Global prevalence of aggressive periodontitis: A systematic review and meta-analysis.

AIM: The prevalence of aggressive periodontitis (AgP) varies considerably between studies. The aim of this meta-analysis was to estimate, throughout the world, the prevalence of this disease. MATERIALS AND METHODS: Pubmed/Medline, Scopus, Science Direct, EBSCO and Cochrane library were systematically searched up to March 2018. Study selection criteria included cross-sectional studies reporting prevalence of AgP in non-specific population and permanent dentition. We assessed risk of bias using the Joanna Briggs Institute tool. A random effect meta-analysis model was used to estimate the prevalence of AgP. Publication bias was assessed by Begg and Egger's tests and visual aspect of funnel plot. RESULTS: A total of 33 articles were included. Pooled prevalence for AgP was 1.6% (95% CI 1.1-2.3). Higher pooled prevalence rates were reported in Africa (4.2%, 95% CI 2.0-7.1) and South America (4.0%, 95% CI 0.9-9.1) compared with Europe (0.1%, 95% CI 0.1-0.2). A pooled prevalence of 1.2%, 95% CI 0.5-2.2 was found in Asia and 0.8%, 95% CI 0.4-1.4 in North America. Heterogeneity between groups was statistically significant (Q statistic p < .001). CONCLUSIONS: A relatively high prevalence of AgP was found in Africa. However, the data support the weakness of the definition of this form of periodontal disease. Studies with less heterogeneity are needed to address accurately the prevalence of AgP.

Risk indicators of aggressive periodontitis in a Jordanian population.

BACKGROUND: Knowledge of the risk indicators of aggressive periodontitis (AgP) will help clinicians to better diagnose the disease, put a treatment plan that involves modification of modifiable risk indicators, understand non-modifiable risk indicators, and may potentially serve as an aid in developing preventive programs. The objective of the present study was to assess risk indicators of aggressive periodontitis (AgP) in Jordan including socio-demographic factors, oral hygiene habits, smoking, family history and parents' consanguinity. METHODS: A total of 162 patients (81 AgP and 81 controls), attending the Periodontology clinic at Jordan University of Science and Technology, Dental Teaching Centre, were interviewed and examined. All AgP subjects had full periodontal and radiographic examination. The data recorded included socio-demographic and economic variables, oral hygiene and smoking habits, family history and parents' consanguinity. RESULTS: Most AgP patients were young females, had ≤12 years of education, lived in urban areas and brushed their teeth ≥ once daily. Risk indicators of AgP included: age > 35 years, female gender and positive family history. CONCLUSIONS: Risk indicators associated with AgP in this study population were: age > 35 years, female gender and positive family history of periodontal disease.

Moderate- to long-term therapeutic outcomes of treated aggressive periodontitis patients without regular supportive care.

BACKGROUND AND OBJECTIVE: Risk for deterioration in treated aggressive periodontitis (AgP) individuals remained unclear. This retrospective cohort study investigated 7-26 years of periodontal outcomes and oral health-related quality of life (OHRQoL) of young adults with advanced periodontitis. MATERIAL AND METHODS: Eighty-nine previously treated patients with AgP were re-examined. Clinical and radiographic parameters before treatment discontinuation and at re-examination were compared. OHRQoL at re-call was assessed with the short-form Oral Health Impact Profile (OHIP-14S). RESULTS: None of the subjects adhered to suggested periodontal therapy and maintenance after discharge. Mean percentage of sites with probing pocket depth (PPD) ≥6 mm at re-examination was 4.5 ± 5.9%. A total of 182 teeth had been lost over time. Tooth loss rate was 0.14/patient/year. From 68 subjects with documented favorable treatment outcomes, higher percentage of sites with PPD ≥6 mm at re-examination and higher radiographic proximal bone loss was associated with current smoking status. Patients with AgP with <20 teeth at re-call had worse OHRQoL than those with ≥20 teeth. Patients with higher full-mouth mean PPD also reported poorer OHRQoL. CONCLUSION: Treatment in patients with AgP who smoke and neglect proper supportive care, risk periodontal disease progression. Substantial tooth loss and higher full-mouth mean PPD led to poorer OHRQoL in this cohort.

Periodontitis epidemiology: is periodontitis under-recognized, over-diagnosed, or both?

Currently, two principal forms of destructive periodontal disease are recognized - chronic periodontitis and aggressive periodontitis - but their distinction in epidemiologic studies has been rather problematic because of substantial overlap of their primary features. This review critically appraises some key features relevant to the epidemiology of human periodontitis that underlie its core 'identity' as a bacterial biofilm-induced, inflammatory disease and discusses its impact within the larger context of aging populations. The currently adopted epidemiologic methodologies/definitions that result in the almost ubiquitous prevalence of periodontitis indeed overestimate the occurrence of the disease that may actually put individuals at a true biologic, functional or psychosocial disadvantage. Use of these definitions has inevitably promoted the inference that periodontitis constitutes an insurmountable oral health problem. In contrast, reliance solely on physical measurements of probing depth and/or attachment loss under-recognizes the true impact that periodontitis may have on the well-being of individuals. It is currently unclear whether inclusion of the psychosocial and systemic dimensions of the disease in case definitions would result in higher or lower prevalence estimates. The review concludes that periodontitis should no longer be defined solely by gingival/periodontal inflammation in the presence of increased probing depths and attachment loss but should incorporate additional dimensions capturing impaired function, esthetics, and impact on general health and quality of life. A multidimensional approach to the assessment of periodontitis would facilitate an improved understanding of its epidemiology and consequences.

Adjunct Antimicrobial Therapy and Periodontal Surgery to Treat Generalized Aggressive Periodontitis: A Case Report.

Here we report a case of generalized aggressive periodontitis treated with periodontal therapy including adjunct antimicrobial therapy and periodontal surgery. The patient was a 22-year-old woman who presented with the chief complaint of gingival recession. Baseline examination revealed generalized plaque deposition and gingival inflammation. Thirty-nine percent of the sites had a probing depth (PD) of 4-6 mm and 2% a PD of ≥7 mm; 63% exhibited bleeding on probing (BOP). Radiographic examination revealed vertical bone loss in the molars and horizontal bone loss in other teeth. Microbiological examination of subgingival plaque revealed the presence of Aggregatibacter actinomycetemcomitans and Tannerella forsythia. Oral health-related quality of life was assessed as a measure of patient-reported outcome. Based on a clinical diagnosis of generalized aggressive periodontitis, initial periodontal therapy and adjunct antimicrobial therapy were implemented. After reducing inflammation and subgingival bacteria, open flap debridement was performed for teeth with a PD of ≥4 mm. Reevaluation showed no sites with a PD of ≥5 mm, a minimal level of BOP, and a marked reduction in the level of the targeted periodontal pathogens. The patient's oral health-related quality of life was slightly worsened during supportive periodontal therapy (SPT). Implementation of adjunct antimicrobial therapy targeting periodontal pathogens and subsequent periodontal surgery resulted in improvement in periodontal and microbiological parameters. This improvement has been adequately maintained over a 2-year period. However, additional care is necessary to further improve the patient's oral health-related quality of life during SPT.

Periodontal disease in children and adolescents of Latin America.

Periodontal diseases are a group of infectious diseases that mainly include gingivitis and periodontitis. Gingivitis is the most prevalent form of periodontal disease in subjects of all ages, including children and adolescents. Less frequent types of periodontal disease include aggressive periodontitis, acute necrotizing ulcerative gingivitis and various diseases of herpesviral and fungal origin. This review aimed to retrieve relevant information from Latin America on the prevalence of periodontal diseases among children and adolescents of the region. Gingivitis was detected in 35% of young Latin American subjects and showed the highest frequencies in Colombia (77%) and Bolivia (73%) and the lowest frequency in Mexico (23%). The frequency of gingivitis in subjects from other Latin American countries was between 31% and 56%. Periodontitis may affect <10% of the young population in Latin America, but the data are based on only a few studies. A more precise assessment of the distribution and severity of periodontal disease in children and adolescents of Latin America may help policy makers and dentists to institute more effective public health measures to prevent and treat the disease at an early age to avoid major damage to the permanent dentition.

10-year survival rate and the incidence of peri-implant disease of 374 titanium dental implants with a SLA surface: a prospective cohort study in 177 fully and partially edentulous patients.

PURPOSE: This prospective cohort study evaluates the 10-year survival and incidence of peri-implant disease at implant and patient level of sandblasted, large grid, and acid-etched titanium dental implants (Straumann, soft tissue level, SLA surface) in fully and partially edentulous patients. MATERIAL AND METHODS: Patients who had dental implant surgery in the period between November 1997 and June 2001, with a follow-up of at least 10 years, were investigated for clinical and radiological examination. Among the 506 inserted dental implants in 250 patients, 10-year data regarding the outcome of implants were available for 374 dental implants in 177 patients. In the current study, peri-implantitis was defined as advanced bone loss (≧1.5 mm. postloading) in combination with bleeding on probing. RESULTS: At 10-year follow-up, only one implant was lost (0.3%) 2 months after implant surgery due to insufficient osseointegration. The average bone loss at 10 year postloading was 0.52 mm. Advanced bone loss at 10-year follow-up was present in 35 dental implants (9.8%). Seven percent of the observed dental implants showed bleeding on probing in combination with advanced bone loss and 4.2% when setting the threshold for advanced bone loss at 2.0 mm. Advanced bone loss without bleeding on probing was present in 2.8% of all implants. CONCLUSION: In this prospective study, the 10-year survival rate at implant and patient level was 99.7% and 99.4%, respectively. Peri-implantitis was present in 7% of the observed dental implants according to the above-mentioned definition of peri-implantitis. This study shows that SLA implants offer predictable long-term results as support in the treatment of fully and partially edentulous patients.

Epidemiology and demographics of aggressive periodontitis.

Epidemiologic studies of aggressive periodontitis have used different study designs and a range of examination methods and case definitions, and this greatly complicates the study of disease prevalence in populations. The wide range of disease case definitions, in particular, profoundly impacts the reported rate of disease, and the use of a standard disease definition is strongly recommended. Surveys of aggressive periodontitis that use only clinical examinations, without radiographic examination to confirm the presence of a distinctive pattern of tissue loss, may overestimate the prevalence of this disease, particularly when a low threshold of attachment loss is used. The prevalence of aggressive periodontitis varies significantly between populations, and differences in race/ethnicities seem to be a key factor. Studies consistently show that aggressive periodontitis is most prevalent in Africa and in populations of African descent and is least prevalent in Caucasians in Europe and North America. Among children and young adults the prevalence of this disease is higher in older than in younger age groups. Most studies show comparable disease prevalence in male and female subjects. These findings show that aggressive periodontitis is a significant health problem in certain populations. This review also highlights a lack of information on the epidemiology and demographics of this disease in many parts of the world, particularly in Asia and Africa. Epidemiologic studies of aggressive periodontitis in high-risk populations are important and could provide vital data on the determinants of this disease, and this information is needed for the establishment of effective health-promotion measures.

Prevalence of Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis and Tannerella forsythia in Japanese patients with generalized chronic and aggressive periodontitis.

This study aimed to investigate the prevalence and levels of major periodontal pathogens, Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis and Tannerella forsythia in subgingival plaque samples of a group of Japanese patients with aggressive periodontitis (AgP) and chronic periodontitis (CP). A total of 40 patients with clinical diagnosis of AgP or CP and 10 periodontally healthy volunteers were subjected to clinical and microbiological analysis. Subgingival plaque samples were analyzed for A. actinomycetemcomitans, P. gingivalis and T. forsythia with a real-time polymerase chain reaction (PCR) technique. The prevalence of P. gingivalis and T. forsythia was relatively high in patients with periodontitis: over 60% of AgP or CP patients harbored these pathogens whereas they were not detected in the subgingival plaque samples from periodontally healthy individuals. P. gingivalis and T. forsythia were relatively frequently detected together in AgP and CP patients. No significant differences in the prevalence or level of the 3 pathogens were found between periodontitis groups. The proportion of T. forsythia was approximately 4-fold higher in CP group than in AgP group (P = 0.02). In periodontitis patients, a significant positive correlation was found between periodontal parameters (probing depth and clinical attachment level) and the numbers of total bacteria, P. gingivalis and T. forsythia. No distinct pattern of the subgingival profile of these pathogens was discerned between the two disease entities, except for the difference in the proportion of T. forsythia. The red complex bacteria, P. gingivalis and T. forsythia were highly prevalent in this population of Japanese AgP and CP patients, collaborating their roles in periodontitis.

Transcription factor STAT1 gene polymorphism is associated with the development of severe forms of periodontal disease.

INTRODUCTION: Periodontal disease (PD) is one of the most common inflammatory diseases, affecting about 10 % of the world population. The establishment of PD is influenced by polymorphisms in genes involved with the inflammatory response. Signal Transducer and Activator of Transcription (STAT)-1 is a transcription factor that plays a key role in the intracellular signaling triggered by cytokines and, thus, its activation is critical in inflammatory diseases. AIM AND METHODS: We aim to evaluate the occurrence of association between STAT-1 (rs3771300) polymorphism and distinct clinical forms and severity of PD; we genotyped 180 subjects using realtime PCR. RESULTS AND CONCLUSION: We observed that the presence of the G allele for STAT-1 was associated with twice as high of a chance to develop aggressive periodontitis, and the most severe form of the disease.

The bleeding site: a multi-level analysis of associated factors.

AIM: To evaluate the association between the probability of a sulcus/pocket to bleed on probing (BoP) and patient related as well as site-specific characteristics. METHODS: Data from 88960 sites were retrospectively derived from the clinical record charts of 601 adult patients. BoP (positive/negative) had been recorded at the initial periodontal visit after probing pocket depth (PPD) assessment. To analyse the influence of patient-, tooth- and site-related factors on the probability for a site to be BoP+, a logistic, 3-level model was built with BoP as the binary outcome variable. RESULTS: (i) The mean probability to be BoP+ for a site with PPD = 3 mm was 18%, and the log odds increased by 0.69 for each 1 mm increment in PPD; (ii) a significantly higher risk for BoP+ was observed for inter-proximal versus approximal surfaces, posterior teeth versus anterior teeth, females versus males, while a significantly lower risk was observed for smokers versus non-smokers; (iii) when controlling for the significant covariates, different BoP+ probabilities could still be observed among sites in patients with a different susceptibility to BoP. CONCLUSIONS: The probability of a site to be BoP+ was associated with either site-specific (i.e. PPD, tooth aspect, tooth type) or patient-related factors (i.e. gender, smoking status).

Occurrence of aggressive periodontitis in patients at a dental school in southern Brazil.

Aggressive periodontitis is a rare, severe and rapidly progressing periodontal disease. Early diagnosis is of utmost importance for establishing treatment in order to stop periodontal destruction and prevent tooth loss. The aim of this study is to describe the occurrence of aggressive periodontitis in patients at a Dental School in Brazil by means of a cross-sectional study. First, records from patients aged 15-36 years were consecutively scrutinized. Patients should not have systemic diseases. The search went up to 383 valid records. By means of periapical radiographs, the distance between the cement-enamel junction and the bone crest was measured. Records in which there was severe bone loss or periodontal destruction incompatible with the age of the patient were selected. Patients with bone loss > or = 3mm were called to answer a questionnaire and undergo periodontal examination, in order to confirm or dismiss the diagnosis of aggressive periodontitis. From a total 383 records, 55.1% (211) were female and 44.9% (172) were male. In 3.9% (15) of the records, presumed diagnosis was aggressive periodontitis, and 12 out of those 15 eligible patients (80%) came in for clinical examination and confirmation or dismissal of the diagnosis. Aggressive periodontitis was diagnosed in 7 patients, corresponding to 1.8% of the total. Of these, 4 (1% of the total) presented generalized aggressive periodontitis and 3 (0.8% of the total) presented localized aggressive periodontitis. In 5 patients (1.3%) chronic periodontitis was diagnosed. It may be concluded, within the limits of the study, that aggressive periodontitis at this Dental School is compatible with world prevalence values, suggesting the need for periodontal diagnosis as from adolescence, considering the possible damage caused by this disease.

[Dissertations 25 years after date 37. Susceptibility to periodontal diseases]. / Proefschriften 25 jaar na dato 37. Vatbaarheid voor parodontale aandoeningen.

In the eighties of the former century it was observed that individuals had different modes of development of periodontitis, largely for unknown reasons. It was assumed that periodontal disease developed as a result of the presence of virulent micro-organisms in combination with an inadequate host response. The concept of this (im)balance in host parasite interactions developed further, in part because of new research techniques. With respect to oral bacteria it was shown that periodontal pathogens like Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis and Tannerella forsythia are risk factors for periodontitis. Furthermore, genetic polymorphisms (SNP's) have been shown to modulate the host response against the periopathogens. Medical and lifestyle factors, e.g. diabetes mellitus, smoking, psychological stress and, to a minor extent, also hormonal changes can have an impact on the progression of periodontitis. All this information contributes to determining the individual risk profile of a patient for developing periodontitis and for estimating the prognosis of periodontal treatment and maintenance care on an individual basis.

[Correlation of gene polymorphism and risk of aggressive periodontal disease].

The study included 179 patients aged 18-45 years (56 with aggressive periodontal disease and 123 with no clinical signs of periodontitis). Gene polymorphism was analyzed by means of real-time PCR and kissing probes in order to reveal marker panel for aggressive periodontal disease predisposition. Significant difference was found for gene MMP9 in rs17576 position for A allele (55.2% in aggressive periodontal disease patients and 69.5% in control group) and in rs3918242 position for C allele (67.7 and 81.7%, respectively).

Prevalence and risk indicators of gingivitis and periodontitis in a multi-centre study in North Jordan: a cross sectional study.

BACKGROUND: There are limited data about the epidemiology and risk factors/indicators of gingivitis, aggressive periodontitis (AgP) and chronic periodontitis (CP) in Jordan. The aim of this study was to assess the prevalence and risk indicators of gingivitis, AgP and CP. METHODS: A sample of 595 subjects was randomly selected from subjects escorting out-patients attending a Medical Center, a Dental Teaching Hospital, and 2 private dental clinics. The socio-demographic variables, oral hygiene habits, income, smoking and Body Mass Index (BMI) were recorded. Full mouth periodontal examination was performed, and radiographs were taken for sites with probing depth > 3 mm. RESULTS: About 76% had gingivitis, 2.2% had AgP and 5.5% had CP. Periodontitis was more frequent among males than females with a M: F ratio of 1.6:1 and the prevalence increased with age. Subjects who reported not using a tooth brush, smokers and subjects with BMI > 30 kg/m2 had significantly higher prevalence of periodontitis. The risk for periodontitis was greater among subjects who reported positive family history and subjects with ≤ 12 years of education. CONCLUSIONS: This is the first study to report on the prevalence of gingivitis, CP and AgP in North Jordanian. Age, low education, low frequency of tooth brushing and family history were significantly associated with increased risk of periodontitis.

Aggressive periodontitis: the silent tooth killer.

Aggressive periodontitis comprises a group of rapidly progressive forms of periodontitis characterized by early onset of clinical manifestations at a young age and a distinctive tendency for cases to aggregate in families. Though once believed to be a rare condition, recent evidence suggest that aggressive periodontitis is more common than assumed. The etiology of aggressive periodontitis is probably due to the expression of highly virulent causative agents in combination with high levels of susceptibility of the individual patient. In addition, there are several factors, such as cigarette smoking and ethnicity, that are associated with higher prevalence or severity of aggressive periodontitis. Since the disease usually appears at a young age, the importance of early detection is paramount in order to avoid tooth loss in early childhood or adolescence.

Molecular epidemiology and spatial distribution of Selenomonas spp. in subgingival biofilms.

The aetiology of periodontal disease has been a field of intensive research in the past decades. Along with a variety of other putative pathogens, different members of the genus Selenomonas have repeatedly been associated with both generalized aggressive periodontitis and chronic periodontitis. For the present study, a specific oligonucleotide probe targeting the majority of all oral Selenomonas spp. was designed. Their prevalence was determined, using dot-blot hybridization, in a total of 742 subgingival samples collected from patients with generalized aggressive (n=62) and chronic periodontitis (n=82), and from periodontitis-resistant subjects (n=19). In addition, fluorescence in situ hybridization (FISH) and electron microscopy were performed to analyze the spatial arrangement of Selenomonas in subgingival biofilms collected from patients with generalized aggressive periodontitis. In the samples from patients, Selenomonas spp. showed a lower prevalence in both diseased groups compared with other putative pathogens, and a relatively high prevalence in the periodontitis-resistant group. Consequently, Selenomonas spp. do not seem to be suitable diagnostic marker organisms for periodontal disease. By contrast, FISH and electron microscopic analysis of periodontal carriers revealed that Selenomonas spp. appeared in large numbers in all parts of the collected biofilms and seemed, if present in a site from patients, to make a relevant contribution to their structural organization.

Prevalence of aggressive periodontitis in 15-18 year old school-children in Tehran, Iran.

OBJECTIVE: Aggressive periodontitis is one of the periodontal diseases that affects systemically healthy individuals usually under the age of 30 years. The disease is characterized by rapid bone destruction which is inconsistent with the amount of bacterial plaque. The purpose of this cross-sectional study is to determine the prevalence of aggressive periodontitis among students aged 15 to 18 years in high schools of Tehran, Iran. RESEARCH DESIGN: Based on systematic and cluster random sampling, 5,590 students were selected. Probing pocket depth on six areas of incisors and first molars was carried out. Students with pocket depth > or = 4 mm on more than one tooth were referred for radiographic examination. In cases where the distance between the crest of interdental septa and CEJs were > or = 2 mm, full clinical and radiographic examination were performed. RESULTS: Only seven persons, four girls and three boys, had the diagnostic criteria of localized aggressive periodontitis. One patient was diagnosed with generalized aggressive periodontitis. Therefore, the prevalence of aggressive periodontitis among 15-18 years old school- children was 0.13% in this study. CONCLUSION: The present study indicates that the prevalence of aggressive periodontitis in Tehran is low and similar to the studies of the same age range and diagnostic criteria in other countries.

Serum IgG titers to periodontal pathogens predict 3-month outcome in ischemic stroke patients.

Several cohort studies have shown that periodontal disease is associated with an increased risk for stroke. However, it remains unclear whether serum antibody titers for a specific periodontal pathogen are associated with outcome after ischemic stroke, and which kinds of pathogens are associated with ischemic stroke. We examined the relationship between serum IgG titers to periodontal pathogens and outcome in ischemic stroke patients. A total of 445 patients with acute ischemic stroke (194 female [44.0%], mean age 71.9±12.3 years) were registered in this study. Serum IgG titers to 9 periodontal pathogens (Porphyromonas gingivalis, Aggregatibacter actinomycetemcomitans, Prevotella intermedia, Prevotella nigrescens, Fusobacterium nucleatum, Treponema denticola, Tannerella forsythensis, Campylobacter rectus, Eikenella corrodens) were evaluated using the enzyme-linked immunosorbent assay (ELISA) method. An unfavorable outcome was defined as a 3 or higher on the modified Rankin Scale. The proportion of patients with unfavorable outcome was 25.4% (113 patients). Based on multivariate logistic regression analysis, numbers of IgG antibodies positive for periodontal pathogens (odds ratio 1.20, 95% CI 1.02-1.41, p = 0.03) were independent predictors of unfavorable outcome in ischemic stroke patients.

Erectile dysfunction might be associated with chronic periodontal disease: two ends of the cardiovascular spectrum.

INTRODUCTION: Both chronic periodontal disease (CPD) and erectile dysfunction (ED) are associated with cardiovascular disease and its risk factors, including smoking and diabetes mellitus. However, the association between ED and CPD has never been studied. AIM: To study the association between ED and CPD. MAIN OUTCOME MEASURES. Prevalence of ED, prevalence of CPD, ED severity. METHODS: The study population consisted of 305 men who filled the Sexual Health Inventory for Men (SHIM) questionnaire in order to detect ED and assess its severity, and underwent a pair of standardized posterior dental bitewing radiographs in order to detect CPD. SHIM questionnaire scores 21 or less represented ED. Alveolar bone loss of >or=6 mm represented CPD. RESULTS: The mean age of included men was 39.5 +/- 6.7 years. Overall, 70 (22.9%) men had ED and 13 (4.3%) had CPD. CPD was significantly more prevalent among men with mild ED (P = 0.004) and moderate to severe ED (P = 0.007) in comparison to men without ED. CONCLUSIONS: ED might be associated with CPD. These preliminary findings are consistent with theories that associate these conditions with systemic inflammation, endothelial dysfunction, and atherosclerosis.