Periodontal health status in Swedish adolescents: an epidemiological, cross-sectional study.

The aim of this epidemiological survey was to analyze the periodontal conditions of 19-year old individuals in two rural county areas, i.e. Fyrbodal and Skaraborg, Västra Götaland, Sweden, with special reference to gender and socioeconomic grouping. A randomized sample of 506 individuals (Fyrbodal 250 and Skaraborg 256 individuals, respectively) was clinically examined with regard to oral hygiene, gingivitis, periodontal pockets and gingival recession. Bitewing radiographs were used for assessment of alveolar bone level (ABL) and dental calculus. A questionnaire-based interview regarding oral hygiene habits was included. A majority of the subjects (76%) claimed to brush their teeth at least twice a day, while interdental hygiene means were used daily by 4%. The subjects showed a mean plaque score of 47% and a gingivitis score of 56%. Forty-six % of the adolescents had a plaque score of > or = 50%, whereas the corresponding figure for gingivitis was 62%. The subjects had on average 5.5 teeth with facial gingival recession. The mean prevalence of sites with probing depth (PPD) of > or = 4 mm was 8, out of which 99% were located at proximal sites. A radiographic bone level of > 2 mm was observed at on average 0.4 teeth per subject. Logistic regression analyses revealed that gender (males) and county area (Fyrbodal) were significant factors for a high plaque and gingivitis score. There was no significant difference in periodontal conditions in relation to socio-economic grouping. In conclusion, the survey revealed higher prevalence of plaque and gingivitis among male than female adolescents, but no differences between socioeconomic groups.

Juvenile dermatomyositis: is periodontal disease associated with dyslipidemia?

BACKGROUND: Association between periodontal disease and dyslipidemia was recently reported in healthy adults. However, a systematic evaluation of concomitant periodontal diseases and lipid profile was not carried out in juvenile dermatomyositis (JDM). A cross-section study was performed in 25 JDM patients and 25 healthy controls, assessing demographic data, periodontal evaluation, fasting lipoproteins and anti-lipoprotein lipase antibodies. Disease parameters, laboratorial tests and treatment were also evaluated in JDM patients. RESULTS: The mean current age was similar in patients and controls (11.5 ± 3.75 vs. 11.2 ± 2.58 years,p = 0.703). Regarding lipid profile, the median triglycerides [80(31-340) vs. 61(19-182)mg/dL,p = 0.011] and VLDL[16(6-68) vs. 13(4-36)mg/dL,p = 0.020] were significantly higher in JDM patients versus controls. Gingival vasculopathy pattern was significantly higher in the former group (60% vs. 0%,p = 0.0001), as well as the median of gingival bleeding index (GBI) [24.1(4.2-69.4) vs. 11.1(0-66.6)%,p = 0.001] and probing pocket depth (PPD) [1.7(0.6-2.4) vs.1.4(0-2.12)mm,p = 0.006]. Comparison between JDM patients with and without dyslipidemia revealed that the median of dental plaque index (PI) [100(26.7-100) vs. 59(25-100)%,p = 0.022], PPD[1.9(0.6-2.4) vs. 1.4(1.2-1.8)mm,p = 0.024] and clinical attachment level (CAL) [1.31(0.7-1.7) vs. 0.8(0.6-1.7)mm,p = 0.005] were significantly higher in patients with dyslipidemia. Further analysis between JDM patients with and without gingivitis revealed that the median of current age [12.4 (8.3-18.4) vs. 9.2 (5.5-17.5) years, p = 0.034] and disease duration [7.09 ± 3.07 vs. 3.95 ± 2.1 years, p = 0.008] were significantly higher in the former group. CONCLUSION: Our study showed that gingival inflammation seems to be related to dyslipidemia in JDM patients, suggesting underlying mechanisms for both complications.

Osteocalcin in serum, saliva and gingival crevicular fluid: their relation with periodontal treatment outcome in postmenopausal women.

BACKGROUND: Osteocalcin levels have been postulated as a marker of inhibition of bone formation. The aim of the present study was to assess plasma, saliva and GCF levels of osteocalcin and correlate them with periodontal treatment outcome in postmenopausal women. METHODS: Thirty-nine postmenopausal women (57.8 -/+8.5 years old) were recruited for the study. Periodontal examination of all women was carried out and plaque, bleeding on probing, probing depth (PD), and clinical attachment level (CAL) were recorded. Serum, saliva and gingival crevicular fluid osteocalcin were measured. Then, periodontal treatment was carried out. Six months after the first appointment a second periodontal examination was carried out. RESULTS: Mean PD and mean CAL decreased significantly at second appointment in the group with serum osteocalcin concentration <10 ng/ml (15.8 -/+15.8% and 15.3 -/+ 21.2% respectively; p < 0.05). Mean PD decreased significantly at second appointment in the groups with saliva osteocalcin concentration < 3 ng/ml (17.1 -/+ 15.9%; p < 0.05) and 3-7 ng/ml (16.2 -/+18.1%; p < 0.05). CONCLUSIONS: Low serum osteocalcin concentration is associated to a significantly higher percentage of decrease in PD and CAL after periodontal treatment in postmenopausal women. Low saliva osteocalcin concentrations are significantly associated to a higher percentage of decrease in PD.

Periodontal conditions in a Swedish city population of adolescents: a cross-sectional study.

The aim of this epidemiological survey was to analyze the periodontal conditions of 19-year old individuals in an urban area of Sweden, with special reference to gender and socioeconomic factors. A randomized sample of 272 individuals living in Göteborg, Sweden, was clinically examined with regard to oral hygiene, gingivitis, periodontal pockets, probing attachment loss (PAL) and gingival recession. Bitewing radiographs were used for assessments of alveolar bone level (ABL) and dental calculus. A questionnaire-based interview regarding oral hygiene habits was included. Data were analyzed with regard to differences between gender and socioeconomic grouping. The subjects showed a mean plaque score of 59% and a gingivitis score of 44%. 70% of the adolescents had a plaque score of > or = 50%, whereas corresponding figure for gingivitis was 37%. 27% of the subjects had at least one tooth with gingival recession. The mean prevalence of sites with probing depth of > or = 6 mm was 0.5, and the prevalence of PAL > or = 2 mm was 0.7. A radiographic bone level of > or = 2 mm was observed at on average 0.8 teeth per subject. Females had significantly less plaque and gingivitis than males and significantly higher number of teeth with gingival recession. There were no clinically significant differences in periodontal conditions between socioeconomic groups. In conclusion,the survey revealed higher prevalence of plaque and gingivitis among male than female adolescents but no differences between socioeconomic groups.

Methods of assessing gingival and periodontal disease: a review.

There has been an effort by the dental profession working in the field of gingival and periodontal disease to find a method of recording the extent and degree of pathological change in tissues leading from gingivitis to periodontitis and to measure reversible as well as irreversible changes. It is obvious that some form of index is required and it should have the following well-defined criteria: (1) Simplicity, (2) Accuracy, (3) Quantitativeness, (4) Reproducibility, (5) Speed, (6) Objectivity, and (7) Amenability to statistical analysis. Indices, as well as determining the prevalence of disease in the group under investigation at a given period in time, must also provide information on incidence of disease, i.e. at different periods of time. Indices must also give data that make it possible to verify the nature, severity and aetiology of the disease process and to evaluate therapeutic measures. Indices yield information about the success or failure of control and prevention of disease, affecting the gingivae and the periodontal tissues. A review of methods of assessing and recording gingival and periodontal disease is presented starting from the early investigations of the century. It is shown that subsequently many variations evolved, often with the same inherent difficulties of interpretation or application. Usually the initial stages of inflammation of the gingivae are more difficult to recognize than established disease. Present methods of recording as objectively and as quickly as possible the gingival state in population groups are discussed with emphasis upon the necessity for providing effective preventive measures based upon assessment of schoolchildren.

Clinical observations following root amputation in maxillary molar teeth.

Thirty-four maxillary molar teeth were evaluated from 11 to 84 months after root amputation. The most consistent finding was that although 24 were neither splinted nor supported in any way, only three developed mobility. Two of these were used as abutments for partial dentures. One other tooth was extracted due to recurrent lateral abscesses and subsequent involvement of the mesial furca.

Observations on temperature and temperature patterns of the gingiva. II. Estimations of the error in measurement.

The diagnostician may expect an error associated with the measurements of clinical parameters. It is important to know how precise these measurements are. The purpose of this study was to make an estimation of the measurement error by comparing repeated measures of the same site. Six dental hygiene students were examined for gingival and were recorded twice. The maximum error associated with 95% of the temperature data and the average error were calculated as 1.3 degrees C and 0.65 degrees C, respectively. The probabilities of making a correct assessment of pocket depth and of sulcular bleeding were computed to be 0.864 and 0.840, respectively. The need for repeated measures was statistically analyzed. It can be concluded from our data that the thermocouple thermometer used in this study is a suitable instrument for measuring the gingival temperature. However, it is necessary to acquire a higher level of precision for the assessment of pocket depth and sulcular bleeding. This can be accomplished by increasing the number of clinical measures on each point.

Correlations among gingival indices: a methodology study.

Using an experimental gingivitis model, 99 subjects completed a 3-week study to determine the correlations between a visual index of gingivitis, the Modified Gingival Index (MGI), and the Gingival Index (GI), the Interdental Bleeding Index (IBI), and the Papillary Bleeding Index (PBI). Following a baseline examination consisting of the MGI and either the GI, IBI, or PBI, each subject received a full mouth scaling and rubber cup polishing to render the teeth plaque and calculus free. Subjects then rinsed twice daily for 30 seconds with 20 ml of either an active antimicrobial or control mouthrinse for 3 weeks while abstaining from all other oral hygiene. The MGI correlated significantly with the GI, IBI, and PBI, both at baseline and at 3 weeks for all subjects.

Pain threshold values during periodontal probing: assessment of maxillary incisor and molar sites.

Probing pain threshold (PPT) assessments were conducted in the facial and oral sulci of maxillary central incisors and first molars of 10 periodontally healthy adults. All subjects were systemically healthy, free of pain, and reported no current medication usage. A computer-linked electronic probe, modified to deliver steadily increasing forces up to 200 grams, was used to collect the data. The system contained a subject operated "off-switch" which, upon activation, signaled the computer to record the subject's PPT. Assessments of each subject's PPTs were conducted on 3 separate occasions at 7-day intervals. Results indicated that the facial sulci of the incisors were the most pain sensitive. They displayed a mean PPT of 50.9 +/- 26.6 grams. The oral sulci of the incisors exhibited a mean PPT of 76.5 +/- 45.2 grams. Facial and oral sulci of the molars evidenced mean PPT values of 102.6 +/- 52.1 grams and 113.5 +/- 51.3 grams, respectively. These data suggest that sulci associated with incisor teeth are nearly twice as pain sensitive as sulci associated with molar teeth. In addition, facial sulci are significantly more pain sensitive than oral sulci. Data did not indicate a visit effect nor a side-of-mouth effect on PPT values.

Smoking influences decision making in periodontal therapy: a retrospective clinical study.

BACKGROUND: Mechanical periodontal therapy consists of a non-surgical course, followed by surgical treatment to eliminate or reduce remaining pathological pockets. Only if diligent mechanical therapy fails are additional measures considered. It has been documented that smoking interferes with the host defense mechanisms. This study addresses the question is meticulous non-surgical periodontal therapy equally successful in smokers and non-smokers? If not, is a thorough and cumbersome non-surgical approach in smokers worth undertaking? METHODS: Thirty-five smokers and 35 non-smokers were selected retrospectively from a pool of 306 patients treated in a private practice over a 17-month period. All had at least 14 teeth present with 8 presenting with gingival pockets > or =6 mm. Non-surgical treatment was performed in 6 to 10 appointments and results were evaluated 6 to 12 weeks after therapy. Bleeding on probing sites with probing depths > or =5 mm were then considered for surgical treatment. RESULTS: Before treatment smokers had statistically significantly higher mean percent of pockets 4 to 5 mm and > or =6 mm (40.36+/-10.65 and 26.51+/-11.95, respectively, compared to 30.38+/-7.57 and 20.42+/-10.03 for non-smokers) and showed significantly lower proportional reduction of these parameters with treatment (50.80+/-33.76 and 81.36+/-19.82 for pocket 4 to 5 mm and 6 mm, compared to 68.43+/-21.23 and 91.7+/-8.92 for nonsmokers). A multivariate analysis gave smoking, plaque control, and initial percent of sites > or =6 mm to be significant predictors of the percent of teeth in need of further therapy. In non-smokers, treatment was apparently successful in all tooth types with the exception of upper first and second molars (28.5% failure) and lower second molar (20% failure). In smokers, rates of further treatment needs were particularly high in the premolar-molar area in both jaws, ranging from 31.4% to 48.5% for an individual tooth type; 42.8% of smokers and 11.5% of non-smokers needed further treatment in 16% of their teeth (pretest probability). A decision analysis showed that for smokers with at least 1 of 5 sites > or =6 mm, one should initiate surgical treatment, rather than first treat non-surgically. If the point of indifference that the decision is correctly set at 95%, the pretest probability should be >12%. There is a higher risk that non-surgical therapy will fail, for instance if we lower the point of indifference to 60%, the pretest probability should be >31%. CONCLUSIONS: It is concluded that smoking impairs healing after nonsurgical periodontal therapy. The decision analysis of this study questions the need for a thorough course of non-surgical treatment in smokers with advanced periodontal disease.

Reproducibility of a clinical screening method for assessing gingival inflammation, pockets and plaque retentions.

The purpose of this study was to evaluate the reproducibility of the Periodontal Treatment Need System (PTNS), when plaque retentions were examined separately. A sample of 8000 persons was drawn to represent the Finnish population aged 30 yr and over. The first clinical examination (total sample) was made by a specially trained expanded-duty dental auxiliary (EDDA). During the second examination (2-6 months later), 20% of the total sample was reexamined by a dentist, and of those, every 6th patient was examined by the EDDA. Reproducibility of the PTNS was assessed as intra- and interexaminer agreement and was calculated using Cohen's kappa and weighted kappa. The intraexaminer weighted kappa values were 0.67 +/- 0.05 for the PTNS and 0.48 +/- 0.15 for plaque retentions. The interexaminer weighted kappa values between the PTNS registrations were 0.77 +/- 0.05 and 0.74 +/- 0.12 in plaque retentions when examinations were made within 1 day, and 0.53 +/- 0.05 and 0.37 +/- 0.07, respectively, when the interexaminer registrations were made with an interval of 2-6 months between them. The kappa values for intra- and interexaminer reliability reflect quite high reproducibility.

Periodontal examination.

With the exception of gingival indices, it is evident that there have not been great changes in the methods used in clinical practice. Rather, the changes made are in the categories of integration of methods and interpretation of data. We know that the extent of periodontal disease cannot be ascertained from any single diagnostic aid alone. The date obtained from the many diagnostic methods described must be evaluated together before an accurate diagnosis can be achieved. A periodontal examination should include a periodontal probing, a radiographic analysis, a gingival index, mobility charting, and an evaluation of the amount of attached gingiva. These clinical exercises require simple instrumentation and a minimal amount of clinical calibration on the part of the examiner. These exercises, however, do not eliminate the need for a general examination that includes the location of caries, plaque index, and medical and dental history. Probing is still considered the single most important examination method in detecting periodontal disease and evaluating therapy. However, probing becomes a great deal more meaningful when combined with data from a gingival index and radiographic analysis. Because the significance of the pocket depth depends not only on the height of the alveolar bone but also on the degree of gingival inflammation, a gingival index should be used as an integral part of a routine examination. A radiographic examination supplements probing by providing information on root length and shape and width of the periodontal ligament space, and aids in determining the configuration of a bony defect. Yet radiographic analysis is of little value without the knowledge of the pocket depths, position of the gingival margin, and mobility patterns. Many forms of sophisticated instrumentation and indices for a periodontal examination have been introduced in the past decade. Unfortunately, many of these new instruments are not practical for clinical practice in their present form. Future trends will no doubt be directed toward simplifying these instruments and indices so that they can be more easily adapted to the clinical practice of periodontics, by both the general dentist and the specialist.

Patient evaluation.

Failure to diagnose periodontal disease is a frequent and unnecessary error. A new periodontal screening examination has been proposed that will accurately detect periodontal disease in approximately five minutes and can be incorporated into a routine dental examination. Simplified treatment planning based on the findings of the periodontal screening examination has also been proposed. Its use could significantly improve the quality of periodontal care for most dental patients.

Periodontal status of orthodontically treated impacted maxillary canines.

Thirty-four unilateral palatal impacted maxillary canines were brought down by orthodontic means after a radical surgical exposure. The contralateral canines which had erupted unaided served as controls during the study. Measurements of the gingival pocket depths showed that the distal pocket on the treated teeth was significantly deeper than on the control teeth. The treated canines displayed significantly more loss of periodontal support on the buccal and palatal surfaces than did the untreated teeth. Radiographically, there was more alveolar bone loss on the mesial surfaces of the corrected than on the uncorrected canines, the mean distance being 2.06 and 1.51 millimeters, respectively. The age of the patients at the start of treatment did not seem to have any profound influence on the loss of attachment, but the individual variation was considerably greater in adults.

Periodontal conditions following surgical exposure of unerupted maxillary canines--a long term follow-up study of two surgical techniques.

Two surgical techniques for exposure of impacted labially positioned maxillary canines were compared as to periodontal conditions at the end of the orthodontic treatment period. In the radical exposure group the alveolar mucosa and bone covering the crown were removed. In the other group a pedicle flap including keratinized gingiva was used for exposure. After the removal of bone the flap was apically positioned and sutured. The non-treated contralateral canines served as controls. The result showed that radical exposure in the region of alveolar mucosa resulted in significantly reduced width of buccal keratinized gingiva, reduced sulcus depth, increased gingival recession and increased gingivitis. The difference between the apically positioned flap group and the non-treated control groups was not significant.

Life and death in the three millimeter pocket.

Periodontal diseases are, in part, the result of an interaction of the patient's immune system with the local bacterial population. We can measure the result of the interaction and sometimes repair it. We can identify the bacteria involved in the process. What we cannot do is measure the patient's immune regulators; therefore we cannot predictably measure the recrudescence of disease activity or differentiate before hand the presence of refractory disease. We need fast, comfortable, inexpensive methods to measure the patient's immune regulators.

[The phagocytosis of polymorphonuclear neutrophilic granulocytes in progressive periodontitis]. / Phagozytose der polymorphkernigen neutrophilen Granulozyten bei der progressiven Parodontitis.

The aim of this paper was the evaluation of the phagocytic activity of neutrophils in blood and in gingival pocket fluid in patients suffering from rapidly progressive periodontitis (RPP) and postjuvenile periodontitis (PJP). Prior to periodontal treatment the authors evaluated the capacity to phagocytose latex particles of peripheral blood neutrophils from 21 patients with RPP, 51 with PJP and 59 healthy subjects (control group) as well as the phagocytic activity of neutrophils in pocket fluid from 21 patients with RPP, 14 with PJP and from 20 healthy subjects. This phagocytic activity was significantly lower in all examined groups in comparison with the control group. A similar evaluation executed 3 months after treatment revealed normal phagocytosis of blood neutrophils from patients with RPP. In patients receiving complementary pharmacotherapy (spiramycine combined with metronidazol), a better improvement of phagocytosis was noted, than that observed in patients treated only surgically.

[An assessment of the state of the internal organs of periodontitis patients]. / Otsenka sostoianiia vnutrennikh organov u bol'nykh parodontitom.

Analysis of the visceral status of patients with generalized periodontitis has shown that 97% of these patients suffer from visceral diseases, often multiple. The structure of visceral diseases, laboratory and immune shifts in these patients necessitate a complex approach to the treatment of periodontitis that should be regarded as a local manifestation of visceral pathology.