Clinical and radiographic periodontal status in hypertensive patients with or without obstructive sleep apnea 10 years after diagnosis and CPAP initiation.

OBJECTIVES: Through inflammation and hyposalivation, obstructive sleep apnea (OSA) is suggested to affect periodontal status over time. Our aim was to compare the clinical and radiographic periodontal status of hypertensive patients with or without long-term presence of OSA, treated or untreated with continuous positive airway pressure treatment (CPAP). MATERIALS AND METHODS: In 2007-2009, a screening for OSA was conducted among 394 hypertensive primary care patients. Polygraphy was used to create three groups: no OSA, non-CPAP, or adherent CPAP based on the apnea hypopnea index (AHI). After 10 years, a cross-sectional sleep and periodontal examination including a clinical and radiographic examination, a questionnaire, and a matrix metalloproteinase-8 (MMP-8) chair-side test was conducted. Based on levels of alveolar bone, bleeding on probing (BoP), and probing pocket depth (PPD), patients were categorized into four periodontal stages: periodontal health/gingivitis and three periodontal disease stages. Periodontal status and periodontal stages were compared between the OSA (n = 49), non-CPAP (n = 38), or adherent CPAP (n = 34) groups. RESULTS: The 121 patients (53% women) had a median age of 71 years. No differences were seen between the OSA groups regarding median number of teeth (p = .061), teeth/implants, (p = .107), plaque index (p = .245), BoP (p = .848), PPD ≥ 4 mm (p = .561), PPD ≥ 6 mm (p = .630), presence of MMP-8 (p = .693) except for bone loss (p = .011). Among patients with stage periodontal health/gingivitis a significant difference was seen, as 70% of those were categorized as no OSA, 20% as non-CPAP, and 10% as adherent CPAP (p = .029). Differences were not seen in periodontal disease stages. CONCLUSIONS: Hypertensive patients with obstructive sleep apnea (OSA) did not have an adverse clinical periodontal status compared to patients without OSA. However, when combining radiographic and clinical status into periodontal stages, patients without OSA more frequently exhibited periodontal health or gingivitis compared to patients without OSA, regardless of CPAP treatment.

Some young adults can maintain good oral health despite socioeconomic challenges.

The association between dental caries experience and socioeconomic status, as reflected in income and educational level, is well known. However, some individuals maintain good health despite socioeconomic disadvantage. The aim of this qualitative study was to explore salutogenic (health-promoting) factors among healthy caries-free young adults of low socioeconomic status. Seventeen participants (11 women), 19-23 years of age, who were caries-free and of low socioeconomic status were interviewed in-depth. The interviews were transcribed verbatim and analysed using qualitative content analysis with an inductive approach. The theme revealed was 'Building trust and shifting responsibility from parent to child throughout children's development lays the salutogenic foundation for oral health', comprising three categories: (i) a basis for health; (ii) creating one's own path by testing wings; and (iii) developing resources for health. A feeling of trust was expressed, participants were confident in the unconditional support of their caregivers, and caregivers were trusting participants to be able to take control over their own oral health. Health-promotive factors were established not only by instilling healthy habits during childhood, but also by parental guidance through adolescence, enabling young adults to develop resources and assets to take control over their own health independently.

Bacterial Composition and Metabolomics of Dental Plaque From Adolescents.

Supragingival dental plaque samples were collected from 40 Swedish adolescents, including 20 with caries lesions (CAR) and 20 caries-free (CF). Fresh plaque samples were subjected to an ex vivo acid tolerance (AT) test where the proportion of bacteria resistant to an acid shock was evaluated through confocal microscopy and live/dead staining, and the metabolites produced were quantified by 1H Nuclear Magnetic Resonance (1H NMR). In addition, DNA was extracted and the 16S rRNA gene was sequenced by Illumina sequencing, in order to characterize bacterial composition in the same samples. There were no significant differences in AT scores between CAR and CF individuals. However, 7 out of the 10 individuals with highest AT scores belonged to the CAR group. Regarding bacterial composition, Abiotrophia, Prevotella and Veillonella were found at significantly higher levels in CAR individuals (p=0.0085, 0.026 and 0.04 respectively) and Rothia and Corynebacterium at significantly higher levels in CF individuals (p=0.026 and 0.003). The caries pathogen Streptococcus mutans was found at low frequencies and was absent in 60% of CAR individuals. Random-forest predictive models indicate that at least 4 bacterial species or 9 genera are needed to distinguish CAR from CF adolescents. The metabolomic profile obtained by NMR showed a significant clustering of organic acids with specific bacteria in CAR and/or high AT individuals, being Scardovia wiggsiae the species with strongest associations. A significant clustering of ethanol and isopropanol with health-associated bacteria such as Rothia or Corynebacterium was also found. Accordingly, several relationships involving these compounds like the Ethanol : Lactate or Succinate : Lactate ratios were significantly associated to acid tolerance and could be of predictive value for caries risk. We therefore propose that future caries risk studies would benefit from considering not only the use of multiple organisms as potential microbial biomarkers, but also their functional adaptation and metabolic output.

Caries incidence and risk assessment during a five-year period in adolescents living in south-eastern Sweden.

OBJECTIVES: The aim was to examine the caries incidence in adolescents using the Public Dental Service (PDS) during a 5-year period in relation to their caries experience at baseline and risk classification. METHODS: A 5-year retrospective cohort study based of the dental records from 17 PDS clinics in south-eastern Sweden was conducted; 159 individuals born in 1997 were included, and their caries risk was classified at 12 and 17 years of age. Caries prevalence and documented risk groups were assessed at baseline and after 5 years. RESULTS: The increment of caries (both initial and manifest caries) was higher, to a statistically significant degree, after 5 years in adolescents who were recorded as caries-free at baseline compared to individuals with caries at baseline (P < .001). In individuals with caries at baseline, the greatest increment of caries was found at approximal sites (P < .001). At baseline, individuals were classified as low (94%), medium (6%) and high risk (0%). After 5 years, the figures were 74%, 20% and 6%, respectively. Although classified in a low-caries risk group, 9% had ≥6 decayed or filled surfaces at baseline, and 23% did after 5 years. Approximately 62% of individuals were registered as caries-free at baseline, and 45% were after 5 years. CONCLUSIONS: There was an increase in caries over 5 years, especially among adolescents without caries experience at baseline. The majority of adolescents had the same risk classification after 5 years. Further research with a larger sample size is needed to evaluate risk assessment for caries.

Outcome of periodontal-orthodontic treatment in subjects with periodontal disease. Part II: a CBCT study of alveolar bone level changes.

AIM: To examine alveolar bone level (ABL) changes before (T1) and after (T2) orthodontic treatment (OT) in subjects with periodontal disease. METHODS: The study included 50 subjects with periodontal disease. All patients received subgingival debridement following baseline examination. Control group patients received final periodontal treatment before the start of OT. For the test group patients final periodontal treatment was performed simultaneous to OT. OT was performed with a straight-wire appliance. Micro-implants or temporary crowns on implants were used for posterior anchorage when needed. ABL measurements of 3821 tooth surfaces were performed on cone beam computed tomography images. RESULTS: No difference was observed between mean ABL at T1 and T2. ABL remained unchanged on 69 per cent of surfaces. A mean of 15.6 (SD 7.4) per cent of surfaces experienced ABL gain, and a mean of 15.1 (SD 7.5) per cent was found with ABL loss. Small significant median ABL difference was observed on mesial and distal surfaces (P < 0.001). A significant difference was found between median ABL changes on mesial/distal in comparison to buccal/lingual surfaces (P < 0.01). Significantly more buccal (17.9 %) and lingual (18.5 %) surfaces experienced ABL loss when compared with mesial (11.3 %) and distal (12.0 %) surfaces (P < 0.001). Significant difference was found in the median ABL change of intruded (0.5 (IQR 0.94) mm) and non-intruded (-0.4 (IQR 1.07) mm) maxillary incisors (P = 0.04). Significant median ABL gain was found on the lingual surface of maxillary incisors, which were retroclined more than 8.6 degree and intruded more than 1.6 mm. CONCLUSIONS: ABL changes after periodontal-orthodontic treatment in patients with periodontal disease were small. ABL gain was more observed on mesial and distal surfaces and ABL loss on buccal and lingual surfaces. Larger orthodontic movements of maxillary incisors influenced ABL gain.

Outcome of orthodontic treatment in subjects with periodontal disease. Part III: a CBCT study of external apical root resorption.

BACKGROUND: No evidence is present on the risk for external apical root resorption (EARR) during orthodontic treatment (OT) of adult patients with periodontal disease. AIM: To examine EARR after OT in subjects with periodontal disease and to analyse how intrusion and change in inclination of the most proclined maxillary incisors influence EARR. METHODS: The study included 50 patients with periodontal disease. Sub-gingival debridement by ultrasonic instrumentation supplemented with hand instruments was performed by experienced dental hygienist after baseline examination for all patients. For the control group, final periodontal treatment (PT) was performed before orthodontic tooth movement. For the test group patients, final PT was performed after levelling and alignment phases were finished, before the active space closure with elastic chain and/or inter-arch elastic traction for sagittal correction was started. OT was performed with a straight-wire appliance. Micro-implants or implants were used for posterior anchorage. Cone beam computed tomography examinations were performed before and after OT. EARR of all single-rooted teeth were measured. EARR of the most proclined maxillary incisor was related to intrusion and change in inclination angle. RESULTS: EARR after OT was observed in median 80.7 per cent (interquartile range 22.02) of single-rooted teeth [mean 1.2 (standard deviation 0.44) mm]. In 82.3 per cent of teeth, EARR was 2 mm or less. Severe EARR was found in 8 per cent of patients and five maxillary incisors (less than 1 per cent of all teeth). The amount of intrusion and change in inclination angle of the most proclined maxillary central incisor influenced the extent of EARR. Mean EARR was significantly higher when OT lasted more than 18 months (P = 0.02). CONCLUSIONS: OT in conjunction with PT in periodontal patients resulted in EARR in 81 per cent of all single-rooted teeth. Intrusion and change in inclination angle of the most proclined maxillary central incisor influenced the extent of EARR, as did longer OT.

Secular trends over 40 years of periodontal health and disease in individuals aged 20-80 years in Jönköping, Sweden: Repeated cross-sectional studies.

AIM: To assess trends over 40 years regarding prevalence and severity of periodontitis in a Swedish adult population. MATERIALS AND METHODS: Cross-sectional examinations using the same clinical protocol have been repeated every 10 years (1973-2013) in a Swedish city with focus on periodontal disease in adults. Periodontal recordings included all teeth, excluding 3rd molars. Periodontal disease experience was classified (no/minor, moderate and severe). RESULTS: The no/minor group increased from 43% in 1983 to 60% in 2013. There was a non-significant trend for a decrease of the severe group. Over the 40-year period, the number of teeth increased significantly and at the examination 2013, the severe group accounted for this increase. More than 60% of the study population in 2013 had no periodontal pockets (PD) ≥6 mm. The number of PD ≥4 mm and ≥6 mm were unaltered between 2003 and 2013 in all age groups, except for the 20-year old individuals. This group showed a statistically significant increase of ≥4 mm PD. CONCLUSIONS: The periodontal health has improved in the population over the 40 years. The number of teeth increased significantly in the population, and in 2013, this increase occurred entirely in the severe group. Finally, there was a trend toward diminished prevalence of severe periodontitis.

Predictors of oral health-related quality of life in Iranian adolescents: A prospective study.

AIM: In the present study, we evaluated the direct and mediating (indirect) effects of clinical oral conditions, dental anxiety, sense of coherence (SOC), and socioeconomic variables on oral health-related quality of life (OHRQoL) and general health-related quality of life (GHRQoL) in Iranian adolescents. METHODS: A longitudinal design was used with a sample of 1052 (694 males, mean age=15.05 years) schoolchildren from Qazvin, Iran. Each participant completed a background information sheet and the following scales at baseline: Modified Dental Anxiety Scale, SOC, PedsQL 4.0 Generic Core Scale, and PedsQL Oral Health Scale. The PedsQL 4.0 Generic Core and Oral Health scales were recompleted at the 18-mo follow up. RESULTS: Father's education, monthly family income, dental anxiety, Community Periodontal Index (CPI), decayed, missing, and filled teeth (DMFT), and SOC significantly and directly predicted OHRQoL at 18 mo. Father's education had indirect effects on OHRQoL through CPI and DMFT, family income had indirect effects through DMFT, and dental anxiety had indirect effects through CPI. OHRQoL at 18 mo (ß=0.499) and SOC (ß=0.084) had significant and direct and mediating effects through OHRQoL on GHRQoL, while father's education, monthly family income, dental anxiety, CPI, and DMFT only showed mediating effects. CONCLUSIONS: Clinical oral indicators had direct effects on OHRQoL, but mediated the effects of dental anxiety and socioeconomic status on both OHRQoL and GHRQoL.

Experiences of xerostomia after radiotherapy in patients with head and neck cancer: A qualitative study.

AIMS AND OBJECTIVES: To describe the experiences of radiation-induced xerostomia in patients with head and neck cancer. BACKGROUND: Xerostomia is the most commonly occurring complication during and following radiotherapy. It can persist for several months or years and can have a significant impact on patients' quality of life. DESIGN: This was a qualitative descriptive study. METHODS: Semi-structured interviews were conducted with a sample of 20 participants. Inductive content analysis was used to analyse the qualitative data. RESULTS: Analysis of the manifest content identified five categories: communication problems, physical problems, psychosocial problems, treatment problems and relief strategies. The latent content was formulated into a theme: due to lack of information from professionals, the patients had to find their own solutions for their problems. CONCLUSIONS: Xerostomia is not only a biophysical symptom but also has a profound effect on the emotional, intellectual and sociocultural dimensions of life. The majority of patients continued to suffer from xerostomia and its associated symptoms after radiotherapy, in part, because of a lack of professional support, including the inability of nurses to provide oral health care. RELEVANCE TO CLINICAL PRACTICE: Nurses need to be knowledgeable about the effects of radiotherapy on oral mucosa and about appropriate interventions. The healthcare system requires a symptom management platform for radiation-induced complications, to help patients, their families and healthcare professionals obtain information about self-care, treatments and relief strategies.

Orthodontic treatment simultaneous to or after periodontal cause-related treatment in periodontitis susceptible patients. Part I: Clinical outcome. A randomized clinical trial.

AIM: To compare two treatment strategies regarding the effect of orthodontic treatment on periodontal status in patients with plaque-induced periodontitis. SUBJECTS AND METHODS: This was a randomized clinical trial. Fifty periodontal patients were randomly assigned to the test or control groups according to periodontal treatment timing. All patients received supra- and subgingival debridement following baseline examination. Control group patients received cause-related periodontal treatment before the start of orthodontic treatment and which was performed simultaneous to orthodontic treatment for the test group patients. RESULTS: No difference between the test and control groups was found regarding change of clinical attachment level (CAL) after periodontal-orthodontic treatment. Fewer sites with initial pocket depth (PD) of 4-6 mm healed after periodontal-orthodontic treatment in the test group (20.5%, IQR = 11.9%) in comparison with controls (30.4%, IQR = 27.1%) (p = .03). Anterior teeth [OR 2.5] and teeth in male patients [OR 1.6] had a greater chance for PD improvement ≥2 mm. Total periodontal-orthodontic treatment duration was significantly longer for the control group (p < .01). CONCLUSIONS: Both groups showed a gain of CAL and a reduction in sites with PD ≥ 4 mm. Orthodontic treatment, simultaneously to the periodontal treatment, could be used in the routine treatment of patients with plaque-induced periodontitis.

Oral health matters for the nutritional status of older persons-A population-based study.

AIMS AND OBJECTIVES: To explore the association between oral health and nutritional status in the context of daily care for older people. BACKGROUND: Oral problems often increase with age and affect a person's ability to chew and swallow. They might also influence the ability to maintain a satisfactory nutritional status. Oral health awareness is therefore of great importance in nursing care for older people. DESIGN: A retrospective cross-sectional study. METHODS: Data from the Swedish quality register, Senior Alert, were used, including structured assessments of both oral and nutritional status using the Revised Oral Assessment Guide-Jönköping and the Mini Nutritional Assessment. In total, 1,156 persons (mean age: 82.8 ± 7.9) had both oral and nutritional assessments registered by the nursing staff in daily care. RESULTS: Approximately 29% of participants had moderate oral health problems. Another 12% had severe problems. Over 60% of the persons were considered at risk of malnutrition or were malnourished. There was a weak correlation between poor nutritional status and poor oral health, and approximately one-third of the persons who were at risk or malnourished had simultaneous oral problems. A multivariate logistic regression revealed that when problems involving voice and swallowing were present, there was also a greater possibility of being assessed as at risk of malnourishment or being malnourished. CONCLUSION: There is a relationship between oral health problems and nutritional status, indicating the importance of evaluating oral health status in older persons with nutritional problems. RELEVANCE TO CLINICAL PRACTICE: Nursing staff involved in care for older people should be aware of the importance of including regular oral health check-ups in their work. There is also a need for nursing staff members and oral health professionals to exchange knowledge.

Treatment of peri-implantitis: clinical outcome of chloramine as an adjunctive to non-surgical therapy, a randomized clinical trial.

PURPOSE: To evaluate the adjunctive clinical effects of a chloramine to non-surgical treatment of peri-implantitis. MATERIAL AND METHODS: Eighteen individuals diagnosed with peri-implantitis (clinical signs of inflammation and progressive bone loss) on at least two implants were included. Clinical variables; plaque accumulation (Pl), probing depth (PD), clinical attachment level (CAL) and bleeding on probing (BoP), were recorded at baseline and at 3-month follow-up. Primary clinical efficacy variable was the change in the number of sites with BoP. The implants were randomized into two different treatment groups: test and control. Both implants received supra- and submucosal debridement by ultrasonic instrumentation supplemented with hand instruments. The implants assigned to the test group first received local applications of a chloramine gel (Perisolv™ ; RLS Global AB, Gothenburg, Sweden) followed by mechanical instrumentation. The oral hygiene was checked at 6 weeks. RESULTS: After 3 months, implants of both groups showed statistically significant reduction (P < 0.001) in the number of BoP-positive sites compared with baseline. The reduction of BoP-positive sites in the test group changed from 0.97 (SD ± 0.12) to 0.38 (SD ± 0.46), and in the control group from 0.97 (SD ± 0.12) to 0.31 (SD ± 0.42). Between-group comparisons revealed no statistically significant differences at baseline and after 3 months, for BoP or any of the other variables. CONCLUSION: In the present randomized clinical trial of peri-implantitis therapy; non-surgical mechanical debridement with adjunctive use of a chloramine is equally effective in the reduction of mucosal inflammation as conventional non-surgical mechanical debridement up to 3 months.

Oral Health Status of Older Adults in Sweden Receiving Elder Care: Findings From Nursing Assessments.

BACKGROUND: Frail elderly people often have poor oral hygiene, contributing to oral health problems that can detract significantly from quality of life. OBJECTIVE: The aim of this study was to describe oral health status of frail elderly individuals using the Revised Oral Assessment Guide-Jönköping (ROAG-J), a mouth assessment instrument that can be used in daily nursing care. METHODS: Data were obtained from the Swedish Senior Alert quality registry in one Swedish municipality. ROAG-J assessments on admission to elder care and one subsequent occasion were used. ROAG-J measurements documented oral health in nine areas: voice, lips, oral mucosa, tongue, gums, teeth, saliva, swallowing, and presence of any prostheses or implants. Assessments were made by nursing staff during the course of daily nursing care. RESULTS: Individuals 65 years of age or older and receiving elder care services (N = 667) were involved; 1,904 assessments made between November 2011 and March 2014 were used for the analysis. On the basis of both assessments, less than one third of participants had oral health problems. No significant difference in any of the oral health variables was found between first and subsequent assessments. At first assessment, men and women differed in tongue health (p < .01); at the subsequent assessment, gender differences in voice (p < .05), mucous membranes (p < .003), tongue (p < .01), and saliva (p < .006) were observed. DISCUSSION: Most participants had good oral health. Assessments made by nursing staff using the ROAG-J demonstrate that this tool can be used in daily nursing care, where different, important oral conditions may be encountered. However, knowledge about oral health conditions and the ROAG-J instrument is important to ensure high validity. The ROAG-J enables nursing staff to detect problems in the mouth and to guide decisions related to oral health interventions.

Oral health-related quality of life in Iranian patients with spinal cord injury: A case-control study.

INTRODUCTION: The study aimed to compare the oral health variables, general, and oral health-related quality of life (QoL), depression, and anxiety between spinal cord injury (SCI) patients and healthy controls and also to determine the key factors related to the oral health-related quality of life (OHRQoL) in the SCI patients. METHODS: A total of 203 SCI patients and 203 healthy controls were enrolled. Patients and healthy adults were invited to attend a dental clinic to complete the study measures and undergo oral clinical examinations. OHRQoL was assessed by the 14-item Oral Health Impact Profile (OHIP-14), and the general health-related quality of life (GHRQoL) was evaluated by SF-36. In SCI patients, depression and anxiety were recorded using the Hospital Anxiety and Depression Scale (HADS), while Functional Assessment Measure (FAM) was used to assess dependence and disability. All the subjects were examined for caries which was quantified using the decayed, missing, and filled Teeth (DMFT) index, gingival bleeding index (GI), plaque index, and periodontal status by community periodontal index (CPI). RESULTS: The analysis of covariance (ANCOVA) revealed significant differences between the two groups in terms of oral health expressed in DMFT, oral hygiene, and periodontal status, controlled for age, gender, family income, and occupational status (p<0.001). Using the hierarchical linear regression analyses, in the final model, which accounted for 18% of the total variance (F(126.7), p<0.01), significant predictors of OHRQoL were irregular tooth brushing (ß=1.23; 95% CI=1.06; 1.41), smoking (ß=0.82; 95% CI=0.66; 0.97), dry mouth (ß=0.37; 95% CI=-0.65 to 0.10) functional and motor functioning (ß=0.32; 95% CI=-0.45 to 0.17), DMFT (ß=0.06; 95% CI=0.02; 0.09), CPI (ß=0.22; 95% CI=0.04; 0.04), physical component measure of GHRQoL (ß=-0.275; 95% CI=-0.42 to 0.13), lesion level at the lumbar-sacral (ß=-0.18; 95% CI=-0.29 to -0.06) and thoracic level (ß=-0.09; 95% CI=-0.11 to -0.06). CONCLUSION: SCI patients had poor oral hygiene practices, greater levels of plaque, gingival bleeding, and caries experience than the healthy controls. In addition, more number of SCI patients had periodontal pockets and dry mouth than the comparative group. SCI patients experienced more depression and anxiety, poor GHRQoL, and OHRQoL than the healthy control group. The factors that influenced OHRQoL in SCI patients were age, toothbrushing frequency, smoking, oral clinical status, depression, physical component of GHRQoL, and level of lesion.

Impact of periodontal disease experience on oral health-related quality of life.

BACKGROUND: Periodontal research has traditionally focused on the site level, regarding etiology, pathogenesis, and treatment outcome. Recently, some studies have indicated that the presence of periodontal disease is associated with reduced quality of life. The aim of this study is to investigate the impact of periodontal disease experience on the quality of life. METHODS: This cross-sectional study includes 443 individuals. Clinical and radiographic examinations were performed; in conjunction, the oral health-related quality of life of all participants was assessed using the Swedish short-form version of the Oral Health Impact Profile (OHIP-14). Based on marginal bone loss, measured on radiographs, three different groups were identified: participants with loss of supporting bone tissue of less than one third of the root length (BL-), loss of supporting bone tissue of one third or more of the root length in <30% of teeth (BL), or loss of supporting bone tissue of one third or more of the root length in ≥ 30% of teeth (BL+). RESULTS: The effect of periodontal disease experience on quality of life was considerable. For the BL- group, the mean OHIP-14 score was 3.91 (SD: 5.39). The corresponding mean values were 3.81 (SD: 5.29) for the BL group and 8.47 (SD: 10.38) for the BL+ group. The difference among all groups was statistically significant (P ≤ 0.001). A comparison among the mean OHIP-14 scores in the different groups (BL-, BL, and BL+) revealed significant differences in six of seven conceptual domains. CONCLUSIONS: The BL+ individuals experienced reduced quality of life, expressed as the OHIP-14 score, compared with the BL and BL- participants.

Different treatment strategies are applied to patients with the same periodontal status in general dentistry.

OBJECTIVE: To analyse how general dental practitioners (GDPs) and dental hygienists judge and plan to treat patients with different periodontal conditions. MATERIALS AND METHODS: Seventy-seven GDPs and 50 dental hygienists in a Swedish county, Halland, participated in a questionnaire study. The response rate was 94%. The questionnaire consisted of four simulated patient cases and an attached answer sheet. The patient cases had different periodontal status, ranging from healthy to moderate bone loss with general inflammation. The clinicians judged the periodontal status as healthy or diseased. If judged as diseased the clinicians suggested a diagnosis, selected treatment options and estimated the number of treatment sessions for each patient case. The clinicians were compared to each other regarding their judgement, as healthy or diseased, diagnostics and treatment. RESULTS: Three out of four patients were judged both as healthy and diseased by different clinicians. If judged as diseased the patients were diagnosed as having gingivitis or periodontitis. Regardless of the clinicians' former judgement and diagnostics there were no differences (p > 0.05) in the selected treatment options but there was a difference (p < 0.05) in the suggested number of treatment sessions. CONCLUSIONS: Clinicians' judgement of the same periodontal condition, as healthy or diseased, varies, which partly results in different treatment decisions considering the number of treatment sessions. The suggested number of treatment sessions varied also between clinicians even if they judged and diagnosed the condition likewise. The willingness to treat and suggested treatment options were not influenced by the variation in judgement and diagnostics.

Marginal bone loss in the adult population in the county of Skåne, Sweden.

UNLABELLED: The aim of this study was to investigate the prevalence and extent of periodontal disease registered as marginal bone loss and subject characteristics in the adult population in the county of Skåne in Sweden. One thousand individuals, 20-89 years old, were randomly selected and 451 subjects agreed to participate in the study. They answered a questionnaire and in conjunction with the clinical and radiological examination the subjects answered questions about their medical history. The examiners were co-ordinated regarding the diagnostic criteria through comprehensive written instructions, practice and discussions of clinical cases. One observer estimated marginal bone loss around the teeth on digital panoramic radiographs and bitewings. The individuals were classified regarding periodontal disease experience according to the following criteria: PD- = loss of supporting bone tissue < 1/3 of the root length, PD = loss of supporting bone tissue > or = 1/3 of the root length in < 30% of the teeth and PD+ = loss of supporting bone tissue > or = 1/3 the root length in > or = 30% of the teeth. Subjects with no or minor bone loss, i.e. PD- constituted 69% of the population. Twenty percent of the study population had marginal bone loss corresponding to localised periodontal disease (PD) and 11% exhibited generalised periodontal bone loss (PD+). The periodontal treatment need, defined as probing pocket depth > or = 6 mm and bleeding on probing > or = 20%, was 53% in the PD+ group. An interesting result was that there were no differences in periodontal disease experience between the genders. CONCLUSIONS: The prevalence and extent of periodontal disease in this study correlates well with recent other studies. Eleven percent of the population has experienced generalised periodontal disease, and 53% of them have a periodontal treatment need defined as 1 or more site with PPD > or = 6 mm and BoP > or = 20%.

Salivary biomarkers for detection of systemic diseases.

BACKGROUND AND OBJECTIVE: Analysis of inflammatory biomarkers in saliva could offer an attractive opportunity for the diagnosis of different systemic conditions specifically in epidemiological surveys. The aim of this study was to investigate if certain salivary biomarkers could be used for detection of common systemic diseases. MATERIALS AND METHODS: A randomly selected sample of 1000 adults living in Skåne, a county in the southern part of Sweden, was invited to participate in a clinical study of oral health. 451 individuals were enrolled in this investigation, 51% women. All participants were asked to fill out a questionnaire, history was taken, a clinical examination was made and stimulated saliva samples were collected. Salivary concentrations of IL-1ß, -6, -8, TNF-α, lysozyme, MMP-8 and TIMP-1 were determined using ELISA, IFMA or Luminex assays. RESULTS: Salivary IL-8 concentration was found to be twice as high in subjects who had experience of tumour diseases. In addition, IL-8 levels were also elevated in patients with bowel disease. MMP-8 levels were elevated in saliva from patients after cardiac surgery or suffering from diabetes, and muscle and joint diseases. The levels of IL-1ß, IL-8 and MMP-8, as well as the MMP-8/TIMP-1 ratio were higher in subjects with muscle and joint diseases. CONCLUSION: Biomarkers in saliva have the potential to be used for screening purposes in epidemiological studies. The relatively unspecific inflammatory markers used in this study can not be used for diagnosis of specific diseases but can be seen as markers for increased systemic inflammation.

Salivary biomarkers of oral health: a cross-sectional study.

AIM: Saliva is a useful diagnostic fluid for oral-related diseases. Monitoring salivary biomarkers for oral and systemic diseases could become an important complement to clinical examinations in epidemiological surveys. Recent findings indicate that it is possible to detect biomarkers for oral diseases within saliva samples. The aim of this study was to investigate if known salivary biomarkers could be used for epidemiological studies for detection of periodontitis. MATERIALS AND METHODS: A randomly selected sample of adults (20-89 years) living in Southern Sweden were invited to participate. Four hundred and fifty-one individuals were examined clinically using standard examination procedures. Stimulated saliva samples were collected and analysed for concentrations of IL-1ß, -6, -8, lysozyme, matrix metalloproteinases (MMP)-8 and tissue inhibitor of metalloproteinase (TIMP)-1 using ELISA, immunofluorometric assay or Luminex assays. RESULTS: Patients with severe periodontitis presented with elevated salivary concentrations of IL-1ß (p < 0.001) and MMP-8 (p < 0.001). In addition, the MMP-8/TIMP-1 ratio was significantly higher in the severe periodontitis group (p < 0.001). Smokers compared with non-smokers showed slightly lower concentrations of IL-8 (p < 0.05) and MMP-8 (p = 0.052). CONCLUSION: This investigation shows that IL-1ß, MMP-8 and the ratio of MMP-8/TIMP-1 could be used as markers of periodontal disease in larger patient populations.

Periodontal disease in Norwegian old-age pensioners.

PURPOSE: To identify factors of importance for periodontal health and disease on an old-age Norwegian population. MATERIALS AND METHODS: From a random sample of 1152 urban and rural elderly Norwegians, aged 67 years or older, 582 individuals were agreed to participate in the study. After exclusion of edentulous individuals, 394 individuals were remained. A standardised clinical examination was performed by the same examiner. In conjunction with the clinical examination, a questionnaire was filled out regarding demographic and social status, educational level, tobacco habits and general condition. RESULTS: In the examined population, 33% of the subjects had periodontal disease. Out of those, 12% had severe periodontitis, that is, ≥3 periodontal pockets ≥6 mm. All variables were tested separately in a logistic regression model with periodontal pockets 6 mm and above, as the outcome variable. After univariate testing the following variables were included in a multivariate logistic regression model: daily smoking, higher plaque score, rural living and lower education. Only daily smoking remained significantly correlated to periodontal disease in the multivariate model. CONCLUSIONS: This study has shown a prevalence of periodontal disease in 33% of the study population. Out of those approximately 12% had more severe periodontitis. Daily tobacco use was the only factor significantly correlated to presence of periodontal disease.