The limited value of three pathogen species in predicting healing of periodontal pockets.

Baseline level of Actinobacillus actinomycetemcomitans has been suggested as being predictive of periodontal treatment outcome. We analyzed the presence of Actinobacillus actinomycetemcomitans, Porphyromonas gingivalis, and Prevotella intermedia in 55 deep periodontal pockets of 29 patients (18 men, 11 women, 37-75 years) before and after periodontal treatment. At baseline and after treatment, 62% and 33%, respectively, of the subjects presented with 1, 2, or a combination of all 3 pathogens. The mean pocket depth of 6.6 mm (0.4 mm) before treatment decreased to 2.2 mm (0.4 mm) in response to treatment (P<0.001). The treatment plan of non-surgical or surgical treatment was based on pocket depths and tooth morphology only. No antimicrobial medications were used during the treatment. Eighty-two percent of the deep pockets healed satisfactorily to < or = 4 mm. The presence of Actinobacillus actinomycetemcomitans, Porphyromonas gingivalis, or Prevotella intermedia at baseline was not associated with the outcome of the periodontal therapy. In conclusion, we found that the presence of the 3 periodontopathogen species had little or no value in predicting healing of periodontal pockets.

The relation between tooth eruption and alveolar crest height in a human skeletal sample.

It is commonly assumed that alveolar crest height increases with continuing tooth eruption unless affected by marginal inflammation. To test this hypothesis, the relation between eruption and alveolar crest height was examined in skulls from a sample consisting of the remains of 244 individuals from the late medieval period. The mandibular first and second molars and second premolars were analysed. The age of the skulls was determined on the basis of dental development and molar attrition. Radiographs were taken and points representing the levels of the inferior dental canal (IDC), root apices (AP), alveolar crest (AC), cementum-enamel junction (CEJ) and occlusal surface were determined on the radiographs. The level of the IDC was used as a reference not changing with age. The distances between the points were measured with a help of a computer-digitizer system. Variable IDC-AP increased with age, indicating continuous eruption of the teeth. The distance between AC and CEJ also increased while the distance between IDC and AC remained constant, showing that the alveolar crest height did not increase accordingly. The lack of inflammatory changes on the alveolar bone surface suggests that occlusal attrition may be compensated for by continuous eruption without bone growth in the alveolar margin.

Molecular forms and concentration of fibronectin and fibrin in human gingival crevicular fluid before and after periodontal treatment.

A total of 23 periodontitis-affected sites from seven adults was selected for the study. Crevicular fluid (CF) samples were collected with paper strips before treatment (scaling, root planing, and curettage) and 2, 5, 10, 20, and 40 days after treatment. Each sample was eluted into sterile saline and two aliquots were drawn for gel electrophoresis: one for fibronectin and one for fibrin analysis. Peptides were transferred to nitrocellulose membranes, and molecules were detected by specific antibodies. The proportions of different molecular forms of fibronectin and fibrin were analyzed by laser densitometry. Plaque Index, Papilla Bleeding Index, and pocket depth were recorded before and 40 days after treatment. Radiologic bone loss was estimated from orthopantomograms. Two days after treatment, an increase was seen in the proportions of intact fibronectin, fibronectin fragments larger than 70 kDa, and fibrin-positive material with a greater molecular mass than intact fibrin. Between days 5 and 10, the proportions of these large fragments decreased. The highest fibronectin and fibrin concentrations were seen 10 days after treatment. These changes probably reflect degradation of the subgingival fibrin clot formed after treatment, and indicate resolution of the clot during the first 10 days of healing. This agrees well with previous observations of CF plasmin activity and concentration of collagen synthesis markers in CF after periodontal treatment, and with the histologic changes seen during periodontal healing. Results of the present study, together with earlier reported findings of collagen synthesis after periodontal treatment, also support the hypothesis of sequential appearance of fibronectin and collagens during the process of wound healing.

Missing teeth and ischaemic heart disease in men aged 45-64 years.

The aim of the present study was to investigate the associations between number of missing teeth (expressing sustained oral infections) and diagnosed ischaemic heart disease using cross-sectional data from 1384 men aged 45-64 years. The study population was derived from a representative sample of adult Finns. Ischaemic heart disease was considered to be present in those with angina pectoris or previous myocardial infarction, whether definite or possible. A tooth was recorded as missing if none of it was visible or could be felt with an instrument. According to multiple linear analyses, the variation in ischaemic heart disease was independently explained by age, clinical diagnosis of arterial hypertension, geographical area, educational level and number of missing teeth. Smoking and cholesterol were not significant explanatory factors. The explanation for the observed association between missing teeth and ischaemic heart disease is that they may share a common behavioural background factor. There may also be a more direct causal relationship between the phenomena.

Changes in the prevalence of subgingival enteric rods, staphylococci and yeasts after treatment with penicillin and erythromycin.

The changes in the balance of microbial flora in the periodontium after antibiotic treatment were investigated in a blind study. The prevalence of gram-negative enteric rods, staphylococci and yeasts was followed before and during penicillin or erythromycin treatment of 72 periodontitis patients without periodontal cleaning. The prevalence of subgingival coagulase-positive staphylococci increased significantly following systemic penicillin therapy. After systemic erythromycin therapy, the prevalence of subgingival gram-negative enteric rods increased. Ten of 24 (42%) patients receiving systemic penicillin therapy developed clinical evidence of periodontal abscesses. In the absence of conventional mechanical cleaning, systemic administration of penicillin and erythromycin antibiotic to patients with pre-existing periodontitis may lead to periodontal superinfection with opportunistic organisms.

Characterization of fibronectin and fibrin(ogen) fragments in gingival crevicular fluid.

A total of 49 crevicular fluid (CF) samples were collected with paper strips from 12 healthy adults. Each sample was eluted into sterile saline and two aliquots were drawn for SDS-PAGE, one for fibronectin and one for fibrin analysis. Peptides were transferred to nitrocellulose membranes, and fibronectin and fibrin were detected using specific antibodies. The relative amounts of different molecular forms of fibronectin and fibrin were analyzed using a laser densitometer. After the sample collection, Plaque Index, Papilla Bleeding Index and pocket depth were measured. Bone loss was estimated from the orthopanthomograms. Fibronectin fragments were seen in all CF samples. Intact fibronectin was seen in 21 samples, of which 76% were collected from periodontitis-affected sites. There was a positive correlation between the proportion of intact fibronectin and the clinical parameters. Intact fibrin and fibrin fragments were seen in all samples. Fibrin-positive material with larger molecular weight than intact fibrin was also seen in all samples. A negative correlation was found between the proportion of intact fibrin and the clinical parameters. There was no correlation between total amounts and concentrations of fibronectin and fibrin. Molecular forms of fibronectin and fibrin may affect the pathogenesis and healing of periodontal diseases, since the biologic effects of the fragments of these molecules differ from those of the intact molecules.

Clinical responses to subgingival application of a metronidazole 25% gel compared to the effect of subgingival scaling in adult periodontitis.

A newly developed metronidazole 25% dental gel was compared with subgingival scaling in the treatment of adult periodontitis. 206 patients in 9 centres participated in the study. Probing pocket depth (PPD) and bleeding on probing (BOP) were recorded before treatment and 2, 6, 12, 18, and 24 weeks after the treatment. All patients had at least 1 tooth in each quadrant with a PPD of 5 mm or more. The treatments consisted of 2 applications of dental gel (days 0 and 7) in 2 randomly selected quadrants (split mouth design) and 2 sessions of subgingival scaling (1 quadrant on day 0, and 1 quadrant on day 7). Instruction in oral hygiene was given 2 weeks after completed treatment. The average PPD and the average frequency of BOP were calculated over all sites with initial PPD of 5 mm or more. PPD and BOP were thus, at each examination, calculated from the same sites. The mean PPD was 5.9 mm before gel application and 5.8 mm before scaling (p = 0.31). BOP was 88% in both treatment groups. 24 weeks after the treatment, PPD and BOP were significantly reduced in both groups and for both parameters (p < 0.01). PPD was reduced by 1.3 mm after gel application and 1.5 mm after scaling; BOP was reduced by 32% and 39%, respectively. The difference between the treatments was statistically significantly, but considered as clinically unimportant.

Protein composition of crevicular fluid before and after treatment.

Crevicular fluid (CF) analysis is a potential tool for site-specific diagnosis of periodontal disease activity. In this study, CF was collected using a novel washing method from 91 sites in 18 adult periodontitis patients both before and after conventional periodontal treatment. The sites studied were classified according to their clinical status and the number of polymorphonuclear leukocytes (PMN's) in CF samples. CF proteins were analyzed from individual sites with gel electrophoresis (SDS-PAGE). Furthermore, both the cell-bound and soluble neutral proteolytic activities of the samples were determined. Albumin was the main protein both in healthy and slightly inflamed sites. The most severely inflamed sites were characterized by high levels of low molecular weight (LMW) proteins (mol. weight ca. 12,000) and strong cell-bound neutral proteolytic activity. Scaling and root planing reduced both the LMW proteins and neutral proteolytic activity markedly in pockets responding well to treatment. The levels of the LMW proteins in CF correlated with the cell-bound neutral proteolytic activity, which reflected the number of PMN's in the sample. The present results suggest that the appearance of the LMW proteins in CF is associated with the periodontal inflammatory status of the site.

An intracrevicular washing method for collection of crevicular contents.

Gingival crevicular contents provide a potential source of markers of the destruction of periodontal structures and the disease activity. This communication introduces a new device designed for efficient collection of samples from the critical area of initial tissue break-up at the bottom of a sulcus or a periodontal pocket. The instrument is characterized by two injection needles fitted one within the other so that during sampling the thinner "ejection needle" is at the bottom of the pocket and the "collection needle" at the gingival margin. The washing solution is manually ejected into the crevice and immediately drained through the collection needle into a sample tube by continuous suction. The technique developed provides an easy and useful method for studies of qualitative differences in the crevicular cells and in the chemical components of the crevicular fluid in various clinical situations. Furthermore, the use of the technique can be extended for localized lavage of acute periodontal pockets with appropriate therapeutic solutions.

Gingival crevicular fluid plasmin activity in different clinical conditions and after periodontal treatment.

Plasmin is an important enzyme in the process of wound healing and it has been suggested that it plays a role in the pathogenesis and healing of periodontal diseases. In this study, plasmin activity in crevicular fluid (CF) was measured in different clinical conditions and after periodontal treatment. 152 CF samples were collected with paper strips from 12 subjects. Five other subjects received a single periodontal treatment after the first sample collection and the post-treatment samples were collected 2, 5, 10, 20 and 40 days thereafter. The individual strips were placed immediately on plasminogen-free fibrin plates or in plastic vials containing sterile saline. The vials were agitated and 20 microliters of each solution was pipetted onto fibrin plates. The remaining solution was used in protein analysis. The plates were incubated for 24 hrs at 37 degrees C and the activity of plasmin determined by weighing the fibrin liquified by the samples. The variation of CF plasmin activity in different pockets within individuals was larger than between the subjects. There was a weak positive correlation between CF plasmin activity and the amount of plaque, bleeding tendency, pocket depth and bone loss by x-ray. However, plasmin concentration (units of plasmin activity per CF volume) did not correlate with clinical parameters. A weak negative correlation between plasmin activity per volume and the amount of CF was seen. Neither did CF protein concentration correlate with the clinical parameters. Periodontal treatment resulted in a dramatic decrease in plasmin activity. In 20 days the activity returned to pre-operative levels in four subjects out of five.

Analyses of periodontal glycosaminoglycans and proteoglycans. Regulation by microbial, chemical and inflammatory factors.

During the last two decades one of the main lines of research in the Department of Periodontology in Turku has related to connective tissue glycosaminoglycans and proteoglycans. A general outline of current knowledge about proteoglycans is presented, with a review of most published and unpublished results on periodontal glycosaminoglycans and proteoglycans obtained in our Department.

Metabolism of progesterone and testosterone by Bacillus cereus strain Socransky 67 and Streptococcus mutans strain Ingbritt.

Bacillus cereus strain Socransky 67 and Streptococcus mutans strain Ingbritt were grown overnight in complex medium and then in fresh medium flasks for 5 h. The bacterial cells in the medium were centrifuged and resuspended; 4-14C-progesterone or 4-14C-testosterone was added, and the samples were incubated for 2 h at 37 degrees C in a shaking water bath. The metabolites were analyzed with column and thin layer chromatography and radioautography and quantified by liquid scintillation counting. On the basis of the metabolites found it was concluded that B. cereus strain Socransky 67 contains 5 alpha-steroid hydrogenase, and 3 beta-, 17 beta- and 20 alpha-hydroxysteroid dehydrogenases and probably also steroid hydroxylases, and that S. mutans strain Ingbritt contains 5 alpha- and 5 beta-steroid hydrogenases, and 3 alpha-, 17 beta- and 20 alpha-hydroxysteroid dehydrogenases. The metabolic activity of B. cereus is several times higher than that of S. mutans. We suggest that the greater ability of B. cereus to metabolize progesterone and testosterone is probably due to its growth milieu in the gingival sulcus, where it is nearer to the gingival tissue.

Caries occurrence in Klinefelter syndrome men (47,XXY males).

Men with the Klinefelter syndrome (47,XXY males) and their brothers were studied as regards their caries experiences as part of a comprehensive study on oral facial growth and health in individuals with sex chromosome anomalies. The results show that caries experience was greater among the 47,XXY men than among their normal brothers, and a greater proportion of the 47,XXY men's cumulative caries experience consisted of extractions.

Gingival crevicular fluid fibronectin degradation in periodontal health and disease.

The molecular forms of fibronectin (FN) in gingival crevicular fluid of five subjects with at least two sites exhibiting clinical signs of inflammation and pockets of at least 4 mm (test group) and five subjects with clinically healthy periodontium (control group) were investigated. Samples were collected with standard filter paper strips. In the test group samples from both diseased and healthy sites were collected. After collection the test group received one episode of periodontal treatment (scaling and root planning). The sampling and clinical recording were repeated for the diseased sites after about 2 wk. The crevicular fluid FN was analyzed using sodium dodecyl sulphate gel electrophoresis followed by western blotting with polyclonal antibodies against FN. Both intact FN and FN fragments were found in all samples. A larger proportion of FN was in degraded form in the diseased sites than in the healthy or the treated sites. FN was also degraded into smaller peptide fragments in the diseased than in the treated sites. These results suggest that crevicular fluid FN is partially degraded both in periodontal health and disease and that the degree of degradation of FN increases with periodontal inflammation and decreases with periodontal treatment.

Effects of penicillin and erythromycin on the clinical parameters of the periodontium.

The clinical effects of systemic penicillin and erythromycin on the periodontium were investigated. There are only a few studies of the effects of these antibiotics on clinical periodontal parameters. Of the 72 subjects in the study, 24 belonged to the penicillin group, 21 to the erythromycin group and 27 to the control group. Plaque and gingival indices, tooth mobility, and probing depths of gingival pockets were recorded before the drug treatment. Radiographs were taken. Both antibiotics decreased plaque, and erythromycin also decreased gingivitis. In the penicillin group 10 of the 24 patients developed abscesses during the study, and the studied clinical parameters worsened. These patients had more severe periodontitis initially than the persons with no acute reaction. The clinical changes had returned to the baseline level by 12 weeks after the antibiotic treatments. There were no significant or lasting effects of antibiotic treatment alone in patients with overt periodontitis.

Vascular and cellular responses to guanidino propyl piperazine CK0569A, a new anti-plaque agent.

Guanidino propyl piperazine CK0569A (abbreviation piperazine) used as a 0.1% mouthrinse has been shown to be effective against plaque bacteria. In addition to its efficacy as an antibacterial agent, its safety should be taken into consideration. In this study the effect of piperazine on the microcirculation of the hamster cheek pouch was studied. The effect of this drug was also investigated on rat leukocytes in vivo and on macrophages and erythrocytes in vitro. Piperazine caused a distinct retardation in the microcirculation of the hamster cheeck pouch even at a low concentration (0.01%), but the effect was abolished in 5 min. The number of leukocytes decreased markedly in the experimentally induced inflammatory exudate in the presence of 0.05% piperazine as compared to the controls. The macrophages in vitro released their lysosomal and cytoplasmic enzymes and lost their viability. The erythrocytes in vitro were destroyed in the presence of 0.005% piperazine as well. Based on these results it can be suggested that 0.005-0.05% piperazine under experimental conditions causes changes that indicate loss of cell viability.