A simple point of care test can indicate the need for periodontal therapy to reduce the risk for adverse pregnancy outcomes in mothers attending antenatal clinics.

INTRODUCTION: Although the association between periodontal disease (PD) and adverse pregnancy outcomes has gained recognition amongst antenatal healthcare workers, not much has changed in practice to address it. This prospective study tested the hypothesis that BANA (N-benzoyl-DL-arginine-2-naphthylamide), a diagnostic test for PD, may inform obstetricians and other antenatal healthcare practitioners, of the risk of adverse pregnancy outcomes in mothers attending antenatal clinics. METHODS: At first visit, the presence of suspected periodontopathogens was assessed by BANA testing of dental plaque from 443 mothers attending antenatal clinics in KwaZulu-Natal, South Africa and an association later sought with pregnancy outcomes. The accuracy of BANA to predict adverse pregnancy outcomes was evaluated by the calculation of likelihood ratios. The study complied with the Declaration of Helsinki. RESULTS: Significant differences were found between pregnancy outcomes of BANA-negative and BANA-positive mothers (p < 0.0001). BANA showed sensitivity and negative predictive values of 87% and 91%; 75% and 78%; 87% and 94% in detecting low birth weight, preterm delivery, and preterm low birth weight delivery respectively. CONCLUSION: This study confirms that BANA may indicate the need for periodontal therapy to reduce the risk of adverse pregnancy outcomes and could form part of the routine antenatal examination.

Relationship of psychological and oral health statuses with self-perceived halitosis in a Jordanian population: a cross-sectional study.

BACKGROUND: Self-perceived halitosis could be a symptom of a psychosomatic or psychogenic disorder. The aim of this cross-sectional study was to clarify the relationship of self-perceived halitosis with psychological and oral health statuses. METHODS: One hundred participants with a history of halitosis were enrolled from a teaching hospital. They were divided into the self-perceived and suggested groups if they sensed and did not sense the malodor, respectively. Demographic and socioeconomic information, smoking status, and oral hygiene practices were noted. Complete nasal, oral, and periodontal examinations with organoleptic tests (OLTs) and N-benzoyl-DL-arginine-2-naphthylamide (BANA) tests were conducted. The participants also completed the validated Arabic version of the 90-item revised symptom checklist (SCL-90R). Data were compared by analysis of variance, chi-square test, Student's t-test, and multivariate logistic regression. RESULTS: The self-perceived group had higher OLT scores (p = 0.005) and were significantly younger (p = 0.001) than the suggested group. A significantly higher number of its participants were smokers (p = 0.004). No significant differences were observed in socioeconomic information, oral hygiene practices, oral conditions, and BANA test results. Further, no significant association was noted between self-perceived halitosis and the nine psychological dimensions of SCL-90R. CONCLUSIONS: Halitosis is a multifactorial symptom that requires multidisciplinary management. Self-reporting of the condition is unique entity and trust worthy symptom. It tends to be related to nonoral pathologies and extrinsic causes such as smoking.

Assessment and management of halitosis.

Halitosis is an unpleasant condition that may be the origin of concern not only for a possible health condition but also for frequent psychological alterations which may lead to social and personal isolation. The most frequent sources of halitosis that exist in the oral cavity include bacterial reservoirs such as the dorsum of the tongue, saliva and periodontal pockets. Volatile sulphur compounds (VSCs) are the prominent elements of oral malodour. Genuine halitosis and pseudo-halitosis should be in the treatment realm of dental practitioners. Clinical Relevance: Halitosis can be a symptom of underlying systemic disease, therefore the exact diagnosis and its source (oral or non-oral) is important in the proper approach to its management.

Comparison between self-estimated and clinical oral malodor.

OBJECTIVES: The aims were to evaluate the validity of patients' self-estimation and clinical diagnosis of oral malodor and to examine the relationship of oral malodor with oral health status. METHODS: The subjects were 252 patients (mean age 43.7 ± 10.7 years) who complained of oral malodor. Oral malodor was assessed by patients' self-estimation, organoleptic test and Oral Chroma. Oral health status, including dental and periodontal conditions, oral hygiene status and flow rate of saliva, was examined. The N-benzoyl-DL-arginine-2-napthilamide (BANA) positive bacteria in tongue coating were evaluated by BANA test. A Spearman's correlation coefficient was used to test correlation between self-perceived and clinical oral malodor. The stepwise multiple regression analysis was used to assess predictors of patients' self-estimated and clinical oral malodor. RESULTS: The percentage of patients who were diagnosed with pseudo-halitosis was 38.5%. Patients' self-estimated oral malodor was significantly correlated with organoleptic test (r = 0.61), H(2)S (r = 0.50) and CH(3)SH (r = 0.46). There were 47.1% of patients who estimated correctly their oral malodor's scores with those by examiner. The highest correspondence was found in patients without oral malodor (52.6%), followed by in those with moderate or strong oral malodor (46.7%) and in those with slight oral malodor (33.3%). The significant predictors of patients' self-estimated and clinical oral malodor were bleeding on probing, tongue coating, BANA test and flow rate of saliva. CONCLUSION: Patients' self-estimated oral malodor was found to correspond significantly with clinical oral malodor and be associated with oral health status. Current findings suggest that self-estimation can be used to judge one's own oral malodor.

The effect of menstrual cycle on periodontal health - a clinical and microbiological study.

PURPOSE: Fluctuations in female sex hormones result in changes in the gingival and periodontal tissues. The purpose of this study was to compare the periodontal status of premenopausal women at different time points during their menstrual cycle and to find the associated subgingival microbiota. MATERIALS AND METHODS: One hundred premenopausal women participated in the study and were divided into two groups: group I consisted of 50 subjects with clinically healthy gingival, and group II consisted of 50 subjects with chronic gingivitis. Group II was further divided into group IIa and group IIb. Group IIa consisted of 25 subjects who did not receive any periodontal therapy during the study period. All the examinations were performed at three points during the menstrual cycle: ovulation (OV), pre-menstruation (PM) and menstruation (M). Plaque Index (PI), Gingival Index (GI), Papillary Bleeding Index (PBI), probing depth (PD), subgingival temperature (ST) recording, gingival crevicular fluid (GCF) collection, and estimation and microbiological examination using the benzoyl-DL-arginine-naphthylamide (BANA) test was carried out. For group IIb subjects, all the examinations were performed again during the next menstrual cycle, which followed 4 weeks after periodontal therapy. RESULTS: Women with clinically healthy gingiva exhibited negligible changes throughout the menstrual cycle, whereas women with gingivitis showed aggravated inflammation during ovulation and pre-menstruation as compared to menstruation. However, there was no alteration in subgingival microbiota. After treating gingivitis, the next menstrual cycle following 4 weeks after periodontal therapy was monitored, and no periodontal changes were detected. CONCLUSION: Ovarian hormones have a negligible effect on clinically healthy periodontium. However, these hormones may exaggerate pre-existing inflammation in gingival tissues, but the clinical significance of these changes remains uncertain.

Clinical trial of oral malodor treatment in patients with periodontal diseases.

BACKGROUND AND OBJECTIVE: Only a few clinical research studies have assessed different therapeutic approaches to oral malodor in subjects affected by periodontal diseases. The aim of this study was to evaluate the effects of periodontal treatment and tongue cleaning on oral malodor parameters in periodontitis and gingivitis patients. MATERIAL AND METHODS: The subjects were 102 periodontitis and 116 gingivitis patients with oral malodor. Oral malodor was measured by organoleptic test and Oral Chroma™. Oral health status, including tooth conditions, periodontal health, tongue coating and proteolytic activity of the BANA test in tongue coating were assessed. Subjects in each periodontal disease group were randomly assigned into two subgroups depending on the sequence of treatment: periodontal treatment and tongue cleaning. Oral malodor and oral health parameters were compared by groups and sequence of treatment. RESULTS: For subjects in the periodontitis group, there were statistically significant reductions in oral malodor after periodontitis treatment or tongue cleaning; however, major reductions were found after periodontitis treatment. For those in the gingivitis group, there were also statistically significant reductions in oral malodor after gingivitis treatment or tongue cleaning, but the most marked reductions were observed after tongue cleaning. At the completion of treatment, all oral malodor parameters fell below the threshold levels in all subgroups. CONCLUSION: The present study indicated that periodontal treatment played an important role and tongue cleaning contributed to a lesser extent to reduction in oral malodor in periodontitis patients. In contrast, tongue cleaning alone can be the primary approach to reduce oral malodor in gingivitis patients.

Periodontal disease and related factors among Vietnamese dental patients.

PURPOSE: Periodontal diseases have a multifactorial etiology and their risk factors are influenced by modifiable and nonmodifiable factors. The information on periodontal disease and associated risk factors in the Vietnamese population is sparse. Vietnamese dental patients are specific groups with high dental needs and often have greater overall oral health problems. Thus, the purpose of this study was to examine the relationships of periodontal disease to sociodemographic, health-behavioural, and biological characteristics in Vietnamese dental patients. MATERIALS AND METHODS: A sample of 243 subjects was selected from the National Hospital of Odonto-Stomatology in Hochiminh City. The sociodemographic and health-behavioural characteristics were investigated by a questionnaire. Oral examination including dental and periodontal conditions was conducted. Bacterial load in tongue coating and hemoglobin in saliva were assessed using the BANA test and Perioscreen test. RESULTS: The Perioscreen test showed moderate sensitivity (0.752) and specificity (0.746) to periodontal disease. The binary logistic regression analyses indicated that older subjects (OR = 2.5), or those who did not frequently visit a dentist (OR = 4.1), brushed their teeth only once a day (OR = 2.5), did not use dental floss (OR = 2.9), were past smokers (OR = 3.1), current smokers (OR = 4.1), or had positive BANA test results (OR = 12.0) were more likely to have periodontal disease. CONCLUSION: The results revealed the periodontal disease was related to age, dental visit behaviour, smoking behaviour, frequency of tooth brushing, use of dental floss, bacterial load in the tongue coating, and hemoglobin in saliva.

[Association between atherosclerosis and periodontitis]. / Aterosclerosis en sujetos con periodontitis.

BACKGROUND: Chronic inflammation and infections are involved in the development and progression of atherosclerotic vascular disease. AIM: To evaluate the association between periodontitis and early atherosclerosis. MATERIAL AND METHODS: Fifty-three subjects who received periodontal treatment and regular maintenance for at least 10 years, and 55 subjects with periodontitis but without a history of periodontal treatment were studied. Carotid artery intima-media wall thickness (CIMT) was measured with high-resolution B-mode ultrasonography. A blood sample was obtained to measure high sensitivity C-reactive protein, fibrinogen, lipoprotein cholesterol, leukocyte count and erythrocyte sedimentation rate. Covariates included age, gender, smoking, level of education, body mass index and physical activity. The benzoyl-DL-arginine-naphthylamide (BANA) test was used to determine the number of periodontal sites with periodontal pathogens. RESULTS: CIMT value was significantly higher in subjects with periodontitis than those without it (0.775 ± 0.268 and 0.683 ± 0.131 mm respectively, p = 0.027). C-reactive protein, leukocyte count and percentage of sites with periodontal pathogens were also significantly higher in subjects with periodontitis. Regression analysis identified age, periodontitis, and smoking as independent predictors of CIMT. CONCLUSIONS: These results suggest that untreated periodontitis is associated with early atherosclerotic carotid lesions and higher levels of inflammatory markers.

Effects of hyperbaric oxygen therapy on the treatment of severe cases of periodontitis.

OBJECTIVES: To evaluate the effect of hyperbaric oxygen therapy (HBO2) as an adjunct to scaling and root planing (SRP) in the treatment of severe cases of chronic periodontitis. MATERIALS AND METHODS: In 20 patients diagnosed with severe generalized chronic periodontitis (pockets>7mm) with bleeding on probing, SRP was rendered in all pockets. Additionally, five consecutive hyperbaric sessions were administered in 10 patients after random allocation (SRP + HBO2). Clinical parameters were assessed at baseline up to six months: plaque index, bleeding on probing, probing depth, clinical attachment level and benzoyl-DL-arginine-naphthylamide (BANA) test. RESULTS: SRP + HBO2 resulted in greater probing reduction and attachment gain than SRP alone three months after treatment (p<0.001). The BANA test was negative after one week only for sites in the SRP + HBO2 group (p<0.05). However, SRP + HBO2 failed to show a significant difference from SRP group after 3 months, where all BANA sites became negative (p>0.05). CONCLUSION: Our data suggest that hyperbaric oxygen therapy had a short-term beneficial effect on pocket reduction and bacterial elimination, and may be considered a potential adjunct therapeutic option to improve the clinical outcomes of scaling in severe cases of chronic periodontitis.

Chlorhexidine Inhibits the Proteolytic Activity of Root and Coronal Carious Dentin in vitro.

The purpose of this study was to evaluate the effect of chlorhexidine on the proteolytic activity of carious coronal and root dentin collected from patients. Sound dentin from freshly extracted human teeth was used as a control. Dentin fragments were mixed with a synthetic substrate for proteolytic enzymes (N-benzoyl-DL-arginine-naphthylamide--BANA) and the suspensions mixed with either 0.12% chlorhexidine digluconate or distilled water. These mixtures were incubated for 18 h at 37 degrees C, color was developed by the addition of 0.1% Fast Garnet and their optical density was recorded spectrophotometrically. BANA hydrolysis measured by the optical density of incubated specimens was detected in all tested groups, but was significantly higher for carious than for sound dentin (p < 0.05). The proteolytic activity was reduced for carious coronal and root dentin by chlorhexidine (p < 0.05; 50 and 30%, respectively). Chlorhexidine also reduced the proteolytic activity in sound root dentin (p < 0.05; 20%). Conversely, changes in the proteolytic activity of sound coronal dentin were not observed in the presence of chlorhexidine. The reduction in proteolytic activity by chlorhexidine was significantly higher in carious coronal dentin than in carious root dentin (p < 0.05). In conclusion, part of the effect of chlorhexidine in controlling caries progression in humans may be due to a decrease in the proteolytic activity of carious coronal and root dentin. Because of the prolonged incubation time in the present study, similar results may be obtained clinically with prolonged dentin exposure to chlorhexidine, e.g. chlorhexidine-containing varnishes.

The use of Perioscan as a potential screening test for mothers at risk for delivery of pre-term and low birth-weight infants.

Increased levels of oestrogen and progesterone during pregnancy may lead to periodontal disease. The anaerobic Gram-negative bacteria classified as the "red complex" (Porphyromonas gingivalis, Tannerella forsythia and Treponema denticola) are frequently associated with periodontal disease. Periodontopathogens produce toxins and enzymes that can enter the bloodstream and cross the placenta to harm the foetus. The response of the mother's immune system to infection by these periodontopathogens brings about the release of inflammatory mediators which may trigger preterm labour or result in low birth-weight infants. The purpose of this study was to examine the use of Perioscan as a potential screening test for mothers at risk for pre-term delivery of low birth weight infants due to periodontal disease. Subgingival plaque samples were obtained from pregnant women between the ages of 17 to 45 years attending an ante-natal clinic in the Western Cape in South Africa. Plaque samples were analyzed by the enzymatic Perioscan test for detection of the red complex in 372 sites from 66 women. Results were confirmed by polymerase chain reaction (PCR) detection of the three species of the red complex. Seventeen (25.75%) of the population group tested positive with Perioscan but only 27 (7.25%) of the 372 sites were positive. Of the 66 mothers examined, we managed to retrieve 29 records post-delivery. In all the mothers examined, Perioscan results showed an association with the indices used to diagnose periodontal disease, and could also be associated with preterm delivery of low birth-weight infants in two of the 29 maternal records recovered.

Effects of sodium lauryl sulphate (SLS), present in dentifrice, on volatile sulphur compound (VSC) formation in morning bad breath.

The purpose of the present investigation was to evaluate the effects of sodium lauryl sulphate (SLS), present in a commercial dentifrice, on the formation of volatile sulphur compounds (VSC) and tongue coating in a panel of periodontally healthy subjects. A two-step blinded, crossover, randomized study was carried out in 25 dental students with healthy periodontium; these were divided into two experimental groups: SLS (dentifrice with SLS) and WSLS (dentifrice without SLS). The volunteers received the designated dentifrice and a new toothbrush for a 3x/day brushing regimen for 2 periods of 30 days. A seven-day washout interval was used between the periods. The assessed parameters were: plaque index (PI), gingival index (GI), organoleptic breath (ORG), VSC levels by portable sulphide monitor before (H1) and after (H2) cleaning of the tongue, tongue coating wet weight (TC) and benzoyl-DL-arginine-naphthylamide (BANA) test from tongue coating samples. The intra-group analysis showed a decrease in the median of organoleptic scores from 3 to 2 after 30 days for the SLS group (p < 0.05). The inter-group analysis showed lower values in ORG and H1 for the SLS group (p < 0.05). There was no difference between the amount of TC in SLS and WSLS groups. In the BANA test, the presence of SLS did not affect the BANA number of +/- results (p > 0.05). These findings suggest that sodium lauryl sulphate (SLS), present in dentifrice, appears to prevent VSC formation in morning bad breath regardless of the amount of tongue coating in periodontally healthy subjects.

Anaerobic dental flora and the acute coronary syndrome.

OBJECTIVE: Evidence exists that coronary heart disease is influenced by anaerobic bacterial flora and gingival inflammation. We assessed the association of periodontal bacteria, coronary artery disease, and acute coronary events. METHODS: The benzoyl-DL-arginine naphthylamide test, which detects several periodontal pathogens, and the papillary bleeding score were used to quantify gingival health. Participants with coronary heart disease (n=245) presenting with (n=92) and without an acute coronary syndrome were compared with persons seeking dental treatment (University dental, n=195) and a healthy cohort (Healthy dental, n=156). RESULTS: An 'infection', defined by a positive benzoyl-DL-arginine naphthylamide test score in>or=50% of sampled sites, was present in 408 participants. Compared with Healthy dental, the odds ratio for coronary heart disease having an infection was 8.6 (95% confidence interval, 4.0-18.4) and for University dental odds ratio=16 (95% confidence interval, 6.5-39.5). Patients with an acute coronary syndrome at the time of benzoyl-DL-arginine naphthylamide sampling were 3.95 times more likely to have an infection compared with coronary heart disease patients with no history of acute coronary syndrome (P=0.003), a finding independent of other covariates. CONCLUSIONS: Persons with coronary heart disease, particularly associated with an acute coronary syndrome, have anaerobic bacterial dental flora similar to individuals seeking periodontal dental care, and unlike periodontally healthy individuals.

Effect of adjunctive systemic azithromycin with periodontal surgery in the treatment of chronic periodontitis in smokers: a pilot study.

BACKGROUND: Along with conventional surgical therapy, systemic antibiotics may provide more effective treatment in smokers by targeting tissue-invasive bacteria. The aim of this randomized, placebo-controlled, double-masked clinical trial was to evaluate the adjunctive effects of systemic azithromycin (AZM) in combination with periodontal pocket reduction surgery in the treatment of chronic periodontitis in smokers. METHODS: Thirty patients with a greater than one pack/day smoking habit and generalized moderate to severe chronic periodontitis were randomized to the test (surgery plus 3 days of AZM, 500 mg) or control group (surgery plus 3 days of placebo). Full-mouth probing depth (PD), clinical attachment level (CAL), bleeding on probing (BOP), gingival index (GI), plaque index, and wound healing indices (WHI) were assessed at baseline and at 2 weeks and 1, 3, and 6 months following surgical intervention. Plaque and gingival crevicular fluid were collected for trypsin-like enzyme activity (benzoyl-dl-arginine naphthylamine) and bone biomarker (crosslinked telopeptide of type I collagen [ICTP]) analyses, respectively, at baseline, 2 weeks, and 1, 3, and 6 months. RESULTS: Surgical treatment of moderate (PD = 4 to 6 mm) and deep (PD > 6 mm) pockets significantly improved clinical parameters of treated and untreated teeth (CAL gain, PD reduction, and reduction of BOP). The additional use of AZM did not enhance this improvement nor did it promote reduction of ICTP levels. Compared to the control group, the test group had significantly better WHI scores at 1 month, significantly less GI at 2 weeks, and sustained reductions of red-complex bacteria with trypsin-like enzyme activity at 3 months. For non-surgery teeth, only the test group showed significant gains in overall CAL compared to baseline. CONCLUSIONS: The findings of this pilot study demonstrated that in heavy smokers, adjunctive systemic AZM in combination with pocket reduction surgery did not significantly enhance PD reduction or CAL gain. However, the clinical value of adjunctive AZM may be appreciated by more rapid wound healing, less short-term gingival inflammation, and sustained reductions of periopathogenic bacteria. More expanded studies are recommended to better determine the clinical effects of adjunctive AZM in patients who smoke.

A review of the current literature on aetiology and measurement methods of halitosis.

OBJECTIVES: This work reviews the current knowledge of aetiology and measurement methods of halitosis. DATA: Halitosis is an unpleasant or offensive odour emanating from the breath. The condition is multifactorial and may involve both oral and non-oral conditions. SOURCES: A private, monthly with keywords halitosis, malodo(u)r, (a)etiology, measurement, and management from Medline and Pubmed updated database of literature was reviewed. CONCLUSIONS: In approximately 80-90% of all cases, halitosis is caused by oral conditions, defined as oral malodour. Oral malodour results from tongue coating, periodontal disease, peri-implant disease, deep carious lesions, exposed necrotic tooth pulps, pericoronitis, mucosal ulcerations, healing (mucosal) wounds, impacted food or debris, imperfect dental restorations, unclean dentures, and factors causing decreased salivary flow rate. The basic process is microbial degradation of organic substrates. Non-oral aetiologies of halitosis include disturbances of the upper and lower respiratory tract, disorders of the gastrointestinal tract, some systemic diseases, metabolic disorders, medications, and carcinomas. Stressful situations are predisposing factors. There are three primary measurement methods of halitosis. Organoleptic measurement and gas chromatography are very reliable, but not very easily clinically implemented methods. The use of organoleptic measurement is suggested as the 'gold standard'. Gas chromatography is the preferable method if precise measurements of specific gases are required. Sulphide monitoring is an easily used method, but has the limitation that important odours are not detected. The scientific and practical value of additional or alternative measurement methods, such as BANA test, chemical sensors, salivary incubation test, quantifying beta-galactosidase activity, ammonia monitoring, ninhydrin method, and polymerase chain reaction, has to be established.

The transmission of anaerobic periodontopathic organisms.

The oral microbial flora is unique, and available evidence indicates that it is passed vertically from parents to children. In this investigation, we used a chairside assay for the N-benzoyl-DL-arginine-2-naphthylamide (BANA)-sensitive enzyme found in Porphyromonas gingivalis, Treponema denticola, and Tannerella forsythensis, to determine the prevalence of these BANA-positive species in young children and their caregivers. We predicted that if the BANA enzyme was found in plaque samples of children, it would also be present in the plaque samples of the caregivers. Forty-four percent of 150 children had at least one plaque sample positive for the BANA enzyme. If the caregiver was BANA-positive, the odds of the child also being BANA-positive was 35 times more than for a child with a BANA-negative caregiver, after adjustment for the child's age and papillary bleeding score (PBS). Other significant predictors were the PBS of children (p < 0.001), a history of periodontal disease, and the ages of the caregivers (p < 0.001).

The diagnosis of periodontal disease in private practice.

BACKGROUND: Periodontal disease is an inflammatory reaction to the bacteria in dental plaque. The present study compared the prevalence of periodontal disease in patients using as a diagnostic either probing depth measurements, an inflammatory marker such as numbers of white blood cells in plaque samples, or microbiological markers such as the microscopic count and the benzoyl-DL-arginine naphthylamide (BANA) test. METHODS: Teeth with the most inflammation and/or deepest pockets in each quadrant were probed and subgingival plaque was sampled from 1,043 consecutive new patients enrolled in a private practice. Multivariate "diagnostic" models were developed based upon the probing depth (general linear models), percentage of white blood cell-positive and percentage of BANA-positive plaques (logistic regression models) to determine the prevalence of patients with periodontal disease. RESULTS: Plaque samples were removed from 3,694 sites. Fifty-two percent of sampled pockets were >4 mm; 49% of sites were inflamed, using the presence of white blood cells, and 28% were infected using the BANA test. Diagnostic models were highly significant at P<0.0001. The white blood cell model was the most parsimonious as demonstrated by the lowest Akaike information criteria statistic and had the highest receiver operator characteristic (ROC) curve relative to the probing depth and BANA models. CONCLUSIONS: Periodontal disease can be diagnosed chairside by the presence of white blood cells in plaque samples, a finding that reflects the inflammatory nature of the disease process. This approach would reduce the misclassification of subjects as having periodontal disease (130 patients in the present study who had pockets) but minimal evidence of an inflammatory response.

Relationship between gingival clinical parameters and the reactivity of the BANA test in subgingival samples from children.

Gingivitis is the first manifestation of periodontal disease, and is characterized by painless and slow evolution. Early diagnosis and intervention must be done to avoid the possibility of precocious periodontitis during the childhood or teenage years. The enzymatic BANA test (N-benzoyl-DL-arginine-naphthylamide) was used to evaluate subgingival samples from 54 children between 6 and 9 years of age. Plaque index (PI) and gingival index (GI) were assessed according to the criteria recommended by Löe (1967). Subgingival plaque was collected from the region that featured the greatest periodontal alteration, represented by a higher gingival index. Resulting data were grouped individually according to visible and non-visible plaque and bleeding and non-bleeding gingiva. Results showed that there was no statistically significant correlation between the presence of visible plaque and the positivity of the BANA test, nor was there a statistically significant correlation between the presence of bleeding and the positivity of the BANA test in subgingival samples obtained from children. This study concluded that the BANA test is not an ideal diagnostic test to be applied to children.

A comparison of the gingival health of children with Down syndrome to healthy children residing in an institution.

The purpose of this study was to compare the onset and severity of gingivitis in children with Down syndrome, when compared to a healthy control group of children. The subjects included 41 children with Down syndrome ages two to 14 years (mean age: 7.6 years) and 112 age-matched healthy controls. We assessed the gingival health of all subjects using the gingival inflammation (M-PMA) index and periodontal probing depth (PD). Children were divided into three age categories: <5 years (AI), 5 to <10 years (AII), and 10 to <17 years (AIII). Supragingival plaque was measured using the Oral Hygiene Index (OHI) and the subjects were screened with the BANA test (Perioscan-Oral-B). Measurement of the M-PMA index in the healthy children showed an age-related increase (F = 10.369, p < 0.001), and the M-PMA index at the younger age group <5 year (AI) was significantly lower than that for the other two age groups All or AIII (p < 0.005, p < 0.001). In contrast, the M-PMA index values at AI and AIII in the subjects with Down syndrome were significantly higher than those for healthy children (p < 0.001, p < 0.001). Both groups had an age-related increase in PD (F = 3.388, p < 0.05 & F = 10.806, p < 0.001), and PD at AIII was significantly higher than that at AI in both groups (p < 0.01, p < 0.001). The children with Down syndrome showed an age-related increase in the BANA test score (F = 3.452, p < 0.05), and the BANA test score at AIII was significantly higher than that at AI (p < 0.02). The BANA test score in the healthy children was not age-related but was significantly higher than that in the children with Down syndrome (p < 0.02, p < 0.05).

Detection and measurement of oral malodour in periodontitis patients.

BACKGROUND & OBJECTIVES: Malodour has been correlated with the concentration of volatile sulphur compounds produced in the oral cavity by metabolic activity of bacteria colonizing the periodontal sites and the dorsum of the tongue. The aim of this study was to detect malodour in mouth air organoleptically and using a portable sulphide monitor and to correlate it with the clinical parameters, halitosis linked toxins and BANA, using tongue and subgingival plaque samples. The halitosis grading is also correlated with the microbial colonies of the subgingival plaque sample. METHODS: 20 patients with chronic periodontitis with 5-7 mm pocket depth, radiographic evidence of bone loss and presence of oral malodour participated in this study. Assessment of mouth air was done organoleptically and by using a portable sulphide monitor. The clinical parameter, plaque index (PI), gingival index (GI), gingival bleeding index (BI), were obtained from all the areas. Samples for BANA and to detect halitosis linked toxins were taken from the dorsal surface of the tongue and periodontal pockets ranging 5-7 mm. Halitosis related microbial colonies were identified using anaerobic culturing from the subgingival plaque. RESULTS: The scores of PI, GI, BI and sample that tested positive for halitosis linked toxins and with the halitosis grading were not significant. The presence of tongue coating and the halitosis grading and toxin levels were significant. BANA has shown to be non contributory due to technical problems. Anaerobic culture has shown to identify Streptococcus, Bacteroides, Fusobacterium, Porphyromonas and Prevotella colonies. INTERPRETATION & CONCLUSION: The results confirmed that there was no correlation between the clinical parameters, halitosis linked toxins and halitosis grading. The microbial colonies have shown to correlate with the presence of oral malodour.