Prevalence of periodontitis: misclassification, under-recognition or over-diagnosis using partial and full-mouth periodontal examination protocols.

OBJECTIVE: The aim of this cross-sectional study was to assess the bias in estimating the prevalence of periodontitis due to partial-mouth periodontal examination protocols (PMPE) and to relate the severity and extent of periodontal damage to periodontitis misclassification when applying case definitions by Centres of Disease Control and Prevention and American Academy of Periodontology (CDC/AAP). MATERIALS AND METHODS: A full-mouth periodontal examination (FMPE) was performed in 721 adults living in North Italy to identify moderate and severe periodontitis. These results were compared with those obtained with two PMPE protocols analyzing two interproximal sites on all teeth (fMB-DL) or four interproximal sites in two random diagonal quadrants (pMDB-MDL). RESULTS: Both PMPE systems estimated the prevalence of moderate periodontitis with limited bias (-2.79% for pMDB-MDL and -3.49% for fMB-DL), whereas produced larger relative biases for severe periodontitis (-28.74% versus - 14.55%). The percentage of under-recognition of existing periodontal disease was 8.9% under fMB-DL and 15.5% under pMDB-MDL. The diagnosis of moderate and severe periodontal disease was correctly assigned to individuals with on average 8% and 30% of pathological sites, respectively. CONCLUSION: These findings suggest that PMPE systems provide high level of bias when using CDC/AAP case definitions.

Orthodontic treatment in patients with aggressive periodontitis.

INTRODUCTION: Aggressive periodontitis (AP) is a condition that promotes breakdown of the periodontal tissues in a short time. In severe cases, pathologic migration of teeth and tooth loss can occur, producing esthetic and functional problems for the patient. Orthodontic treatment may be recommended to restore esthetics and masticatory function. We assessed the effects of orthodontic movement in the periodontal tissues of treated patients with AP. METHODS: Ten subjects (ages 25.0 ± 5.22 years) with AP received periodontal treatment followed by orthodontic treatment. Maintenance sessions were performed monthly under a strict dental biofilm control. They were compared with 10 periodontally healthy subjects (ages 22.9 ± 5.23 years) who received orthodontic treatment. Probing pocket depth, clinical attachment level, bleeding on probing, and dental plaque index were measured at baseline, after orthodontic treatment, and after 4 months. RESULTS: Statistical analysis showed improvement in all clinical parameters between baseline and 4 months after orthodontic treatment: probing pocket depth (0.29 mm), clinical attachment level (0.38 mm), bleeding on probing (4.0%), and dental plaque index (11%). CONCLUSIONS: The periodontal parameters of the AP patients remained stable during orthodontic treatment under strict biofilm control.

Dental and periodontal health, and microbiological and salivary conditions in patients with or without diabetes undergoing haemodialysis.

OBJECTIVE: The aim of this cross-sectional study was to evaluate the dental and periodontal health, as well as the microbiological and salivary conditions, of patients with and without diabetes mellitus (DM) who are receiving haemodialysis. METHODS: One-hundred and fifty-nine haemodialysis patients were included and divided into groups according to the pre-existing diabetes status: DM or no DM. The oral examination included dental findings and assessment of the periodontal situation. The periodontal condition was classified as healthy/mild, moderate or severe periodontitis. Subgingival biofilm samples were analysed using the polymerase chain reaction. The salivary diagnostics included measurement of unstimulated and stimulated salivary flow, pH and buffer capacity. Statistical analyses used Fisher's test, the t-test and the Mann-Whitney U-test (α = 5%). RESULTS: The dental findings showed no significant difference between patients with and without DM (P = 0.44). The prevalence of periodontitis was high (96% in patients with DM and 97% in patients who did not have DM) and there was no significant difference between the groups (P = 0.71). There was a higher prevalence of Porphyromonas gingivalis, Parvimonas micros, Eubacterium nucleatum and Capnocytophaga spp. in patients without DM (P < 0.05). The salivary pH was significantly higher in patients without DM (P < 0.01). CONCLUSION: While differences in the prevalence of periodontal pathogenic bacteria and in the salivary pH were detected between the groups, the dental and periodontal status was comparable between patients with and without DM. Accordingly, DM appears to have no decisive influence on the oral health in patients treated with haemodialysis who have well-controlled diabetes.

Clinical Efficacy of Subgingivally Delivered 1.2 mg Simvastatin in the Treatment of Patients with Aggressive Periodontitis: A Randomized Controlled Clinical Trial.

Simvastatin (SMV) is a specific competitive inhibitor of 3-hydroxy-2-methylglutaryl coenzyme A reductase that promotes bone formation. The present clinical trial was designed to investigate the effectiveness of 1.2 mg SMV as a local drug delivery system and as an adjunct to scaling and root planing (SRP) in the treatment of aggressive periodontitis (AgP). A total of 68 intrabony defects from 24 patients with AgP were treated either with 1.2 mg SMV gel or placebo gel. The subjects were randomly assigned to SRP + placebo (group 1; n = 12) or SRP + SMV (group 2; n = 12). Clinical parameters were recorded at baseline and at 3 and 6 months and included bleeding index, Plaque Index, probing depth (PD), and clinical attachment level (CAL). At baseline and after 6 months, radiologic assessment of bone defect fill was done. The mean decrease in PD at 6 months was 1.14 ± 0.04 mm and 3.78 ± 0.62 mm in groups 1 and 2, respectively. Significant gain in mean CAL was found between the groups (P < .05). Furthermore, significantly greater mean percentage of bone fill was found in group 2 (34.01%) compared to group 1 (2.62%). Locally delivered SMV provides a comfortable method to improve clinical parameters and promotes bone formation.

Sense of coherence and periodontal health outcomes.

OBJECTIVE: Sense of Coherence (SOC) has been associated with perceived oral health measures, but the contribution of SOC to clinical measures is still unclear. The aim of the present cross-sectional study was to evaluate the potential association between periodontal health outcomes, such as periodontal clinical parameters and perceived periodontal health, and SOC. MATERIALS AND METHODS: The study sample comprised 276 individuals, aged 18-60 years, from Belo Horizonte, Brazil. Participants answered questionnaires covering sociodemographic variables, self-perceived periodontal health and SOC. Full-mouth periodontal examinations were performed. The sample was divided into three groups according to SOC score: (a) SOC1 = weak (24-46); (b) SOC2 = moderate (47-51); (c) SOC3 = strong (52-65). Multivariate analyses including appropriate logistic or linear regression models were performed to evaluate the association between periodontal health outcomes and biological, sociodemographic and behavioural variables. RESULTS: Perceived general oral health was associated with family income bracket (p = 0.010), smoking (p = 0.004), dental flossing (p = 0.017) and SOC (weak SOC: p = 0.005). Perceived gum disease and perceived periodontal disease were associated with SOC (weak SOC: p = 0.001 and p = 0.015, respectively). CONCLUSIONS: Overall, perceived periodontal health outcomes were associated with SOC. However, no association between clinical periodontal health outcomes and SOC were observed.

Possible Association Between the Mallampati Score of the Oropharynx and Measures of Tongue Coating, Oral Hygiene and Periodontal Status.

PURPOSE: To assess oral hygiene and the gingival and periodontal disease status in subjects scored under the modified Mallampati classification (MMC) of the oropharynx. PATIENTS AND METHODS: The clinical parameters included recording MMC scores, simplified oral hygiene index (OHI-S), modified gingival index (MGI), tongue coating index (TCI) and periodontal status of the subjects. Eight additional parameters, which included percentage of sites with bleeding on probing (BOP), sites with probing depth (PD) ≥ 5 mm, tooth loss, attachment loss (AL):age ratio, diabetic status, smoking, the interplay of dental status and systemic factors (DS-SFI), and background characteristics (socioeconomic status and stress) were also assessed. RESULTS: Class IV MMC group showed the highest mean scores for OHI-S, periodontal status, AL:age ratio, diabetic status, background characteristics, PD ≥ 5 mm and DS-SFI when compared to other groups. In measures of OHI-S, periodontal status, PD > 5 mm, AL:age ratio and background characteristics, Class IV MMC group showed significant intergroup differences over MMC class I. Regression analysis revealed a highly significant but low degree of correlation (R2 = 0.079; p ≤ 0.001) between the predictors and the dependent values. CONCLUSION: The results suggest that increasing MMC scores can be a possible determinant in identifying gingival and periodontal disease. Any dental professional dealing with a multifactorial disease such as periodontitis can use this classification as a basic screening tool in identifying the modifiable factors of periodontitis.

Comparison of longitudinal changes in clinical periodontal parameters of canines and first molars treated with fixed orthodontic appliances.

INTRODUCTION: Our objective was to learn the possible effects of fixed orthodontic therapy on the periodontium of the extraction sites adjacent to canines and first molars. This was a prospective cohort study. METHODS: Sixty-two systemically healthy subjects were selected. The study was divided into the period of oral hygiene instructions and the period of active orthodontic treatment. Plaque index, gingival index, probing pocket depth, and clinical attachment loss were recorded for the canines and first molars at baseline, after 1 month of orthodontic therapy, and every 3 months until the completion of the orthodontic treatment. RESULTS: There was a statistically significant increase in all clinical parameters (plaque index, gingival index, probing pocket depth, and attachment loss; P <0.05) on the first molars compared with the canines. Significant increases in attachment loss were noted in both the canines (baseline, 0.06 ± 0.01 mm; end of treatment, 0.17 ± 0.02 mm) and the molars (baseline, 0.07 ± 0.01 mm; end of treatment, 0.20 ± 0.02 mm). CONCLUSIONS: Attachment loss cannot be explained solely by the effect of plaque or the banding of teeth. Other factors such as tooth extractions adjacent to the canines, tooth movement, and occlusal trauma may have contributing roles in the loss of periodontal support in adolescent patients.

The effects of periodontal therapy on gingival crevicular fluid matrix metalloproteinase-8, interleukin-6 and prostaglandin E2 levels in patients with rheumatoid arthritis.

OBJECTIVE: The aim of this study was to evaluate the effects of non-surgical periodontal therapy on gingival crevicular fluid levels of matrix metalloproteinase-8 (MMP-8), interleukin-6 (IL-6) and prostaglandin E2 (PGE2 ) in patients with rheumatoid arthritis (RA) with periodontal disease. MATERIAL AND METHODS: Twenty-seven patients with gingivitis and periodontitis with RA, 26 patients with gingivitis and periodontitis that were systemically healthy and 13 periodontally and systemically healthy volunteers (control group) were included in this study. RA activity was assessed by disease activity score test. The clinical periodontal parameters, fasting venous blood and gingival crevicular fluid samples were obtained and gingival crevicular fluid MMP-8, IL-6 and PGE2 levels were evaluated at baseline and at 3 mo follow-up after non-surgical periodontal treatment. RESULTS: Gingival crevicular fluid MMP-8, PGE2 and IL-6 levels were higher in all groups than the control group. Following periodontal therapy, there were significant decreases in gingival crevicular fluid MMP-8, PGE2 and IL-6 levels from patients with RA with periodontitis (p < 0.05). Plaque index, gingival index and bleeding on probing were significantly correlated with IL-6 and PGE2 at baseline and at 3 mo follow-up after non-surgical periodontal treatment. CONCLUSION: Non-surgical periodontal therapy of patients with RA with periodontitis may provide beneficial effects on local inflammatory control via decreases in gingival crevicular fluid MMP-8, PGE2 and IL-6 levels.

The effect of indocyanine green-mediated photodynamic therapy as an adjunct to scaling and root planing in the treatment of chronic periodontitis: A comparative split-mouth randomized clinical trial.

OBJECTIVE: The aim of this study was to assess the effect of adjunctive photodynamic therapy (PDT) (using 810 nm diode laser and Indocyanine green as photosensitizer) in chronic periodontitis. MATERIALS AND METHODS: Patients with untreated chronic periodontitis were included. Treatment was done according to a split mouth design. All sites received periodontal treatment comprising scaling and root-planing (SRP). Test group were additionally treated with PDT. Plaque Index (PI), Gingival Index (GI), Probing Pocket Depth (PPD) and Relative Attachment Level (RAL) were evaluated at baseline, 1 month and 3 months. RESULTS: Mean baseline values for PI, GI, PPD and RAL were not different in the test group and control group. Statistical significant difference in PPD and RAL, 3 months after treatment was seen in test group as compared to the control group. CONCLUSIONS: In patients with chronic periodontitis, clinical outcomes of conventional SRP can be improved by adjunctive PDT.

Tumor necrosis factor-alpha gene promoter methylation in Japanese adults with chronic periodontitis and rheumatoid arthritis.

BACKGROUND AND OBJECTIVE: Over-expression of tumor necrosis factor-alpha (TNF-α) plays a pathological role in chronic periodontitis (CP) and rheumatoid arthritis (RA), which might be regulated by the epigenetic mechanism. The aim of the present study was to evaluate whether there is a unique methylation profile of the TNF-α gene promoter in blood cells of individuals with CP and RA. MATERIAL AND METHODS: The study participants consisted of 30 Japanese adults with RA (RA group), 30 race-matched adults with CP only (CP group) and 30 race-matched healthy controls (H group). Genomic DNA isolated from peripheral blood was modified by sodium bisulfite and analyzed, by direct sequencing, to investigate DNA methylation of the TNF-α gene promoter region. The level of TNF-α produced in mononuclear cells stimulated with Porphyromonas gingivalis lipopolysaccharide was determined using ELISA. RESULTS: Twelve cytosine-guanine dinucleotide (CpG) motifs were identified in the TNF-α promoter fragment from -343 to +57 bp. The CP group showed a significantly higher methylation rate and frequency at -72 bp than the H group (p < 0.01). The RA group exhibited significantly higher methylation rates at seven CpG motifs (-302, -163, -119, -72, -49, -38 and +10 bp), and significantly higher methylation frequencies at six CpG motifs (-163, -119, -72, -49, -38 and +10 bp), than the H group (p < 0.01 for all comparisons). The levels of TNF-α produced were significantly different between individuals with and without methylation at -163 bp (p = 0.03). CONCLUSION: These results suggest that the hypermethylated status of CpG motifs in the TNF-α gene promoter in blood cells may be unique to Japanese adults with CP and RA.

Gingival crevicular fluid vascular endothelial cell growth factor and platelet-derived growth factor-BB release profile following the use of perforated barrier membranes during treatment of intrabony defects: a randomized clinical trial.

BACKGROUND AND OBJECTIVE: Perforated barrier membranes open channels between the suprabony and intrabony compartments of the defect, which could allow for more physiologic cellular interactions between different components of the periodontium during guided tissue regeneration surgery. To test this assumption, this study was designed to evaluate levels of vascular endothelial cell growth factor (VEGF) and platelet-derived growth factor (PDGF)-BB in gingival crevicular fluid during the early stages of healing of localized intrabony defects treated with perforated membranes (PMs) or non-PMs, as compared with open flap debridement. MATERIAL AND METHODS: Thirty non-smoking patients with severe chronic periodontitis participated in this prospective, randomized and single blinded trial. Each patient contributed one interproximal defect that was randomly assigned to the PM group (n = 10), occlusive membrane (OM) group (n = 10) or open flap debridement (OFD) group (n = 10). Plaque index, gingival index, probing depth, clinical attachment level and the intrabony depth of the defect were measured at baseline and reassessed at 6 and 9 mo after therapy. Gingival crevicular fluid samples were collected on days 1, 3, 7, 14, 21 and 30 d after therapy for the changes in VEGF and PDGF-BB levels. RESULTS: During the early stages of healing (1, 3 and 7 d), the mean VEGF and PDGF-BB concentrations at sites treated with PMs and OFD peaked with a statistically significant difference as compared with the OM-treated group. VEGF and PDGF-BB levels at sites treated with PMs and OFD were not statistically different. Growth factor levels decreased sharply in the samples obtained at days 21 and 30 with non-significant differences between the three groups. Nine months after therapy, the PM-treated group showed a statistically significant improvement in probing depth, clinical attachment level and intrabony defect compared to the OM and OFD groups. CONCLUSIONS: Within the limits of the present study, one can conclude that PM coverage of periodontal defects is associated with initial gingival crevicular fluid growth factor upregulation that could improve the clinical outcomes of guided tissue regeneration surgery.

The effectiveness of a resorbable bone substitute with a resorbable membrane in the treatment of periodontal infrabony defect - A multicenter randomised controlled trial.

PURPOSE: To evaluate the effectiveness of a bone substitute covered with a resorbable membrane versus open flap debridement for the treatment of periodontal infrabony defects. MATERIALS AND METHODS: Ninety-seven patients with one infrabony defect, which was 3 mm or deeper and at least 2 mm wide were randomly allocated either to grafting with a bone substitute covered with a resorbable barrier (BG group) or open flap debridement (OFD group) according to a parallel group design in five European centres. Blinded outcome measures assessed tooth loss, complications, patient's satisfaction with treatment and aesthetics, changes in probing attachment levels (PAL), probing pocket depths (PPD), gingival recessions (REC), radiographic bone levels (RAD) on standardised periapical radiographs, plaque index (PI) and marginal bleeding index (MBI). RESULTS: 49 patients were randomly allocated to the BG group and 48 to the OFD group. At baseline there were more mobile teeth in the BG group (29 versus 15). One year after treatment two patients dropped out from the BG group and no teeth were lost. Three complications (minor postoperative wound dehiscence) occurred in the BG group versus none in the OFD group, where the difference was not statistically significant. The BG group obtained significantly greater statistical PAL gain (mean difference = -0.8 mm, 95% CI [-1.51; -0.03], P = 0.0428), PPD reduction (mean difference = -1.1 mm, 95% CI [-1.84; -0.19], P = 0.0165) and RAD gain (mean difference = -1.2 mm, 95% CI [-2.0; -0.4], P = 0.0058) compared to the OFD group. No statistically significant differences between the groups were observed for gingival recession, or the patient's satisfaction with the treatment and aesthetics. There were some statistically significant differences between the centres for PAL and PPD with the Italian centres reporting better outcomes. CONCLUSIONS: The use of a bone substitute covered with a resorbable membrane yielded significantly better statistical clinical outcomes than open flap debridement in the treatment of periodontal infrabony defects deeper than 3 mm, with regard to PAL gain, PPD reduction and RAD gain.

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.

Efficacy of Human Chorion Membrane Allograft for Recession Coverage: A Case Series.

BACKGROUND: Membranes of human placentas have been used in the field of medicine for skin grafts, treatment of burns, and ulcerated skin conditions with great success. The use of placenta allografts in dentistry is a more recent development, with the first commercial product being made available in 2008. The unique inherent biologic properties in placenta allografts enhance wound healing and may propagate regeneration. METHODS: Ten healthy adult patients presenting with 21 Miller Class I gingival recession (GR) defects (isolated or adjacent multiple) were surgically treated with a modified coronally advanced flap and chorion membrane for root coverage. Clinical parameters measured at baseline, 3 months, and 6 months were probing depth, clinical attachment level, GR height, width of keratinized gingiva, and assessment of gingival biotype. Statistical analysis was performed to compare the treatment outcomes at the follow-up intervals. RESULTS: The results showed statistically significant (P <0.001) improvements in all clinical parameters at the 3- and 6-month follow-ups. The mean percentage of root coverage at the end of 6 months was 89.92% ± 15.59%, and 14 of 21 treated GR defects showed 100% root coverage. The gingival biotype also showed a thick biotype in nine sites that had an initial thin biotype. CONCLUSIONS: Fetal membranes possess distinctive properties that can be harnessed to promote periodontal healing. The chorion membrane covered by a modified coronally advanced flap is a new approach that has shown promising results in terms of root coverage, increased width of keratinized tissue, and thickness of the gingival biotype.

Bias in estimating the cross-sectional smoking, alcohol, obesity and diabetes associations with moderate-severe periodontitis in the Atherosclerosis Risk in Communities study: comparison of full versus partial-mouth estimates.

OBJECTIVE: To assess whether partial-mouth protocols (PRPs) result in biased estimates of the associations between smoking, alcohol, obesity and diabetes with periodontitis. METHODS: Using a sample (n = 6129) of the 1996-1998 Atherosclerosis Risk in Communities study, we used measures of probing pocket depth and clinical attachment level to identify moderate-severe periodontitis. Adjusting for confounders, unconditional binary logistic regression estimated prevalence odds ratios (POR) and 95% confidence limits. Specifically, we compared POR for smoking, alcohol, obesity and diabetes with periodontitis derived from full-mouth to those derived from 4-PRPs (Ramfjörd, National Health and Nutrition Examination survey-III, modified-NHANES-IV and 42-site-Random-site selection-method). Finally, we conducted a simple sensitivity analysis of periodontitis misclassification by changing the case definition threshold for each PRP. RESULTS: In comparison to full-mouth PORs, PRP PORs were biased in terms of magnitude and direction. Holding the full-mouth case definition at moderate-severe periodontitis and setting it at mild-moderate-severe for the PRPs did not consistently produce POR estimates that were either biased towards or away from the null in comparison to full-mouth estimates. CONCLUSIONS: Partial-mouth protocols result in misclassification of periodontitis and may bias epidemiologic measures of association. The magnitude and direction of this bias depends on choice of PRP and case definition threshold used.

Association Between Periodontal Disease and Kidney Function Decline in African Americans: The Jackson Heart Study.

BACKGROUND: Chronic kidney disease (CKD) remains a prevalent public health problem that disproportionately affects African Americans, despite intense efforts targeting traditional risk factors. Periodontal disease, a chronic bacterial infection of the oral cavity, is both common and modifiable and has been implicated as a novel potential CKD risk factor. The authors seek to examine to what extent periodontal disease is associated with kidney function decline. METHODS: This retrospective cohort study examines 699 African American participants with preserved kidney function (defined by estimated glomerular filtration rate (eGFR) >60 mL/minute/1.73 m(2) at baseline) who underwent complete dental examinations as part of the Dental-Atherosclerosis Risk in Communities study (1996 to 1998) and subsequently enrolled in the Jackson Heart Study (2000 to 2004). Using multivariable Poisson regression, the authors examined the association of periodontal disease (severe versus non-severe) with incident CKD, defined as incident eGFR <60 mL/minute/1.73 m(2) and rapid (5% annualized) eGFR decline at follow-up among those with preserved eGFR at baseline. RESULTS: Mean (± SD) age at baseline was 65.4 (± 5.2) years, and 16.3% (n = 114) had severe periodontal disease. There were 21 cases (3.0%) of incident CKD after a mean follow-up of 4.8 (± 0.6) years. Compared with participants with non-severe periodontal disease, those with severe periodontal disease had a four-fold greater rate of incident CKD (adjusted incidence rate ratio 4.18 [95% confidence interval 1.68 to 10.39], P = 0.002). CONCLUSIONS: Severe periodontal disease is prevalent among a population at high risk for CKD and is associated with clinically significant kidney function decline. Further research is needed to determine if periodontal disease treatment alters the trajectory of renal deterioration.

A root canal filling per se does not have a significant negative effect on the marginal periodontium.

AIM: To evaluate the periodontal status of single-rooted endodontically treated teeth (ET), correcting for patient- and tooth-related factors. METHODS: Clinical parameters (BoP,PD,CAL) of 240 ET and 240 contralateral vital teeth (VT), before and after non-surgical periodontal treatment, were extracted retrospectively from the journals of 175 patients. Possible patient-related (age, gender, smoking status) and tooth-related (interproximal restoration, root canal filling's extent, post, tooth type) confounders were tested. RESULTS: At baseline, frequency of BoP at an interproximal site at ET versus VT was 70.4% versus 65.0%, respectively. The frequency of teeth with interproximal PD ≥ 5 mm and CAL ≥ 5 mm was 47.9% versus 42.9% and 54.6% versus 49.6% at ET and VT, respectively. Interproximal PD and CAL at ET versus VT were 3.86 versus 3.61 mm and 4.11 versus 3.95 mm. After correcting for tooth-related factors, no significant differences were observed between ET and VT. An improper restoration had a significant (p < 0.001) negative effect on BoP [OR 3.49 (95%CI: 1.95-6.27)], PD [36.81% (95%CI: 18.52-57.92)] and CAL [27.01% (95%CI: 12.67-43.18)]. No significant differences between ET and VT were observed regarding clinical outcome of non-surgical periodontal therapy. CONCLUSIONS: Presence of a root canal filling per se does not have a significant negative influence on the marginal periodontium, when correcting for the quality of the interproximal restoration.

Periodontal status and pathogenic bacteria after gastric bypass: a cohort study.

AIM: The aim this study was to evaluate the influence of gastric bypass surgery (GBS) on periodontal disease and quantify the periodontopathogenic bacteria in patients undergoing this surgery. MATERIAL AND METHODS: This prospective study was composed of 50 patients who underwent bariatric surgery and the data collection was performed in three periods pre-operative, 6 (6M) and 12 months (12 M) postoperative. The oral clinical examination to assess periodontal disease; gingival fluid sample collection for quantification of the periodontopathogenic bacteria Porphyromonas gingivalis, Tannerella forsythia, Treponema denticola, and Prevotella intermedia using q-PCR; body mass index (BMI) and for collection of the individual's health-related data from medical files. RESULTS: There was a significant reduction in serum C-reactive protein (CRP) and glucose levels after surgery. The mean probing pocket depth (PPD) and clinical attachment level (CAL) increased significantly in the postoperative period of 6 months (p = 0.001). In the same period, the amount of P. gingivalis increased (p = 0.028) and the other bacteria decreased slightly (p > 0.050). In the presence of P. gingivalis, T. forsythia, T. denticola and P. intermedia, a poor periodontal condition was observed. CONCLUSION: The periodontal disease increased in severity and P. gingivalis increased after GBS. A systemic inflammation resolution due to bariatric surgery in obese subjects does not seem to affect the course of periodontal disease.

Adiposity Measurements and Non-Surgical Periodontal Therapy Outcomes.

BACKGROUND: Obesity is considered a risk factor for periodontitis. However, its influence on periodontal therapy has not been clearly determined. The aim of this case-control study is to evaluate the association between adiposity measurements, non-surgical periodontal treatment outcomes, and influencing factors in patients with chronic periodontitis. METHODS: Eighteen obese and 18 normal-weight (NW) patients are included in this study. The waist/hip ratio (WHR), plaque index, bleeding on probing, probing depth (PD), and clinical attachment level (CAL) were measured at baseline and 3 and 6 months after treatment. Univariable and multivariable analyses were used to evaluate the influence of sex, age, baseline percentage of PD >3 mm, WHR, and obesity on periodontal treatment outcomes. RESULTS: Demographic and periodontal characteristics at baseline were similar in both groups. All periodontal parameters were improved during treatment in both groups. PD reduction and CAL gain were 0.88 and 0.84 mm in NW individuals and 0.79 and 0.68 mm in obese individuals. The difference in moderate-to-deep pocket (PD >5 mm) percentages between the baseline and 6-month examinations was 9.1% in NW individuals and 6.08% for obese individuals. Multivariable analysis showed that obesity negatively influenced changes of PD >5 mm percentages. This influence was also observed at 3 months for improving sites (PD decrease >2 mm between examinations) if WHR was also considered in the analysis. CONCLUSIONS: A negative association between adiposity measurements and periodontal treatment outcomes was observed mainly for moderate-to-deep pockets. Consideration of WHR and other influencing factors amplified the negative effect of obesity on periodontal treatment outcomes.