Comparison of periodontal inflammatory disease in young adults with and without pericoronitis involving mandibular third molars.

PURPOSE: To compare the prevalence and severity of periodontal inflammatory disease in subjects with pericoronitis involving a mandibular third molar and those without pericoronitis. PATIENTS AND METHODS: Data obtained from healthy adults consecutively enrolled in an institutional review board-approved trial with pericoronitis affecting at least 1 mandibular third molar (study group) were compared with data obtained during the same time frame from subjects without pericoronitis enrolled in a longitudinal third molar monitoring study (comparison group). The periodontal status of each subject was classified based on periodontal probing depths (PD): all PD <4 mm, no disease; 1 to 3 PD >or=4 mm, incipient disease; at least 4 PD >or=4 mm, early disease. Full mouth periodontal probing data were obtained as clinical measures of periodontal status. Data were aggregated to the subject level for the third molar region, the 6 third molar probing sites and the 2 second molar distal probing sites, the non-third molar region, and all remaining probing sites. The prevalence of disease in the study and comparison groups were compared with the Fisher's exact test. As an indicator of disease severity, the number of PD >or=4 mm in the 2 groups were compared by the Kruskal-Wallis test. Level of significance was set at P values less than .05. RESULTS: Median age of the 56 subjects with pericoronitis was 23.3 years (IQR 21.3-26.0 years). Fifty-five percent were Caucasian, 16% African American, and 22% Asian. Males and females were almost equally represented in the study group and in the comparison group. The 194 subjects enrolled without pericoronitis were significantly older (32.8 years; IQR 27.2-40.0 years; P < .001). Eighty-four percent were Caucasian, 10% African American, and 4% Asian. The proportion of subjects with periodontal inflammatory disease in the third molar region was significantly different between the study and comparison groups. Thirty-one percent of the subjects with pericoronitis had incipient and 55% early disease in the third molar region compared with 25% with incipient and 38% with early disease among subjects without pericoronitis (P = .003). The pattern was similar, but the proportion of subjects was not significantly different between the groups for the non-third molar region. In the study group, 32% had incipient disease and 32% early disease compared with 27% with incipient disease and 22% with early disease in the comparison group (P = .09). The median number of PD >or=4 mm for all teeth differed significantly for subjects with and without pericoronitis (median 5 [IQR 3-9] vs 3 [IQR 0-8], respectively; P = .03). CONCLUSION: Pericoronitis involving mandibular third molars may reflect more underlying periodontal inflammatory disease in affected young adults than might be found in young adults with retained third molars and no pericoronitis.

The relationship between pericoronitis, wisdom teeth, putative periodontal pathogens and the host response.

PURPOSE: To review the literature concerning pericoronitis, in particular the nature of the lesion and its aetiology, what factors may be used to predict if some patients would benefit from early removal of third molars, and if a scoring system can be developed for this purpose. METHOD AND MATERIALS: A literature search using PubMed and the facilities of the Dublin Dental Hospital (DDH) library were used to gather the relevent information. PubMed lists all of the journals available in the DDH library and was used to identify relevent papers, which were then retrieved from the shelves and stacks with the help of library staff. The key word used was 'pericoronitis'. RESULTS: The studies reviewed assert that the bacteriology of pericoronitis is predominantly anaerobic in character, yet no causative species has been identified. Marker organisms for periodontitis were not generally isolated. Host factors examined in various studies were the inflammatory markers interleukin 1b and prostaglandin E2, and the immunological responses of neutrophils, macrophages, natural killer cells, T cells, helper T cells and suppressor/cytotoxic T cells. While all of these factors, with the exception of prostaglandin E2, tend to be elevated in cases of pericoronitis, both symptomatic and asymptomatic, no clearcut measurable entity has emerged that can be used as a predictive marker. CONCLUSION: A hypothesised scoring system to predict which patients would benefit from early removal of asymptomatic impacted lower third molars would be clinically advantageous in justifying prophylactic third molar surgery, but is not yet feasible or proven.

Flow-cytometric analysis of T-lymphocyte subsets after different treatment methods in patients with pericoronitis.

PURPOSE: The aim of this study was to determine whether there was any change in T-lymphocyte subsets in patients with periocoronitis after the application of different treatment methods. PATIENTS AND METHODS: Twenty-six patients with acute pericoronitis were included in the study. In every phase of the treatment (pretreatment, postcurettage, and postextraction), the biopsy samples were taken from the gingival tissues at sites of pericoronitis. Then, CD4(+) and CD8(+) lymphocyte and CD4(+)/CD8(+) ratio values were determined using flow cytometry in the biopsy samples. At the same time, gingival index (Löe-Silness) and plaque index (Silness-Löe) scores were recorded to assess the periodontal status in patients. To determine the correlation between the clinical measurements and the laboratory results obtained before the treatment, after curettage, and after extraction, we conducted an analysis using a paired t-test. RESULTS: The normal values in peripheral blood of CD4(+) and CD8(+) lymphocytes are 25% to 29% and 19% to 48%, respectively. However, the CD4(+) and CD8(+) lymphocyte values in the patients with acute pericoronitis were found to be 22.12% +/- 6.15% and 7.69% +/- 4.12%, respectively. These values are lower than the normal values. The CD4(+) lymphocyte value increased to 31.06% +/- 7.09% postcurettage and to 32.24% +/- 3.11% postextraction. The CD8(+) lymphocyte value increased to 16.21% +/- 5.27% postcurettage and to 18.25% +/- 3.13% postextraction. The CD4/CD8 ratio increased postcurettage and postextraction. This increase was statistically significant (P <.001). Postcurettage, there was decrease in clinical indexes, which was statistically significant (P <.001). A significant correlation between CD4(+) lymphocyte and ginigival index values and also between CD8(+) lymphocyte and plaque index values was determined postcurettage (P <.05). CONCLUSION: CD4(+) and CD8(+) T-lymphocytes could play a significant role in pericoronitis pathobiology.

Chronic inflammation around painless partially erupted third molars.

OBJECTIVES: We sought to assess the histologic host response in chronic, symptomless pericoronitis. STUDY DESIGN: Gingival mucosal (n = 20) and dental follicle (n = 20) samples were collected during extraction from patients with pericoronitis and clinically healthy control subjects. Antibodies-recognizing macrophages (CD68), natural killer cells (CD56), T cells (CD2), helper T cells (CD4), suppressor/cytotoxic T cells (CD8), and neutrophils (lactoferrin) were applied in a labelled streptavidin-biotin method by using a DAKO TechMate staining robot. RESULTS: Macrophage was the most numerous kind of cell in pericoronitis, but CD2+ T lymphocytes, with a normal CD4/CD8 ratio, were also increased (P < .01). Neutrophils were not increased and did not show signs of activation. Dental follicles did not contain increased numbers of inflammatory cells. CONCLUSION: This type of pericoronitis is a chronic/smoldering, rather than an acute/purulent, infection. Because of the chronic and often symptomless nature of pericoronitis, various long-term sequelae may result, which may lead to the need for extraction.

Clinical/biological outcomes of treatment for pericoronitis.

PURPOSE: This prospective clinical study was designed to determine the clinical and biologic outcomes of treatment for minor signs and symptoms of pericoronitis. PATIENTS AND METHODS: Patients (n = 20) with all third molars, presenting consecutively to an academic clinical center for treatment of minor signs and symptoms of pericoronitis, were enrolled in the study. At the initial visit, gingival crevicular fluid (GCF) samples to assess levels of the cytokines interleukin- 1b (IL-1b) IL-1b and prostaglandin E2 (PGE2) as a measure of the host inflammatory response, and plaque samples to identify microorganisms, were collected from the distal of all second molars and the mesial of first molars. Standardized vertical bite wing radiographs were taken to assess alveolar bone height on the distal of the second molars and the inclination and the degree of eruption of the third molar. Full-mouth periodontal probing was conducted to determine probing depths and relative clinical attachment levels (CAL). Pain levels were assessed with Gracely verbal descriptor scales for sensory intensity and unpleasantness and 10-cm visual analog scales. Symptomatic third molar sites were treated with local debridement and irrigation after baseline data collection. One week after entry, data were collected again. Subsequently, the patients were scheduled for removal of all third molars. Data collection was repeated 3 months postsurgery. As controls, data were collected from 12 subjects who had asymptomatic third molars removed previously. RESULTS: At entry, symptomatic mandibular third molars (n = 21) were mostly vertical (n = 18) and at or above the occlusal plane (n = 19). No maxillary teeth had symptoms. Microbial counts were elevated for specific anaerobic microorganisms. GCF IL-1b levels were elevated at the distal of second molars adjacent to symptomatic third molars, as compared with asymptomatic third molars and second molars in control patients. Alveolar bone levels and CAL on the distal of second molars were normal. At 1 week, patients' pain symptoms and IL-1b levels were reduced, but microbial counts remained high. Three months after surgery, patients had no pain symptoms, and alveolar bone levels and CAL were similar to entry levels. IL-1b levels were elevated at both the distal of second molars and the mesial of first molars for all patients; microbial counts decreased, although not to levels of control patients. No increase in microbial counts for Porphyromonas gingivalis or Bacteroides forsythus, or GCF PGE2 levels, risk factors for progressive periodontal disease, was detected in samples taken from the study patients. CONCLUSION: Pericoronitis expressed by minor signs/symptoms in these patients was associated with considerable discomfort. Symptomatic mandibular third molars were vertical and at or near the occlusal plane. Additionally, this condition was characterized by microbial flora and GCF inflammatory mediator levels that are more consistent with gingivitis than periodontitis. Removal of third molars eliminated symptoms, but the microbial burden and an affected patient's inflammatory response, as measured by IL-1b levels, remained elevated as compared with controls. Further study is needed to determine which of these factors can be used to identify patients at risk for pericoronitis before symptoms arise.

[The microbial flora and humoral protective factors in odontogenic inflammations in the maxillofacial area]. / Mikrobnaia flora i gumoral'nye faktory zashchity pri odontogennykh vospaleniiakh v cheliustno-litsevoi oblasti.

Some features in the pathogenesis of various forms of an inflammatory process were demonstrated by immunologic and microbiologic methods in patients with odontogenic infections. A close relationship has been revealed between microflora of an inflammatory focus, immune response type, and inflammation course in the maxillofacial area.

Enumeration, isolation, and species identification of mycoplasmas in saliva sampled from the normal and pathological human oral cavity and antibody response to an oral mycoplasma (Mycoplasma salivarium).

Saliva samples collected from 393 subjects with and without oral diseases were examined for concentrations of mycoplasmas and Mycoplasma species. Mycoplasmas were isolated from 383 (97%) of the 393 subjects. Viable counts ranged from zero to 7.6 X 10(7) CFU/ml (median, 6.9 X 10(4)) and were significantly (P less than 0.01) higher in diseased subjects, except for those with arthrosis temporomandibularis, than in controls. Of 1,400 isolates, 897 (64%), 442 (30%), and 8 (1%) were identified as Mycoplasma salivarium, M. orale, and M. hominis, respectively, and the remaining 73 isolates (5%) were unidentifiable. More than two-thirds of the isolates from diseased subjects versus only half from controls were identified as M. salivarium. In diseased subjects other than those with ostitis (especially those with arthrosis temporomandibularis), the incidence of M. salivarium was higher than that of M. orale, whereas the former occurred about as frequently as the latter in the controls. Antibodies to M. salivarium were also measured in sera from some subjects by the metabolism inhibition test. Sera with metabolism inhibition titers of 16 or greater were rated positive. There was no significant difference in the prevalence of antibodies between diseased subjects (60%) and controls (40%), but the mean titers (97 to 220) of all positive sera from diseased subjects were two to four times those for sera from controls. In addition, a fourfold or greater rise or fall of antibody titers to the organism was shown in paired sera from some subjects. On the basis of these results, M. salivarium was strongly suggested to participate etiologically in some cases of oral infection.

Efeito de um modulador da resposta imune (levamisole) na evolução da inflamação gengival: avaliação clínica / Efect of a modulator of the imune response (levamisole) on the evolution of the gingival inflammation: clinical evaluation

Os autores estudaram a possibilidade de se alterar a evolução da doença gengival inflamatória num grupo de pacientes jovens, do sexo masculino, de idade variável entre 11 e 15 anos, através de um agente modulador da resposta imune, Levamisole, durante 6 semanas consecutivas. Foi possível concluir que: 1) Levamisole provocou uma diferença significativa no índice de placa dos pacientes tratados; 2) Indice gengival dos pacientes tratados aumentou, consideravelmente do 21º ao 42º dia do experimento