Teeth under High Occlusal Force may Reflect Occlusal Trauma-associated Periodontal Conditions in Subjects with Untreated Chronic Periodontitis.

OBJECTIVE: To determine the association of high occlusal force (HOF) with the signs of occlusal trauma and periodontal conditions in periodontitis patients, and elaborate the relevant clinical implications. METHODS: Periodontal parameters and signs of occlusal trauma were recorded for 807 teeth in 30 subjects with untreated chronic periodontitis. The T-scan II occlusal analysis system determined the HOF during maximum intercuspation, lateral excursion and protrusive excursion. The correlation of HOF with periodontal parameters and signs of occlusal trauma was analysed. RESULTS: Overall, the teeth with HOF existed mainly in molars and presented with deeper probing depth (PD) and higher frequency of bleeding on probing (BOP) than those without HOF. The fixed-effect analysis showed that HOF was positively correlated with PD and BOP (P < 0.05) in posterior teeth; widened periodontal ligament space on radiographs in upper (r = 0.179, P < 0.01) and lower posterior teeth (r = 0.205; P < 0.05); as well as functional mobility in upper posterior teeth (r = 0.168; P < 0.05). CONCLUSION: This study suggests that the posterior teeth with HOF in subjects with chronic periodontitis may reflect occlusal trauma-associated periodontal conditions that could probably increase the risk of further periodontal destruction. These findings may improve the clinical assessment of occlusal trauma and related periodontal conditions for better patient management and treatment outcomes.

Perception of Non-surgical Periodontal Treatment in Individuals Receiving or Not Receiving Local Anaesthesia.

PURPOSE: Patients might refuse the offer of local anaesthesia (LA) administration prior to dental treatment. This study investigates subjective discomfort perception during non-surgical mechanical periodontal therapy delivered with or without LA. MATERIALS AND METHODS: Sixty patients with mild to moderate chronic periodontitis and prior periodontal debridement experience were randomly enrolled in nonsurgical therapy of a quadrant with or without LA administration. Patients were free to comply or not with the allocated LA arrangement. Visual analogue scales (VAS) of discomfort perception at various stages of the treatment as well as overall satisfaction were recorded. Demographic, psychosocial and periodontal parameters were recorded. RESULTS: Thirty-one patients undergoing nonsurgical periodontal therapy not receiving (LA-) and 29 participants receiving LA (LA+) were studied. Compared to LA- patients, LA+ individuals perceived less discomfort during treatment and reported less dental anxiety (p<0.05). Lower overall treatment satisfaction was associated with prior unpleasant periodontal experience (p=0.047). Overall, debridement discomfort was associated with not receiving LA, noncompliance with the pain control regimen allocated, longer treatment duration, greater gingival inflammation and a higher percentage sites with probing pocket depths≥5 mm (p<0.05). CONCLUSION: Clinicians should be aware that patients who refuse LA can experience higher dental anxiety and therefore may require various pain control strategies for comfort during nonsurgical periodontal therapy, which, if not employed, can lead to less periodontal treatment satisfaction.

Effect of non-surgical periodontal therapy on serum levels of TNF-a, IL-6 and C-reactive protein in periodontitis subjects with stable coronary heart disease.

OBJECTIVE: To evaluate the effects of periodontal non-surgical therapy on serum levels of the inflammatory cytokines in chronic periodontitis subjects with stable coronary heart disease. METHODS: Seventy-five subjects with both chronic periodontitis (CP) and stable coronary heart disease (CHD) were enrolled in the study. Forty subjects received periodontal nonsurgical treatment including oral hygiene instruction, scaling and root planing, whereas 35 subjects received oral hygiene instruction only. At baseline and 3 months after completion of periodontal treatment, clinical periodontal parameters were recorded. Serum levels of tumour necrosis factor-α (TNF-α), interleukin-6 (IL-6) and C-reactive protein (CRP), lipid profile markers and white blood cell count were assayed. Pearson's correlation analysis was applied to examine the correlation between the change of TNF-α, IL-6 and CRP levels and the change of periodontal parameters after non-surgical periodontal treatment. RESULTS: At baseline, there were no statistical differences in all clinical, biochemical parameters and cytokine levels between these two groups. Three months later in the treatment group, all clinical parameters improved significantly and the serum levels of TNF-α, IL-6, and CRP reduced significantly. Reduction of TNF-α was significantly positively correlated with the reduction of bleeding index and plaque index; reduction of IL-6 was significantly positively correlated with the reduction of clinical attachment loss; reduction of CRP was significantly positively correlated with the reduction of clinical attachment loss and plaque index. CONCLUSION: Non-surgical periodontal therapy decreased serum TNF-α, IL-6 and CRP levels in CP subjects with stable CHD, which could help to reduce the inflammatory burden of stable coronary heart disease subjects.

Lipoprotein-associated phospholipase A2 and serum lipid levels in subjects with chronic periodontitis and hyperlipidemia.

OBJECTIVE: To evaluate the relationships between clinical periodontal parameters and levels of lipoprotein-associated phospholipase A2 (Lp-PLA2) and lipid profile markers in subjects with or without hyperlipidaemia. METHODS: Forty chronic periodontitis (CP) subjects with hyperlipidaemia (CP/HPL group), 40 systemically healthy CP subjects (CP group) and 20 systemically and periodontally healthy subjects (control group) were enrolled. The clinical periodontal parameters, the serum concentrations of Lp-PLA2, lipid profiles including total cholesterol (TC), triglyceride (TG), high-density lipoprotein cholesterol (HDL-c), low-density lipoprotein cholesterol (LDL-c) and white blood cell (WBC) counts were determined and compared between different groups. Linear regression analysis was performed to identify the contributing factors of Lp-PLA2. RESULTS: Serum Lp-PLA2 level in the CP/HPL group and the CP group was significantly higher than in the healthy group. TC and TG levels in the CP/HPL group were higher than in the CP and control groups. No difference was observed for levels HDL-c and LDL-c and WBC counts among the groups. Linear regression analysis showed that the serum level of Lp-PLA2 was positively associated with bleeding on probing and WBC counts. CONCLUSION: Elevated level of Lp-PLA2 is associated with periodontal inflammation, indicating that periodontal treatment could reduce the risk of cardiovascular disease in CP subjects with hyperlipidaemia.