Topical application of glycyrrhetinic acid in the gingival sulcus inhibits attachment loss in lipopolysaccharide-induced experimental periodontitis in rats.

BACKGROUND AND OBJECTIVE: Attachment loss of the junctional epithelium and alveolar bone destruction are signs of periodontitis, which is mainly caused by an inflammatory response to dental plaque. Glycyrrhetinic acid (GA), a component of the licorice herb, has been shown to have important anti-inflammatory activities; however, there are no previous reports on the ability of its inhibitory effects to prevent periodontal diseases. Hence, in this study, using our experimental periodontitis model, we attempted to evaluate whether GA had an effect on the prevention of attachment loss and alveolar bone loss. MATERIAL AND METHODS: Rats were intraperitoneally immunized with Escherichia coli lipopolysaccharide (LPS). The LPS group (n = 5) received 3 topical applications of 50 µg/µL of LPS followed by one application of the vehicle (propylene glycol:ethyl alcohol:phosphate-buffered saline [PBS] = 8:1:1) into the gingival sulcus. This protocol was repeated twice per day for 10 days. The low (n = 5) and high (n = 5) groups received topical application of LPS and 0.03% or 0.3% GA, respectively. The control group received topical application of PBS and vehicle. The rats were killed on the 10th day. Attachment loss, alveolar bone level and inflammatory cell infiltration were investigated histometrically. The formation of immune complexes and infiltration of LPS were evaluated immunohistologically. RESULTS: Attachment loss, formation of immune complexes and infiltration of inflammatory cells were increased in the LPS group compared with the control group, and were completely inhibited in the low and high groups compared with the LPS group. The LPS group showed greater alveolar bone destruction compared with the control group and GA-treated groups. In addition, invasion of LPS was detected in the LPS group, was absent in the control group and was weaker in the GA-treated groups than in the LPS group. CONCLUSION: In the present study, we showed that GA inhibits periodontal destruction in the rat experimental periodontitis model.

Nonsurgical and surgical treatment of periodontitis: how many options for one disease?

Treatment of periodontitis aims at preventing further disease progression with the intentions to reduce the risk of tooth loss, minimize symptoms and perception of the disease, possibly restore lost periodontal tissue and provide information on maintaining a healthy periodontium. Therapeutic intervention includes introduction of techniques to change behavior, such as: individually tailored oral-hygiene instructions; a smoking-cessation program; dietary adjustment; subgingival instrumentation to remove plaque and calculus; local and systemic pharmacotherapy; and various types of surgery. No single treatment option has shown superiority, and virtually all types of mechanical periodontal treatment benefit from adjunctive antimicrobial chemotherapy. Periodontal treatment, because of the chronic nature of periodontitis, is a lifelong commitment to intricate oral-hygiene techniques, which, when properly implemented, will minimize the risk of disease initiation and progression.

Terapéutica periodontal de mantenimiento / Supportive periodontal therapy

INTRODUCCIÓN: El mantenimiento es una fase fundamental de la terapia y prevención de las enfermedades periodontales. Los objetivos de esta revisión son: a) Determinar cuáles son los aspectos de la terapia periodontal de mantenimiento; b) conocer el valor del mantenimiento sobre los resultados a largo plazo del tratamiento periodontal; c) revisar los factores de riesgo del paciente, del diente y de la localización; d) establecer un protocolo de acción ante las distintas situaciones. Material, métodos y resultados: Para la realización de este trabajo se han analizado 46 artículos científicos. Para la búsqueda se han empleado la base de datos MEDLINE y Cochrane. DISCUSIÓN: Los objetivos de la terapia de mantenimiento son prevenir la iniciación y recurrencia de las enfermedades periodontales. Independientemente del tipo de tratamiento que realicemos, los parámetros clínicos no mejoraran si el mantenimiento por parte del profesional no se lleva a cabo. Para establecer los intervalos de las citas y las localizaciones a tratar, será fundamental la valoración de los factores de riesgo asociados al paciente, al diente y a la localización

INTRODUCTION: Supportive periodontal therapy (SPT) is an essential phase of periodontal disease prevention and therapy. The objectives of this review are: a) to determine the different aspects from SPT; b) to know the value of SPT in long term results after active periodontal therapy; c) to review the patient, the tooth and the site related risk factors; d) to establish clinical protocols for managing the different situations. Materials, METHODS AND RESULTS: For the preparation of this work, 46 scientific articles have been analyzed the MEDLINE and Cochrane databases have been used to make the search. DISCUSSION: The objectives of SPT are to prevent the initiation or recurrence of periodontal diseases. Independently of the type of treatment, the clinical outcomes won't improve if we don't perform a professional SPT. To establish the appointment intervals and the sites to be treated, we have to evaluate the risk factors associated to the patient, the tooth and the site

[How to analyze periodontal morphotypes in order to reduce the risk of periodontal recession]. / Savoir analyser le morphotype parodontal pour minimiser les risques de récessions parodontales.

INTRODUCTION: The periodontal morphotype is a leading feature to be born in mind during surgical, implant, prosthetic, restorative as well as orthodontic treatment. A fragile morphotype will rapidly trigger severe and worrying clinical repercussions for the patient. MATERIALS AND METHODS: In order to minimize the risks involved, sound knowledge of the different morphotypes and of the techniques for clinically evaluating them is a major requirement. These factors need to be regularly reassessed since morphotypes can vary throughout the course of treatment. RESULTS: Detecting and controlling mucogingival risk factors will enable an appropriate clinical approach designed to avoid the onset of secondary recessions or other gingival pathologies.

Influence of a triclosan toothpaste on periodontopathic bacteria and periodontitis progression in cardiovascular patients: a randomized controlled trial.

BACKGROUND AND OBJECTIVE: Triclosan/copolymer toothpaste is effective in controlling plaque and gingivitis and in slowing the progression of periodontitis. This study describes its influence on microbiological and clinical outcomes, over a 5-year period, in patients with established cardiovascular disease (CVD). MATERIAL AND METHODS: Four-hundred and thirty-eight patients were recruited from the Cardiovascular Unit at The Prince Charles Hospital, Brisbane, Australia, and randomized to triclosan or placebo groups. Six sites per tooth were examined annually for probing pocket depth and loss of attachment. These outcomes were analysed, using generalized linear modelling, in 381 patients who had measurements from consecutive examinations. Concurrent load of the periodontal pathogens Aggregatibacter actinomycetemcomitans, Fusobacterium nucleatum, Tannerella forsythia and Porphyromonas gingivalis was determined, using quantitative real-time PCR, in 437 patients with baseline plaque samples. Group comparisons were expressed as geometric means. The chi-square test was used to test for differences between the two groups of patients with regard to the proportion of patients with different numbers of bacterial species. RESULTS: There was no difference in general health or periodontal status between the groups at baseline. There was a significant reduction in the number of interproximal sites showing loss of attachment between examinations, by 21% on average (p < 0.01), in the triclosan group compared with the placebo group. The prevalence of patients with F. nucleatum and A. actinomycetemcomitans was high and remained relatively constant throughout the 5 years of the study. In contrast, the prevalence of T. forsythia and P. gingivalis showed more variability; however, there was no significant difference between the groups, at any time point, in the prevalence of any organism. A significant difference in the geometric means for P. gingivalis (p = 0.01) was seen at years 1 and 4, and for F. nucleatum (p = 0.01) and in the total bacterial load (p = 0.03) at year 2; however, these differences were not statistically significant following a Bonferroni correction for multiple comparisons. There was no difference between the groups in the geometric means for each organism at year 5. CONCLUSION: Within the limitations of the study, these data suggest that the use of triclosan/copolymer toothpaste significantly slowed the progression of periodontitis in patients with CVD but that it had little influence on key subgingival periodontopathic bacteria in these patients over the 5 years of the study.

[A study on effects of immediate bone grafting at mandibular first molar fresh extraction socket on maintaining alveolar bone height after space closure].

Objective: To investigate the effect of immediate bone grafting at mandibular first molar extraction socket on maintaining alveolar bone height after space closure. Methods: Thirty adult orthodontic patients who need to extract mandibular first molar, totally 38 target teeth, were included. The samples were divided into two groups randomly: graft group and non-graft group. All extraction space was closed orthodontically. Dental models of all patients were taken before extraction (T0), before space closure(T1) and after space closure (T2). The distance, time of the space closure and the velocity of tooth movement were recorded. Probing depth (PD) and clinical attachment level (CAL) at six sites (mesial buccal, buccal, mesial lingual, lingual, distal buccal and distal lingual) on adjacent teeth were measured before extraction (T0) and after space closure (T2). Cone-beam CT (CBCT) was taken at T0 and T2 to compare the changes of alveolar bone height at six sites on adjacent teeth using Invivo Dental 5.0 software. Results: The extraction space in both graft group and non-graft group was closed successfully. However, the space in graft group was closed more slowly than in non-graft group. In graft group, PD and CAL at the six sites on both the second molar and the second premolar did not change significantly after space closure, and CBCT showed that the alveolar bone height of the second premolar had no significant difference after treatment. In non-graft group, alveolar bone height decreased in both adjacent teeth and periodontal attachment loss was found after space closure. On average, alveolar bone height and periodontal attachment of the second premolar decreased (0.75±0.16) mm and (0.64±0.15) mm, respectively. Meanwhile, alveolar bone height and periodontal attachment of the second molar decreased (0.79±0.23) mm and (0.80±0.24) mm, respectively. Conclusions: Bone graft immediately after mandibular first molar extraction could delay alveolar bone resorption and preserve the periodontal attachment of the adjacent teeth during space closure. However, the procedure could slow down tooth movement.

Maintaining Osseointegration: Understanding, preventing, and treating Risk Factors for Peri-implant Diseases.

The dental implant is a predictable way of restoring fully and partially edentulous patients and has shown high success rate for managing a broad range of clinical conditions. Improving implant surfaces has revolutionized the osseointegration of implants and changed the focus of implant research from osseointegration more toward the risk factors associated with the failure of implants in the long-term.

The role of probiotic bacteria in managing periodontal disease: a systematic review.

INTRODUCTION: The frequent recolonization of treated sites by periodontopathogens and the emergence of antibiotic resistance have led to a call for new therapeutic approaches for managing periodontal diseases. As probiotics are considered a new tool for combating infectious diseases, we systematically reviewed the evidences for their effectiveness in the management of periodontitis. AREAS COVERED: An electronic search was performed in the MEDLINE, SCOPUS and Cochrane Library databases up to March 2016 using the terms 'periodontitis', 'chronic periodontitis', 'probiotic(s)', 'prebiotic(s)', 'symbiotic(s)', 'Bifidobacterium and 'Lactobacillus'. Only randomized controlled trials (RCTs) were included in the present study. Analysis of 12 RCTs revealed that in general, oral administration of probiotics improved the recognized clinical signs of chronic and aggressive periodontitis such as probing pocket depth, bleeding on probing, and attachment loss, with a concomitant reduction in the levels of major periodontal pathogens. Continuous probiotic administration, laced mainly with Lactobacillus species, was necessary to maintain these benefits. Expert commentary: Oral administration of probiotics is a safe and effective adjunct to conventional mechanical treatment (scaling) in the management of periodontitis, specially the chronic disease entity. Their adjunctive use is likely to improve disease indices and reduce the need for antibiotics.

The effect of an inhibitor of gut serotonin (LP533401) during the induction of periodontal disease.

BACKGROUND AND OBJECTIVE: LP533401 is an inhibitor of tryptophan hydroxylase 1, which regulates serotonin production in the gut. Previous work indicates that LP533401 has an anabolic effect in bone. Thus, we hypothesized that inhibition of gut serotonin production may modulate the host response in periodontal disease. In this study, we aimed to analyze the effects of LP533401 in a rat periodontitis model to evaluate the role of gut serotonin in periodontitis pathophysiology. MATERIAL AND METHODS: Twenty-four rats were divided into three groups: treated group (T: ligature-induced periodontal disease and LP533401, 25 mg/kg/d) by gavage; ligature group (L: ligature-induced periodontal disease only); and control group (C: without ligature-induced periodontal disease). After 28 d, radiographic alveolar bone support was measured on digital radiographs, and alveolar bone volume fraction, tissue mineral density and trabeculae characteristics were quantified by microcomputed tomography in the right hemi-mandible. Left hemi-mandibles were decalcified and alveolar bone loss, attachment loss and area of collagen in the gingiva were histologically analyzed. RESULTS: Significant difference between the L and C groups was found, confirming that periodontal disease was induced. We observed no difference between the T and L groups regarding alveolar bone destruction and area of collagen. CONCLUSION: LP533401 (25 mg/kg/d) for 28 d does not prevent bone loss and does not modulate host response in a rat model of induced periodontal disease.

Adjunctive Non-Surgical Therapy of Inflamed Periodontal Pockets During Maintenance Therapy Using Diode Laser: A Randomized Clinical Trial.

BACKGROUND: Numerous studies have documented the clinical outcomes of laser therapy for untreated periodontitis, but very few have reported on lasers treating inflamed pockets during maintenance therapy. The aim of this study is to compare the effectiveness of scaling and root planing (SRP) plus the adjunctive use of diode laser therapy to SRP alone on changes in the clinical parameters of disease and on the gingival crevicular fluid (GCF) inflammatory mediator interleukin-1ß (IL-1ß) in patients receiving regular periodontal maintenance therapy. METHODS: This single-masked and randomized, controlled, prospective study includes 22 patients receiving regular periodontal maintenance therapy who had one or more periodontal sites with a probing depth (PD) ≥ 5 mm with bleeding on probing (BOP). Fifty-six sites were treated with SRP and adjunctive laser therapy (SRP + L). Fifty-eight sites were treated with SRP alone. Clinical parameters, including PD, clinical attachment level (CAL), and BOP, and GCF IL-1ß levels were measured immediately before treatment (baseline) and 3 months after treatment. RESULTS: Sites treated with SRP + L and SRP alone resulted in statistically significant reductions in PD and BOP and gains in CAL. These changes were not significantly different between the two therapies. Similarly, differences in GCF IL-1ß levels between SRP + L and SRP alone were not statistically significant. CONCLUSION: In periodontal maintenance patients, SRP + L did not enhance clinical outcomes compared to SRP alone in the treatment of inflamed sites with ≥ 5 mm PD.

Preventing and Treating Peri-Implantitis: A Cost-Effectiveness Analysis.

BACKGROUND: A large number of treatments for peri-implantitis are available, but their cost-effectiveness remains uncertain. This study evaluates the cost-effectiveness of preventing and treating peri-implantitis. METHODS: A Markov model was constructed that followed each implant over 20 years. Supportive implant therapy (SIT) for managing peri-implant mucositis and preventing development of peri-implantitis was either provided or not. Risk of peri-implantitis was assumed to be affected by SIT and the patient's risk profile. If peri-implantitis occurred, 11 treatment strategies (non-surgical or surgical debridement alone or combined with adjunct therapies) were compared. Treatments and risk profiles determined disease progression. Modeling was performed based on systematically collected data. Primary outcomes were costs and proportion of lost implants, as assessed via Monte Carlo microsimulations. RESULTS: Not providing SIT and performing only non-surgical debridement was both least costly and least effective. The next best (more costly and effective) option was to provide SIT and perform surgical debridement (additional 0.89 euros per 1% fewer implants lost). The most effective option included bone grafts, membranes, and laser treatment (56 euros per 1%). For patients at high risk, the cost-effectiveness of SIT increased, whereas in low-risk groups, a cost-optimized strategy was cost-effective. CONCLUSIONS: Although clinical decision-making will be guided mainly by clinical condition, cost-effectiveness analyses might add another perspective. Based on these findings, an unambiguous comparative effectiveness ranking was not established. However, cost-effectiveness was predominantly determined by provision of SIT and initial treatment costs. Transferability of these findings to other healthcare systems needs further confirmation.

The utility of gingival crevicular fluid matrix metalloproteinase-8 response patterns in prediction of site-level clinical treatment outcome.

BACKGROUND: Different gingival crevicular fluid (GCF) matrix metalloproteinase (MMP)-8 response patterns were studied among non-smoking and smoking patients with chronic periodontitis (CP) and generalized aggressive periodontitis (GAgP) to test the utility of GCF MMP-8 levels predicting the site-level treatment outcome. METHODS: Data from four independent longitudinal studies were combined. Altogether, the studies included 158 periodontal sites from 67 patients with CP and 32 patients with GAgP, and GCF samples were collected at baseline, after the treatment, and during the 6-month maintenance period. All GCF samples were analyzed by immunofluorometric assay for MMP-8. Different site-level MMP-8 response patterns were explored by the cluster analysis. Most optimal MMP-8 cutoff levels were searched with receiver operating characteristic analyses, and the predictive utility of defined levels was tested. RESULTS: Distinct types of MMP-8 response patterns were found in both smokers and non-smokers. MMP-8 levels exceeding the optimal cutoff levels separately defined for smokers and non-smokers indicated increased risk for compromised treatment outcome at baseline and during the maintenance period. Seventy-one percent of non-smokers (positive likelihood ratio of 4.22) and 88% of smokers (positive likelihood ratio of 5.00) with positive test results at both baseline and the maintenance period had compromised treatment outcome. The double-positive result indicated 46% and 39% point risk increase for the compromised outcome, respectively. CONCLUSION: GCF MMP-8 analysis with defined cutoff levels could be used to predict the site-level treatment outcome and for longitudinal monitoring of the disease status during the maintenance period.

Effectiveness of lifestyle change plus dental care program in improving glycemic and periodontal status in aging patients with diabetes: a cluster, randomized, controlled trial.

BACKGROUND: Currently, there is an increased prevalence of diabetes mellitus among the aging adult population. To minimize adverse effects on glycemic control, prevention and management of general and oral complications in patients with diabetes are essential. The objective of this study is to assess the effectiveness of the lifestyle change plus dental care (LCDC) program to improve glycemic and periodontal status in aging patients with diabetes. METHODS: A cluster, randomized, controlled trial was conducted in Health Centers 54 (intervention) and 59 (control) from October 2013 to April 2014. Sixty-six patients with diabetes per health center were included. At baseline, the intervention group attended 20-minute lifestyle and oral health education, individual lifestyle counseling, application of a self-regulation manual, and individual oral hygiene instruction. At month 3, the intervention group received individual lifestyle counseling and oral hygiene instruction. The intervention group received booster education every visit by viewing a 15-minute educational video. The control group received a routine program. Participants were assessed at baseline and 3- and 6-month follow-up for glycemic and periodontal status. Data were analyzed by using descriptive statistic, χ(2) test, Fisher exact test, t test, and repeated-measures analysis of variance. RESULTS: After the 6-month follow-up, participants in the intervention group had significantly lower glycated hemoglobin, fasting plasma glucose, plaque index, gingival index, probing depth, and attachment loss when compared with the control group. CONCLUSION: The combination of lifestyle change and dental care in one program improved both glycemic and periodontal status in older patients with diabetes.

Gelatinases and extracellular matrix metalloproteinase inducer are associated with cyclosporin-A-induced attenuation of periodontal degradation in rats.

BACKGROUND: The present study aims to examine the inhibitory effect of cyclosporin-A (CsA) on periodontal breakdown and to further explore the correlations of CsA-induced attenuation of periodontal bone loss with the expressions of gelatinases (i.e., matrix metalloproteinase [MMP]-2 and MMP-9) and extracellular matrix metalloproteinase inducer (EMMPRIN). METHODS: Forty Sprague-Dawley rats were randomly divided into four groups: 1) control; 2) CsA; 3) ligature (Lig); and 4) ligature plus CsA (Lig + CsA). The CsA group received 10 mg ⋅ Kg(-1) ⋅ d(-1) CsA for 8 days. The Lig group received silk ligature on selected molars. The Lig + CsA group received silk ligature and CsA treatment. The inhibitory effects of CsA on the ligature-induced periodontal breakdown was examined with microcomputed tomography (micro-CT) and histometric analyses to analyze the amount of attachment loss, crestal bone loss, connective tissue attachment, and the surface area with inflammatory cell infiltration. The effects of CsA on ligature-induced expressions of gelatinases and EMMPRIN in gingival tissues were examined with Western blotting and zymography, respectively. RESULTS: By micro-CT and histology, the Lig + CsA group had significantly more periodontal breakdown than the control and CsA groups but less periodontal breakdown than the Lig group. Consistent results were found for the expressions of gelatinases and EMMPRIN among the groups demonstrating that the Lig + CsA group had significantly less gingival protein expression of gelatinases and EMMPRIN than the Lig group. CONCLUSIONS: CsA inhibited the expressions of gelatinase MMPs and EMMPRIN and partially prevented the periodontal breakdown in ligature-induced experimental periodontitis. The CsA-induced attenuation of periodontal bone loss was strongly correlated positively with the expressions of MMP-2, MMP-9, and EMMPRIN in gingiva.

Effect of professional mechanical plaque removal performed on a long-term, routine basis in the secondary prevention of periodontitis: a systematic review.

AIMS: To systematically review the evidence evaluating the efficacy of long-term, routine, professional mechanical plaque removal (PMPR) in the prevention of periodontitis progression. METHODS: A literature search was conducted to identify prospective studies evaluating the effect of PMPR in periodontitis patients undergoing active periodontal therapy and enrolled in a maintenance programme including PMPR for at least 3 years. RESULTS: No RCTs evaluating the efficacy of the intervention when compared with no treatment during maintenance were found. Nineteen prospective studies assessing the effect of PMPR as part of the supportive therapy were included. In general, studies reported no to low incidence of tooth loss during follow-up. The weighted mean yearly rate of tooth loss was 0.15 ± 0.14 and 0.09 ± 0.08 for follow-up of 5 years or 12-14 years, respectively, with no significant differences between groups. Mean clinical attachment loss was <1 mm at follow-up ranging from 5 to 12 years. CONCLUSIONS: Supportive therapy, which encompasses PMPR, may limit the incidence and yearly rate of tooth loss as well as the loss in clinical attachment in patients treated for periodontitis. However, whether and to what extent the intervention may impact on long-term periodontal parameters still needs to be assessed.

Green tea extract inhibits the onset of periodontal destruction in rat experimental periodontitis.

BACKGROUND AND OBJECTIVE: Green tea extract exerts a variety of biological effects, including anti-inflammatory activities. However, there has been no report on the effect of green tea extract on loss of attachment, which is an important characteristic of periodontitis. Here, we examined the inhibitory effects of green tea extract on the onset of periodontitis in a rat model. MATERIAL AND METHODS: Rats were immunized intraperitoneally with Escherichia coli lipopolysaccharide (LPS). The LPS group (n = 12) received a topical application of LPS onto the palatal gingival sulcus every 24 h. The green tea extract group (n = 12) received a topical application of LPS mixed with green tea extract, sunphenon BG, every 24 h. The phosphate-buffered saline (PBS) group (n = 6) received a topical application of PBS every 24 h. The levels of anti-LPS immunoglobulin G (IgG) in serum were determined using ELISA. Rats in the LPS and green tea extract groups were killed after the 10th and 20th applications. Rats in the PBS group were killed after the 20th application. Loss of attachment, level of alveolar bone and inflammatory cell infiltration were investigated histopathologically and histometrically. RANKL-positive cells and the formation of immune complexes were evaluated immunohistologically. RESULTS: There was no significant difference in the serum levels of anti-LPS IgG between the LPS group and the green tea extract group. In contrast, loss of attachment, level of alveolar bone, inflammatory cell infiltration and RANKL expression in the green tea extract group were significantly decreased compared with those in the LPS group. CONCLUSION: These findings demonstrate that green tea extract suppresses the onset of loss of attachment and alveolar bone resorption in a rat model of experimental periodontitis.

Periodontal and serum protein profiles in patients with rheumatoid arthritis treated with tumor necrosis factor inhibitor adalimumab.

BACKGROUND: Tumor necrosis factor (TNF)-α inhibitor has been shown to affect the periodontal condition of patients with rheumatoid arthritis (RA). The aim of the present study is to assess the effect of a fully humanized anti-TNF-α monoclonal antibody, adalimumab (ADA), on the periodontal condition of patients with RA and to compare serum protein profiles before and after ADA therapy. METHODS: The study participants consisted of 20 patients with RA treated with ADA. Clinical periodontal and rheumatologic parameters and serum cytokine levels were evaluated at baseline and 3 months later. Serum protein spot volume was examined with two-dimensional sodium dodecyl sulfate polyacrylamide gel electrophoresis. Proteins with significant difference in abundance before and after ADA therapy were found and identified using mass spectrometry and protein databases. RESULTS: The patients showed a significant decrease in gingival index (P = 0.002), bleeding on probing (P = 0.003), probing depth (P = 0.002), disease activity score including 28 joints using C-reactive protein (P <0.001), and serum levels of TNF-α (P <0.001) and interleukin-6 (P <0.001) after ADA medication, although plaque levels were comparable. Among a total of 495 protein spots obtained, nine spots were significantly decreased in abundance at reassessment, corresponding to complement factor H, phospholipase D, serum amyloid A, complement component 4, and α-1-acid glycoprotein (P <0.01). CONCLUSION: These results suggest a beneficial effect of ADA therapy on the periodontal condition of patients with RA, which might be related to differences in serum protein profiles before and after ADA therapy.

The role of self-efficacy in health coaching and health education for patients with type 2 diabetes.

PURPOSE: To assess the role of toothbrushing self-efficacy (TBSE) in diabetes management by comparing health education (HE) and health coaching (HC) in type 2 diabetes. METHODS: The data [HbA1c , Clinical Attachment Loss (CAL), TBSE] were collected initially and after intervention. Participants were allocated randomly to HC (n = 77) and HE (n = 109) groups. RESULTS: The low TBSE subgroup showed greater improvement in TBSE in the HC group (∆mean:23.4 ± 9.2) than the HE group (∆mean:12.4 ± 10.3), (P < 0.01). The moderate TBSE group showed significant improvements only in the HC group (P < 0.001).There was a significant reduction in HbA1c and CAL in all the TBSE subgroups in HC (P < 0.05), which was significantly higher than in the HE groups (P < 0.05). Improvements in TBSE and CAL were explanatory variables for the reduction in HbA1c among the HC patients in all the TBSE subgroups (P < 0.05). Among HE patients, improvement in CAL was an explanatory variable for change at HbA1c in the low TBSE subgroup. CONCLUSIONS: The present findings show that HC is more effective in terms of reduced HbA1c and CAL compared with HE. The data suggest that HC unlocks positive self-intrinsic motivation, anchoring the self-efficacy/competency beliefs for adjustment of healthy lifestyles. Thus, TBSE may be a practical starting point for empowerment and more effective outcomes.

Routine prophylaxes every 3 months improves chronic periodontitis status in type 2 diabetes.

BACKGROUND: Periodontitis and type 2 diabetes mellitus (T2DM) are major health problems, especially in low-income populations with little access to dental care. Low-cost models for treatment of periodontal disease have not been tested in controlled studies in low-income populations. Dental prophylaxis, which includes removal of supragingival calculus and plaque, has been shown to arrest the progression of periodontitis. A controlled clinical trial was conducted to determine the effect of dental prophylaxis on periodontitis in T2DM. METHODS: Twenty-six patients with T2DM and chronic periodontitis (CP) and 26 without T2DM with CP were selected. Periodontal probing depth (PD), gingival bleeding on probing (BOP), clinical attachment level (CAL), and surfaces with plaque were recorded at baseline and 3, 6, and 9 months after initial treatment. All the participants received instructions on oral hygiene and one session of dental prophylaxis at baseline and every 3 months. Glycated hemoglobin (HbA1c) levels were measured at baseline and every 3 months in patients with T2DM. RESULTS: A significant improvement of PD, BOP, and sites with plaque was observed 3 months after treatment in patients with T2DM (P = 0.001). In controls, mean PD significantly improved after 6 months compared with baseline (P = 0.001). No significant improvement of CAL occurred in either group. No significant differences in periodontal parameters between the groups were detected, and no participant showed progression of CP during the 9-month study period. Dental prophylaxis did not influence HbA1c levels, and no association among HbA1c concentration, pretreatment metabolic status, and severity of CP was found. CONCLUSION: Routine prophylaxes every 3 months significantly improve periodontal health and prevent progression of CP in both poorly controlled and well-controlled patients with T2DM.

Crestal bone changes at teeth and implants in periodontally healthy and periodontally compromised patients. A 10-year comparative case-series study.

BACKGROUND: Limited data exist on the longitudinal crestal bone changes around teeth compared with implants in partially edentulous patients. This study sought to compare the 10-year radiographic crestal bone changes (bone level [BL]) around teeth and implants in periodontally compromised (PCPs) and periodontally healthy (PHPs) patients. METHODS: A total of 120 patients were evaluated for the radiographic crestal BL around dental implants and adjacent teeth at time of implant crown insertion and at the 10-year follow-up. Sixty patients had a previous history of periodontitis (PCPs), and the remaining 60 were PHPs. In each category (PCP and PHP), two different implant systems were used. The mean BL change at the implant and at the adjacent tooth at the interproximal area was calculated by subtracting the radiographic crestal BL at the time of crown cementation from the radiographic crestal BL at the 10-year follow-up. RESULTS: At 10 years after therapy, the survival rate ranged from 80% to 95% for subgroups for implants, whereas it was 100% for the adjacent teeth. In all eight different patient categories evaluated, teeth demonstrated a significantly more stable radiographic BL compared with adjacent dental implants (teeth BL, 0.44 ± 0.23 mm; implant BL, 2.28 ± 0.72 mm; P <0.05). Radiographic BL changes around teeth seemed not to be influenced by the presence or absence of advanced bone loss (≥3 mm) at the adjacent implants. CONCLUSIONS: Natural teeth yielded better long-term results with respect to survival rate and marginal BL changes compared with dental implants. Moreover, these findings also extend to teeth with an initial reduced periodontal attachment level, provided adequate periodontal treatment and maintenance are performed. As a consequence, the decision of tooth extraction attributable to periodontal reasons in favor of a dental implant should be carefully considered in partially edentulous patients.