Analysis of mutations in the SOS-1 gene in two Polish families with hereditary gingival fibromatosis.

OBJECTIVES: To establish whether two families from Malopolska and Mazovia provinces in Poland are affected by hereditary gingival fibromatosis type 1, caused by a single-cytosine insertion in exon 21 of the Son-of-Sevenless-1 gene. MATERIAL AND METHODS: Six subjects with hereditary gingival fibromatosis and five healthy subjects were enrolled in the study. Gingival biopsies were collected during gingivectomy or tooth extraction and used for histopathological evaluation. Total RNA and genomic DNA were purified from cultured gingival fibroblasts followed by cDNA and genomic DNA sequencing and analysis. RESULTS: Hereditary gingival fibromatosis was confirmed by periodontal examination, X-ray, and laboratory tests. Histopathological evaluation showed hyperplastic epithelium, numerous collagen bundles, and abundant-to-moderate fibroblasts in subepithelial and connective tissue. Sequencing of exons 19-22 of the Son-of-Sevenless-1 gene did not reveal a single-cytosine insertion nor other mutations. CONCLUSIONS: Patients from two Polish families under study had not been affected by hereditary gingival fibromatosis type 1, caused by a single-cytosine insertion in exon 21 of the Son-of-Sevenless-1 gene. Further studies of the remaining regions of this gene as well as of other genes are needed to identify disease-related mutations in these patients. This will help to unravel the pathogenic mechanism of gingival overgrowth.

The significance of motivation in periodontal treatment: the influence of adult patients' motivation on the clinical periodontal status.

UNLABELLED: Motivation plays an important role in the treatment process of chronic diseases, as treatment requires behavioural change and lifelong adherence to medical recommendations. Periodontitis is a good example of such health condition as to maintain good periodontal health patients have to adhere to a strict oral hygiene regimen. OBJECTIVE: To examine whether the motivation of patients suffering from chronic periodontitis influences their clinical periodontal condition. BASIC RESEARCH DESIGN: Cross sectional study. CLINICAL SETTING: Department of Periodontology and Oral Medicine, Dental University Clinic, Jagiellonian University, Krakow, Poland. PARTICIPANTS: 199 adult periodontal patients, aged 20-78 years. INTERVENTIONS: Questionnaire concerning patients' medical and dental history, modified Zychlinscy motivation assessment questionnaire, clinical periodontal examination. MAIN OUTCOME MEASURES: The extent of motivation. Periodontal status evaluated with the use of periodontal indices (API, BOP, CPITN). RESULTS: The mean motivation score was 57.4. The mean API and BOP values were 55.7% and 46.4%, respectively. For most of the patients the recorded CPITN value was 3. Correlations were observed between motivation and both API and BOP, and between API and BOP. CONCLUSION: Periodontal patients with greater motivation having better oral health (lower API and BOP) suggests an influence on the quality of their self-management of the disease (i.e. adherence to their oral hygiene regimen).

The significance of motivation in periodontal treatment: validity and reliability of the motivation assessment scale among patients undergoing periodontal treatment.

OBJECTIVE: The individual evaluation of patients' motivation should be introduced to the protocol of periodontal treatment, as it could impact positively on effective treatment planning and treatment outcomes. However, a standardised tool measuring the extent of periodontal patients' motivation has not yet been proposed in the literature. Thus, the objective of the present study was to determine the validity and reliability of the Zychlinscy motivation scale adjusted to the needs of periodontology. BASIC RESEARCH DESIGN: Cross sectional study. CLINICAL SETTING: Department of Periodontology and Oral Medicine, Dental University Clinic, Jagiellonian University, Krakow, Poland. PARTICIPANTS: 199 adult periodontal patients, aged 20-78. INTERVENTIONS: 14-item questionnaire. The items were adopted from the original Zychlinscy motivation assessment scale. MAIN OUTCOME MEASURES: Validity and reliability of the proposed motivation assessment instrument. RESULTS: The assessed Cronbach's alpha of 0.79 indicates the scale is a reliable tool. Principal component analysis revealed a model with three factors, which explained half of the total variance. Those factors represented: the patient's attitude towards treatment and oral hygiene practice; previous experiences during treatment; and the influence of external conditions on the patient's attitude towards treatment. CONCLUSION: The proposed scale proved to be a reliable and accurate tool for the evaluation of periodontal patients' motivation.

HDAC3 Regulates Gingival Fibroblast Inflammatory Responses in Periodontitis.

Histone deacetylases (HDACs) are important regulators of gene expression that are aberrantly regulated in several inflammatory and infectious diseases. HDAC inhibitors (HDACi) suppress inflammatory activation of various cell types through epigenetic and non-epigenetic mechanisms, and ameliorate pathology in a mouse model of periodontitis. Activation of gingival fibroblasts (GFs) significantly contributes to the development of periodontitis and the anaerobic bacterium Porphyromonas gingivalis plays a key role in driving chronic inflammation. Here, we analyzed the role of HDACs in inflammatory responses of GFs. Pan-HDACi suberoylanilide hydroxamic acid (SAHA) and/or ITF2357 (givinostat) significantly reduced TNFα- and P. gingivalis-inducible expression and/or production of a cluster of inflammatory mediators in healthy donor GFs (IL1B, CCL2, CCL5, CXCL10, COX2, and MMP3) without affecting cell viability. Selective inhibition of HDAC3/6, but not specific HDAC1, HDAC6, or HDAC8 inhibition, reproduced the suppressive effects of pan-HDACi on the inflammatory gene expression profile induced by TNFα and P. gingivalis, suggesting a critical role for HDAC3 in GF inflammatory activation. Consistently, silencing of HDAC3 expression with siRNA largely recapitulated the effects of HDAC3/6i on mRNA levels of inflammatory mediators in P. gingivalis-infected GFs. In contrast, P. gingivalis internalization and intracellular survival in GFs remained unaffected by HDACi. Activation of mitogen-activated protein kinases and NFκB signaling was unaffected by global or HDAC3/6-selective HDACi, and new protein synthesis was not required for gene suppression by HDACi. Finally, pan-HDACi and HDAC3/6i suppressed P. gingivalis-induced expression of IL1B, CCL2, CCL5, CXCL10, MMP1, and MMP3 in GFs from patients with periodontitis. Our results identify HDAC3 as an important regulator of inflammatory gene expression in GFs and suggest that therapeutic targeting of HDAC activity, in particular HDAC3, may be clinically beneficial in suppressing inflammation in periodontal disease.

Salivary oxidative status in patients with oral lichen planus.

Reactive oxygen species (ROS) are involved in the pathogenesis of many inflammatory diseases, including oral lichen planus. Therefore, determining the salivary markers of oxidative stress is an excellent alternative approach to diagnosing oral cavity diseases. The objective of our study was to provide preliminary validation and determination of the salivary markers of oxidative stress in both patients with reticular and erosive forms of oral lichen planus as well as in healthy individuals without any oral lesions. In total, 62 patients with oral lichen planus (OLP) were enrolled in the study, including 31 with the reticular form of lichen planus (44.63 ± 11.05 years) and 31 with erosive forms (40.43 ± 10.05 years), who had never been treated for their disease. The control group comprised 30 individuals without any oral lesions (42.12 ± 12.22 years). We determined the saliva levels in glutathione (GSH), total antioxidant capacity (TAC), and thiobarbituric acid reactive substances (TBARS). The mean saliva levels of GSH and TAC were significantly lower (P < 0.01) in OLP patients compared to the control group. The mean levels of salivary TBARS were higher in both OLP groups (reticular and erosive) compared to the control group (P = 0.01). The lower saliva levels of GSH and TAC in patients with OLP indicate that free radicals and the resulting oxidative damage may play an important role in the pathogenesis of OLP lesions. In conclusion, monitoring the oxidant-antioxidant status of saliva may serve as an efficient and less intrusive marker for determining stages of disease development in patients with OLP.

[Dynamics of the changes in bacterial flora in a deep periodontal pocket]. / Dynamika zmian flory bakteryjnej glebokiej kieszonki przyzebnej.

Microbiological flora of 9 mm deep pathological pocket was studied. Samples were taken every two weeks during 3 months' time and examined using media and techniques for culturing of anaerobic bacteria. Curves, illustrating counts of anaerobic bacteria from the dark-field microscope, slide and viable counts, were similar in shape and stayed almost parallel to one another in diagram. Sample 4 was the largest out of 6 samples taken, when bacterial population was compared. Gram positive cocci were found in 3 samples, Gram positive rods in 5 samples and Gram negative cocci in 1 sample out of 6 samples; Gram negative rods in all of the samples. Gram negative motile and non-motile anaerobic rods and facultative Gram negative rods were present in 5 samples. Total viable count of bacterial population in the pocket examined changed in time, proportions of identified bacteria and related to them bacterial species changed periodically in time.

In vitro testing the potential of a novel chimeric IgG variant for inhibiting collagen fibrils formation in recurrent hereditary gingival fibromatosis: chimeric antibody in a gingival model.

Gingival fibromatosis is a progressive enlargement of the gingiva. It may hinder oral cavity hygiene and result in underlying bone loss. The long-term benefits of surgery cannot be predicted. On the other hand, alternative, efficient and non-invasive methods are not available at present. The aim of this study was to test the inhibitory effects of a chimeric IgG variant on collagen fibril formation in the cell culture of gingival fibroblasts taken from a patient with hereditary gingival fibromatosis with a high propensity for recurrence. Gingival biopsies were collected from the mandibular gingiva and used for histological evaluation as well as to establish a fibroblast culture. A histological evaluation was made in haematoxylin-eosin and Heidenhain's trichrome stained tissue sections. The inhibitory effect of a chimeric antibody on collagen fibril formation was determined in fibroblast cultures by using a collagen-specific Western blot and immunofluorescent staining. A histological evaluation revealed epithelial acanthosis with singular elongated rete pegs extending into the underlying connective tissue stroma that consisted of locally abundant, irregular collagen bundles. Based on observations with an in vitro model we conclude that a chimeric anti-collagen antibody efficiently inhibits collagen fibril accumulation in cell culture derived from diffuse, hereditary gingival fibromatosis that is characterized by a high propensity for recurrence (high proliferation index). Employing cell cultures from standardized group of patients with recurrent hereditary gingival fibromatosis as well as standarizing relevant 3D (tissue-like) models will be crucial for further tests of the antibody.

Peptidylarginine deiminase from Porphyromonas gingivalis contributes to infection of gingival fibroblasts and induction of prostaglandin E2 -signaling pathway.

Porphyromonas gingivalis (P. gingivalis) expres-ses the enzyme peptidylarginine deiminase (PPAD), which has a strong preference for C-terminal arginines. Due to the combined activity of PPAD and Arg-specific gingipains, P. gingivalis on the cell surface is highly citrullinated. To investigate the contribution of PPAD to the interaction of P. gingivalis with primary human gingival fibroblasts (PHGF) and P. gingivalis-induced synthesis of prostaglandin E2 (PGE2 ), PHGF were infected with wild-type P. gingivalis ATCC 33277, an isogenic PPAD-knockout strain (∆ppad) or a mutated strain (C351A) expressing an inactive enzyme in which the catalytic cysteine has been mutated to alanine (PPAD(C351A) ). Cells were infected in medium containing the mutants alone or in medium supplemented with purified, active PPAD. PHGF infection was assessed by colony-forming assay, microscopic analysis and flow cytometry. Expression of cyclo-oxygenase 2 (COX-2) and microsomal PGE synthase-1 (mPGES-1), key factors in the prostaglandin synthesis pathway, was examined by quantitative reverse transcription polymerase chain reaction (qRT-PCR), while PGE2 synthesis was evaluated by enzyme immunoassay. PHGF were infected more efficiently by wild-type P. gingivalis than by the ∆ppad strain, which correlated with strong induction of COX-2 and mPGES-1 expression by wild-type P. gingivalis, but not by the PPAD activity-null mutant strains (Δppad and C351A). The impaired ability of the Δppad strain to adhere to and/or invade PHGF and both Δppad and C351A to stimulate the PGE2 -synthesis pathway was fully restored by the addition of purified PPAD. The latter effect was strongly inhibited by aspirin. Collectively, our results implicate PPAD activity, but not PPAD itself, as an important factor for gingival fibroblast infection and activation of PGE2 synthesis, the latter of which may strongly contribute to bone resorption and eventual tooth loss.

Quality assurance, benchmarking, assessment and mutual international recognition of qualifications.

The aim of this report is to provide guidance to assist in the international convergence of quality assurance, benchmarking and assessment systems to improve dental education. Proposals are developed for mutual recognition of qualifications, to aid international movement and exchange of staff and students including and supporting developing countries. Quality assurance is the responsibility of all staff involved in dental education and involves three levels: internal, institutional and external. Benchmarking information provides a subject framework. Benchmarks are useful for a variety of purposes including design and validation of programmes, examination and review; they can also strengthen the accreditation process undertaken by professional and statutory bodies. Benchmark information can be used by institutions as part of their programme approval process, to set degree standards. The standards should be developed by the dental academic community through formal groups of experts. Assessment outcomes of student learning are a measure of the quality of the learning programme. The goal of an effective assessment strategy should be that it provides the starting point for students to adopt a positive approach to effective and competent practice, reflective and lifelong learning. All assessment methods should be evidence based or based upon research. Mutual recognition of professional qualifications means that qualifications gained in one country (the home country) are recognized in another country (the host country). It empowers movement of skilled workers, which can help resolve skills shortages within participating countries. These proposals are not intended to be either exhaustive or prescriptive; they are purely for guidance and derived from the identification of what is perceived to be 'best practice'.

Pain perception in children during caries removal with the Vector system: a pilot study.

AIM: A pilot study to compare pain perception during caries treatment in children by means of: the Vector system versus a mechanical method. STUDY DESIGN AND METHODS: A population of 31 children, aged 7-11 years, with a positive attitude towards dental treatment was recruited. Every child had two permanent molar teeth treated, one using the Vector system (piezo-driven ultrasonic device) and the other using conventional method (dental bur). Corah, Hochman and the visual scale (Facial Expression Scale) were applied to evaluate anxiety and pain perception. RESULTS: Treatment with the Vector system required significantly longer time 31.1 versus 4.7 mins for the conventional method. With the Vector system 54.8% of children and with conventional method 29.0% felt no pain. Girls admitted to feeling more pain than boys (verbal scale p < 0.018, visual scale p < 0.072). A high statistical correlation between verbal and visual scales was confirmed (r = 0.821; p < 0.001 and a greater level of pain was found using conventional method. CONCLUSIONS: The Vector system is useful in treating caries in children, because it minimizes the negative attitudes to pain but takes significantly longer to use.

[Estimation of distant results of the repeated endodontic treatment of teeth]. / Ocena odleglych wyników powtórnego leczenia endodontycznego zebów.

An attempt of treatment of 78 teeth with root canals filled incorrectly has been undertaken. The treatment has been correctly brought to completion in case of 67 teeth (84%). After 3 to 36 months no clinical pathological symptoms was found during follow-up examinations and total bone reconstruction was found by radiological examinations in 53.7% of cases. In the other cases pathological changes were decreasing. Root apex resorption took place in one case.

[In vitro assessment of metronidazole adapted to the treatment of periodontopathies]. / Ocena in vitro metronidazolu przystosowanego do leczenia parodontopatii.

Chemical and biological assessment was done in vitro of a form of metronidazole for application into deep pouches in periodontal diseases. The obtained plates with metronidazole contained 1.4 mg (37%) of pure substance. Comparing the effect of metronidazole release in time against a control plate it was noted that the drug was released during 3 days in similar proportions from the chemical and biological samples.

[Temporomandibular joint dysfunction and its relations to prosthetic needs]. / Zaburzenia w stawie skroniowo-zuchwowym i ich zaleznosc od potrzeb protetycznych.

As part of the programme of the Ministry of Health and Social Care 180 subjects aged 35-44 years living in Cracow, Wieliczka and its environs were studied. They were divided into 6 groups of 30 subjects in each. Temporomandibular joint dysfunction was found in 44.44% of the studied material, it was slightly more frequent in women (47.77%). The frequency was greater in the subjects living in villages. A comparison of the studied groups failed to show any statistical significance of the differences. In the analysis of temporomandibular joint dysfunction in relation to occupation it was revealed that it was most frequent in qualified workers. The need for prosthetic treatment was estimated in subjects with this dysfunction and this need was recognized in 83.75% of these subjects.

[Periodontological therapeutic needs of children aged 7 years assessed in the province of Cracow]. / Ocena parodontologicznych potrzeb leczniczych u dzieci 7-letnich woj. krakowskiego.

The values of the CPITN index and the need for periodontological treatment were determined in 180 children aged 7 years in the Province of Cracow. The results were obtained and compared in children from the City of Cracow, Wieliczka and villages in that region. A good condition of the periodontium was found in children living in Wieliczka, that is a region under particular protection. The worst state of the periodontium was found in Cracow. In all, 50.0% of children required instruction and improvement of oral hygiene. The mean sextant value of healthy periodontium per one child was 4.39.

[Assessment of the periodontium condition and therapeutic needs by the CPITN index in children aged 12 years in the province of Cracow]. / Ocena wskaznikiem CPITN stanu przyzebia i potrzeb leczniczych dzieci 12-letnich z województwa krakowskiego.

The aim of the study was assessment of the condition of the periodontium and therapeutic needs in children aged 12 years in the City of Cracow, Wieliczka and villages in the Province of Cracow. The total number of the studied children was 180 including 90 girls and 90 boys, 30 girls and 30 boys in each group. The number of sextants with healthy periodontium was 738, the mean value per one child was 4.10, it was higher in girls--4.24 and lower in boys--3.95. The per cent of children with healthy periodontium was 24.44%, the per cent of children with bleeding on probing was 30.56%, and with tartar--45.00%. The highest values of this parameter were found in Wieliczka children, and the lowest ones in village children. The needs for treatment of the periodontium in children aged 12 years were as follows: 75.56% required improvement of oral hygiene, 45.00% required removal of tartar. The lowest needs were in Wieliczka children--60.00%, and the highest in village children--86.67%.

[Calcitonin in direct and indirect pulp capping]. / Kalcytonina w posrednim i bezposrednim przykryciu miazgi.

Calcitonin, the hormone produced by C cells of the thyroid playing a great role in calcium homeostasis, was used for direct and indirect pulp capping. This procedure was done on 200 teeth. Late follow-up after 12, 18 and 24 months or even longer was obtained in 146 cases: 110 with indirect pulp capping and 36 with direct capping. In the first follow-up examination 7 cases were regarded as failures, in late follow-up 5 failures were found, thus the total failure rate was 3.8%. The usefulness of calcitonin for biological treatment of pulp is unquestionable.

[Indicator of periodontal therapeutic needs (CPITN) in adults aged between 35-44 years from three population groups in Cracow province]. / Wskaznik parodontologicznych potrzeb leczniczych (CPITN) u doroslych w wieku 35-44 lat trzech grup populacyjncy województwa Krakowskiego.

Parodontological therapeutic needs in 180 persons aged between 35-44 years among inhabitants of Cracow, Wieliczka and villages of Cracow province have been determined. Among women and men under examination the following needs have predominated: the necessity of dental deposits removal and curretage of pathological gingival pockets (75.56--77.78%). In 39 persons (21.68%) there was a need of complex treatment.

[Incidence of oral mucosa diseases in three populations in the province of Cracow]. / Wystepowanie chorób blony sluzowej jamy ustnej w trzech populacjach województwa krakowskiego.

In three population groups in the Province of Cracow: in Cracow, Wieliczka and the villages of the Province a cross-sectional examination of oral mucosa was carried out in 180 subjects aged 35-44 years, 30 subjects in each group. Males and females were considered separately. In all, pathological changes were found in 22 subjects, that is 12.22%. The total number of pathological changes was 23, since in one man two disease entities were present. The frequency of mucosal changes was greater in males than females. In males the prevailing lesion was leucoplakia, in females candidiasis. The least number of lesions was found in the population in Wieliczka.