Assessment of periodontal status in patients with oral lichen planus.

OBJECTIVE: Inflammatory pathogenesis is common to periodontitis and oral lichen planus. This study was conducted to assess and compare the periodontal status of patients with and without oral lichen planus. METHOD AND MATERIALS: 108 patients comprising 54 with oral lichen planus and 54 age-matched systemically healthy participants without oral lichen planus were selected. Periodontal parameters, ie Plaque Index, Gingival Index, bleeding on probing, probing pocket depth, clinical attachment level, and periodontal phenotype were measured. RESULTS: On comparing the test and control groups, statistically significant differences were observed in respect to Plaque Index (P = .00), Gingival Index (P = .00), and bleeding on probing (P = .00). A higher proportion of sites with deeper pockets was observed in the test group (P = .00). On comparison of various oral lichen planus subtypes, significant difference was observed in respect to Gingival Index (P = .00) and bleeding on probing (P = .00). A higher proportion of sites with deeper pockets (P = .01) and greater CAL (P = .00) was observed in the erosive/atrophic subgroup compared to the reticular group. However, the differences between the reticular (a less severe form of oral lichen planus) and control group in terms of Gingival Index (P = .94), Plaque Index (P = .05), bleeding on probing (P = .17), probing pocket depth (P = .56), and clinical attachment level (P = .23) were not statistically significant. Statistically significant differences were observed in terms of Gingival Index (P = .01) and bleeding on probing (P = .00) between thin and thick periodontal phenotypes in the oral lichen planus group. Statistically significant positive correlations in periodontal parameters with increased gingival involvement and severity were observed using Spearman rank correlation coefficient. CONCLUSION: Significantly greater periodontal inflammation in the test group means there is a risk of greater attachment loss in future. Thus, increased attention towards periodontal health in these patients might reduce the rate of disease progression.

Reliability assessment of the 2018 classification case definitions of peri-implant health, peri-implant mucositis, and peri-implantitis.

BACKGROUND: The purpose of this study was to evaluate the reliability and accuracy in the assignment of the case definitions of peri-implant health and diseases according to the 2018 Classification of Periodontal and Peri-implant Diseases and Conditions. METHODS: Ten undergraduate students, 10 general dentists, and 10 experts in implant dentistry participated in this study. All examiners were provided with clinical and radiographic documentation of 25 dental implants. Eleven out the 25 cases were also accompanied by baseline readings. Examiners were asked to define all cases using the 2018 classification case definitions. Reliability among examiners was evaluated using the Fleiss kappa statistic. Accuracy was estimated using percentage of complete agreement and quadratic weighted kappa for pairwise comparisons between each rater and a gold standard diagnosis. RESULTS: The Fleiss kappa was 0.50 (95% CI: 0.48 to 0.51) and the mean quadratic weighted kappa value was 0.544. Complete agreement with the gold standard diagnosis was achieved in 59.8% of the cases. Expertise in implantology affected accuracy positively (p < 0.001) while the absence of baseline readings affected it negatively (p < 0.001). CONCLUSION: Both reliability and accuracy in assigning case definitions to dental implants according to the 2018 classification were mostly moderate. Some difficulties arose in the presence of specific challenging scenarios.

Comparative assessment of periodontal treatment needs among the electronic cigarette users and traditional smokers.

OBJECTIVE: It is currently presumptuous that electric cigarettes are less harmful than the conventional ones; this is increasing the consumption of electric cigarettes. Therefore, this study intended to evaluate the periodontal treatment needs among conventional smokers, electronic cigarette smokers and non-smokers. This cross-sectional designed study involved 150 patients with a mean age of 29.88±7.81 years. PATIENTS AND METHODS: Among all patients, 50 patients were recruited in each group. The periodontal condition and the treatment need for the patients were assessed using the community periodontal index treatment need (CPITN). Fisher exact test was used to find the significant association of all three groups with the periodontal status and the treatment need. Female patients (12.5%) showed better periodontal status than the male patients (87.5%) and required less complicated periodontal treatment independently from smoking type. RESULTS: Furthermore, deeper pocket depth ≥6 mm (75%) has been found among the conventional cigarette smokers whereas the majority of the electric cigarette smokers (50%) have calculus deposition. Thus, 50% of the electric smokers require professional scaling whereas 57.1% of conventional smokers prerequisite complex periodontal treatment. CONCLUSIONS: Besides, there was a significant difference (p≤0.05) observed among all groups in periodontal health index and treatment need. Conventional cigarette consumers need more complicated periodontal treatment compared to the patients who consume electric cigarettes.

CLINICAL AND MICROBIOLOGICAL ASSESSMENT OF NON-SURGICAL TREATMENT OF CHRONIC PERIODONTITIS IN CONTROLLED AND UNCONTROLLED TYPE 2 DIABETIC PATIENTS.

Chronic periodontitis is a common complication in diabetes. The aim of this study was to evaluate some clinical and microbiological parameters in controlled and uncontrolled type 2 diabetes mellitus (type 2 DM) patients compared to non-diabetic (NDM) individuals, as well as to assess the effect of non-surgical periodontal therapy on these parameters. The study was performed in 61 type 2 DM patients with periodontitis (group 1A: 29 patients having achieved good metabolic control, HbA1c <7%; group 1B: 32 patients with poor metabolic control, HbA1c ≥7%), and 31 NDM individuals suffering from periodontitis. Periodontal indices (plaque index, PI; gingival index, GI; probing pocket depth, PPD; and clinical attachment level, CAL) were measured and subgingival plaque samples were analyzed using polymerase chain reaction prior to treatment initiation and 3 months post-treatment. The results recorded on the majority of measured parameters indicated that differences in treatment success achieved in the three treatment groups were not statistically significant (∆PI p=0.646; ∆GI p=0.303; and ∆CAL p=0.233). Likewise, comparison of the effectiveness in microorganism reduction revealed no significant differences between DM groups and NDM patients. Therefore, study results supported the hypothesis that periodontal therapy outcome was unaffected by the level of glycemic control in patients with diabetes.

Assessment of mucin and alpha-amylase levels in gingival crevicular fluid of chronic periodontitis patients.

BACKGROUND: Chronic periodontitis is the most common form of periodontitis. Several immune and inflammatory factors responsible for periodontal destruction have been found in gingival crevicular fluid (GCF). The current study was conducted to determine the correlation between mucin and alpha-amylase protein values in GCF with chronic periodontitis. METHOD: Forty-five patients with moderate-to-severe chronic periodontitis were selected. Samples of GCF were taken from a specific part of a single root tooth and placed in a closed test tube containing phosphate-buffered saline (PBS) (pH = 7). Sampling was done again after one month. Pre- and post-treatment samples were analyzed for measuring the levels of mucin and alpha-amylase proteins. RESULTS: Paired t test results for these two variables showed that the difference between mucin and alpha-amylase levels before and after treatment is significant. CONCLUSION: The level of both mucin and alpha-amylase in GCF in patients with chronic periodontitis was higher than that of patients who have recovered successfully; and evaluating the values of these two markers could be used to determine the activity of the periodontal disease.

Evaluating Cognitive/Emotional and Behavioral Mediators of Oral Health Outcomes in Vulnerable Older Adults.

Inconsistent outcomes of oral hygiene interventions require testable theories combining cognitive and behavioral domains to guide intervention and improve results. This article evaluates the integrated model as a cognitive-behavioral approach to improve oral health clinical outcomes in ethnically diverse low-income older adults. Baseline data from a clinical trial utilizing the integrative model (IM) model evaluated predictors of gingival index (GI) and plaque score (PS). Individual logistic regression was performed for all predictors in relation to GI and PS. Multiple logistic regression was performed with significant predictors of GI and PS only. Greater locus of control and more brushing predicted lower GI; greater locus of control predicted lower PS. Both cognitive and behavioral domains impact GI, requiring more prolonged effort for improvement while locus of control, a cognitive variable, predicts PS, immediately improved by daily brushing/flossing. A streamlined IM including locus of control and tooth brushing should improve oral hygiene of low-income older adults.

Índice de necesidad de tratamiento periodontal en embarazadas y no embarazadas que asisten a la maternidad provincial de Córdoba, Argentina / Periodontal index for treatment needs in pregnant and non-pregnant women attending the provincial maternity hospital in Córdoba, Argentina

Objetivo: Comparar la salud periodontal de embaraza- das y no embarazadas mediante la aplicación del Índice de Periodontal Comunitario (IPC). Materiales y métodos: Se realizó un estudio ob- servacional de corte transversal. Se reclutaron 100 mujeres embarazadas (EMB) y 50 no embarazadas (NoEMB) que concurrieron al Hospital Materno Provincial de la Ciudad de Córdoba, Dr. Raúl F. Lucini. En todas se registró el IPC con la sonda periodontal WHO 621 en los 6 sextantes de la boca. Los datos se analizaron con el software Infostat/SP; el nivel de significación establecido fue de P <0,05. Resultados: El 70% de las pacientes presentó edades de entre 18 y 25 años. En las EMB el código 3 del IPC fue el más frecuente presente en 240 sextantes (40,1%) y en las NoEMB el código 2 fue el más frecuente con 39 sextantes (43%). A ambos grupos de estudio les corresponde el trata- miento de instrucción de higiene bucal, instrumentación supra y/o subgingival, y/o regularización de obturaciones. Conclusiones: El código 3 fue el más frecuente entre las EMB, a quienes les corresponde un Código de tratamiento periodontal (CTP) 2; las NoEMB presentaron un IPC de 1 y 2 como los más frecuentes y se vinculan con un CTP 1 y 2. Nos encontramos frente a una situación clínica periodontal posible de resolver con terapia básica que puede ser realizada por odontólogos generalistas (AU)

Aim: To compare the periodontal health of pregnant and non-pregnant women by applying the Community Periodontal Index (CPI). Materials and methods: In an observational, cross-sec- tional study, 100 pregnant women (PREG) and 50 non-preg- nant women (NonPREG) were recruited at the Dr. Raúl F. Lu- cini Provincial Maternity Hospital in Córdoba City. The CPI was determined in the 6 sextants of the mouth using a WHO 621 periodontal probe. The data were analyzed with Infostat SP software. P <0.05 was considered significant. Results: 70% of the patients were 18 to 25 years old. In the PREG group, CPI Code 3 was the most frequent, present in 240 sextants (40.1%), while in the non-PREG group, CPI Code 2 was the most frequent, with 39 sextants (43%). Treat- ment needs in both study groups are oral hygiene instruction, supra- and/or subgingival instrumentation, and/or correction of plaque retentive margins. Conclusions: Code 3 was the most frequent among preg- nant women, which corresponded to Periodontal Treatment Code (CTP) 2. CPI 1 and 2 were the most frequent in non-pregnant women, corresponding to CTP 1 and 2. This periodontal clinical condition can be treated with initial dental hygiene therapy, which can be performed by general dentists (AU)

Evaluating mechanisms of change in an oral hygiene improvement trial with older adults.

BACKGROUND: This paper compares the relationship between theoretically-driven mechanisms of change and clinical outcomes across two different interventions to improve oral hygiene of older adults participating in a group randomized trial. METHODS: Six low-income senior residences were paired and randomized into two groups. The first received a face to face counseling intervention (AMI) and the second, a peer-facilitated health campaign (three oral health fairs). Both were based on Fishbein's Integrated Model. 331 participants were recruited at baseline and 306 completed the post-assessment one month after intervention. Clinical outcomes were Gingival Index (GI) and Plaque score (PS), collected by calibrated dental hygienists. Surveys obtained data on patient background characteristics and ten mechanisms of change including oral health beliefs, attitudes, norms and behaviors. GLMM was used to assess the effects of time, intervention arm, participant characteristics, intervention mechanisms and differences between the two interventions over time in relation to outcomes. RESULTS: At baseline, both groups had similar background characteristics. Both groups improved significantly in outcomes. Overall GI scores changed from baseline mean of 0.38 (SD = .032) to .26 (SD = .025) and PS scores changed from baseline mean of 71.4 (SD = 18%) to 59.1% (SD = 21%). T-tests showed that fears of oral disease, oral health intentionality, oral health norms, worries about self-management of oral health, flossing frequency and sugar control improved significantly in both interventions from baseline to post intervention. Oral health self-efficacy, perceived risk of oral health problems, oral health locus of control and brushing frequency improved significantly only in the counseling intervention. GLMM models showed that the significant predictors of GI improvement were intentionality to perform oral hygiene, locus of control, and improvement in frequency of brushing and flossing in association with the counseling intervention. Predictors of PS improvement were worries about oral hygiene self-management and fear of oral diseases, in association with the counseling intervention. In the reduced final models, only oral health locus of control (predicting GI) and fears of oral diseases (predicting PS) were significant in association with the counseling intervention. Locus of control, a key concept in oral hygiene interventions including the IM was the main contributing mechanism for GI improvement. Fear, an emotional response, drove improvement in PS, reinforcing the importance of cognitive/emotional mechanisms in oral hygiene interventions. CONCLUSIONS: Though both groups improved in outcomes, GI and PS outcomes improved more in response to the counseling intervention than the campaign. The counseling intervention had an impact on more mechanisms of change than the campaign. Improvements in intervention mechanisms across both interventions however, suggest a closer examination of the campaign intervention impact on outcomes over time. TRIAL REGISTRATION: Clinicaltrials.gov NCT02419144, first posted April 17, 2015.

Assessment of the effect of vacuum-formed retainers and Hawley retainers on periodontal health: A systematic review and meta-analysis.

BACKGROUND: Recently, increasing attention has been paid to the periodontal health of orthodontic patients in the maintenance stage in clinical practice. The focus of this meta-analysis was to compare the effects of vacuum-formed retainers (VFR) and Hawley retainers (HR) on periodontal health, in order to provide a reference for clinical selection. METHODS: From the establishment of the database until November 2020, a large number of databases were searched to find relevant randomized control trials, including the Cochrane Library databases, Embase, PubMed, Medline via Ovi, Web of Science, Scopus, Grey Literature in Europe, Google Scholar and CNKI. Related literature was manually searched and included in the analysis. Two researchers screened the literature according to relevant criteria. The size of the effect was determined using RevMan5.3 software, and the mean difference and 95% confidence intervals (CI) were used to estimate the results using a random effects model. RESULTS: This meta-analysis included six randomized controlled trials involving 304 patients. The results of the meta-analysis showed that there was no statistical difference in sulcus probing depth status between the VFR group and the HR group, including at 1, 3, and 6 months. Compared with the VFR group, the HR group showed a lower gingival index at 1 month (mean difference = 0.12, 95%CI: 0.06 to 0.19) and 3 months (mean difference = 0.11, 95%CI: 0.06 to 0.17), while there was no statistically significant difference at 6 months (mean difference = 0.10, 95%CI: -0.07 to 0.27). The plaque index of the HR group also showed a good state at 1 month (mean difference = 0.06, 95%CI: 0.01 to 0.12), 3 months (mean difference = 0.12, 95%CI: 0.08 to 0.16), and 6 months (mean difference = 0.19, 95%CI: 0.09 to 0.29). Subgroup analysis of PLI showed that when all teeth were measured, PLI status was lower in the HR group at 6 months (mean difference = 0.32, 95%CI: 0.18 to 0.46). PLI status was also low for the other teeth group (mean difference = 0.15, 95%CI: 0.08 to 0.22). CONCLUSION: Our meta-analysis showed that patients using the Hawley retainer had better periodontal health compared with those using vacuum-formed retainers. However, more research is needed to look at the periodontal health of patients using these two retainers.

Oral health status and dental treatment needs of psoriatic patients with different therapy regimes.

The aim of the study was to investigate the dental treatment requirements and oral health status of psoriatic patients with different severities of the disease, managed by different methods, including biological therapies. METHODS: One hundred and twenty-seven patients diagnosed with psoriasis were enrolled in this study. All subjects completed a general medical history and a Dermatology Life Quality Index (DLQI) questionnaire. The severity of the disease was assessed using the Psoriasis Area and Severity Index (PASI) scale and a DLQI questionnaire. In order to evaluate the oral health status, the following techniques were used: Approximal Plaque Index (API), the Community Periodontal Index (CPI) and the Decayed, Missing and Filled Teeth (DMFT) index. RESULTS: Patients treated with biologicals presented a significantly lower mean CPI index and required no surgical interventions. Subjects managed with topical therapy had significantly more decayed teeth and higher treatment needs. Only 11.3% of patients did not require dental intervention. CONCLUSIONS: The study revealed a high need for dental interventions in patients with psoriasis. The type of treatment used may affect the oral health status of patients. However, further investigations are required to explain the significantly lower CPI value in the group treated with biologicals.

Case-control study for assessment of factors associated with periodontitis among adults attending a university hospital in Karachi, Pakistan.

OBJECTIVE: To compare the physiological and biochemical markers in healthy and periodontitis subjects, and to relate these markers with the periodontal health condition. METHOD: The case-control study was conducted at the Dow University of Health Sciences, Karachi, from April 2017 to March 2018, and comprised systematically healthy controls and periodontitis cases. Periodontal probing depth, clinical attachment loss, oral hygiene indices, educational status and body mass index were recorded for all the subjects. Serum levels of biochemical markers, including calcium, phosphate and interleukin-6, were also measured. Data was analysed using SPSS 16. RESULTS: Of the 150 subjects, 75(50%) each were in the case and control groups. The overall mean age was 31.23±3.7 years (range: 22-42 years). The cases had relatively poor oral hygiene indices and educational status compared to the controls (p<0.05). Serum calcium level was lower, whereas mean body mass index was higher in the cases compared to the controls (p<0.05). No significant difference was found in interleukin-6 and phosphate levels (p>0.05). Clinical attachment loss showed significant correlation (p<0.05). CONCLUSIONS: Low serum calcium and educational levels, higher body mass index and poor oral hygiene were found to be the risk factors for the progression of periodontitis.

Asociación entre enfermedad periodontal y parto pretérmino en un grupo de mujeres puérperas del norte de México / Association between periodontal disease and preterm birth in a group of puerperal women from northern of Mexico

Introducción: La enfermedad periodontal puede ser causa de lesiones sistémicas. Se conoce la prevalencia de enfermedad periodontal en mayores de 35 años y el aumento de los factores de riesgo en mujeres embarazadas, pero no se sabe si estos factores se potencializan en mujeres embarazadas menores de 35 años. En México son muy prevalentes tanto el embarazo en mujeres jóvenes como el parto pretérmino. Con el objetivo de conocer la prevalencia de la enfermedad periodontal y su asociación con el parto prematuro, se realizó este estudio en mujeres puérperas menores de 35 años en una población abierta. Material y métodos: Estudio de tipo observacional, descriptivo y transversal, analizando casos y controles. La población de estudio fueron pacientes puérperas entre 17 y 35 años que ingresaron a un hospital público durante parte del año 2019. Se utilizó el índice de necesidad de tratamiento periodontal en la comunidad (CPITN, por sus siglas en inglés) para la medición de enfermedad periodontal (EP), se consideró embarazo prematuro (PP) cuando el parto ocurrió con menos de 37 semanas de embarazo. Como covariables se consideraron edad, tabaquismo y paridad. Se buscó la asociación mediante regresión logística para el cálculo de la razón de momios. Resultados: Se analizaron 323 mujeres, 200 (62%) tuvieron niveles 3 y 4 CPITN; 10.8% (35) tuvieron parto prematuro, la razón de momios cruda para la asociación entre código CPITN 3 y 4 y parto prematuro fue de 3.3 (p < 0.01). Después de ajustar por otros predictores la asociación se mantuvo en 3.8 (p < 0.01). Conclusiones: Es la primera vez en nuestro medio que se encuentra esta asociación entre enfermedad periodontal y parto prematuro. La prevalencia de parto prematuro en este grupo fue más alta que la media nacional. Es necesaria la revisión odontológica durante las visitas prenatales. Debe continuarse la línea de investigación con un estudio prospectivo (AU)

Introduction: Periodontal disease can cause systemic injuries. Prevalence of periodontal disease in people older than 35 years old is known, as well as the risk factors for pregnant women; however, it is not known if these factors also apply for pregnant women younger than 35 years of age. In Mexico, pregnancy among young women and preterm birth are very prevalent. The present study was done with the objective of finding out the prevalence of periodontal disease and its relationship with preterm birth in puerperal women younger than 35 years old in a population without social security. Material and methods: The study is observational, descriptive and transversal, analysis type cases and controls was done. The population for the study consists on puerperal patients between the ages of 17 to 35 years, all of them were admitted into a public hospital in a period of 2019. The Community Periodontal Index of Treatment Need (CPITN) was used to measure periodontal disease in the patients. Preterm birth was defined as a birth occur before 37 weeks of pregnancy. Age, smoking and parity were used as covariables. Logistic regression was used to evaluate the association between periodontal disease and preterm birth through odds ratio values. Results: 323 women were analyzed, 200 (62%) had levels of 3 and 4 on the CPITN. 10.8% (35) had preterm birth, the raw odds ratio for the association between the codes 3 and 4 from the CPITN was of 3.3 (p < 0.01), after adjusting other predictors the association was 3.8 (remaining as a p < 0.01). Conclusions: It is the first time that such an association between periodontal disease and preterm birth has been found in the region. Prevalence of preterm birth in the group studied was higher than the national's average. An odontological revision during prenatal visits is needed. This line of research should be continued through a prospective study (AU)

Risk-based, 6-monthly and 24-monthly dental check-ups for adults: the INTERVAL three-arm RCT.

BACKGROUND: Traditionally, patients are encouraged to attend dental recall appointments at regular 6-month intervals, irrespective of their risk of developing dental disease. Stakeholders lack evidence of the relative effectiveness and cost-effectiveness of different recall strategies and the optimal recall interval for maintenance of oral health. OBJECTIVES: To test effectiveness and assess the cost-benefit of different dental recall intervals over a 4-year period. DESIGN: Multicentre, parallel-group, randomised controlled trial with blinded clinical outcome assessment at 4 years and a within-trial cost-benefit analysis. NHS and participant perspective costs were combined with benefits estimated from a general population discrete choice experiment. A two-stratum trial design was used, with participants randomised to the 24-month interval if the recruiting dentist considered them clinically suitable. Participants ineligible for 24-month recall were randomised to a risk-based or 6-month recall interval. SETTING: UK primary care dental practices. PARTICIPANTS: Adult, dentate, NHS patients who had visited their dentist in the previous 2 years. INTERVENTIONS: Participants were randomised to attend for a dental check-up at one of three dental recall intervals: 6-month, risk-based or 24-month recall. MAIN OUTCOMES: Clinical - gingival bleeding on probing; patient - oral health-related quality of life; economic - three analysis frameworks: (1) incremental cost per quality-adjusted life-year gained, (2) incremental net (societal) benefit and (3) incremental net (dental health) benefit. RESULTS: A total of 2372 participants were recruited from 51 dental practices; 648 participants were eligible for the 24-month recall stratum and 1724 participants were ineligible. There was no evidence of a significant difference in the mean percentage of sites with gingival bleeding between intervention arms in any comparison. For the eligible for 24-month recall stratum: the 24-month (n = 138) versus 6-month group (n = 135) had an adjusted mean difference of -0.91 (95% confidence interval -5.02 to 3.20); the risk-based (n = 143) versus 6-month group had an adjusted mean difference of -0.98 (95% confidence interval -5.05 to 3.09); the 24-month versus risk-based group had an adjusted mean difference of 0.07 (95% confidence interval -3.99 to 4.12). For the overall sample, the risk-based (n = 749) versus 6-month (n = 737) adjusted mean difference was 0.78 (95% confidence interval -1.17 to 2.72). There was no evidence of a difference in oral health-related quality of life between intervention arms in any comparison. For the economic evaluation, under framework 1 (cost per quality-adjusted life-year) the results were highly uncertain, and it was not possible to identify the optimal recall strategy. Under framework 2 (net societal benefit), 6-month recalls were the most efficient strategy with a probability of positive net benefit ranging from 78% to 100% across the eligible and combined strata, with findings driven by the high value placed on more frequent recall services in the discrete choice experiment. Under framework 3 (net dental health benefit), 24-month recalls were the most likely strategy to deliver positive net (dental health) benefit among those eligible for 24-month recall, with a probability of positive net benefit ranging from 65% to 99%. For the combined group, the optimal strategy was less clear. Risk-based recalls were more likely to be the most efficient recall strategy in scenarios where the costing perspective was widened to include participant-incurred costs, and in the Scottish subgroup. LIMITATIONS: Information regarding factors considered by dentists to inform the risk-based interval and the interaction with patients to determine risk and agree the interval were not collected. CONCLUSIONS: Over a 4-year period, we found no evidence of a difference in oral health for participants allocated to a 6-month or a risk-based recall interval, nor between a 24-month, 6-month or risk-based recall interval for participants eligible for a 24-month recall. However, people greatly value and are willing to pay for frequent dental check-ups; therefore, the most efficient recall strategy depends on the scope of the cost and benefit valuation that decision-makers wish to consider. FUTURE WORK: Assessment of the impact of risk assessment tools in informing risk-based interval decision-making and techniques for communicating a variable recall interval to patients. TRIAL REGISTRATION: Current Controlled Trials ISRCTN95933794. FUNDING: This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme [project numbers 06/35/05 (Phase I) and 06/35/99 (Phase II)] and will be published in full in Health Technology Assessment; Vol. 24, No. 60. See the NIHR Journals Library website for further project information.

Traditionally, dentists have encouraged both patients at low risk and patients at high risk of developing dental disease to attend their dental practices for regular 6-month 'check-ups'. There is, however, little evidence available for either patients or dentists to use when deciding on the best dental recall interval (i.e. time between dental check-ups) for maintaining oral health. In this study, we wanted to find out, for adult patients who regularly attend the dentist, what interval of time between dental check-ups maintains optimum oral health and represents value for money. A total of 2372 adults who regularly attended 51 different dental practices across Scotland, Northern Ireland, England and Wales were involved. Patients aged 18 years or over who received all or part of their care as NHS patients were randomly allocated to groups to receive a check-up either every 6 months, at an individualised recall interval based on their own risk of oral disease (risk-based recall), or every 24 months (if considered at low risk by their dentist). The recruited adults completed questionnaires at their first trial appointment and then every year of the 4-year study. Their attendance at recall appointments was recorded and they received a clinical assessment taken by study staff at the end of their involvement at year 4. After 4 years, there was no evidence of a difference in the oral health of patients allocated to a 6-month or variable risk-based recall interval. For patients considered by their dentists to be suitable for a 24-month recall interval, there was no difference between those in the 24-month, 6-month or risk-based recall intervals. However, people greatly value and are willing to pay for frequent dental check-ups. The recall strategy that offers the best value for money to patients and the NHS, therefore, depends on what people and decision-makers wish to value within a health-care system.

Has the Health Insurance Coverage of Scaling Contributed Positively to Periodontal Health in Korea?

This study aimed to evaluate the effectiveness of the health insurance coverage of dental scaling (introduced in 2013) using the Community Periodontal Index of Treatment Needs parameter among Korean adults aged 20 years or older. We used the Korea National Health and Nutrition Examination Survey data from before and after 2013 to analyze the statistical significance and associations of the covariates with the prevalence of healthy periodontal tissues, prevalence of people in need of scaling, and prevalence of periodontal diseases. The results showed that the prevalence of healthy periodontal tissues increased by 4.9% (from 34.2% to 39.1%), the number of people in need of scaling decreased by 5% (from 65.9% to 60.9%), and the prevalence of periodontal diseases increased by 7.2% (from 23.4% to 30.6%). Moreover, after the scaling coverage policy, the odds ratio of the prevalence of healthy periodontal tissues was 1.10 times higher, the prevalence of the need for scaling was 1.5 times higher, and the prevalence of periodontal diseases was 0.90 times lower. Therefore, the state should formulate policies that provide dental biofilm management through a disclosing agent, impart education about oral hygiene, and develop a health management system that enables the concurrent management of periodontal diseases and systemic diseases.

Global Prevalence of Periodontal Disease and Lack of Its Surveillance.

BACKGROUND: Periodontal disease is a public health problem and is strongly associated with systemic diseases; however, its worldwide distribution is not fully understood. OBJECTIVE: To evaluate global data of periodontal disease: (1) among adolescents, adults, and older population and (2) in low-, middle-, and high-income countries. METHODS: This ecological study included data of periodontal disease from the World Health Organization's data bank which are based on the Community Periodontal Index of Treatment Needs (CPITN code: 0 = no disease; 1 = bleeding on probing; 2 = calculus; 3 = periodontal pocket (PD) 4-5 mm; 4 = PD (6+ mm). Age- and income-related periodontal disease inequalities were evaluated across the globe. RESULTS: Compared with 9.3% of adults and 9.7% of older persons, 21.2% of adolescents had no periodontal disease (P = 0.005). Nearly 18.8% of adolescents compared with 8.9% of adults and 5% of older persons had bleeding on probing (P ≤ 0.001). Similarly, 50.3% of adolescents, 44.6% of adults, and 31.9% older persons demonstrated the occurrence of calculus (P = 0.01). On the other hand, older persons had the highest prevalence of PD 4-5 mm and PD 6+ mm than adults and adolescents (P ≤ 0.001). The distribution of periodontitis (CPITN code 3 + 4) in adults differed significantly in low- (28.7%), lower-middle- (10%), upper-middle- (42.5%), and high-income countries (43.7%) (P = 0.04). However, no significant differences in periodontitis (CPITN code 3 + 4) were observed in adolescents and older persons in low- to high-income countries. CONCLUSIONS: Within the limitations of data, this study found that the distribution of periodontal disease increases with age. Periodontitis was the most common in older persons and in population from high-income countries.

Relationship between periodontitis and subclinical risk indicators for chronic non-communicable diseases.

In view of the epidemiological relevance of periodontal disease and chronic noncommunicable diseases, the study aimed to evaluate the relationship between them through subclinical indicators of systemic risk in a population group with healthy habits, including alcohol and tobacco abstinence. A complete periodontal examination of six sites per tooth was performed in a sample of 420 participants from the Advento study (Sao Paulo), submitted to anthropometric and laboratory evaluation. Periodontitis was defined and classified based on the Community Periodontal Index score 3 (periodontal pocket = 4-5 mm) and score 4 (periodontal pocket ≥ 6 mm). The prevalence of mild/moderate and severe periodontitis was 20% and 8.2%, respectively. Both categories of periodontal disease had significantly higher levels of triglycerides, C-reactive protein, calcium score, and calcium percentile, whereas blood glucose after tolerance test was significantly higher among people with severe periodontitis and HDL-c levels were lower (p < 0.05). Young adults with severe periodontitis had significantly higher prevalence of obesity, pre-diabetes, hypertension, and metabolic syndrome. Besides these conditions, the older adults with severe periodontitis had significantly higher prevalence of dyslipidemia and subclinical atherosclerosis. The group with periodontitis had also a higher coronary heart disease risk based on the PROCAM score (p < 0.05). The results indicated associations of periodontitis with several systemic indicators for chronic noncommunicable diseases, and highlighted the need for multiprofessional measures in the whole care of patients.

Volumetric assessment of tissue changes following combined surgical therapy of peri-implantitis: A pilot study.

AIM: To assess volumetric tissue changes at peri-implantitis sites following combined surgical therapy of peri-implantitis over a 6-month follow-up period. MATERIALS AND METHODS: Twenty patients (n = 28 implants) diagnosed with peri-implantitis underwent access flap surgery, implantoplasty at supracrestally or bucally exposed implant surfaces and augmentation at intra-bony components using a natural bone mineral and application of a native collagen membrane during clinical routine treatments. The peri-implant region of interest (ROI) was intra-orally scanned pre-operatively (S0), and after 1 (S1) and 6 (S2) months following surgical therapy. Digital files were converted to standard tessellation language (STL) format for superimposition and assessment of peri-implant volumetric variations between time points. The change in thickness was assessed at a standardized ROI, subdivided into three equidistant sections (i.e. marginal, medial and apical). Peri-implant soft tissue contour area (STCA) (mm2 ) and its corresponding contraction rates (%) were also assessed. RESULTS: Peri-implant tissues revealed a mean thickness change (loss) of -0.11 and -0.28 mm at 1 and 6 months. S0 to S1 volumetric variations pointed to a thickness change of -0.46, 0.08 and 0.4 mm at marginal, medial and apical regions, respectively. S0 to S2 analysis exhibited corresponding thickness changes of -0.61, -0.25 and -0.09 mm, respectively. The thickness differences between the areas were statistically significant at both time periods. The mean peri-implant STCA totalled to 189.2, 175 and 158.9 mm2 at S0, S1 and S2, showing a significant STCA contraction rate of 7.9% from S0 to S1 and of 18.5% from S0 to S2. Linear regression analysis revealed a significant association between the pre-operative width of keratinized mucosa (KM) and STCA contraction rate. CONCLUSIONS: The peri-implant mucosa undergoes considerable volumetric changes after combined surgical therapy. However, tissue contraction appears to be influenced by the width of KM.

Assessment of Periodontal Status Based on Carotid Artery Intima Media Thickness.

PURPOSE: Atherosclerosis is a devastating disease worldwide since it is the most frequent cause of myocardial infarction, stroke, renal failure, peripheral vascular disease and perhaps dementia. There is a well-documented evidence supporting the association between clinical/subclinical atherosclerosis and periodontitis. Carotid intima media wall thickness (CIMT) is a histopathologically validated marker of atherosclerosis. This study's purpose was to assess periodontal status based on carotid artery intima media thickness. MATERIALS AND METHODS: A cross-sectional study was carried out among subjects who visited the Care Hospital, Nampally Hyderabad for CIMT test. Oral hygiene status was evaluated using Simplified Oral Hygiene Index and periodontal health status was measured using modified World Health Organization (WHO) Oral Health Assessment form, 1997. The data was analysed using Statistical Package for Social Sciences (SPSS) version 21.0. The proportions and mean scores were compared using chi-square test, Mann-Whitney U test and analysis of variance (ANOVA). Logistic regression analysis determined the relationship between periodontitis, as an independent variable and other variables with CIMT. P < 0.05 was considered statistically significant. RESULTS: A total of 600 individuals were classified based on CIMT thickness ≤ 1 mm (292; 48.6%) and CIMT > 1 mm (308; 51.3%) according to variables. Significantly higher mean scores were observed for all oral parameters among subjects with CIMT > 1 mm aged > 45 years and among males (p ≤ 0.05*). Logistic regression analysis showed that increasing age group, ie,> 45 years (OR 3.5), males (OR 2.02), university education (OR 2.99), no history of previous dental visit (OR 3.71); and visit ≥ 1 year (OR 0.76) and previous history of tobacco (OR 1.13) and alcohol use (OR 1.65), poor OHI-S (OR 8.00), Community Periodontal Index (CPI) with Code 3, 4 (OR 4.41) and loss of attachment (LOA) with Code 2 (OR 3.05) and Code 3 (OR 5.80) had significantly higher odds among individuals with subjects with CIMT > 1 mm compared to their counterparts (p ≤ 0.05*). CONCLUSION: The results of the study concluded that periodontal disease and poor oral hygiene were more severe among the subjects with CIMT > 1 mm. To halt the progression of increasing CIMT, preventive oral health programmes need to be integrated in the cardiac setting with established dental referral which can bring out positive health behaviours.

Efficacy assessment of the scheme for prevention of herpesvirus infection manifestations in the oral cavity of patients with herpes-associated generalized moderate severity periodontitis.

OBJECTIVE: The aim: Efficacy assessment of herpesvirus infection drug prophylaxis (HVI) manifestations in the mouth of patients with chronic herpes-associated generalized periodontitis (CHGP) of moderate severity during and shortly after closed curettage. PATIENTS AND METHODS: Materials and methods: The total of 87 patients with CHGP of moderate severity aged 35-60 years were examined and divided into groups according to the presence of HVI: Group I (main) included 48 patients who had herpesvirus infection; group II (comparison) - 39 patients who were not found herpesvirus infection. Group III was formed based on the data of out-patient medical reports retrospective analysis and was used to compare the number of complication cases. The control group included 20 patients with intact periodontium. Prior to treatment, patients in group I, was additionally assigned multicomponent phytocomplex. The treatment efficacy was assessed by the concentration dynamics of A, G, M immunoglobulins, circulating immune complexes (CIC) and sIgA, hygienic and periodontal indices, as well as by the dynamics of gum fluid and the recovery terms. RESULTS: Results: The study on the dynamics of clinical indices and some humoral immunity indices confirmed the main group patients after closed curettage had positive shifts in sIgA, IgA, IgG, IgM and CIC levels. Their indices did not have a statistically significant difference with similar indicators of the comparison group. In group I, complications in the form of HVI manifestations in the buccal mucous membrane (BMM) were found in 8.33% of patients, which had a statistically significant difference (p <0.001) from the percentage of patients with HVI, with complications in group III (35.71% ). The recovery terms for patients in group I were by 16.7% shorter than the similar terms in group III. CONCLUSION: Conclusions: The results obtained indicate that the phytocomplex used by us can be applied as an immunomodulatory agent for the prevention of herpes virus infection manifestations in the oral cavity of patients with interventions in BMM and periodontal tissues.

Microbial Assessment of Two Different Abutment Designs in Peri-implant Sulcus and Implant Abutment Interface: A Case Control Postloading Study.

This study evaluates the microbial colonization in the peri-implant sulci and in implant-abutment interfaces of Laser-Lok implants (BioHorizons) with laser-microgrooved abutments (test group) and machined abutments (control group) 18 months after functional loading Real-time polymerase chain reaction revealed significantly greater total and specific microbial load in both the peri-implant sulcus and implant-abutment interface in the control group (P ≤ .05) Similarly, there was a significant reduction in the radiographic crestal bone loss in the test group (P ≤ .05) In total, 14 patients were assessed for clinical and radiographic parameters and microbial evaluation Peptostreptococcus micros and Porphyromonas gingivalis were positively correlated with site-specific plaque scores and bleeding scores, and mean crestal bone loss, respectively Hence, the authors propose using Laser-Lok implants with laser-microgrooved abutments to reduce microbial colonization and consequently preserve the crestal bone levels.