Reduced systemic inflammatory mediators after treatment of chronic gingivitis.

OBJECTIVE: To assess the changes in the level of C-reactive protein (CRP) and tumor necrosis factor-alpha (TNF-alpha) in gingival crevicular fluid (GCF) after treatment of chronic gingivitis in systemically healthy individuals. METHODS: This is a clinical trial conducted at Case Western Reserve University, Cleveland, Ohio, United States of America from February to December 2011. A total of 41 systemically healthy subjects were assigned to 2 groups according to the severity of gingival inflammation. Group I consisted of 18 subjects who had mild gingival inflammation; and group II consisted of 23 with more severe gingival inflammation. Periodontal assessment consisted of gingival index (GI), probing depths (PD), and GCF volume. Four to six weeks after prophylaxis and oral hygiene instruction, the same measurements were repeated. The level of CRP and TNF-alpha in the GCF was determined using enzyme-linked immunosorbent assays. RESULTS: A statistically significant reduction in the mean CRP and TNF-alpha levels after the treatment was found in the severe, but not in the mild gingivitis group. Both groups showed a statistically significant reduction in GI, PD, and periotron readings after the treatment. CONCLUSION: Treatment of severe chronic gingivitis reduces the levels of CRP and TNF-alpha in GCF of otherwise systemically healthy individuals, which could have an impact on preventing or controlling future or existing systemic disease conditions.

Epidemiology of dental caries among adults in a rural area in India.

BACKGROUND: Data on epidemiology of dental caries of adults in rural India appear to be sparse. OBJECTIVE: The purpose of the study was to assess the oral health status and dental treatment needs of a rural Indian population. MATERIALS AND METHODS: The study population consisted of 189 volunteer subjects with a mean age of 34.9 ± 14.2 years and 54% males. Decayed, missing due to caries and filled teeth (DMFT) and tooth surfaces (DMFS) assessed the dental caries experience. Structured interviews collected data on perception of health including oral health, oral hygiene practices and snacking habits. RESULTS: While only 38.1% perceived themselves to be in good or very good dental health, nearly 85% felt the same about general health. The most common sugar exposure was sweetened tea; 75% consumed the beverage at least once a day. More than 80% of the subjects had untreated caries with mean DMFT and DMFS scores of 5.1 ± 3.9 and 13.8 ± 17.8, which lacked any gender differences. Dental treatment needs ranged from 16.9% two-surface fillings to 60.8% one-surface fillings; 23.8% crowns or bridges and 37.6% extractions. Those who perceived themselves to be in better oral health had significantly lower DMFT (4.0 ± 3.2 vs 5.9 ± 4.1) and DMFS (8.4 ± 11.7 vs 17.1 ± 20.0) scores (p < 0.05). A similar trend was observed between perception of general health and DMFT (4.8 ± 3.4 vs 7.0 ± 5.6) and DMFS (11.9 ± 13.7 vs 24.1 ± 30.7) scores. CONCLUSION: Results indicate high levels of dental caries as well as dental treatment needs among the study participants.

Response to periodontal therapy in patients who had weight loss after bariatric surgery and obese counterparts: a pilot study.

BACKGROUND: Periodontitis and obesity are both chronic health problems, and the literature supports an association between the two. Weight loss after bariatric surgery (BS) has been shown to decrease overall mortality as well as the development of new health-related conditions in morbidly obese patients. The present study aims to assess whether significant weight loss would improve the response to non-surgical periodontal therapy in obese patients. METHODS: This study included 30 obese (body mass index >30 kg/m(2)) patients affected with chronic periodontitis. Of these, 15 patients had previously undergone BS and lost ≥40% of their excess weight for ≥6 months after surgery. The other 15 patients were also obese but did not have the surgery, nor did they lose weight to serve as a control group. All participants received non-surgical periodontal therapy (scaling and root planing and oral hygiene instructions). Probing depth (PD), clinical attachment level (CAL), bleeding on probing (BOP), gingival index (GI), and plaque index were measured at baseline and at 4 to 6 weeks after the periodontal treatment. Descriptive statistics, linear mixed-effects models, and linear regression models were used for data analysis. RESULTS: The mean age of the study participants was 47.1 ± 11.5 years, and 36.7% of the participants were males. There was a statistically significant improvement after periodontal therapy in the BS compared with the obese group (P <0.05). The PD had a mean reduction of 0.45 mm in the BS group versus 0.28 mm in the control group. The reduction in CAL was 0.44 mm versus 0.30 mm, percentage of BOP sites was 16% versus 15%, and GI was 1.03 versus 0.52 in the BS and control groups, respectively. CONCLUSION: An improved response to non-surgical periodontal therapy is observed in obese patients who had significant weight loss after BS compared with obese patients who did not have such a surgery.

Sugar consumption and preference among Mexican, Chinese, and Nigerian immigrants to Texas.

This pilot study investigated the relationship between sugar consumption/ preference and the length of residence in the U.S. among certain immigrant groups. The study sample consisted of 213 volunteers from community organizations and church groups, of Nigerian (45%), Mexican (31%), and Chinese (24%) descent. Data were collected on demographics, sugar consumption/preference (24-hour dietary recall), and oral health status. The age of respondents varied from 18 to 93 years with a mean age of 37.0 ± 11.7 years. The mean length of residence was 9.2 ± 7.2 years, and the mean sugar consumption was 122.4 ± 114.6 g/day. Immigrants from Mexico and Nigeria reported consuming more servings of sweets per day than the Chinese (p= .006); Mexican immigrants had the highest level of sugar preference (p= .001). No significant differences were observed between the length of residence and either sugar consumption or sugar preference. Greater availability of sugar and sweet snacks does not always result in increased sugar consumption or sugar preference.

Retainer wear and compliance in the first 2 years after active orthodontic treatment.

INTRODUCTION: The purpose of this descriptive study was to estimate retainer wear and compliance among orthodontic patients in the first 2 years after active orthodontic treatment. METHODS: A random sample of 1200 orthodontic patients was selected from 4 offices. Data were collected by a self-administered questionnaire that consisted of 6 items: type of retainer prescribed, age, sex, length of time since debond, and hours per day and nights per week that patients wore their retainers. Responses were solicited by mail or the Internet. Data were gathered on a categorical scale and analyzed. RESULTS: The overall response rate was 36% during a 6-week period. In the first 3 months after debond, 60% of patients were wearing their retainers more than 10 hours during a 24-hour cycle, and 69% were wearing the retainers every night. At 19 to 24 months after debond, 19% of the patients were not wearing their retainers, and 81% wore their retainers at least 1 night per week. Compliance rates during the periods of 0 to 3, 4 to 6, 7 to 9, 10 to 12, 13 to 18, and 19 to 24 months were 69%, 76%, 55%, 62%, 45%, and 45%, respectively. Age, sex, and type of retainer did not influence the levels of compliance. CONCLUSIONS: Most continued to wear their retainers at least 1 night per week, with compliance rates, as defined, tending to decrease in our sample. It was encouraging that 81% of the patients in this sample largely maintained their orthodontic result.

Association between periodontal disease and prostate-specific antigen levels in chronic prostatitis patients.

BACKGROUND: Prostate-specific antigen (PSA) is an inflammatory marker produced by the epithelial cells of the prostate acini. In the presence of inflammation or malignancy of the prostate, PSA levels are > or = 4 ng/ml. This preliminary study was conducted to evaluate any association between periodontitis and PSA levels in chronic prostatitis patients. METHODS: Thirty-five subjects who underwent prostate biopsy because of abnormal findings on digital rectal examination or elevated PSA (> or = 4 ng/ml) participated in the study. Plaque and gingival indices, bleeding on probing, probing depth, and clinical attachment level (CAL) were determined. Two-sided independent sample t tests assessed any significant differences in the PSA levels between and among the groups of prostatitis and periodontitis. RESULTS: Mean PSA levels were significantly higher (P = 0.04) in subjects with moderate/severe prostate inflammation than those with none/mild (8.8 +/- 5.8 versus 5.7 +/- 3.1 ng/ml). Subjects with CAL > or = 2.7 mm had higher but not statistically significant PSA levels than those with CAL <2.7 mm (7.7 +/- 5.2 versus 5.7 +/- 3.2 ng/ml), respectively. Individuals having both moderate/severe prostatitis and CAL > or = 2.7 mm (10.8 +/- 7 ng/ml) had significantly higher mean PSA levels (P = 0.05) than those with neither condition (5.6 +/- 3.7 ng/ml) nor only CAL > or = 2.7 mm (5.7 +/- 2.4 ng/ml) or moderate/severe prostatitis (6 +/- 1.9 ng/ml). CONCLUSION: Subjects having comorbidity of CAL > or = 2.7 mm and moderate/severe prostatitis have higher PSA levels than those with either condition alone.

Dental caries trends in primary teeth among third-grade children in Harris County, Texas.

PURPOSE: The purpose of this study was to assess trends in dental caries in the primary dentition of third-grade children in suburban Harris County, Texas. METHODS: The study populations for the 2 cross-sectional surveys consisted of 1,584 third-grade children in 1991 and 1,039 in 1998. Trained dentists collected data on decayed and filled tooth surfaces (dfs). Chi-square tests analyzed the differences in proportions of children with and without dental caries experience in 1991 and 1998 by demographic subgroups: (1) gender; (2) ethnicity; and (3) socioeconomic status (SES). Student's t test investigated the differences in mean dfs scores in subgroups. RESULTS: The prevalence of caries decreased significantly from 59% to 54% between 1991 and 1998 (P = .01). The caries prevalence was lower in 1998 than 1991 in certain subgroups: 1) females; 2) Caucasians; and 3) low SES. The mean dfs score decreased significantly from 4.81 to 3.16, and lower dfs scores were seen in certain demographic subgroups between the 2 studies (P < .05). Children from a low SES had high levels of untreated caries in both studies. CONCLUSIONS: Despite a decline in primary teeth caries of study participants, intergroup disparities exist, emphasizing the need for preventive strategies, especially for the low SES children.

Fluoride knowledge and prescription practices among dentists.

The purpose of this study was to assess dentists' knowledge about fluorides as well as their prescription practices. The study population consists of all general and pediatric dentists in Houston, and the sample consists of 360 general and forty-one pediatric dentists. Data were collected with a self-administered mail questionnaire, which consisted of thirteen open-ended and twenty-nine precoded items. After three mailings, the effective response rate was 46.4 percent. Respondents had been in practice on an average of 18.9 +/-6.6 years; the majority were male. More than 75 percent of respondents believed fluoride level in drinking water is an important determinant of fluoride supplement prescription, and 29 percent felt the same about a patient's weight. The correct ages at which to begin (six months) and to discontinue (sixteen years) the fluoride supplements to children were identified by 14.7 and 14.9 percent of the respondents, respectively. Only 6.7 percent of those prescribing fluoride supplements routinely tested the fluoride level in the patient's drinking water. Even though pediatric and general dentists differed in certain items, the two groups did not differ significantly in prescribing fluorides (OR=2.4, 95% CI=0.94, 6.27). Deficiencies and ambiguity in respondents' fluorides knowledge as well as prescription practices indicated a need for educational interventions.

Period between completion of radiation therapy and prosthetic rehabilitation in edentulous patients: a retrospective study.

PURPOSE: The primary purposes of this study were: (1) to describe the number and types of complications patients had before and after insertion of a removable prosthesis (i.e., denture) following radiation therapy to the head and neck and (2) to investigate whether the time between radiation therapy and denture insertion might contribute to those complications. MATERIALS AND METHODS: This research evaluated edentulous patients and those who were rendered edentulous as a result of their cancer treatment. After obtaining institutional approval following HIPAA regulations, a total of 349 charts were identified: 152 patients from Houston Veterans Administration Medical Center (HVAMC) and 197 patients from M. D. Anderson Cancer Center (MDACC). A total of 190 patients met the inclusion criteria with data available for review. RESULTS: No significant differences were found in any of the comparisons made, except when comparing complications that occurred after the dentures were inserted and the amount of time it took for prosthetic rehabilitation. The majority of patients had no complications. The patients who received their dentures in 180 days or less had the same number of complications when compared with those patients who received their dentures in 181 to 365 days and those who had to wait longer than a year for prosthetic rehabilitation. Patients with more pre-insertion complications tended to have delayed prosthetic rehabilitation. Those patients who had complications both before and after denture insertion tended to have bilateral dosing of their radiation treatment. Patients who had received radiation therapy were 1.7 times more likely to have post-prosthesis insertion complications. The majority of patients who experienced complications before and after denture insertion had greater than 5000 cGy. CONCLUSIONS: The numbers of complications reviewed in this retrospective analysis were considerably fewer than the number expected. There appears to be no difference in the number of pre- and post-insertion complications as a function of the time delay from oral surgical procedure to start of radiation treatment (10 to 21 days vs. 22 days or more).

Expression analysis of cystatin C and M in laser-capture microdissectioned human breast cancer cells--a preliminary study.

Cathepsins B and L, implicated in the progression of malignant tumors, are regulated by a family of endogenous inhibitors referred to as the cystatins. Cystatin M was identified by differential display as down-regulated gene in metastatic breast cancer cells. However, this finding has yet to be confirmed in clinical breast cancer specimens. Our objective is to examine the expression levels of cystatins C, M, and cathepsins B and L mRNA in breast cancer cells isolated by laser capture microdissection. The mRNA and protein levels of cathepsin B, L, and cystatin C and M in breast cancer specimens were determined utilizing laser capture microdissection/RT-PCR, Western blotting, and immunohistochemical methods. Expression levels of either cystatin M or C were not significantly different between lymph node-positive and -negative breast carcinomas. Increased expression levels of both cystatin M and C correlated significantly with larger tumor size. Cystatin M mRNA was detected by in situ hybridization in both primary and metastatic breast cancer cells. Our findings are at variance with a previous report proposing a metastasis suppressive function for cystatin M. Therefore, additional studies in a larger series with adequate follow-up are necessary to elucidate the biologic significance of cystatin M expression in breast cancer metastasis.

Oral cancer knowledge and practices of dentists along the Texas-Mexico border.

BACKGROUND: The study assessed the knowledge and clinical practices of Texas-Mexico border dentists in oral cancer prevention and early detection. METHODS: A pretested, self-administered questionnaire was mailed to all 398 dentists registered to practice along the Texas-Mexico border. RESULTS: Inadequacies and ambivalence in respondents' oral cancer knowledge and practices were evident. Performance of oral cancer examinations was associated with positive perception of undergraduate oral cancer training (P =.02). Most respondents (81%) were interested in oral cancer continuing education (CE). CONCLUSIONS: More emphasis on oral cancer training for dental students as well as provision of oral cancer CE to respondents are recommended.

Clinical response to 2 different therapeutic regimens to treat peri-implant mucositis.

BACKGROUND: Maintenance of implants is imperative, since implants, like teeth, are susceptible to bacterial plaque accumulation and calculus formation, and thus at risk of developing peri-implant mucositis or peri-implantitis. METHODS: This study determined the clinical effects of chlorhexidine treatment on peri-implant mucositis at 1 and 3 months as determined by the modified plaque index, the modified sulcus bleeding index, clinical attachment level, and probing depth. Through DNA probes, the effect of chlorhexidine on the microbial flora of mucositic lesions was also evaluated. The population consisted of 16 adult male and female subjects (ages 34 to 76). After the baseline examination, the subjects received a dental prophylaxis and were randomly assigned to the test or control group. Subjects in the test group received antiseptic therapy (Treatment 1), which included mechanical cleansing and oral hygiene instructions supplemented by the local irrigation with chlorhexidine 0.12%, using a plastic syringe, and the topical application of a 0.12% chlorhexidine gel. The subjects in the control group received only mechanical cleansing and oral hygiene instructions (Treatment 2). RESULTS: Both modalities of treatment were effective in reducing peri-implant mucositis and probing depths, and improving attachment levels. The trends suggested that mechanical cleansing alone may be sufficient to treat and reduce peri-implant mucositis at 1 and 3 months after treatment. The addition of chlorhexidine to mechanical debridement did not enhance the results as compared to mechanical debridement alone. CONCLUSIONS: Mechanical debridement as well as mechanical debridement supplemented with chlorhexidine can be beneficial to patients with peri-implant mucositis. Both treatments resulted in a reduction of plaque, inflammation, and probing depth, as well as a gain in clinical attachment level, and are effective in suppressing or eradicating the pathogenic bacteria often associated with peri-implant inflammation.