Periodontal grading-estimation of responsiveness to therapy and progression of disease.

OBJECTIVE: To investigate the capability of periodontal grading to estimate the progression of periodontal disease and the responsiveness to therapy. MATERIALS AND METHODS: Eighty-four patients who underwent non-surgical therapy (NST) were included. Direct and indirect evidence of progression were determined according to the current classification. Responsiveness to therapy was examined using mean pocket probing depths reduction (PPDRed), reduction of bleeding on probing (BOPRed), and the rate of pocket closure (%PC) after six months. RESULTS: Statistical analysis revealed no agreement between direct and indirect evidence in grading periodontitis (κ = 0.070). The actual rate of progression as determined by longitudinal data was underestimated in 13% (n = 11), overestimated in 51% (n = 43) and correctly estimated in 30% (n = 36) by indirect evidence. No significant differences in responsiveness to therapy were observed in patients graded according to direct evidence. Using indirect evidence, patients assigned grade C showed more PPDRed but less BOPRed and lower %PC compared to grade B. CONCLUSION: The present data indicate that indirect evidence may lead to inaccuracies compared to direct evidence regarding the estimation of periodontal progression. However, indirect evidence seems to be more suitable in the estimation of responsiveness to therapy than direct evidence, helping to identify cases that are more likely to require additional therapies such as re-instrumentation or periodontal surgery. CLINICAL RELEVANCE: Regarding the estimation of disease progression and responsiveness to periodontal therapy, accuracy and reliability of both direct and indirect evidence are limited when grading periodontitis.

Revisão crítica da nova classificação das periodontites / Critical review of periodontitis classification

Para o correto diagnóstico e tratamento da doença periodontal precisamos usar as classificações da doença periodontal. A mais recente foi proposta pela Academia Americana de Periodontia em conjunto com a Federação Europeia de Periodontia. Para a assimilação dos conceitos estabelecidos precisamos avaliar criticamente as informações que foram trazidas pelo consenso realizado há quase 6 anos. O objetivo do presente estudo é revisar o tópico periodontite da classificação, de forma a colaborar para o entendimento dessa doença pelos estudantes de graduação.

The periodontal diseases classifications are important for the correct diagnosis and treatment of periodontal diseases. The most recent classification was proposed by the American Academy of Periodontology in a consensus with the European Federation of Periodontology. For the assimilation of the established concepts, a critical evaluation of the information that was brought by the consensus almost 6 years ago, must be performed. The objective of the present study is to review the periodontitis topic of the new classification, in order to contribute to the understanding of this disease by undergraduate students.

Distribution of biopsied non plaque-induced gingival lesions in a Chilean population according to the classification of periodontal diseases.

BACKGROUND: Many gingival lesions are not induced by plaque. The aim of this study was to analyze the frequency of biopsied non-plaque-induced gingival lesions (NPIGL) in a Chilean population. METHODS: One thousand twelve cases of biopsied gingival lesions with confirmed anatomopathologic diagnosis were included, from the records of the Oral Pathology Referral Institute (OPRI), Faculty of Dentistry, University of Chile, between years 1990 and 2009. RESULTS: The most frequent non plaque-induced gingival lesions categories from biopsied cases included hyperplastic lesions, malignancies and benign neoplasms. The most frequent diagnoses in each category were fibrous hyperplasia (35.47%), squamous cell carcinoma (3.85%) and giant cell fibroma (2.08%), respectively. From all lesions, only 8.3% fitted in the specified categories of the current classification of periodontal diseases. CONCLUSIONS: The most frequent biopsied NPIGL were hyperplastic lesions and neoplasms. These categories represent relevant lesions to be included in a future periodontal classification system to improve the care needs of the patients, as well as early diagnosis and treatment.

Efeitos terapêuticos do uso de produtos derivados da romã (punica granatum) como coadjuvante no tratamento das doenças periodontais: uma revisão de literatura / Therapeutic effects of the use of pomegranate products (Punica granatum) as adjuvant in the treatment of periodontal diseases: a review of the literature

A romã (Punica granatum) possui uma vasta história médica conhecida por sua ação antibacteriana, antioxidante e anti-inflamatória. A presente revisão teve como objetivo verificar os potenciais efeitos terapêuticos do uso de produtos derivados da P. granatum como coadjuvante no tratamento das doenças periodontais. Descritores em inglês e português dos termos: "romã", "doença periodontal", "gengivite", "periodontite" e "punica granatum", foram utilizados para consulta nas bases de dados Pubmed, Lilacs e Scielo. Para avaliação dos efeitos anti-inflamatórios, antimicrobianos e clínicos da romã foram incluídos trabalhos clínicos e pré-clínicos, sem restrições de data. Os diferentes estudos selecionados avaliaram P. granatum em diferentes formulações, incluindo bochechos, géis, infusão, dentifrícios, e chips biodegradáveis. Os resultados demostraram que os componentes fitoquímicos de P. granatum, como polifenóis flavonoides, punicalaginas, ácido punícico e antocinas apresentam propriedades relevantes pró-saúde periodontal, que incluem efeitos anti-inflamatórios, antioxidantes, hemostáticos e imunoregulatórios. Estudos in vivo utilizando diferentes formulações da romã em participantes acometidos por gengivite ou periodontite apresentaram reduções nos índices de placa, sangramento gengival e profundidade de sondagem em graus variados. Conclui-se que P. granatum pode ser uma promissora alternativa à terapia antimicrobiana padrão, para auxílio do controle mecânico de placa, com melhora dos sinais clínicos das doenças periodontais. Contudo, mais estudos clínicos ainda são necessários. (AU)

The pomegranade (Punica granatum) has a vast medical history know by its antibacterial, antioxidant and antiinflammatory action. The presente review aimed at verifying the potential therapeutic effects of products derived from P. granatum as adjuvant in the treatment of periodontal diseases. English and Portugueses descriptors of the terms "pomegranate", "periodontal disease", "gingivitis", "periodontitis" and "Punica granatum" were used for search in Pubmed, Lilacs and Scielo databases. To assess the anti-inflammatory, antimicrobial and clinical effects of pomegranate, clinical and preclinical were included, with no date restrictions. The different studies evaluated P. granatum in different formulations, including mouthwash, gels, infusion, dentifrices, and biodegradable chips. Results showed that the phytochemical components of P. granatum, such as polyphenois flavonoids, punicalagins, punicic acid and antocines, demonstrated relevant periodontal prohealth properties, including anti-inflammatory, antioxidant, hemostatic and immunoregulatory effects. In vivo studies, using different pomegranade formulations in individuals affected by gingivitis or periodontitis, showed reductions in plaque index, gingival bleeding and probing depth in different levels. It was concluded that P. granatum could be a promising alternative to the standard antimicrobial therapy in order to aid the mechanical control of plaque, with improvement of clinical signs of periodontal diseases. However, more clinical studies are still necessary. (AU)

Clasificación de las enfermedades periodontales: evolución y cambios futuros / Classification of periodontal diseases: evolution and future changes

El propósito de este trabajo es, en primer término, determinar cuales son los factores más importantes en el diagnóstico periodontal; su evolución en el tiempo y cuál sería el futuro en la clasificación de las enfermedades periodontales en base a los avances que se están realizando en biología molecular. Se está trabajando en la investigación de los biomarcadores salivales como predictores de la enfermedad periodontal, un rápido test de saliva podría diagnosticar dicha patología (21, 22, 27, 28, 29). Las clasificaciones van evolucionando a medida que se conoce más sobre estasenfermedades (2). Aún falta mucha investigación para poder realizar una clasificación basada en la etiología (2).La biología molecular parece ser muy prometedora, ya que podríamos ser másespecíficos en la etiología de la enfermedad y esclarecer muchas de nuestras incertidumbres (21)

The purpose of this essay is to determine which are the most importantfactors in the periodontal diagnosis, its evolution in time and also determinewhich would be the future classification of periodontal diseases based on theadvances being made in molecular biology.Even today determining the causes of periodontal disease remains a complexmatter.Work is being done today in the research of salivary biomarkers as predictorsof periodontal desease, through rapid saliva test could diagnose thisdisease.21, 22, 27, 28, 29Classifications are evolving as we know more about this disease.2There is still way more research to be made in order to be able to establisha classification based in etiology.2Molecular biology seems to be very promising in that we can be more specificin the etiology of the disease and clarify many of our uncertainties.

Association Between Periodontal Disease and Kidney Function Decline in African Americans: The Jackson Heart Study.

BACKGROUND: Chronic kidney disease (CKD) remains a prevalent public health problem that disproportionately affects African Americans, despite intense efforts targeting traditional risk factors. Periodontal disease, a chronic bacterial infection of the oral cavity, is both common and modifiable and has been implicated as a novel potential CKD risk factor. The authors seek to examine to what extent periodontal disease is associated with kidney function decline. METHODS: This retrospective cohort study examines 699 African American participants with preserved kidney function (defined by estimated glomerular filtration rate (eGFR) >60 mL/minute/1.73 m(2) at baseline) who underwent complete dental examinations as part of the Dental-Atherosclerosis Risk in Communities study (1996 to 1998) and subsequently enrolled in the Jackson Heart Study (2000 to 2004). Using multivariable Poisson regression, the authors examined the association of periodontal disease (severe versus non-severe) with incident CKD, defined as incident eGFR <60 mL/minute/1.73 m(2) and rapid (5% annualized) eGFR decline at follow-up among those with preserved eGFR at baseline. RESULTS: Mean (± SD) age at baseline was 65.4 (± 5.2) years, and 16.3% (n = 114) had severe periodontal disease. There were 21 cases (3.0%) of incident CKD after a mean follow-up of 4.8 (± 0.6) years. Compared with participants with non-severe periodontal disease, those with severe periodontal disease had a four-fold greater rate of incident CKD (adjusted incidence rate ratio 4.18 [95% confidence interval 1.68 to 10.39], P = 0.002). CONCLUSIONS: Severe periodontal disease is prevalent among a population at high risk for CKD and is associated with clinically significant kidney function decline. Further research is needed to determine if periodontal disease treatment alters the trajectory of renal deterioration.

A cross-sectional assessment of biomarker levels around implants versus natural teeth in periodontal maintenance patients.

BACKGROUND: Recent studies point to the clinical utility of using peri-implant sulcular fluid (PISF) as a valuable diagnostic aid for monitoring peri-implant tissue health. The objectives of this study are to determine the levels of key biomarkers in PISF in periodontal maintenance participants and compare them with their corresponding levels in gingival crevicular fluid (GCF) obtained from the same participants. METHODS: PISF and GCF were collected from an implant and a contralateral natural tooth after the clinical examination of 73 participants. The levels of interleukin (IL)-1α, IL-1ß, IL-6, IL-8, IL-10, IL-12, IL-17A, tumor necrosis factor (TNF)-α, C-reactive protein, osteoprotegerin, leptin, and adiponectin were determined using multiplex proteomic immunoassays. The correlation of biomarker concentrations between GCF versus PISF, within GCF or PISF, and with several covariates (age, brushing frequency, days since professional cleaning, probing depth [PD], and plaque index) were also determined. RESULTS: Significantly higher levels of IL-17A (P = 0.02) and TNF-α (P = 0.03) were noted in PISF when compared with their levels in GCF. Significant positive correlations were noted between the concentrations of cytokines in PISF versus their levels in GCF. Among the covariates, a significant positive correlation was noted between mean PDs around implants and levels of IL-1ß (P <0.05) and IL-8 (P <0.05) in PISF. CONCLUSION: The results of this study point to the differential expression of specific biomarkers in GCF versus their levels in PISF in periodontal maintenance patients, which is critical information before establishing PISF as a diagnostic fluid to monitor peri-implant health.

Bleeding on probing as it relates to smoking status in patients enrolled in supportive periodontal therapy for at least 5 years.

AIM: To relate the mean percentage of bleeding on probing (BOP) to smoking status in patients enrolled in supportive periodontal therapy (SPT). MATERIALS AND METHODS: Retrospective data on BOP from 8'741 SPT visits were related to smoking status among categories of both periodontal disease severity and progression (instability) in patients undergoing dental hygiene treatment at the Medi School of Dental Hygiene (MSDH), Bern, Switzerland 1985-2011. RESULTS: A total of 445 patients were identified with 27.2% (n = 121) being smokers, 27.6% (n = 123) former smokers and 45.2% (n = 201) non-smokers. Mean BOP statistically significantly increased with disease severity (p = 0.0001) and periodontal instability (p = 0.0115) irrespective of the smoking status. Periodontally stable smokers (n = 30) categorized with advanced periodontal disease demonstrated a mean BOP of 16.2% compared to unstable smokers (n = 15) with a mean BOP of 22.4% (p = 0.0291). Assessments of BOP in relation to the percentage of sites with periodontal probing depths (PPD) ≥ 4 mm at patient-level yielded a statistically significantly decreased proportion of BOP in smokers compared to non-smokers and former smokers (p = 0.0137). CONCLUSIONS: Irrespective of the smoking status, increased mean BOP in SPT patients relates to disease severity and periodontal instability while smokers demonstrate lower mean BOP concomitantly with an increased prevalence of residual PPDs.

Nueva clasificación de rebordes atróficos en el sector posterior maxilar para el tratamiento con implantes dentales / A new classification of atrophic ridges in the posterior jaw for the treatment with dental implants

El edentulismo en el sector posterior maxilar es una de las condiciones más comunes que se presenta en la consulta odontológica9, 10, 12. La prevalencia del edentulismo difiere sustancialmente en la mayoría de los países del mundo (4). Algunos de los índices más altos son encontrados en el Reino Unido y Nueva Zelandia, y los más bajos en Estados Unidos.

Supportive post-implant therapy: patient compliance rates and impacting factors: 3-year follow-up.

AIM: To evaluate patient compliance rates and influential factors regarding a systematic SIT program. MATERIALS AND METHODS: Between 2005 and 2008, we identified all patients who were provided with implant-supported restorations in the study centre. They had been recommended to attend a SIT program with a 3-month recall. In 2012, a clinical retrospective cohort study on compliance rates over the first 3 years was performed different data were assessed in a regression analysis to identify potential influential factors. RESULTS: The inclusion criteria were met by 236 patients with 540 implants. Non-compliance rates increased over the 3 years (5.37%/7.78%/13.33%). Total non-compliance was observed in four patients (1.69%). No correlation to patient compliance was detected for "Age," "Gender," "Cardiovascular disease," "Pus/suppuration," or "Surgical case complexity." No decreasing effect of higher compliance rates on the patients' bleeding on probing (BOP+) values was found, but a statistical significance between lower compliance rates and increased pocket probing depth (PPD) was detected. The correlation between the presence of plaque and compliance did not reach statistical significance. CONCLUSIONS: When patients with implant-supported restorations are strongly recommended to comply with a SIT program with a 3-month recall, considerably high rates of compliance can be achieved.

Occurrence of spontaneous periodontal disease in the SAMP1/YitFc murine model of Crohn disease.

BACKGROUND: Oral involvement is often associated with inflammatory bowel disease (IBD). Recent evidence suggests a high incidence of periodontal disease in patients with Crohn disease (CD). To the best of the authors' knowledge, no animal model of IBD that displays associated periodontal disease was reported previously. The aim of this study is to investigate the occurrence and progression of periodontal disease in SAMP1/YitFc (SAMP) mice that spontaneously develop a CD-like ileitis. In addition, the temporal correlation between the onset and progression of periodontal disease and the onset of ileitis in SAMP mice was studied. METHODS: At different time points, SAMP and parental AKR/J (AKR) control mice were sacrificed, and mandibles were prepared for stereomicroscopy and histology. Terminal ilea were collected for histologic assessment of inflammation score. Periodontal status, i.e., alveolar bone loss (ABL) and alveolar bone crest, was examined by stereomicroscopy and histomorphometry, respectively. RESULTS: ABL increased in both strains with age. SAMP mice showed greater ABL compared with AKR mice by 12 weeks of age, with maximal differences observed at 27 weeks of age. AKR control mice did not show the same severity of periodontal disease. Interestingly, a strong positive correlation was found between ileitis severity and ABL in SAMP mice, independent of age. CONCLUSIONS: The present results demonstrate the occurrence of periodontal disease in a mouse model of progressive CD-like ileitis. In addition, the severity of periodontitis strongly correlated with the severity of ileitis, independent of age, suggesting that common pathogenic mechanisms, such as abnormal immune response and dysbiosis, may be shared between these two phenotypes.

Non-surgical and supportive periodontal therapy: predictors of compliance.

AIM: To identify predictors of compliance during non-surgical and supportive periodontal therapy (SPT). MATERIALS AND METHODS: In this retrospective study, demographic, dental, medical data of 427 new patients in a private practice were collected. Data were analysed in statistical models with non-surgical therapy and SPT compliance used as dependent variables. RESULTS: Of the 427 patients, 17.3% never agreed to initial therapy, 10.7% never completed therapy and 20.8% completed treatment, but never entered SPT. Of the 218 SPT patients, 56% became non-attenders after a period of 20 months, 33% were erratic attenders and 10.5% were regular attenders until the end of the observation period (5.5-6.5 years). Patients became erratic attenders after a mean period of regular attendance of 18.1 ± 16.2 months, whereas 49.6% of the patients, who abandoned SPT, were regular attenders until the time they stopped. In a univariate correlation model, periodontal disease severity emerged as a significant predictor of the completion of non-surgical periodontal therapy (p = 0.01). In a multivariate linear regression model, smoking was negatively associated with SPT compliance (p = 0.047). CONCLUSIONS: A low compliance of the population was observed. Smoking and periodontal disease severity represented significant, but modest modifiers of a patient compliance with SPT and initial therapy respectively.

Vitamin D status and 5-year changes in periodontal disease measures among postmenopausal women: the Buffalo OsteoPerio Study.

BACKGROUND: Vitamin D is hypothesized to prevent periodontal disease progression through its immune-modulating properties and its role in maintaining systemic calcium concentrations. The authors investigated associations between plasma 25-hydroxyvitamin D [25(OH)D] (collected 1997 to 2000) and the 5-year change in periodontal disease measures from baseline (1997 to 2000) to follow-up (2002 to 2005) among 655 postmenopausal women in a Women's Health Initiative Observational Study ancillary study. Exploratory analyses were conducted in 628 women who also had 25(OH)D measures at follow-up. METHODS: Four continuous measures of the 5-year change in periodontal disease were assessed using alveolar crest height (ACH), clinical attachment level (CAL), probing depth (PD), and percentage of gingival sites that bled on assessment. Linear regression was used to estimate ß-coefficients, standard errors, and P values corresponding to change in periodontal disease (a 1-mm change in ACH, CAL, or PD or a 1-unit change in the percentage of gingival sites that bled) for a 10-nmol/L difference in 25(OH)D. Models were adjusted for age, education, dental visit frequency, smoking, diabetes status, current medications affecting bone health, baseline measures of periodontal disease, body mass index, and recreational physical activity. RESULTS: No statistically significant associations were observed between baseline 25(OH)D and change in periodontal disease measures, overall or in a subset (n = 442) of women with stable 25(OH)D concentrations [25(OH)D change <20 nmol/L from baseline to follow-up]. RESULTS also did not vary significantly in analyses that were stratified by baseline periodontal disease status. CONCLUSIONS: No association between baseline 25(OH)D and the subsequent 5-year change in periodontal disease measures was observed. Vitamin D status may not influence periodontal disease progression. More studies are needed to confirm these results.

Compliance of cigarette smokers with scheduled visits for supportive periodontal therapy.

AIM: To evaluate the compliance of cigarette smokers with scheduled visits for supportive periodontal therapy (SPT). MATERIALS AND METHODS: Qualitative and quantitative analyses of compliance with scheduled SPT visits were performed using retrospective data from patients undergoing dental hygiene treatment at the Medi School of Dental Hygiene (MSDH), Bern, Switzerland 1985-2011. RESULTS: A total of 1336 patients were identified with 32.1% (n = 429) being smokers, 23.1% (n = 308) former smokers and 44.8% (n = 599) non-smokers. Qualitatively, significantly less smokers returned for SPT than non-smokers or former smokers (p = 0.0026), whereas 25.9% (n = 346) never returned for SPT. Further quantitative analysis of patients returning twice or more (n = 883) revealed that the overall mean %-compliance was 69.8% (SD ±22.04),whereas smokers complied with 67.0% (SD ±22.00), former smokers with 69.7% (SD ±22.03), and non-smokers with 71.7% (SD ±21.92) reaching statistical significance (p = 0.0111). Confounder adjusted analysis, however, revealed that older age (p = 0.0001), female gender (p = 0.0058), longer SPT intervals (p < 0.0001) and higher severity of periodontal disease (p < 0.0001) had a much greater impact on %-compliance than smoking (p = 0.7636). CONCLUSIONS: This study suggests that qualitatively, smokers return less likely for SPT than non-smokers or former smokers while quantitatively, a lower mean %-compliance of smokers attending scheduled SPT visits may be attributed to confounders.

Clinical and subclinical effects of power brushing following experimental induction of biofilm overgrowth in subjects representing a spectrum of periodontal disease.

AIM: Investigate short-term effects of power brushing following experimental induction of biofilm overgrowth in periodontal disease states. MATERIALS AND METHODS: Overall, 175 subjects representing each of five biofilm-gingival interface (BGI) periodontal groups were enrolled in a single-blind, randomized study. After stent-induced biofilm overgrowth for 21 days subjects received either a manual or a power toothbrush to use during a 4 weeks resolution phase. At baseline and during induction and resolution, standard clinical parameters were measured. Subclinical parameters included multikine analysis of 13 salivary biomarkers and 16s Human Oral Microbe Identification Microarray (HOMIM) probe analysis of subgingival plaque samples. RESULTS: All groups exhibited significantly greater reductions in bleeding on probing (BOP) (p = 0.002), gingival index (GI) (p = 0.0007), pocket depth (PD) (p = 0.04) and plaque index (p = 0.001) with power brushing compared to manual. When BGI groups were combined to form a shallow PD (PD ≤ 3 mm) and a deep PD group (PD > 4 mm) power brushing reduced BOP and GI in subjects with both pocket depths. Power brushing significantly reduced IL-1ß levels at resolution while changes in bacterial levels showed non-significant trends between both brushing modalities. CONCLUSIONS: Short-term changes in select clinical parameters and subclinical salivary biomarkers may be useful in assessing efficacy of power brushing interventions in a spectrum of periodontal disease states.

A cross-sectional study on the relationship between behavioral variables and economic status in periodontal disease among elderly individuals.

OBJECTIVES: The objectives of this study were to examine the relationship between behavioral variables, such as smoking and level of income on the periodontal disease among older South Indian adults. MATERIALS AND METHODS: Data pertaining to participants aged 55 years and above from the Outpatient Department of MR Ambedkar Dental College and Hospital were used. A total of 209 elderly subjects were selected by convenient sampling and a complete evaluation of their periodontal status was carried out. RESULTS: Our study showed that patients belonging to the lower income group and smokers had more severe disease compared to other groups. They were found to have higher plaque scores, higher calculus scores, deeper pockets and attachment loss compared to the subjects of the other groups. CONCLUSION: Variables, such as smoking, gender and low income are associated with the severity of periodontal disease in older adults.