Diagnostic accuracy of severe periodontitis case definitions: Comparison of the CDC/AAP, EFP/AAP, and CPI criteria.

BACKGROUND: This cross-sectional study aimed to evaluate the diagnostic accuracy of severe periodontitis by three different case definitions. METHODS: Patients aged >35 years (n = 243, mean age = 47.8 ± 9.3 years) were evaluated by periodontal examinations and classified in patients with severe periodontitis according to the case definition proposed by the Centers for Disease Control and Prevention (CDC) in collaboration with the American Academy of Periodontology (AAP)-CDC/AAP, the new periodontal disease classification proposed jointly by the AAP and the European Federation of Periodontology (EFP/AAP), and the Community Periodontal Index (CPI). The primary outcome was to compare the diagnostic accuracy of severe periodontitis between the three case definitions. Sensitivity (SS), specificity (SP), and area under the receiver operating characteristic (ROC) curve were used to analyze the accuracy. RESULTS: The proportion of subjects presenting the most severe definitions of each classification was: severe periodontitis (CDC/AAP) = 47.3%, type III and IV periodontitis (EFP/AAP) = 43.2% and CPI code 4 = 44.4%. When comparing the CDC/AAP case definitions with the EFP/AAP classification, SS, SP, and ROC of 81.7%, 91.4%, and 0.866 (CI, 95%: 0.816 to 0.916), respectively, were obtained. Similarly, when comparing CDC/AAP to CPI code 4, SS, SP, and ROC of 81.7%, 89.1%, and 0.854 (CI, 95%: 0.802 to 0.906), respectively, were obtained. When type III and IV periodontitis (EFP/AAP) was compared with CPI code 4, the values were 92.4%, 92%, and 0.922 (CI, 95%: 0.883 to 0.961), respectively. CONCLUSIONS: The EFP/AAP classification and the CPI demonstrated high diagnostic accuracy with the CDC/AAP case definition to diagnose severe periodontitis.

Periodontitis, edentulism and glycemic control in patients with type 2 diabetes: a cross-sectional study.

OBJECTIVES: To compare the glycemic control in non-smoking patients with type 2 diabetes according to their periodontal and dental status. RESEARCH DESIGN AND METHODS: This cross-sectional study investigated patients previously diagnosed with type 2 diabetes and under antidiabetic medication. Clinical data and fasting blood glucose (FBG) levels were collected from medical and dental records. Patients were divided into three groups according to dental and periodontal diagnosis: no or mild periodontitis (NO/MILD, n=96), moderate or severe periodontitis (MOD/SEV, n=74) and edentulous (n=141). FBG levels were compared between groups. Logistic regression was also applied to estimate the OR of presenting hyperglycemia. RESULTS: Edentulous patients had significantly higher FBG levels of 155.7±70.9 (mean±SD mg/dL) than those in the MOD/SEV (136.6±33.8) and the NO/MILD (123.1±36.7) groups. Differences between the latter two groups were also significant. Edentulous patients had adjusted ORs of 4.53, 4.27 and 3.95 of having FBG≥126, ≥150 and ≥180 mg/dL, respectively, in comparison with NO/MILD group. The MOD/SEV group also presented significant odds of having FBG≥126 mg/dL (OR=2.66) and ≥150 mg/dL (OR=2.45) than the NO/MILD group. CONCLUSIONS: Patients in the MOD/SEV group had worse glycemic control than the ones in the NO/MILD group. However, edentulous patients presented higher glycemic levels than both dentate groups, and also presented with higher odds of having hyperglycemia.

Aggressive periodontitis presents a higher degree of bilateral symmetry in comparison with chronic periodontitis.

The purpose of this cross-sectional study was to evaluate the occurrence of bilateral symmetry in the distribution of clinical parameters in subjects with generalized aggressive periodontitis (GAP) and severe chronic periodontitis (SCP). The sample comprised 53 subjects with GAP and 33 with SCP. Probing depth (PD) and clinical attachment loss (CAL) were recorded from both buccal and lingual interproximal sites of incisors and molars. The symmetry of periodontal destruction was analyzed in terms of intraclass coefficient correlations (ICC) for pairs of contralateral sites at which PD and/or CAL was ≥5 mm at one of the sites of the subjects in each group. GAP patients had a higher proportion of both PD and CAL ≥ 5 mm and also a higher mean proportion of subjects having PD and/or CAL ≥ 5 mm at one or both sites. The GAP group had 20 pairs of contralateral sites with PD (ICC = 0.22-0.63) and 26 pairs with CAL (ICC = 0.20-0.63), the correlation being statistically significant, while the SCP group had only 2 pairs (ICC = 0.36-0.48) with PD and 5 pairs with CAL (ICC = 0.33-0.58) showing a significant correlation. It can be concluded that GAP shows more symmetric periodontal destruction than SCP.

Intrapocket topical anesthetic versus injected anesthetic for pain control during scaling and root planing in adult patients: Systematic review and meta-analysis.

BACKGROUND: In this systematic review and meta-analysis, the authors evaluated the pain during scaling and root planing with use of topical anesthetic versus that with the use of injected anesthetic in adult patients. TYPES OF STUDIES REVIEWED: The authors searched 6 databases for randomized clinical trials in which the investigators compared the clinical effectiveness of intrapocket and injectable anesthetics. The primary outcome was the risk of developing pain or intensity of pain. Quality assessment followed the guidelines from the Cochrane Collaboration's risk-of-bias tool. The authors performed meta-analyses on studies considered at low and unclear risk of bias. RESULTS: From 976 articles identified, 6 remained in the qualitative synthesis (4 at low and 2 at unclear risk of bias). Injected anesthetic produced lower pain intensity than did anesthetic gel (P = .03) and required less rescue anesthetic than did topical anesthetic (P < .0001). There was no difference in patient preference (P = .09). CONCLUSIONS AND PRACTICAL IMPLICATIONS: Injected anesthetic decreased the intensity of pain and the need for rescue anesthetic during scaling and root planing, but the risk of developing pain yielded similar results for injected and topical anesthetics.

Influence of Periodontal Disease on Changes of Glycated Hemoglobin Levels in Patients With Type 2 Diabetes Mellitus: A Retrospective Cohort Study.

BACKGROUND: Little evidence is available regarding the effects of long-term periodontal infection on diabetes mellitus (DM) control. The aim of this retrospective cohort study is to evaluate influence of periodontal status on changes of glycated hemoglobin (HbA1c) levels of patients with type 2 DM (DMt2). METHODS: Eighty patients (mean age: 56.0 ± 8.9 years) with DMt2 were included. Patients were non-smokers, aged ≥40 years, and using antidiabetic drugs. Demographics, health history, and HbA1c levels were retrieved from medical charts. Probing depth and clinical attachment loss (AL) were recorded. RESULTS: Patients were examined at two time points within a mean interval of 38.6 ± 6.6 months. Increase in HbA1c over time was statistically significant when severe periodontitis was diagnosed at baseline (2.32%, 95% confidence interval [CI]: 1.50% to 3.15%), in patients showing at least one tooth with ≥2 mm of AL progression (2.24%, 95% CI: 1.56% to 2.91%), in males (2.75%, 95% CI: 1.72% to 3.78%), and in those with HbA1c <6.5% at baseline (3.08%, 95% CI: 2.47% to 3.69%). After adjusting for baseline HbA1c, significant changes were still observed for severe periodontitis and progression of AL with increases of 0.85% and 0.9%, respectively. After adjusting for sex and HbA1c, AL progression was also statistically significant, with increases of 0.84%. CONCLUSIONS: Periodontitis progression was associated with increase in HbA1c in patients with DMt2. Identification of these risk factors suggests that periodontal treatment may improve glycemic control of patients with DMt2 by eliminating periodontal infection.

Clinical efficacy of a 1% Matricaria chamomile L. mouthwash and 0.12% chlorhexidine for gingivitis control in patients undergoing orthodontic treatment with fixed appliances.

This pilot study evaluated the clinical efficacy of a mouthwash containing 1% Matricaria chamomilla L. (MTC) extract in reducing gingival inflammation and plaque formation in patients undergoing orthodontic treatment with fixed appliances. This randomized, double-blind, placebo-controlled study enrolled a total of 30 males and females (age, 10-40 years) with fixed orthodontic appliances and a minimum of 20 natural teeth. The participants were allocated to three groups (n = 10 each) and asked to rinse with 15 mL of a placebo, 0.12% chlorhexidine (CHX), or 1% MTC mouthwash, immediately after brushing for 1 min, in the morning and evening, for 15 days. Data (mean ± SD) on visible plaque index (VPI) and gingival bleeding index (GBI) were recorded on days 1 and 15. The placebo group exhibited increases in VPI and GBI (10.2% and 23.1%, respectively) from day 1 to day 15. As compared with placebo, VPI and GBI significantly decreased in the MTC group (-25.6% and -29.9%, respectively) and the CHX group (-39.9% and -32.0%, respectively). In summary, MTC reduced biofilm accumulation and gingival bleeding in patients with gingivitis, probably because of its antimicrobial and anti-inflammatory activities.(J Oral Sci 58, 569-574, 2016).

Intra-pocket anaesthesia and pain during probing, scaling and root planing: a systematic review and meta-analysis.

AIM: A systematic review/meta-analysis was performed to evaluate pain during probing, scaling and root planing using intra-pocket anaesthesia versus placebo in adult patients. METHODS: A search was performed in PubMed, Scopus, Web of Science, Latin American and Caribbean Health Sciences Literature database, Brazilian Library in Dentistry, Cochrane Library and Grey literature. IADR abstracts, unpublished trials registries, dissertations and theses were also searched for randomized clinical trials comparing the clinical effectiveness of intra-pocket anaesthesia and placebo. Risk/intensity of pain was the primary outcome. The risk of bias tool from the Cochrane Collaboration was used for quality assessment. Meta-analysis was performed on studies considered at low risk of bias. RESULTS: A total of 1740 articles were identified. Eleven remained in the qualitative synthesis, and nine studies were considered at "low" risk of bias for meta-analysis. Standardized Hedge's g mean difference for pain intensity using visual analogue scale and Heft-Parker pain scales was -0.576 (95% confidence interval [CI] -0.94 to -0.22; p = 0.002) and for verbal rating scale pain scale it was -1.814 (95% CI -3.38 to -0.245; p = 0.023). The odds ratio for the risk of pain was 0.025 (95% CI 0.003 to 0.25; p = 0.002) and the odds ratio for the need for rescue anaesthesia it was 0.358 (95% CI 0.174 to 0.736; p = 0.005). CONCLUSIONS: The anaesthetic gel decreases the risk and intensity of pain during probing/SRP.

Clinical and microbiological studies of children and adolescents receiving orthodontic treatment.

PURPOSE: This case-controlled study examined clinical and microbiological parameters in Brazilian children and adolescents receiving orthodontic treatment using fixed orthodontic appliances or removable orthodontic appliances. METHODS: The plaque index, gingival index, number of decayed, missing and filled teeth, and probing pocket depth was measured on each fully erupted tooth in 30 patients treated with fixed orthodontic appliances and an equal number of age and sex-matched control subjects. The same parameters were also measured in 18 patients treated with removable orthodontic appliances and an equal number of age and sex-matched control subjects. In the patients treated with fixed orthodontic appliances, subgingival plaque samples were collected from four teeth with orthodontic brackets and from four teeth with orthodontic bands. In the patients with removable appliances, subgingival plaque samples were collected from clasped maxillary permanent first molar teeth and from four unclasped permanent teeth. Samples of unstimulated whole saliva and samples from the dorsal surface of the tongue were also obtained from each subject. Each sample was analyzed for the presence of 19 target bacteria by dot blot. A subset of samples was examined by direct amplification of bacterial nucleic acids. RESULTS: Compared to their respective age and sex-matched controls, whole mouth means for plaque index and gingival index were significantly elevated in both the fixed and removable orthodontic groups. There was no difference in the DMFT. Subjects with fixed orthodontic appliances had a higher prevalence of each of the target species except for L. fermentum, Neisseriaceae and S. mutans. The prevalence of A. naeslundii and Streptococcus sp. was significantly higher on teeth with orthodontic brackets alone compared to teeth with both orthodontic bands and brackets. Subjects with removable orthodontic appliances had a higher prevalence of A. actinomycetemcomitans, C. rectus, E. corrodens, L. fermentum, Neisseriaceae, and spirochetes. The prevalence of Neisseriaceae was significantly higher on unclasped teeth compared to clasped teeth. There was no difference between sample sites for the target bacteria except for A. actinomycetemcomitans that was detected less frequently in saliva. Orthodontic patients demonstrated higher proportions of gram negative species by direct amplification of nucleic acids including species frequently associated with periodontal disease as well as rarely cultivable or non-cultivable species such as Abiotrophia defectiva, Gemella haemolysans, Granulicatella adiacens, Lautropia sp., Terrahaemophilus aromaticivorans, and TM7 bacterium.