Progression of periodontitis in a sample of regular and irregular compliers under maintenance therapy: a 3-year follow-up study.

BACKGROUND: To our knowledge, prospective studies (matched for sex, smoking, and diabetes) that investigated the influence of compliance in the progression of periodontitis and tooth loss in periodontal maintenance therapy (PMT) programs were not previously reported. METHODS: A total of 58 regular complier (RC) and 58 erratic complier (EC) individuals were recruited from a prospective cohort with 238 patients under PMT and matched by sex, diabetes, and smoking habits. A full-mouth periodontal examination that included bleeding on probing (BOP), probing depths (PDs), clinical attachment levels, and number of teeth were determined at all PMT visits during a 3-year interval. The influence of variables of interest was tested through multivariate logistic regression. RESULTS: The progression of periodontitis and tooth loss was significantly lower among RC compared to EC patients. A higher progression of periodontitis was observed among EC patients who smoked. The final logistic model for the progression of periodontitis in the RC group included smoking (odds ratio [OR]: 4.2) and >30% of sites with BOP (OR: 2.8), and the final logistic model for the progression of periodontitis in the EC group included smoking (OR: 7.3), >30% of sites with BOP (OR: 3.2), PDs of 4 to 6 mm in 10% of sites (OR: 3.5), diabetes (OR: 1.9), and number of lost teeth (OR: 3.1). CONCLUSIONS: RC patients presented a lower progression of periodontitis and tooth loss compared to EC patients. This result highlighted the influence of the pattern of compliance in maintaining a good periodontal status. Moreover, important risk variables such as smoking and diabetes influenced the periodontal status and should be considered when determining the risk profile and interval time for PMT visits.

Dental treatment for children with chronic idiopathic thrombocytopaenic purpura: a report of two cases.

Idiopathic thrombocytopaenic purpura (ITP) is the most common acquired bleeding disorder occurring in previously healthy children. The condition is benign and self-limiting, with a high possibility of recovery. Only 15-30% of children with acute ITP develop the chronic form. Clinically, ITP presents with petechiae, ecchymoses, haematomas, epistaxis, haematuria, mucocutaneous bleeding, and occasionally, haemorrhage into tissues. Oral manifestations include spontaneous gingival bleeding, petechiae or haematomas of the mucosa, tongue or palate. Two paediatric case reports are described concerning female patients diagnosed with chronic ITP. Oral findings and dental procedures are described. Standard dental treatment was performed with a platelet count higher than 50,000/mm3. The importance of adequate dental plaque control techniques in order to prevent inflammation, potential bleeding and infection in these patients is emphasized. The paediatric dentist must be aware of the clinical appearance of ITP in order to recognize the condition and successfully manage the patient.

The influence of gingival health status on periodontal probing measurements. A clinical study in humans.

This study aimed to clarify the extent to which gingival health status alters probing measurements. One hundred sites from 26 patients undergoing periodontal treatment were selected as follows: 50 sites without inflammation and 50 sites with bleeding on probing even after basic therapy. All sites required periodontal surgery and were submitted to two probings with a constant-force probe (0.25 N). The pre-surgical probing (S1) measured the relative attachment level. The second probing (S2), during an open flap procedure, in the same location as S1, measured the distance between the occlusal surface of the stent and the bone crest. The difference between the measurements of the two probings (S2 - S1) performed at each site determined the distance between the bottom of the clinical pocket and the bone crest (S3). The median and the mean of the S1 measurements were 1.60 mm and 1.64 +/- 1.23 mm in the healthy sites and 1.50 mm and 1.63 +/- 1.03 mm in the bleeding sites, respectively. There was no statistically significant difference between healthy and bleeding sites (Mann-Whitney test, p = 0.625). It may be concluded that the penetration of the constant-force periodontal probe (0.25 N) was not influenced by bleeding on probing.

A life-course approach to assess the relationship between social and psychological circumstances and gingival status in adolescents.

BACKGROUND: Several models have been proposed to explain the causes of periodontal diseases. None have adopted the life-course approach. OBJECTIVE: To investigate the relationship between social, psychosocial and biological conditions experienced in early life and through the life course and gingival bleeding on probing. METHODS: A two-phase study was carried out in Brazil. In Phase I, 652 13-year-olds were clinically examined and interviewed. In Phase II, 311 families were randomly selected for an interview to collect information on the teenager's state at birth and selected impacts in their early years of life. Clinical examination included assessment of dental caries, periodontal and dental trauma status. The data analysis used logistic regression and the models were determined using stepwise procedure. FINDINGS: Adolescents who were born in a non-brick house, who were living in an overcrowded house at 13 years of age, those whose mother had less than 8 years of education, who were at a lower school grade for their age, those who reported high levels of paternal punishment and those who were from reconstituted families were significantly more likely to experience high levels of bleeding gums after probing. CONCLUSION: Early life and life-course experiences were important determinants of the level of gingival bleeding after probing in adolescents.

Hemopatías: sus manifestaciones orales / Hemopathies: it's oral manifestations

La mucosa oral es frecuentemente asiento de lesiones vinculadas a enfermedades sistémicas, y dentro de éstas destacamos las discrasias sanguíneas. Se estudiaron en el Hospital de Clínicas José de San Martín, 15 pacientes con patologías de la mucosa oral cuyas enfermedades de base fueron leucemia, aplasia medular y linfoma. De estos, 10 presentaron manifestaciones hemorragíparas, 7 pacientes con lesiones ulceronecróticas y 2 casos de hipertrofia gingival por infiltración neoplásica

Hemopatías: sus manifestaciones orales / Hemopathies: its oral manifestations

La mucosa oral es frecuentemente asiento de lesiones vinculadas a enfermedades sistémicas, y dentro de éstas destacamos las discrasias sanguíneas. Se estudiaron en el Hospital de Clínicas José de San Martín, 15 pacientes con patologías de la mucosa oral cuyas enfermedades de base fueron leucemia, aplasia medular y linfoma. De estos, 10 presentaron manifestaciones hemorragíparas, 7 pacientes con lesiones ulceronecróticas y 2 casos de hipertrofia gingival por infiltración neoplásica

[Fibrinolytic activity of gingival fluid in hemophiliac patients]. / Actividad fibrinolítica del fluído gingival en pacientes hemofílicos.

The purpose of this investigation is to compare the fibrinolytic activity in the gingival fluid, of 32 hemophilic patients with 36 normal subjects. Oral examination was carried out in both groups in order to determine the extent of periodontal disease, using the Ramfjord Periodontal Index. The disease was classified in three grades according to the depth of the gingival crevices: grade I: 0 to 3 mm (Normal Deepness); grade II: from 3 to 6 mm; grade III higher than 6 mm. The fibrinolytic activity was measured in fibrin plates, prepared with thrombin and fibrinogen with and without plasminogen. It was found that the fibrinolytic activity was similar in the groups studied and related to the depth of the gingival crevices, with the exception of hemophilic patients with grade I disease, who showed higher fibrinolytic activity in the fibrin plates with plasminogen, than in the corresponding controls (p less than 0.001). This result could possibly be due to mucosal traumatism during the withdrawal of the sample, which permitted the release of plasminogen activators from the damaged vessels. It is important to mention the absence of grade III periodontal disease in the hemophilic group. The reason for this result could be due to the important bleeding occurring in grade II, which induces the patient to seek immediate professional attention. The above mentioned results suggest that the fibrinolytic activity of the gingival fluid in hemophilic and control patients is directly related to the degree of periodontal disease.