Rate of reformation of tongue coatings in young adults.

BACKGROUND: Reviewing the literature, no study on the rate of regrowth of tongue coatings after tongue cleaning was found. Therefore, the purpose of this study in young adults was to study the rate of reformation of tongue coatings after mechanical removal. MATERIAL AND METHODS: Thirty-five dental students participated in the present study. Following preparatory study instructions, baseline examinations were carried out followed by 3 days of observation. At baseline, tongue coating scores (prescraping) were obtained followed by tongue scrapings and determination of the wet weights of the coatings. A second tongue coating score was then obtained within 5 min of the first score (immediate post-scraping). The subjects returned for repeated tongue coating scores after 1 and 2 days and for final examination after 3 days, which included both tongue coating scores (prescraping and immediate post-scraping) and determination of the wet weights of the coatings. RESULTS: Prior to scraping the tongue at day 0 (baseline), mean tongue coating amounted to a surface extension of 33% of the entire dorsum of the tongue. Scraping the tongue reduced the score to 9%. On average, tongue coating scores had returned to baseline levels on day 2. The mean wet weights of tongue scrapings at days 0 and 3 were similar and amounted to 0.09 +/- 0.07 and 0.09 +/- 0.06 g, respectively. CONCLUSION: If tongue cleaning is to be recommended, the results of this study in dental students indicate that tongue cleaning should be performed on a daily basis.

Evaluation of tongue coating indices.

AIM: The purpose of this study was to determine inter-examiner reproducibility of two modified Winkel tongue coating indices and to study the relationship between each of these two indices and the amount of tongue coating as determined by wet weight of scrapings from the dorsum of the tongue. MATERIALS AND METHODS: Twenty-five participants were selected for the study from among dental students. The selection was made to assure that a wide range of degrees of tongue coating were represented. Two independent examiners scored the tongue coatings using the two modified Winkel tongue coating indices (mWTCI 1 + 2 and mWTCI 2). After completion of index recordings, tongue scrapings were performed by one of the examiners. RESULTS: Inter-examiner reproducibility of mWTCI 1 + 2 and mWTCI 2 using Pearson's coefficients of correlation amounted to r = 0.48 and 0.93 respectively. Overall, mWTCI 2 showed higher correlations to wet weight of tongue scrapings than mWTCI 1 + 2. CONCLUSION: The mWTCI 2 was found to be highly reproducible and also valid as related to wet weight of tongue scrapings. This index would seem suitable for further studies on tongue coatings; effect of tongue cleaning; and rate of reformation of coatings after cleaning.

Effect of different frequencies of preventive maintenance treatment on periodontal conditions. 5-Year observations in general dentistry patients.

The protocol for this study was designed to evaluate the effects of supportive recall treatments provided with different frequencies, viz. at 3-, 6-, 12- and 18-month intervals. The subjects for the study were recruited from patients attending a public, general dentistry clinic. Prior to baseline, the subjects were given necessary dental treatments to provide a proper baseline for the study. Baseline, intermittent and final recordings included scores of dental plaque, bleeding on probing, probing depth and probing attachment level. Results were evaluated statistically by intergroup comparisons of changes for the various parameters from baseline to final examination after 5 years. The analyses showed some advantage to shorter recall intervals for plaque and bleeding scores. Although not statistically significant, there was a trend suggesting some rebound of sites > or =6 mm deep at the end of the study for the 18-month group, but not for the other groups. Similarly, there was a trend that the 18-month group showed a higher percentage of buccal/lingual furcation sites with attachment loss > or = 1.0 mm than the other groups. Apart from these trends, the analyses failed to demonstrate differences between the groups for either changes of probing depths or probing attachment levels. The negative observations included identification of individuals with 'disease progression' in the various groups, using a series of arbitrary definitions for this parameter. The results of this trial suggest that recall intervals extended to a year may be acceptable for the purpose of reducing periodontal disease progression in individuals with a history of limited susceptibility to the disease.

Patterns of attachment loss in advanced periodontitis patients monitored following initial periodontal treatment.

2 main concepts seem to exist for the progression of periodontitis: (1) a slow continuous process of attachment loss; (2) periodic bursts of activity followed by quiescence or remission. This study addresses this problem and presents data for 69 sites having experienced a net loss of probing attachment amounting to > or = 3.0 mm over 42 months. The sites originated from 16 adult patients monitored after nonsurgical treatment of advanced chronic periodontitis. Probing attachment level recordings were obtained every 3rd month. The sequential probing attachment level data for each site were smoothed using cubic splines. Subjective evaluation of the raw and the smoothed data from the study sites suggested that the majority of the sites seemed to lose probing attachment in a continuous fashion, and over periods of 12 months or more. The smoothed curves were subjected to principal components analysis, which allowed the 69 sites to be ordered according to curve similarity. Nonparametric runs test failed to show that the shape of the curves for the sites was significantly associated with any of the following characteristics: patient, tooth type, tooth surface, initial probing depth, bleeding frequency, occurrence of suppuration, or a combination of inflammatory characteristics of sites.

Reproducibility of clinical caries diagnoses on coronal and root surfaces.

Intra- and interexaminer reproducibility of clinical caries diagnoses was studied using 3 experienced dentists, who independently examined 20 patients twice at an interval of 2-6 weeks. The lesions were classified as one of the following four diagnoses: (1) initial active caries, (2) initial inactive caries, (3) manifest active caries, and (4) manifest inactive caries. For the various diagnoses, signs of cavitation, surface structure and discolouration were used. The reproducibility at a patient level was evaluated using intraclass correlation coefficients and at a surface level using kappa statistics. At a patient level, for the total number of lesions, the intraclass coefficients of correlation varied from 0.55 to 0.77. For the individual diagnoses, total manifest caries showed the highest coefficients of correlation, ranging from 0.73 to 0.92. At a tooth surface level, the kappa values varied from 0.29 to 0.61. The most common shift was that from any type of caries diagnosis to a diagnosis of a sound surface. There was little difference between the results for coronal and root caries and between initial and manifest lesions. Nor was there any difference for buccal + lingual surfaces only compared to all surfaces. Judging from the pattern of change in diagnosis between the repeated examinations, the main source of error seemed to be due to the fact that the lesions observed at one examination were overlooked at the other examination.

Clinical indicators of probing attachment loss following initial periodontal treatment in advanced periodontitis patients.

16 advanced periodontitis patients were subjected to initial periodontal treatment and monitored every 3rd month during 42 months. Clinical characteristics at baseline and during the 42-month maintenance period were investigated for their association with probing attachment loss over the 42-month period, both on a patient level and on a site level. On a patient level, averaged full-mouth plaque and bleeding on probing scores over the maintenance interval showed little association with probing attachment loss. Little association was also observed for % sites with depth > or = 6 mm at baseline. However, a notable relationship was seen for % sites > or = 6 mm at 3 months. This finding initiated a separation of the 16 subjects into 2 groups based upon % sites > or = 6 mm at 3 months (groups 'high' and 'low'). Site level analyses for these groups showed little association between frequent presence of plaque at the sites over the maintenance interval and probing attachment loss. Frequent bleeding on probing showed limited relationship with attachment loss for group 'low', but an appreciable association for group 'high'. The findings suggest that advanced periodontitis patients with multiple residual probing depths > or = 6 mm at re-evaluation run a greater risk of developing sites with additional attachment loss than patients with few such residual depths. For such higher risk patients, bleeding on probing at maintenance examinations may be a useful indicator of subsequent deterioration at a site level.

Clinical characteristics of periodontal sites with probing attachment loss following initial periodontal treatment.

Periodontal sites which had undergone probing attachment loss were identified in 16 advanced periodontitis patients subjected to initial periodontal treatment and monitored every 3rd month for 42 months. Many sites with probing attachment loss showed no increase in probing depth and bled on probing at a few of the examinations during maintenance. Others showed increase in depth, frequent bleeding and suppuration. An arbitrary classification of 'questionable periodontitis' sites was used and included sites with the following characteristics: probing depth at 42 months < or = 3.5 mm + bleeding on probing at no more than 5 of the 14 examinations 3-42 months + no suppuration on probing 3-42 months. The % sites in this category ranged from 21-35%, depending upon method used to determine probing attachment loss. Widely varying characteristics of sites identified with probing attachment loss were evident for all surface locations and all subgroups of initial probing depth. From a traditional viewpoint, a significant proportion of the losing sites might not have been afflicted with periodonitis. On the other hand, deterioration does not necessarily have to be coupled with obvious inflammation, particularly following therapy.

Treatment of mandibular class III periodontal furcation defects. Coronally positioned flaps with and without expanded polytetrafluoroethylene membranes.

Twenty-six mandibular class III furcation defects were treated in 26 subjects using a regenerative therapy that included citric acid root conditioning, placement of freeze-dried decalcified bone allograft and coronally positioned flaps secured by crown-attached sutures. In addition to this therapy, expanded polytetrafluoroethylene (ePTFE) membranes were placed in 14 of the 26 defects. The effect of these therapies was evaluated after 52 to 60 weeks through a series of soft and hard tissue probing measurements including residual furcation classification. For both treatments, mean improvements were observed for furcal probing attachment levels, furcal bone levels, and defect volumes. However, only a few of these through-and-through defects had become closed as judged by a panel of 3 independent examiners. Four defects in each of the 2 treatment groups had changed from Class III to Class I/II or Class II/II evaluated with the soft tissue in place. One defect treated without membrane and 3 defects treated with membranes had changed from Class III to Class II as recorded after reflection of the soft tissues at re-entry. Little difference was observed between defects treated with and without membranes. Further studies with larger sample sizes and longer observation times are needed to fully evaluate these regenerative procedures and their potential for healing Class III furcation defects.

Treatment of periodontal furcation defects. Coronally positioned flap with or without citric acid root conditioning in class II defects.

A total of 27 mandibular, buccal class II furcation defects were treated in 16 subjects using a coronally positioned flap procedure, with or without citric acid conditioning of the root surfaces. The effect of the therapies was evaluated from a series of soft and hard tissue measurements. Mean improvements were slightly greater for acid treated than for non-acid treated defects. However, none of the mean differences reached statistical significance, indicating that citric acid conditioning may not be a necessary part of the regenerative, coronally positioned flap procedure in mandibular furcations.

Marginal bone loss in the primary dentition of patients with juvenile periodontitis.

118 patients with juvenile periodontitis (JP), diagnosed when the patients were 13-19 years old, were studied retrospectively with respect to radiographic marginal bone loss in the primary dentition, experienced when the patients were 5-12 years old. 168 other 13-19 year old patients without any signs of bone loss in the permanent teeth were used as a reference group. The JP patients were classified into 2 groups according to the number of sites with bone loss in the permanent dentition: JP group I having 1 site with bone loss (n = 45) and JP group II having > or = 2 sites with bone loss (n = 73). It was found that 35 patients (52%) of JP group II displayed 1 or more sites with bone loss in the primary dentition during the age of 5-12 years. The corresponding numbers for JP group I and the reference group were 9 (20%) and 8 (5%) respectively. These findings indicate that juvenile periodontitis, at least in some individuals, may have its onset already in the primary dentition.

Treatment of periodontal furcation defects. Mandibular class III defects.

Twenty-seven mandibular class III furcation defects were treated in 27 subjects using a regenerative therapy that included citric acid root conditioning and coronally positioned flaps secured by crown-attached sutures. In addition to this therapy, 13 of the 27 defects received freeze-dried, decalcified allogenic bone grafts. The effect of these therapies was evaluated from soft tissue probing measurements, including furcation probings to determine soft tissue closure of the defects. At 6 months postsurgery, the mean vertical probing depth reduction and the mean probing attachment level gain in the furcation area were 2.6 mm and 2.2 mm for the non-grafted defects and 1.9 mm and 1.5 mm for the grafted defects. One of the 14 non-grafted defects and 3 of 13 grafted defects were judged to show soft tissue clinical closure by a panel of 3 independent examiners. No statistically significant differences were observed between defects treated with or without bone grafts.

Periodontal repair in dogs: effect of root surface treatment with stannous fluoride or citric acid on root resorption.

This study evaluated healing, with emphasis on root resorption, following root surface treatment with 1% aqueous stannous fluoride (SnF2), saturated citric acid (CA), or saline control (C) in conjunction with periodontal flap surgery. Supraalveolar periodontal defects were surgically created and immediately treated in the mandibular premolars in 6 beagle dogs. The defect height approximated 5 to 6 mm from the reduced alveolar bone to the cemento-enamel junction. Root treatments were rotated between experimental teeth within jaw quadrants and duplicated in left and right quadrants in the dogs. Flaps were raised to cover most of the crowns of the teeth and sutured. The dogs were sacrificed 12 weeks after surgery and tissue blocks with teeth and adjacent structures were processed for histometric analysis. SnF2-treated teeth healed with significantly longer junctional epithelium, less connective tissue repair to the root surface, and less bone regeneration than CA and C-treated teeth. New cementum formation was limited in all treatment groups. Root resorption was observed in almost all teeth exhibiting connective tissue repair, however to a lesser amount and not as frequent in SnF2 treated teeth due to limited connective tissue repair. No differences were found in amount and frequency of root resorption in CA and C-treated teeth. An inhibitory effect on root resorption of SnF2 could not be disclosed in this experiment, however, it may be concluded that CA treatment of the root surface in conjunction with reconstructive periodontal flap surgery does not seem to enhance root resorption.

Periodontal repair in dogs. Effect of heparin treatment of the root surface.

Studies on periodontal repair to denuded root surfaces have suggested that initial clot adhesion to the root surface may be important for the nature of subsequent healing. To study this hypothesis, circumferential periodontal defects, approximately 5 mm in vertical dimensions, were surgically created and immediately treated around the mandibular premolars in 4 beagle dogs. Prior to wound closure, the root surfaces were treated with either the anticoagulant heparin or with saline. Tissue blocks were obtained at sacrifice 4 weeks after surgery. Histometric analysis showed that connective tissue repair to the root surface averaged 50% of the defect height for heparin-treated teeth as compared to 95% for saline-treated teeth. Junctional epithelium amounted to an average of 33% of the defect height in heparin-treated teeth in contrast to 5% following saline treatment. It can be concluded that heparin treatment of the root surface compromises connective tissue repair, confirming clot adhesion as one prerequisite for connective tissue repair of periodontal defects.

Subjective criteria and probing attachment loss to evaluate the effects of plaque control and root debridement.

11 adult patients with moderate to advanced periodontitis were treated with oral hygiene instruction and an initial, single episode of root debridement. Before therapy, 3 independent clinicians examined all patients and identified sites that in their opinion probably would not respond to the therapy and would continue to lose attachment. On 2 occasions, 3 and 12 months later, the clinicians re-examined and re-evaluated all patients and all sites. The results of therapy were also monitored by probing attachment level measurements performed every 3rd month. All 11 patients completed 24 months of follow-up, and 6 subjects were available until 36 months. Sites with probing attachment loss after 12, 24 and 36 months were identified using linear regression analysis and compared to the clinicians' prediction of probing attachment loss. The results demonstrated a limited agreement between probing attachment loss determined by linear regression and the clinicians' predictions of probing attachment loss. It appears that the traditional clinical signs and factors used to forecast and identify periodontal disease activity are only moderately associated with probing attachment loss. This suggests that attachment loss may be caused by several factors, at least following initial therapy. The progression of an inflammatory disease of microbial etiology may be only 1 of such causes. Further studies are needed to clarify the nature and cause of probing attachment loss.

[The effectiveness of surgical compared to nonsurgical treatment of periodontal disease. 1. Molar surfaces. 24-month study]. / La efectividad del tratamiento quirúrgico comparado con el tratamiento no quirúrgico de la enfermedad periodontal. 1. Superficies planas de molares; estudio de 24 meses.

The response to the treatment and periodontal maintenance during a period of 24 month, was investigated in 17 patients with periodontal disease by comparing root debridement alone versus root debridement plus surgery, in the molar flat surfaces sites. A total of 443 sites were controlled every 3 month and recorded every 6 month in regard to plaque indice bleeding frequency, probing pocket depth and changes of probing attachment level. The results analysed using linear regression, demonstrated that in sites with initial probing depth 0-3 mm or 4-6 mm. at 24 th months there was an evident improvement in the clinical conditions of the periodontal tissues, independent in the treatment modality. Sites with initial probing depth of 7 or more mm., however, showed a different result. In this sites, the plaque indice and the probing pocket depth were considerable reduced, but the frequency of bleeding and the clinical attachment level showed a negative result, in those sites treated by root debridement alone compared with root debridement plus surgery.

Effect of root debridement on the elimination of Actinobacillus actinomycetemcomitans and Bacteroides gingivalis from periodontal pockets.

The aims of this 6-month longitudinal study were: (1) to investigate to what extent root debridement of pockets in adult periodontitis will reduce the subgingival presence of Actinobacillus actinomycetemcomitans, Bacteroides gingivalis and some other bacterial groups; (2) to relate the microbiological results following debridement to clinical measurements of healing. 16 patients and a total of 111 periodontally involved sites with probing depth greater than or equal to 6 mm served for the study. Duplicate subgingival microbial samples and duplicate clinical recordings were obtained 1 week apart at baseline and at 6 months following supra- and subgingival debridement. The results demonstrated reductions of the mean total viable counts and reductions of the mean counts of several of the cultured groups of micro-organisms coupled with significant improvements of mean clinical measurements. B. gingivalis was eliminated from a majority of infected subgingival sites. A. actinomycetemcomitans, on the other hand, still remained after therapy in a high proportion of sites initially infected with this microorganism. Subgingival persistence of A. actinomycetemcomitans appeared to be associated with a reduced healing response following debridement. Further studies are needed to clarify why A. actinomycetemcomitans is poorly eliminated following debridement. Also, the long-term clinical significance of the subgingival perseverance of A. actinomycetemcomitans needs to be elucidated.

On the inability of root debridement and periodontal surgery to eliminate Actinobacillus actinomycetemcomitans from periodontal pockets.

In a previous study, we observed that root debridement was inefficient in eliminating Actinobacillus actinomycetemcomitans from adult periodontitis lesions. The present report describes the effects on A. actinomycetemcomitans of subsequent treatments of 6 patients that had at least 2 separate sites still harboring A. actinomycetemcomitans 6 months following debridement. 1 site or more in each individual was treated with renewed root debridement and at least 1 other site was treated by surgical excision of the gingival tissue. The results indicated that retreatment with either repeated root debridement or with surgical excision of the gingival tissue was not more effective in eliminating A. actinomycetemcomitans than initial debridement. The possible reasons for this limited therapeutic effect on the subgingival presence of A. actinomycetemcomitans are discussed.

5-year follow up of periodontal intraosseous defects treated by root planing or flap surgery.

Intraosseous, periodontal defects in 12 subjects initially treated by root planing alone (21 defects) or by flap surgery (21 defects) were monitored during a 5-year postoperative interval. Maintenance therapy during this interval was limited to reinforcement of oral hygiene and tooth polishing every 6 months. No subgingival instrumentation was performed at the defect sites. Longitudinal clinical measurements demonstrated that surgically-treated lesions responded with somewhat more reduction of probing depth and more gain of probing bone level than root-planed lesions. Mean gains of probing attachment level were similar for the 2 treatments. Some relapse of the clinical conditions could be observed towards the end of the 5-year observation interval compared to the results at year 1 and year 2. However, the majority of defects subjected to either treatment showed 60-month recordings of probing attachment and probing bone levels equal to or slightly improved compared to those at baseline. Counts from cultures of subgingival, microbial samples were obtained at 42, 48 and 60 months. No significant difference between the 2 therapies was observed for the investigated groups of micro-organisms.

Connective tissue repair in circumferential periodontal defects in dogs following use of a biodegradable membrane.

A biodegradable polylactic acid membrane was evaluated for its ability to enhance periodontal regeneration. In 8 Labrador dogs, circumferential defects were created around the maxillary 1st premolars. The defects were combination "1-wall vertical and horizontal". A membrane was adjusted to cover the defect on one side of the jaw, while the contralateral tooth served as control without membrane. After 3 months, healing was evaluated histologically. The results demonstrated that the amount of connective tissue repair with newly formed cementum approximated 50% of the defect height for both test and control groups. Thus, no advantage to the use of membrane was found, which is contradictory to the findings of our previous dog study using the same biodegradable membrane. The possible reasons for this difference in results are discussed relative to suggested mechanisms for membrane effects in periodontal regeneration.