Gingival blood flow and temperature changes in young humans with a history of periodontitis.

Whether such individuals have different gingival blood flow and temperature responses to local cooling than age- and sex-matched healthy controls was tested. Ten patients with a history of localized juvenile periodontitis or rapidly progressive periodontitis were selected from a periodontal clinic and matched with healthy controls. Gingival blood flow and temperature were monitored continuously before and after cooling via a twin probe placed in the gingival sulcus on the buccal of tooth No. 26. Blood flow was assessed by laser Doppler flowmetry and temperature by a small metal thermistor. Resting values were first recorded for 5 min, followed by 3 min of cooling to 19 degrees C by a gentle stream of cool air, then 12 min of rewarming was allowed. This protocol was repeated twice. Blood flow changes were analysed as the slope of the line formed between the last 2 min of cooling and the last 2 min of rewarming; temperature curves were analysed by a least-squares curve fit of a bi-exponential function. Patients with localized juvenile periodontitis and rapidly progressive periodontitis had similar rewarming temperature curves, but significantly faster blood flow recovery curves than controls (p less than 0.03). Thus, gingival blood flow in young periodontitis patients recovered more rapidly after local cooling than in healthy controls.

Costs of periodontal and prosthodontic treatment and evaluation of oral health in patients after treatment of advanced periodontal disease.

Retrospective estimations of dental care costs of periodontal and prosthodontic treatment and evaluation of oral health in 37 patients with advanced periodontal disease were carried out. Measures of their subjective evaluation of oral health 7-10 yr after the treatment are presented as a health profile and as indices in single numbers. The relations between oral health as an index and the dimensions in the health profile are analyzed. Dental care costs for treatment in the mandible was SEK 35 550, for the maxilla SEK 45 380 and for both jaws SEK 74 230. After the treatment oral health as well as general health were in excess of 75 on a 0 to 100 scale. Chewing ability, comfort and aesthetics were the variables found to significantly affect the subjective oral health. Oral health in terms of periodontal and prosthodontic conditions was maintained over the observation period.

A proportional analysis of the soft tissue facial profile in young adults with normal occlusion.

A proportional soft tissue profile analysis is presented, based on natural head position (NHP) and an extracranial vertical reference line through Porion. Twelve linear soft tissue variables and norms for 11 indices expressing vertical and horizontal soft tissue proportions of the face were obtained from lateral skull radiographs of 40 Swedish adults (20 males, and 20 females) with good occlusion. Sexual dimorphism, with larger dimensions in men than in women, was most pronounced in the vertical plane. With regard to facial soft tissue proportions, significant differences between men and women were found only for those indices which involved measurements of lower jaw prominence and facial height. The means and standard deviations for six indices in the female group were compared with corresponding data obtained from the Peck and Peck sample, which had been selected on esthetic grounds. The results showed a close match between the groups. The proportional soft tissue analysis is recommended for the treatment planning of patients scheduled for orthognathic surgery.

Periodontal conditions in 70-year-old women with osteoporosis.

The aim of the present study was to examine the periodontal conditions in an age cohort of 70-year-old women and compare an osteoporosis group with a control group with normal bone mineral density. 210 women 70 years old and randomly sampled from the population register of the community of Linköping were examined. Bone mineral density (BMD) of the hip was measured by dual energy X-ray absorptiometry. 19 women were diagnosed with osteoporosis (BMD below 0.640 g/cm2 in total hip). 15 of them accepted to participate in the study. As a control group 21 women with normal bone mineral density (BMD exceeding 0.881 g/cm2) were randomly selected from the initial population. The clinical examination included registration of the number of remaining teeth, dental plaque and periodontal conditions. The radiographic examination included a dental panorama and vertical bite-wing radiographs. The subjects also answered a questionnaire about their general health, age at menopause, concurrent medication, smoking and oral hygiene habits. The results from this study showed no statistically significant differences in gingival bleeding, probing pocket depths, gingival recession and marginal bone level between the women with osteoporosis and the women with normal bone mineral density. In conclusion, the present randomly selected and controlled study of osteoporotic and non-osteoporotic women, showed no statistically significant differences in periodontal conditions or marginal bone level. As periodontitis as well as osteoporosis are associated with age, our study of a well-defined age cohort is of interest, but the results should be interpreted with caution since the compared groups are small.

Clinical evaluation of maxillary and mandibular prognathism.

This study focuses on the importance of using natural head posture as a basis for cephalometric analysis. It describes a simple method for transferring a vertical plumbline from a lateral head photograph to a profile radiograph. The method is shown to have a relatively small technical error. Means and standard deviations for the angles HOR/N-A and HOR/N-B between the horizontal line (HOR) on one side and the nasion-subspinale (A-point) and nasion-supramentale (B-point) lines on the other, in random individuals, are presented as standards from which individual cases can be evaluated.

Natural head position as a basis for cephalometric analysis.

In a sample of orthodontic patients (27 boys and 25 girls, 10 to 14 years old), natural head position (NHP) was photographically recorded. A vertical axis was recorded on the photographs with a plumb line and transferred to the lateral head radiographs of the patients. Three cephalometric reference lines (sella-nasion, basion-nasion, and porion-orbitale) were compared with regard to their inclination to the horizontal plane. These angles showed standard deviations of between 4.5 degrees and 5.6 degrees. Reproducibility of NHP, assessed as the error of a single observation, was close to 2 degrees. These findings, in combination with the fact that the NHP represents a realistic appearance of patients, support its use as a basis for cephalometric analysis of dentofacial anomalies. A strong correlation was found between the inclinations of the three cephalometric reference lines to the horizontal plane. The close anatomic relationship between these lines, in combination with the small random movements of the head around NHP, were believed to explain the covariation.

Proportional analysis of the facial profile in natural head position in Caucasian and Chinese children.

A proportional analysis of the facial soft tissue profile in natural head position involving 11 indices (ratios), was applied to 80 Caucasian, and 80 Chinese male and female 12-year-old children in Hong Kong. The analysis is based on the true horizontal and the porion vertical, and has the advantage that its foundation lies on a more stable (less growth affected) region of the head compared to profile soft tissue landmarks. Measurements were made on cephalograms recorded in natural head position. Male subjects were larger than the females for most of the horizontal measurements, but for both population samples the vertical measurements displayed virtually no significant intersex differences at 12 years. No very significant intersex differences were found for the proportional indices. Ethnic differences were mainly found with the horizontal measurements. Relative to the porion vertical the Caucasian children were more protrusive over soft tissue nasion, nose tip, and sulcus labialis superior, whilst the Chinese displayed more protrusion over the lower lip and sulcus labialis inferior. Ethnic proportional differences relative to nasion were combined with a shorter porion-nasion distance in the Chinese as compared with the Caucasian children. The sella-nasion line was found to be more forwards-upwards inclined in Chinese than Caucasian children. It was concluded that a proportional soft tissue profile analysis, based on natural head position, is a useful method for the comparison of ethnic population groups. This study amplified ethnic differences previously reported by Cooke (1986) and Cooke and Wei (1989).

Quantitative evaluation of the soft tissue profile in the planning of orthognathic surgery.

The clinical application of a proportional soft tissue profile analysis based on natural head position is presented. The analysis provides data concerning the morphological basis of facial disharmony in individual cases. The use of this information during treatment planning and evaluation of treatment results after orthognathic surgery is demonstrated in four patients with severe deviation from midnormal profiles.

Mandibular growth direction following adenoidectomy.

The purpose of this article is to test the hypothesis that the establishment of nasal respiration in children with severe nasopharyngeal obstruction can be eliminated as a factor in determining mandibular growth direction. The article describes the changes in mandibular growth direction (MGD) in a 5-year period after adenoidectomies and the establishment of nasal breathing in a population of Swedish children. Measurements of mandibular growth directions were obtained from serial cephalometric radiographs after adenoidectomies in 38 Swedish children aged 7 to 12 years with previous nasopharyngeal obstructions. These were compared with the growth directions in a control sample of 37 Swedish children with clear airways and matched for age and sex. The adenoidectomy sample initially showed significantly longer lower face heights, steeper mandibular plane angles, and more retrognathic mandibles than the matched controls. Analysis showed that during the 5 years after adenoidectomies, the girls had a more horizontal MGD (P less than 0.02) than did the female controls. A corresponding but not significant trend was found for the boys. The individual growth directions that were obtained following adenoidectomies were more variable than those found in the controls.

A proportional analysis of some facial height and depth variables in 10 to 16 year old children.

A method for analysing the horizontal and vertical proportions of the face is described, based on natural head orientation (NHO). It demonstrates how individual deviations from the mean proportions can be quantified both horizontally and vertically. Correlation between facial depth to height (index 1) and the mandibular plane angle was determined and found to be fairly strong and highly significant (r = 0.5, P < 0.001). Facial depth to height and lower facial height to total facial height (index 2) relationships were found to be strongly correlated at each age between 10 and 16 years, with only small mean differences. For this reason the norm values presented for 12-year-old children for indices 1 and 2 should be applicable to orthodontic patients within this age range. The relationship between mandible and maxilla (index 3) increases continually between 10 and 16 years in boys, and between 10 and 14 years in girls, about 0.3 units a year. It can provide supplementary information for individual case analysis. For boys the increase was 2.2 units per year between 14 and 16 years of age.

Oral state of children with epilepsy on treatment with sodium valproate.

The aim of the study was, due to two recent reports about gingival and mucosal lesions, to survey the frequency of intraoral side effects in connection with sodium valproate treatment in epileptics. All patients on this drug treatment available at the University Hospital in Linköping, Sweden - in all 10 children, aged 8-14 - with absence seizures (simple petit mal), and treated for 1 to 4 yr, constituted a treatment group. Untreated age-matched, newly diagnosed epileptics constituted a comparison group. In each individual the oral hygiene state, gingival and periodontal condition, mucosal condition, caries prevalence, saliva secretion rate, salivary buffer capacity and lactobacillus count were estimated. The results revealed no divergences in the treated as compared with the untreated individuals which could be regarded as intraoral side effects deriving from the drug treatment.

Effects of anti-epileptic drug treatment with carbamazepine or phenytoin on the oral state of children and adolescents.

Oral conditions were studied in 48 children and adolescents who, during short or long periods, had been assigned to anti-epileptic drug treatment with carbamazepine or phenytoin. The individuals were diagnosed as suffering from partial seizures or generalized tonic-clonic seizures and were distributed between three test groups according to the drug selected for treatment; patients on active carbamazepine (I) or phenytoin (II) medication, and patients previously treated with phenytoin (III). Untreated, newly diagnosed epileptics served as controls. The results showed that individuals treated with carbamazepine for an average of 3 years displayed no intra-oral side-effects from the drug treatment. Compared with those on carbamazepine medication the subjects treated with phenytoin demonstrated a significantly greater number of gingival units with increased probing depths, lower saliva secretion rates and lower salivary buffer capacities. In all groups a majority of the individuals showed unsatisfactory plaque control. As a consequence of the results of the investigation it appears justified, from a dental point of view, to support carbamazepine as the first drug of choice for treatment of the types of seizures mentioned.

Panel assessments of the facial frontal view as related to mandibular growth direction.

This paper describes study No. 6 in a series dealing with mandibular growth direction (Lundström and Woodside, 1980). Study No. 5. (Lundström, Woodside and Popovich 1987) investigated facial harmony and disharmony of the facial profile. The present paper describes a study of the frontal views of the same children as paper No. 5. A mixed panel of 17 individuals (four categories of three, four and six people in each) made an aesthetic evaluation of the frontal facial view of 64 subjects (32 of each sex) from the Burlington serial experimental group. The sample consisted of equal numbers of individuals who displayed vertical, average or horizontal mandibular growth between the ages 6-20 years. We calculated correlations between the four assessor groups and found these to be acceptable. On average the panel found no change in frontal appearance between 12 and 18 years because of the balance between individuals improving and deteriorating. Our earlier work showed systematic differences in profile view between those with vertical growth on the one hand and average o horizontal on the other. The vertical cases were more disharmonious than the other categories. Corresponding findings were made also in the frontal view. Mean overall evaluations by all assessors showed a positive correlation between profile and front view assessments.

Effect of combined systemic antimicrobial therapy and mechanical plaque control in patients with recurrent periodontal disease.

The aim of the present study was to analyze the effect of systemic antimicrobial therapy and mechanical plaque control in patients with recurrent periodontal disease. 9 patients volunteered for the combined therapy. At a baseline examination they were randomly distributed into 2 groups, one given tetracycline therapy for 2 weeks and the other metronidazole therapy for 1 week. A mechanical plaque control program comprising oral hygiene training, professional cleaning of all teeth and subgingival debridement at diseased sites was carried out at the baseline examination and at all recall visits, i.e. once every month during the first 6 months and then after 9, 12, and 18 months. The results demonstrated clinically and microbiologically that a combination of an initial antimicrobial and a continuous systematic mechanical plaque control program may be a valuable therapeutic approach in a strictly selected group of refractory patients. Recurrent periodontal lesions which still displayed severe inflammation despite renewed conventional therapy showed a marked reduction in probing depths, bleeding and suppuration from the pockets, and further, a reduced presence of spirochetes and motile rods during the trial. The results indicate that the level and longevity of success is also related to whether or not self-performed oral hygiene measures are sufficiently carried out. No superior effect of the combined program could be observed in cooperating patients receiving tetracycline as compared with those given metronidazole.

Natural head position and natural head orientation: basic considerations in cephalometric analysis and research.

Natural head position (NHP) provides the key for meaningful cephalometric analysis because an extracranial reference line is used instead of intracranial reference lines, known to be subject to considerable biological variation in their inclination. Although the principle of natural head position is being recognized in the orthodontic literature, its registration may contain an element of unavoidable error that requires correction. A new concept of natural head orientation (NHO) has been introduced to maximize the contribution of NHP to cephalometrics. It is defined as the head orientation of the subject perceived by the clinician, based on general experience, as the natural head position in a standing, relaxed body and head posture, when the subject is looking at a distant point at eye level. The present study was designed to determine the accuracy and validity of NHO, using lateral profile photographs cut in a circular shape, obtained from 27 orthodontic patients, 10-14 years old. Findings among four investigators showed a high correlation (r = 0.82-0.96), in orientating these profile photographs in estimated natural head position (NHP). Moreover, investigators showed good correlation (r = 0.57-0.84) in head orientation after a 3-week interval. Mean differences for the same period varied between 0.1 and 2.9 degrees. The validity of NHO was supported also by a panel investigation. Clinicians as well as auxiliary personnel can be trained to make a critical judgement of the recorded natural head position and correct head orientation, whenever indicated, to enhance the reliability of cephalometric analysis in clinical practice and research.

Mandibular and maxillary growth after changed mode of breathing.

The amount of maxillary and mandibular growth and the direction of maxillary growth were studied in 38 children during the 5 years after adenoidectomy for correction of severe nasopharyngeal obstruction. The amount of mandibular growth measured between successive gnathion points on superimposed radiographs was significantly greater in the group who had an adenoidectomy than in the matched controls. In the boys the difference was 3.8 mm (p less than 0.001), and in the girls the difference was 2.5 mm (p less than 0.01). The boys also showed a tendency toward greater growth in the maxilla as measured between successive subnasal points (1.2 mm, p less than 0.05). We detected no difference in the direction of maxillary growth between who had undergone adenoidectomy and the controls.