Experimental vitamin C depletion and supplementation in young men. Nutrient interactions and dental health effects.

Biochemical indices of AA clearly showed that the young men in this study were brought into various states of AA depletion and repletion according to their dietary AA intakes. While previous studies have postulated that supplemental intakes of AA may adversely affect body status of vitamins B6 and B12, we found no changes in the B vitamin status of the young men receiving varying AA intakes. Moderate AA supplementation (605 mg/day) showed no antagonistic effect on markers of vitamins B6 and B12. Blood markers of fat-soluble vitamins A and E and iron status were not affected by AA intakes. The propensity of the gingiva to become inflamed or bleed on probing was reduced after normal (65 mg/day) AA intakes as compared to deficient (5 mg/day) intakes and upon supplementary (605 mg/day) AA intakes as compared to normal intakes. The results suggest that AA status may influence early stages of gingival inflammation and crevicular bleeding, and warrant further study of the relationship between AA and periodontal health.

Effects on gingivitis of two different 0.4% SnF2 gels.

For nine months we monitored the periodontal health of 81 adolescents undergoing orthodontic treatment with fixed appliances, to determine whether daily use of a brush-on 0.4% SnF2 gel would be better than toothbrushing alone in maintaining periodontal health in these patients, and whether a gel supplying a high percentage of available Sn2+ ion would be more beneficial than a gel supplying a low percentage of available Sn2+ ion. The subjects were matched for age and sex and placed into a control group, which used toothbrushing alone, and two treatment groups, which used toothbrushing supplemented with daily use of a SnF2 gel. One treatment group used a gel with 98% available Sn2+ ion twice daily for the entire nine months. The other treatment group used a gel with less than 2% available Sn2+ once a day for six months, then twice a day for the remaining three months of the study. Clinical assessments (Plaque Index, Gingival Index, Bleeding Tendency, pocket depth, and coronal staining) were made before appliances were placed and at one, three, six, and nine months after appliances were placed. Results indicated that the group using the high-availability Sn2+ gel twice daily had significantly lower Gingival Index and Bleeding Tendency scores at the one-, three-, six-, and nine-month examinations than did the control group. The group using the low-availability Sn2+ gel showed no significant differences in these assessments from the control group. Neither treatment group showed significant differences from the control group in Plaque Index or pocket depth. In the group using the high-availability Sn2+ gel, one subject developed mild coronal staining, and two developed moderate staining.

Response of lingual ascorbic acid test and salivary ascorbate levels to changes in ascorbic acid intake.

This study sought to determine whether the lingual ascorbic acid test (LAAT) and measurement of salivary ascorbate reflect plasma and leukocyte ascorbate levels during controlled periods of ascorbic acid depletion and supplementation. Eleven healthy non-smoking men, aged 19-28 years, ate a diet that was repeated every seven days and was adequate in all nutrients except ascorbic acid (AA). This basal diet, which provided less than 5 mg of AA per day, was supplemented with 60 mg of AA per day for two weeks, 0 mg (placebo) per day for four weeks, 600 mg per day for three weeks, and 0 mg per day for four weeks. Oral examinations, the lingual ascorbic acid test, and measurement of salivary, plasma, and leukocyte ascorbate concentrations were conducted throughout the study. Ascorbic acid concentrations in plasma and leukocytes responded rapidly to changes in vitamin C intake. LAAT-derived ascorbate values were unrelated to ascorbic acid intake and plasma and leukocyte ascorbate concentrations. Salivary ascorbate levels approached the lower limits of detection of the assay and remained constant throughout the investigation. Oral hygiene was consistently excellent, and no severe mucosal or periodontal changes were observed. It was concluded that lingual ascorbic acid test values and salivary ascorbate levels are not related to changes in ascorbic acid intake and are not consistent with plasma or leukocyte ascorbate concentrations.

Effects of ascorbic acid depletion and supplementation on periodontal health and subgingival microflora in humans.

This study describes the relationship between varying ascorbate intake, periodontal status, and subgingival microflora as part of a multidisciplinary investigation of ascorbic acid (AA) metabolism in young men housed for 13 weeks in a nutrition suite that provided controlled periods of ascorbic acid depletion and repletion. Twelve medically healthy non-smoking men, aged 25 to 43 years, ate a rotating four-day diet adequate in all nutrients except ascorbic acid. Following an initial baseline period during which the subjects received 250 mg AA/day, the subjects received 5 mg AA/day for a 32-day depletion period. Eight of the 12 subjects participated in a subsequent 56-day repletion period designed to replace the reduced body AA pool slowly. Plasma and leukocyte ascorbate levels, Plaque Index, Gingival Index, probing depths, and attachment level were monitored at the beginning and end of the depletion and repletion periods. Subgingival plaque samples were obtained and examined for selected organisms by indirect immunofluorescence microscopy. A uniform oral hygiene program was reinforced after each examination. Ascorbate concentrations in plasma and leukocytes responded rapidly to changes in vitamin C intake. There were no significant changes in plaque accumulation, probing pocket depth, or attachment level during the study. In contrast, gingival bleeding increased significantly after the period of AA depletion and returned to baseline values after the period of AA repletion. However, no relationship could be demonstrated between either the presence or proportion of target periodontal micro-organisms and measures of bleeding or ascorbate levels.

The effect of controlled ascorbic acid depletion and supplementation on periodontal health.

To determine if systemic levels of vitamin C influence periodontal health, changes in plaque accumulation, gingival health and periodontal probing depth were measured in healthy subjects housed for 3 months in a nutrition suite that provided controlled periods of ascorbic acid depletion and supplementation. Eleven healthy, nonsmoking men, aged 19 to 28 years, ate a rotating 7-day diet adequate in all nutrients except ascorbic acid. This basal diet, which contained less than 5 mg/day ascorbic acid, was supplemented with 60 mg/day ascorbic acid for 2 weeks, 0 mg/day ascorbic acid for 4 weeks, 600 mg/day ascorbic acid for 3 weeks and 0 mg/day ascorbic acid for 4 weeks. Plasma, urine and leukocyte ascorbate levels, Plaque Index, Gingival Index, Bleeding Index and probing depths were monitored throughout the study. A uniform oral hygiene program was maintained in which oral hygiene instructions were reinforced bi-weekly. Ascorbate concentrations in body fluids and leukocytes responded rapidly to changes in ascorbic acid intake. No mucosal pathoses or changes in plaque accumulation or probing depths were noted during any of the periods of depletion or supplementation. However, measures of gingival inflammation were directly related to the ascorbic acid status. The results suggest that ascorbic acid may influence early stages of gingivitis, particularly crevicular bleeding.

Periodontal status of HIV-1 and HIV-2 seropositive and HIV seronegative female commercial sex workers in Senegal.

Comprehensive studies of 92 commercial sex workers in Senegal, Africa included an oral examination in which we obtained measurements of decayed, missing, and filled (DMF) teeth; plaque index; gingival index; recession; probing depth (PD); clinical attachment loss (CAL); and the presence of HIV-associated periodontal lesions, under conditions wherein the examiner was unaware of the subject's HIV status. Twenty-seven subjects (29%) were HIV seropositive, 19 of whom were positive for HIV-1, 7 positive for HIV-2, and 1 positive for both. Most subjects were not taking any medications and previous dental care was limited. HIV-seronegative and HIV-seropositive subjects were similar in mean age, number of DMF teeth, percentage of sites with visible plaque, and number of sites with recession. However, the frequency of sites with gingival bleeding, with PD > or = 6 mm, and with CAL > or = 6 mm was significantly greater in seropositive than seronegative subjects. No differences were observed between HIV-1 and HIV-2 positive subjects. About 26% of HIV-seropositive subjects and about 5% of the seronegative subjects exhibited at least one site with concurrent PD > or = 6 mm and CAL > or = 6 mm. HIV-associated periodontal lesions were seen in 3 HIV-seropositive subjects (2 linear gingival erythema, 1 necrotizing periodontitis). One HIV-seronegative subject exhibited necrotizing gingivitis. In this population with multiple risks to oral health, both HIV-1 and HIV-2 infections were associated with a significantly increased prevalence of periodontal disease.

The association of simple anterior dental crossbite to gingival margin discrepancy.

The purpose of this study was to determine the severity of gingival margin discrepancy affecting the mandibular incisors in children with a single-tooth anterior crossbite. The response of the position of the gingival margin to correction of the crossbite also was investigated. Twenty-two subjects with a single central crossbite and 16 subjects with a single lateral crossbite were identified from two orthodontic practices. Seventeen of the 22 central incisor patients had immediate posttreatment records available; six patients had long-term follow-up records. An insufficient number of posttreatment records were available for the patients with lateral crossbites. The mean clinical crown length of crossbite mandibular incisors, measured on the study models, was compared with mean crown length of contralateral control incisors and the difference in clinical crown length was determined. A gingival margin discrepancy was identified when the gingival margin of the crossbite incisor was at least 1.0 mm apical to the gingival margin of the control incisor. The proportion of subjects with gingival margin discrepancy was significantly higher in subjects with central incisor crossbite (12/22 = 54%) than in those with lateral incisor crossbite (4/16 = 25%), P less than 0.05. While a gingival margin discrepancy persisted for eight of the 17 central incisor crossbites after discontinuing the appliance, 8.9 +/- 4.7 months, the severity of the discrepancy showed a significant reduction from 2.2 +/- 0.5 mm to 1.3 +/- 0.8 mm, P less than 0.05. True recession with exposure of cementum was not observed in any subjects.(ABSTRACT TRUNCATED AT 250 WORDS)

Oral manifestations of HIV infection in children.

Human immunodeficiency virus (HIV) infection was first recognized in children in 1983 and has now assumed the proportions of a major public health challenge. This article briefly reviews, on the basis of the literature, the epidemiology, diagnosis, clinical and immunologic characteristics, and prognosis of HIV infection in children. The clinical oral manifestations in children are described on the basis of the literature and the personal observations of HIV-infected pediatric patients.

Oral complications of cancer therapies. Oral complications in the pediatric population.

A number of acute oral complications may be associated with cancer therapy in children, but the extent and duration of these complications, and the most effective management techniques. have not been well described. The few studies differ in design, making comparisons difficult. Well-controlled, prospective clinical studies are needed to define the most effective strategies for the management of acute oral complications in children. However, it is clear that dental intervention prior to cancer therapy is an important factor in the optimal preparation of the patient. During cancer therapy, intensive supervised oral preventive protocols appear to be of benefit to the child's oral health, overall comfort, and well-being. Furthermore, the prevention of oral infection may significantly reduce the morbidity associated with cancer therapy. Long-term preventive oral care may help prevent dental disease and infection in medically compromised children and contribute to improving the quality of life.

Phase contrast microscopy of microbial aggregates in the gingival sulcus of Macaca mulatta. Subgingival plaque bacteria in macaca mulatta.

The objective of this study was to study the relationship of microbial aggregates in the subgingival crevice to changes in periodontal health in Macaca mulatta. The sample included 68 oral sites from 17 Rhesus monkeys of various ages. The periodontal health of each site was evaluated using Plaque and Gingival Indices and crevice depth measurement. The subgingival plaque samples were examined by phase contrast microscopy and recorded on 16 mm film. A Microbial Index was developed based on a qualitative estimate of the numbers of organisms, morphology of predominant organisms, and the presence or absence of motility. The Microbial Index was demonstrated to be simple in use and highly reproducible. The findings indicate that changes in the Microbial Index are consistent with tissue changes seen in the periodontal status in M. mulatta. From this preliminary study, the oral flora of adult M. mulatta appears to have sufficient similarities to human oral flora to be used as a microbial model for experimental periodontal disease research. Future studies to refine and confirm the validity of the Microbial Index are warranted. It may prove to be a useful tool to monitor the effect of various treatment modalities on the periodontal flora and to determine the presence or absence of active disease.

Periodontal implications of orthodontic treatment in adults with reduced or normal periodontal tissues versus those of adolescents.

This longitudinal study monitored periodontal status in 20 adults and 20 adolescents undergoing fixed orthodontic treatment. Ten adults had generalized periodontitis and received periodontal treatment, including periodontal surgery, before orthodontic treatment. They also received periodontal maintenance at 3-month intervals during orthodontic treatment. The other 10 adults had normal periodontal tissues. Neither these latter adults nor the adolescents received periodontal maintenance during orthodontic treatment. Periodontal status was determined (1) at six standard sites before fixed appliances were placed (baseline), (2) at 1, 3, 6, 9, 12, and 18 months after appliances had been placed, and (3) 1, 3, 6, and 12 months after appliances had been removed. At each of these visits, these sites were assessed for plaque index, gingival index, bleeding tendency, and pocket depth. Loss of attachment between baseline and 3 months after appliances were removed and tooth loss were also determined. Complete data were obtained for 15 adolescents and 14 adults. During orthodontic treatment the adolescent group showed significantly more (p less than 0.05) periodontal inflammation and supragingival plaque than the adults; after appliances were removed, this pattern was no longer statistically significant. For loss of attachment, there were no significant differences among adolescents, adults with normal periodontal tissues, or adults with reduced but healthy periodontal tissues who had undergone treatment for periodontal disease. For tooth loss, three nonstudy site teeth with pockets deeper than 6 mm and/or furcation involvements were lost because of periodontal abscesses in the adult group treated for periodontal disease.

Parotid gland enlargement and xerostomia associated with labial sialadenitis in HIV-infected patients.

Infection with human immunodeficiency virus (HIV) may be associated with enlargement of the major salivary glands or symptoms of dry mouth. We term this condition HIV-associated salivary gland disease (HIV-SGD). In this report we describe 12 patients with HIV-SGD. Nine patients (one child, eight adults) had enlargement of the parotid glands, and three had xerostomia alone. Symptoms of dry mouth, dry eyes or arthralgia occurred in 11, five and five patients, respectively. Salivary flow rates were normal or slightly reduced in seven patients and severely reduced in five. Labial salivary gland (LSG) biopsy specimens from patients contained lymphocytic infiltrates in focal and other patterns, whereas specimens from three HIV-infected patients without salivary gland symptoms did not. The inflammatory infiltrates in LSG specimens showed a preponderance of T8-positive cells and a tissue T4/T8 average ratio of 0.66. The mean T4/T8 ratio of peripheral blood lymphocytes was 0.4. Serum antinuclear antibodies were present in one patient, but rheumatoid factor, SS-A, and SS-B antibodies were absent in all. Search for Epstein-Barr virus and cytomegalovirus in the LSG tissue of the six patients tested did not reveal evidence of antigens or DNA. HIV-SGD patients show a number of similarities to and differences from patients with Sjögren's syndrome (SS). The similarities include the oral and salivary features, histopathology and possibly changes in other organs. The differences include the lower salivary gland T4/T8 ratio and the absence of autoantibodies in serum. The causes of HIV-SGD as well as of Sjögren's syndrome are unknown.

Prognostic significance of oral lesions in children with perinatally acquired human immunodeficiency virus infection.

OBJECTIVE: To assess the prevalence and prognostic significance of oral lesions in children with human immunodeficiency virus infection. DESIGN: Clinical cohort study. SETTING: Children's Hospital Center at Jackson Memorial Hospital, Miami, Fla. PARTICIPANTS: Ninety-nine children with perinatally acquired human immunodeficiency virus infection examined longitudinally for oral lesions. INTERVENTIONS: None. MEASUREMENTS/MAIN RESULTS: Presence of oral lesions was determined by a pediatrician who had been trained in the diagnosis of oral lesions. The cumulative prevalence of lesions was 72% for oral candidiasis, 47% for parotid enlargement, and 24% for herpes simplex. The median time from birth to development of a lesion was 2.4 years for candidiasis, 4.6 years for parotid enlargement, and 5 years for herpes simplex. The median time from lesion to death was 3.4 years for patients with candidiasis, 5.4 years for patients with parotid enlargement, and 4.3 years for patients with herpes simplex. In a time-dependent proportional-hazards model, oral candidiasis was associated with a more rapid rate of progression to death (relative hazard, 14.2; 95% confidence interval, 4.8 to 41.8), while parotid enlargement was associated with a less rapid rate of progression to death (relative hazard, 0.38; 95% confidence interval, 0.16 to 0.88) and herpes simplex was unrelated to the rate of progression (relative hazard, 1.3; 95% confidence interval, 0.5 to 3.1). CONCLUSIONS: The presence of oral candidiasis and parotid enlargement confer important prognostic information and should be incorporated into decisions regarding therapy for HIV-infected children.