and volatile sulfur compound measurement. The psychologic condition of patients was assessed using the Cornell Medical Index (CMI). RESULTS: Every item in the CMI questionnaire was negatively correlated with the OLT scores. Nine of 21 subjects (42.9%) diagnosed with pseudohalitosis and approximately 20% of subjects diagnosed with genuine halitosis were considered to be provisionally neurotic. Subjects with pseudohalitosis reported significantly higher physical scores, but not mental scores, than those with genuine halitosis. Subjects with physiologic halitosis showed significantly higher symptoms of depression than those with oral pathologic halitosis. CONCLUSION: The psychologic condition of patients complaining of halitosis was associated with the actual degree of malodor and the clinical characteristics.

Ultrasonic preparation improves outcome in apical surgery.

DESIGN: This was a randomised controlled trial (RCT). INTERVENTION: Root-end resection and preparation with a round dental bur was compared with the use of ultrasonic diamond coated retro-tips. OUTCOME MEASURE: Treatment was considered a success when the radiological and clinical criteria listed (Table 1) were met. RESULTS: Out of a total group of 399 patients who were included in the study, adequate followup could be obtained in 290 patients. The overall success rate in the ultrasonic group was 80.5% and in the group treated with a bur was 70.9% (P 0.056). In molars, the difference in success rate was significant (P 0.02). CONCLUSIONS: The use of an ultrasonic device in apical surgery showed a clear benefit over the traditional treatment. Especially in molars, the results were significant.

Association between vitamin D receptor gene haplotypes and chronic periodontitis among Japanese men.

BACKGROUND: The vitamin D receptor (VDR) is involved in a variety of biological processes, such as bone metabolism and modulation of the immune response. Recent findings suggest that the pathway involving bone mineral density-mediated effects is important for the development of periodontitis, but their effects of combined VDR gene polymorphisms have not been confirmed on periodontitis. We assessed the relationship between ApaI, BsmI, and FokI VDR polymorphisms and the risk of severe chronic periodontitis among Japanese adult men. MATERIALS AND METHODS: In a cross-sectional study, we examined 97 unrelated healthy Japanese men (mean age: 45.6 years, range: 22-59). A clinical examination was performed at a worksite health checkup, and information was obtained using a self-reported questionnaire. DNA was extracted from whole blood, and the VDR ApaI, BsmI, and FokI polymorphisms were genotyped using polymerase chain reaction. RESULTS: F-carriers of FokI VDR polymorphisms were less likely to develop severe chronic periodontitis than non-F-carriers (p = 0.09). The ApaI and BsmI VDR polymorphisms did not show significant differences in the alleles or genotypes between the subjects with or without severe chronic periodontitis. The haplotype analysis of the three combined VDR polymorphisms revealed that the Abf homozygote had a notably higher prevalence of severe chronic periodontitis than the others, and adjustments for age, smoking status, number of teeth present, and prevalence of diabetes did not change this association (OR = 7.5; 95% CI = 1.6-34.4; p = 0.01). CONCLUSION: The VDR haplotype constructed from the ApaI, BsmI, and FokI polymorphisms is related to the risk of severe chronic periodontitis in Japanese men.

Periodontal disease and atherosclerosis from the viewpoint of the relationship between community periodontal index of treatment needs and brachial-ankle pulse wave velocity.

BACKGROUND: It has been suggested that periodontal disease may be an independent risk factor for the development of atherosclerosis. However, the relationship between periodontal disease and atherosclerosis has not been fully elucidated. This study aimed to assess the effects of periodontal disease on atherosclerosis. METHODS: The study design was a cross-sectional study. Subjects were 291 healthy male workers in Japan. We used the Community Periodontal Index of Treatment Needs (CPITN) score, average probing depth and gingival bleeding index (rate of bleeding gums) to assess the severity of periodontal disease. We also used the Brachial-Ankle Pulse Wave Velocity (baPWV) as the index for the development of atherosclerosis. RESULTS: The unadjusted odds ratio (OR) of atherosclerosis in relation to the CPITN score was 1.41 [95% CI: 1.16-1.73]. However, after adjustment for age, systolic blood pressure and smoking, the CPITN score had no relationship with atherosclerosis (adjusted OR: 0.91 [0.68-1.20]). CONCLUSION: Our results show no relationship between mild periodontal disease and atherosclerosis after appropriate adjustments.