LIGHT protein: A novel gingival crevicular fluid biomarker associated with increased probing depth after periodontal surgery.

AIM: To evaluate the protein profiles in gingival crevicular fluid (GCF) in relation to clinical outcomes after periodontal surgery and examine if any selected proteins affect the mRNA expression of pro-inflammatory cytokines in human gingival fibroblasts. MATERIALS AND METHODS: This exploratory study included 21 consecutive patients with periodontitis. GCF was collected, and the protein pattern (n = 92) and clinical parameters were evaluated prior to surgery and 3, 6 and 12 months after surgery. Fibroblastic gene expression was analysed by real-time quantitative polymerase chain reaction. RESULTS: Surgical treatment reduced periodontal pocket depth (PPD) and changed the GCF protein pattern. Twelve months after surgery, 17% of the pockets showed an increase in PPD. Levels of a number of proteins in the GCF decreased after surgical treatment but increased with early signs of tissue destruction, with LIGHT being one of the proteins that showed the strongest association. Furthermore, LIGHT up-regulated the mRNA expression of pro-inflammatory cytokines interleukin (IL)-6, IL-8 and MMP9 in human gingival fibroblasts. CONCLUSIONS: LIGHT can potentially detect subjects at high risk of periodontitis recurrence after surgical treatment. Moreover, LIGHT induces the expression of inflammatory cytokines and tissue-degrading enzymes in gingival fibroblasts.

Periodontal disease and a poor response to periodontal treatment were associated with an increased risk of incident diabetes: A longitudinal cohort study in Sweden.

AIM: To investigate whether periodontal disease or the response to periodontal treatment could influence the risk of future diabetes. MATERIALS AND METHODS: The eligible population consisted of 8983 individuals referred for periodontal treatment between 1980 and 2015. Diabetes incidence was obtained from the Swedish registers for cause of death, hospital discharge, and national diabetes registers. Data concerning treatment outcome 1 year after treatment were available for 5258 individuals. Poor response to treatment was defined as having >10% sites with probing pocket depth ≥5 mm and bleeding on probing (BOP) at ≥20% of the sites. RESULTS: Among the 8983 individuals during a median follow-up of 21.3 years, 1117 cases of diabetes occurred. The number of teeth and BOP at baseline were significantly associated with incident diabetes in a dose-dependent manner after adjusting for age, sex, smoking, education level, and civil status [incident rate ratio (IRR) = 0.88 (95% confidence interval [CI] 0.84-0.93), p < .001 and IRR = 1.06 (95% CI 1.02-1.11), p = .003, respectively]. Poor response to treatment (14%) was associated with an increased risk (37%) for future diabetes (95% CI 1.12-1.68, p = .002) compared with good responders. CONCLUSIONS: Periodontal disease with increased tooth loss and BOP, as well as poor response to treatment, was associated with an increased risk for diabetes.

'Caries disease among an elderly population-A 10-year longitudinal study'.

OBJECTIVES: To investigate the prevalence of dental caries and to identify risk factors for dental caries in an elderly population between 2008 and 2018. METHODS: This longitudinal study used data from a questionnaire survey and a clinical examination administered on two occasions 10 years apart to 273 individuals who were 65 and 75 years of age in 2008. The variables included were prevalence of dental caries as well as socioeconomic and socio-behavioural factors. RESULTS: The number of teeth decreased in both age groups by a mean of 2 over the 10-year study period, but the prevalence of dental caries remained stable. Approximately, a quarter of the participants had caries lesions. Toothbrushing once a day or less was the factor most strongly correlated with dental caries lesions (OR: 3.82, 95% CI: 1.68-8.66, p = 0.001), followed by need for homecare (OR: 3.50, 95% CI: 1.55-7.93, p = 0.003) and interproximal cleaning less than once a day (OR: 2.65, 95% CI: 1.36-5.19, p = 0.004). CONCLUSIONS: This longitudinal study revealed no increase in the prevalence of dental caries lesions, indicating that good oral health can be preserved among elderly people. The highest risk for dental caries lesions was among participants with inadequate oral hygiene routines (toothbrushing once a day or less and seldom using interproximal devices) and in need of help in daily living, emphasizing the importance of oral hygiene and collaboration between dental services and community-based health care.

Influence of smoking on periodontal healing one year after active treatment.

OBJECTIVE: To investigate the impact of smoking on the reduction of pockets >4 mm deep and a composite variable of residual pockets >4 mm and bleeding on probing (BoP) after treatment. METHODS: Eligible after exclusion due to missing records were 3,535 individuals, referred for periodontal treatment between 1980 and 2015. The number of teeth (NT), probing pocket depth (PPD), proportion of plaque (PLI) and BoP were registered before treatment and 1 year after treatment. To analyse the impact of smoking on PPD reduction, a mixed model adjusted for age, sex, type of therapy, baseline PPD, reduction of PLI, BoP and NT was used. Depending on residual PPD and BoP, two categories were created: good and poor responders. RESULTS: PLI was reduced by 20% in non-smokers and by 18% in smokers, and BoP by 46% and 37%, respectively. In the adjusted mixed model, the mean reduction of PPD > 4 mm among smokers undergoing surgery was 14.4 versus 9.7 in non-smokers (p < .001). The odds ratio for being a poor responder was 2.40 (95% CI 1.99-2.91, p < .001) for smokers. CONCLUSION: Although surgical treatment reduced PPD >4 mm in smokers more effectively than in non-smokers, significantly more non-smokers were good responders after periodontal therapy.

Peri-implant crevicular fluid proteome before and after adjunctive enamel matrix derivative treatment of peri-implantitis.

AIM: The aim of this study was to explore which peri-implant crevicular fluid (PICF) protein pattern is associated with the active peri-implantitis process. MATERIALS AND METHODS: Peri-implant crevicular fluid from 25 peri-implantitis sites were subjected to proteomic analysis using liquid chromatography-tandem mass spectrometry before and at 3, 6 and 12 months after treatment, to identify associations between PICF protein pattern and implant loss, bleeding on probing, pocket depth and enamel matrix derivative (EMD) treatment. RESULTS: Clustering of subjects based on their 3-12 months PICF proteomic profiles by principal component analysis defined two major clusters. Cluster 2 differentiated from cluster 3 by 52 proteins (R2  = 90%, Q2  = 80%) and belonging to cluster 2 was associated with implant loss (p = 0.009) and bleeding on probing (p = 0.001). Cluster 3 was associated with implant survival and EMD treatment (p = 0.044). CONCLUSION: Here, we demonstrate that a specific PICF proteomic profile associates with active peri-implantitis process and implant loss.

Surgical treatment of peri-implantitis using enamel matrix derivative, an RCT: 3- and 5-year follow-up.

OBJECTIVE: To assess the clinical and radiographic outcomes 3 and 5 years after the surgical treatment of peri-implantitis per se or in combination with an enamel matrix derivative (EMD). MATERIALS AND METHODS: At baseline, 29 patients were randomized to surgical treatment with adjunctive EMD or no EMD. One year after the surgical treatment of peri-implantitis, 25 patients remained eligible for survival analyses at the 3- and 5-year follow-up. The primary outcomes were implant loss and bone level (BL) change measured on radiographs, and the secondary outcomes, bleeding on probing, pus and plaque at each implant were analysed in 18 and 14 patients at the 3- and 5-year follow-up, respectively. RESULTS: After exclusion of four patients who discontinued the study, at the 3-year follow-up, 13 (100%) implants survived in the EMD group, and 10 of 12 (83%) in the non-EMD group. At the 5-year follow-up, 11 of 13 (85%) implants in the EMD group and nine of 12 (75%) in the non-EMD group survived. In multivariate modelling, BL changes and EMD treatment were positively associated with implant survival. Similarly, the same trend was seen in univariate analysis. CONCLUSIONS: An exploratory analysis suggests that adjunctive EMD is positively associated with implant survival up to 5 years, but larger studies are needed.

KNOWLEDGE GAPS IN ORAL AND MAXILLOFACIAL SURGERY: A SYSTEMATIC MAPPING.

OBJECTIVES: The aim of this study was to evaluate available knowledge and identify knowledge gaps within the field of oral and maxillofacial surgery, by systematically collecting and evaluating systematic reviews. Twelve specific domains were selected: surgical removal of teeth, antibiotic and corticosteroid prophylaxis, orofacial infections, dental and facial trauma, orthognathic surgery, reconstructive surgery, benign tumors, cysts, premalignant lesions, oral complications of treatment of malignant tumors, hyperbaric oxygen therapy, temporomandibular joint surgery, cost effectiveness of different surgical treatments, and ethics. METHODS: The literature search, covering four databases, was conducted during September 2014: PubMed, The Cochrane library, Centre for Reviews and Dissemination and EBSCO dentistry and oral science source. Retrieved systematic reviews were quality assessed by AMSTAR. RESULTS: In all, 1,778 abstracts were identified, of which 200 met the inclusion criteria. Forty-five systematic reviews were assessed as of high to moderate quality. The results disclosed some existing evidence in a few domains, such as surgical removal of teeth and implant survival after sinus lifts. However, in all domains, the search revealed a large number of knowledge gaps. Also of concern was the lack of data regarding health economics and ethics. CONCLUSIONS: In conclusion, there is a need for well-conducted clinical research in the fields of oral and maxillofacial surgery.

Effectiveness of enamel matrix derivative on the clinical and microbiological outcomes following surgical regenerative treatment of peri-implantitis. A randomized controlled trial.

OBJECTIVE: This randomized clinical trial aimed at comparing radiological, clinical and microbial effects of surgical treatment of peri-implantitis alone or in combination with enamel matrix derivative (EMD). METHODS: Twenty-six subjects were treated with open flap debridement and decontamination of the implant surfaces with gauze and saline preceding adjunctive EMD or no EMD. Bone level (BL) change was primary outcome and secondary outcomes were changes in pocket depth (PD), plaque, pus, bleeding and the microbiota of the peri-implant biofilm analyzed by the Human Oral Microbe Identification Microarray over a time period of 12 months. RESULTS: In multivariate modelling, increased marginal BL at implant site was significantly associated with EMD, the number of osseous walls in the peri-implant bone defect and a Gram+/aerobic microbial flora, whereas reduced BL was associated with a Gram-/anaerobic microbial flora and presence of bleeding and pus, with a cross-validated predictive capacity (Q(2) ) of 36.4%. Similar, but statistically non-significant, trends were seen for BL, PD, plaque, pus and bleeding in univariate analysis. CONCLUSION: Adjunctive EMD to surgical treatment of peri-implantitis was associated with prevalence of Gram+/aerobic bacteria during the follow-up period and increased marginal BL 12 months after treatment.

Prevalence of dental caries and influencing factors, time trends over a 30-year period in an adult population. Epidemiological studies between 1983 and 2013 in the county of Dalarna, Sweden.

OBJECTIVE: The aim of this study was to investigate the prevalence of dental caries in an adult population using four different cross-sectional studies over a 30-year period and to assess its possible associations with socio-economic and socio-behavioural factors. MATERIALS AND METHODS: Four cross-sectional epidemiological studies were performed in the county of Dalarna, Sweden, in 1983, 2003, 2008 and 2013. Random samples of 1012-2244 individuals, aged 20-85 years, who answered a questionnaire about socio-economic and socio-behavioural factors, were radiographically and clinically examined. RESULTS: The proportion of individuals with at least one decayed surface (DS) was 58% in 1983 and significantly lower, 34% in 2008 (p < 0.05) and 33% in 2013; the mean number of DS was 2.0 in 1983 and 1.1 in 2013 in the age group 35-75 (p < 0.05). In the age group 85, the mean number of DS was 1.2 in 2008 and 2.4 in 2013. Adjusted for age and number of teeth, irregular dental visits, limited financial resources for dental care, smoking, education below university, male gender, daily medication and single living were positively and statistically associated with manifest caries. CONCLUSION: The declining trend in the prevalence of manifest caries seems to be broken. In the oldest age group mean number of DS was higher in 2013 compared with 2008, indicating a possible beginning of an increase. This needs special attention as this group increases in the population, retaining natural teeth high up in age. Manifest caries was found to be associated with socio-economic and socio-behavioural factors.

Comparison of oral status in an adult population 35-75 year of age in the county of Dalarna, Sweden in 1983 and 2008.

UNLABELLED: The aim was to study the prevalence and distribution of number of teeth, number of intact and decayed teeth and prevalence and distribution of removable dentures and periodontal disease over 25 years 1983-2008. Two cross-sectional studies (EpiWux) were performed in the County of Dalarna, Sweden in 1983 and 2008. In the 1983 study a random sample of 1012 individuals were invited to participate in this epidemiological and clinical study and 1440 individuals in 2008. A total number of 1695 individuals, stratified into geographical areas (rural and urban areas), in the age groups 35, 50, 65 and 75 answered a questionnaire and were also clinically and radiographically examined.The number of edentulous individuals decreased from 15% in 1983 to 3% in 2008. Number of teeth increased from 22.7 in 1983 to 24.2 in 2008 and decayed surfaces per tooth showed a three-time reduction over this period of time. As a consequence of better oral status the prevalence of complete removable dentures in both jaws decreased from 15% in 1983 to 2% in 2008. Individuals with moderate periodontitis decreased from 45% in 1983 to 16% in 2008. CONCLUSION: Covering a period of 25 years the present study can report dramatic improvements in all aspects of dental status that were investigated.This is encouraging for dental care professionals, but will not necessarily lead to less demand for dental care in the future as the population is aging with a substantial increase in number of teeth.

'Periodontal health and disease in an older population: A 10-year longitudinal study'.

OBJECTIVES: To investigate alveolar bone loss (ABL), which is an indicator of periodontitis, and to identify risk factors for ABL in an older population between 2008 and 2018. METHODS: This longitudinal study used data from a questionnaire survey and a clinical examination administered on two occasions ten years apart to 273 individuals who were 65 years and 75 years in 2008. RESULTS: The mean number of teeth decreased significantly over the ten-year study period, while the proportion of individuals with calculus and moderate ABL visible on radiographs increased. For both ages, the number of teeth decreased by a mean of 2 teeth. The proportions of participants reporting poor general health, daily medication, xerostomia, living singly, visiting dental care irregularly and being in need of extra support in their homes all increased over the observation period. CONCLUSIONS: Despite an increased progression of moderate alveolar bone loss, a fairly good dentition and chewing capacity was retained in this older population. However, the individual's age and fragility are important indicators that need to be considered when planning oral health care and the availability of dental care.

Self-estimated oral and general health are related and associated with clinically investigated dental health.

UNLABELLED: The aim was to investigate whether the self-estimation of oral and general health is correlated and related to clinical parameters for dental health. Furthermore, to investigate the influence of socioeconomic factors on the self-assessment of oral and general health. During 2007 a dental health survey was performed in the Community of Gävle located in central Sweden. 1, 224 subjects randomized from the general population of Gävle (adult population 75, 000) were invited to participate. Seven hundred and forty-eight individuals answered a questionnaire regarding their health and 373 of these subjects participated in a dental examination. Self-estimated oral and general health was correlated (p<0.0001, r=0.35) and individuals who perceived their oral health as bad had more decayed surfaces, surfaces with secondary caries, fewer teeth and more bleeding on probing than those with good estimated oral health (p<0.017 for all). In a logistic regression analysis with self-estimated oral health as the dependent variable was related to, the independent variables NT, DFT, self-estimated general health and age were related to self-estimated oral health, but not to income or educational level. However, subjects with low disposable income and low education level had significantly more clinical caries and fewer teeth than subjects with high income or a high educational level. CONCLUSIONS: In the present study, self-estimation of oral and general health was correlated and related to some clinical oral parameters. Subjects in the low socioeconomic group had worse dental health and a tendency to underestimate their need of dental care.

Serum proteins associated with periodontitis relapse post-surgery: A pilot study.

BACKGROUND: The knowledge of which genes and proteins that are connected to the susceptibility to gingivitis with subsequent local tissue degradation seen in periodontitis is insufficient. Changes of serum proteins associated with recurrence of bleeding on probing (BOP) and increased periodontal pocket depths (PPD) after surgical treatment of periodontitis could reveal molecules that could be early signals of tissue destruction and/or of importance for systemic effects in other tissues or organs. METHODS: We performed a longitudinal pilot study and followed 96 inflammation-related proteins over time in serum from patients who underwent surgical treatment of periodontitis (n= 21). The samples were taken before (time 0), and then at 3, 6, and 12 months after surgery. Changes in protein levels were analysed in relation to the clinical outcome measures, that is, proportion of surfaces affected by BOP and PPD. RESULTS: Changes in treatment outcomes with early signs of relapse in periodontitis after surgical treatment, for example, increased BOP and PPDs, were during 12-months follow up associated with increased serum levels of high-sensitivity C-reactive protein (hs-CRP) and programmed death-ligand 1 (PD-L1), and reduced serum levels of cystatin-D protein. CONCLUSION: This study shows that clinical signs of recurrence of periodontitis after surgery are reflected in serum, but larger studies are needed for verification. Our novel findings of an association between increased PD-L1- and decreased cystatin D-levels and recurrence in periodontitis are interesting because PD-L1 has been shown to facilitate bacterial infections and chronic inflammation and cystatin D to inhibit tissue destruction. Our results justify mechanistic studies regarding the role of these molecules in periodontitis.

Cytokine and clinical predictors for treatment outcome of visually guided temporomandibular joint irrigation in patients with chronic closed lock.

PURPOSE: This study investigates selected predictors for clinical outcome of temporomandibular joint (TMJ) irrigation in patients with chronic closed lock (CCL). PATIENTS AND METHODS: Fifty-six patients with unilateral CCL, who underwent a visually guided TMJ irrigation (VGIR), were enrolled in this study. They were divided into either successful (s-group; n = 38) or unsuccessful groups (u-group; n = 18), according to the clinical success criteria. The investigated predictive factors were age, gender, duration of symptoms before the VGIR, preoperative painless range of mandibular motion, preoperative self-evaluated TMJ pain on visual analog scale (VAS), severity of arthroscopically observed pathologies, and presence and concentrations of a set of pro- and anti-inflammatory cytokines (ie, tumor necrosis factor [TNF]-alpha, interleukin [IL]-1beta, IL-6, IL-8, IL-12, and IL-10) in the aspirated synovial fluid (A-SF). Several comparative analyses and logistic regression analyses were used for statistical studies. RESULTS: The preoperative VAS score, detection rate of IL-8, and concentrations of IL-6 and IL-8 in the A-SF were significantly higher in the u-group (P < .05). Conversely, the detection rate and concentrations of IL-10 were significantly higher in the s-group (P < .05). The multivariate adjusted odds ratio (OR) showed that the detectable IL-10 in the A-SF (OR, 10.882; P = .047) is significantly predictive for a successful VGIR. CONCLUSIONS: The presence of IL-10 in the A-SF is a significant predictor of successful outcome of TMJ irrigation for CCL. Severe TMJ pain and detectable IL-6 or IL-8 in the A-SF seem to indicate a poor outcome after TMJ irrigation.

Clinical, socioeconomic and patient outcomes of intensive versus conventional scaling and root planing in the treatment of periodontal infection.

PURPOSE: To compare the two non-surgical periodontal treatment methods with regard to socioeconomic aspects, treatment results and complications. METHODS AND RESULTS: Twenty-five patients were randomly divided into two groups for non-surgical treatment consisting of scaling and root planing. One group had intensive treatment (InT) performed within 24 h and the other group received conventional treatment (CoT) with one treatment session a week for 4 weeks. All the patients rinsed their mouth with chlorhexidine 0.2% after each treatment session for 5 weeks. The investigation before and after the treatment was performed by the same clinician blinded to the treatment modalities, and all the treatments were performed by the same dental hygienist. Treatment had significantly reduced the number of pockets in both the treatment groups, but there was no difference between the two treatment modalities regarding pocket reduction or reported discomfort/pain graded on the visual analogue scale. Only one patient receiving the InT was not satisfied. However, in the CoT group six patients answered that they would have preferred the InT, whereas the remaining patients answered that it did not matter whether they received InT or CoT. The patients in the CoT group consumed more analgesics after the treatment. The mean total travelling time for the InT group was 113 min compared with 357 min for the CoT group. CONCLUSIONS: Most patients preferred the InT if they were to undergo the treatment again. Furthermore, InT resulted in a substantial socioeconomic gain with no difference in the treatment result and the complication rate compared with CoT.

Tooth loss is related to the presence of metabolic syndrome and inflammation in elderly subjects: a prospective study of the vasculature in Uppsala seniors (PIVUS).

PURPOSE: To investigate how the number of remaining teeth relates to the presence of metabolic syndrome (MetS) and markers of inflammation. MATERIALS AND METHODS: A population-based prospective investigation of the vasculature in Uppsala seniors (PIVUS) study was carried out on 1016 subjects, aged 70. RESULTS: The number of teeth was self-reported in 947 subjects and was found to be less in those with MetS using National Cholesterol Education Program/Adult Treatment Panel III (NCEP/ATP Ill) criteria (n = 219, mean 17.7 +/- 9.0 [SD]), compared with n = 728, mean 20.7 +/- 7.2 in those without MetS (p < 0.0001), and in proportion to the number of criteria fulfilled (p < 0.0001). The number of teeth was also inversely related to markers of inflammation (r = -0.15, p < 0.0001 for leukocyte count; r = -0.10, p = 0.0023 for C-reactive protein). In a multiple regression analysis, the presence of MetS, smoking, educational level, leukocyte count and height were independent predictors of the number of teeth. CONCLUSIONS: In addition to established risk factors for tooth loss, the presence of MetS and inflammation were independent predictors of the number of teeth in an elderly population.

Oral health and cardiovascular disease risk in a cohort of periodontitis patients.

BACKGROUND AND AIMS: The aim of this study was to determine whether oral health is uniformly associated with three different cardiovascular diseases (CVDs), including myocardial infarction (MI), stroke, and heart failure (HF), which has not been studied previously. METHODS: A full mouth investigation was performed in 8999 individuals referred to a specialized periodontology clinic between 1979 and 2012. The number of deepened pockets (NDP), number of teeth (NT), and bleeding on probing (BOP) were investigated. Incident CVD diagnosis was obtained from the Swedish cause of death and the hospital discharge registers. RESULTS: During a median follow-up time of 15.8 years (153,103 person years at risk), 1338 incident cases of fatal/non-fatal CVD occurred (672 fatal/non-fatal MI, 545 stroke and 302 HF). When NT, BOP and NDP were all included in the same model with age, sex, smoking, calendar time, and education level, NT and NDP, but not BOP, were significantly related to future CVD (combined end-point, p = 0.0003 for NT and p = 0.007 for NDP). In similar analyses of 3 separate CVD outcomes, NT was significantly related to MI, with an incidence rate ratio (IRR) for a given interquartile range change of 0.90 (95% CI 0.82-0.99) and to HF, with an IRR of 0.87 (95% CI 0.77-0.99). However, NT was not significantly related to stroke. BOP and NDP were not significantly related to any of the three separate CVD outcomes. CONCLUSION: Oral health, mainly represented by NT, was related to incident MI and HF, but not to incident stroke. Therefore, oral health does not seem to relate to all major CV disorders in a similar fashion.

Severity of periodontal disease and number of remaining teeth are related to the prevalence of myocardial infarction and hypertension in a study based on 4,254 subjects.

BACKGROUND: During the past 15 years, mounting evidence for the association between periodontal and cardiovascular disease has been presented in epidemiological studies. The aim of this study was to investigate how the severity of periodontal disease and number of remaining teeth relates to myocardial infarction (MI) and hypertension (HT). METHODS: Self-reported history of HT and MI was collected in 3,352 patients referred to the Department of Periodontology, Gävle County Hospital, and in 902 subjects randomly selected from the general population. Severity of periodontitis was estimated by a combination of the amount of bone loss around each tooth investigated from a full-mouth x-ray, the presence or absence of bleeding on probing (BOP), and involvement of furcations. RESULTS: The severity of periodontitis was significantly associated with HT (prevalence 16%; P<0.0005), even after adjustment for age, gender, number of teeth, and smoking in the total sample, and with MI (prevalence 1.7%, P<0.03) after above-mentioned adjustments, but in middle-aged (40 to 60 years) subjects only. The number of diseased periodontal pockets was related to HT only (P<0.0001), and this relationship remained after the above-mentioned adjustments. The number of teeth was associated with MI (P<0.03) even after correction for age, gender, and smoking but was not related to hypertension. CONCLUSIONS: The severity of periodontal disease was related to HT independent of age but to the prevalence of MI in middle-aged subjects only. The number of diseased pockets was significantly related to HT only. On the other hand, the number of teeth was associated with the prevalence of MI independent of age but not to HT. These data support the view that oral health is related to cardiovascular disease in a dose-dependent manner.

Reactive arthritis in relation to internal derangements of the temporomandibular joint: a case control study.

The aim of this study was to find out if reactive arthritis was involved in the aetiology of chronic closed lock of the temporomandibular joint (TMJ) by looking for bacterial antigens in the synovial membrane of the TMJ, and by studying the antibody serology and carriage of human leucocyte antigen (HLA) B27 in patients with chronic closed lock. Patients with reciprocal clicking and healthy subjects acted as controls. We studied a total of 43 consecutive patients, 15 with chronic closed lock, 13 with reciprocal clicking, and 15 healthy controls with no internal derangements of the TMJ. Venous blood samples were collected from all subjects for measurement of concentrations of HLA tissue antigen and serology against Chlamydia trachomatis, Yersinia enterocolitica, Salmonella spp., Campylobacter jejuni, and Mycoplasma pneumoniae. Samples of synovial tissue from patients with closed lock and reciprocal clicking were obtained during discectomy and divided into two pieces, the first of which was tested by strand displacement amplification for the presence of C trachomatis, and the second of which was analysed for the presence of species-specific bacterial DNA using 16s rRNA pan-polymerase chain reaction (PCR). There were no significant differences between the groups in the incidence of antibodies against M pneumoniae, Salmonella spp. or Y enterocolitica. No patient had antibodies towards C trachomatis or C jejuni. We found no bacterial DNA in the synovial fluid from any patient. The HLA B27 antigen was present in 2/15 subjects in both the closed lock and control groups, and none in the reciprocal clicking group. In conclusion, reactive arthritis does not seem to be the mechanism of internal derangement of the TMJ.

Visually guided temporomandibular joint irrigation in patients with chronic closed lock: clinical outcome and its relationship to intra-articular morphologic changes.

OBJECTIVE: The aim of this study was to evaluate the clinical outcome after visually guided irrigation (VGIR) of the temporomandibular joint (TMJ) and its relationship with postoperative arthroscopic changes. STUDY DESIGN: Of the original 69 patients, thirty patients (30 TMJs) underwent VGIR of the TMJ a second time. After the first VGIR, the clinical outcome was assessed, and 18 patients were assigned to the good outcome group. The remaining 12 patients were assigned to the poor outcome group. The arthroscopic findings related to the articular surface, synovial lining, and fibrous adhesion scores were recorded. Then, the arthroscopic findings in the first and second VGIR were compared. RESULTS: The intra-articular tissue status between the first and second VGIR was unchanged in approximately 40% of all joints. No significant differences with respect to an improvement in tissue status were found when the good outcome and poor outcome groups were compared. CONCLUSIONS: In patients with chronic closed lock of the TMJ, a clinical improvement after VGIR does not seem to be accompanied by improved intra-articular tissue status.